Arthroscopic minimum saucerization and inferior-leaf meniscectomy for a horizontal tear of a complete discoid lateral meniscus: Report of two cases

Tsujii, Akira; Matsuo, Tomohiko; Kinugasa, K.; Yonetani, Yasukazu; Hamada, Masayuki

doi:10.1016/j.ijscr.2018.11.027

Cited by 6 publications

(3 citation statements)

References 21 publications

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“…Arthroscopic partial meniscectomy is an important technique for treating a horizontal tear of the lateral meniscus with excellent clinical outcomes [2,8,9]. This procedure is usually performed using the standardised anterolateral portal (ALP) and anteromedial portal (AMP), particularly in patients with mid-body and posterior horn tears of the lateral menisci.…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic inferior leaf meniscectomy of the involved anterior horn in the lateral meniscus horizontal tear via an accessary extreme far anteromedial portal

Guo,

Yang,

Wang

et al. 2024

BMC Musculoskelet Disord

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Background An accessory extreme far anteromedial portal can improve visualisation and ease inferior leaf meniscectomy in patients with lateral meniscal anterior horn horizontal tears. However, the therapeutic outcomes of adding an accessory extreme far anteromedial portal remain unclear. This study aimed to evaluate the clinical efficacy of adding an accessory extreme far anteromedial portal for treating lateral meniscal horizontal tears involving the anterior horns. Methods This retrospective study included 101 patients with anterior horn involvement in lateral meniscal horizontal tears who underwent arthroscopic unstable inferior leaf meniscectomy between January 2016 and December 2020. The pathologies were diagnosed using physical examinations and magnetic resonance imaging. The anterior horn involved in the lateral meniscal horizontal tears was treated using inferior leaf meniscectomy. The primary endpoints were changes in the visual analogue scale, Lysholm, International Knee Documentation Committee, and Tegner scores at the final follow-up. The secondary endpoint was meniscal cure rate at 3 months postoperatively. The preoperative and postoperative functional scores were compared. The occurrence of complications was recorded. Results All patients were followed up for an average of 4.9 ± 1.2 years (range 2.3–7.5 years). After 4 months, none of the patients experienced pain, weakness, instability, or tenderness in the lateral joint line, achieving an imaging cure rate of 98%. At the final follow-up, significant postoperative improvements were observed in the average values of the visual analogue scale score (3.5 ± 0.7 vs. 0.7 ± 0.6), Lysholm score (62.7 ± 4.4 vs. 91.8 ± 3.1), International Knee Documentation Committee score (61.9 ± 3.7 vs. 91.7 ± 9.5), and Tegner score (2.0 ± 0.7 vs. 6.1 ± 0.7). Excellent Lysholm scores were obtained in 81 patients, and good outcomes were obtained in 18 patients, with an excellent-to-good rate of 98.0%. Conclusions Inferior leaf resection via the accessory far anteromedial portal is a safe treatment option for the involved anterior horn in lateral meniscal horizontal tears. This approach enhances visibility and facilitates surgical procedures, with minimal complications.

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Section: Introductionmentioning

confidence: 99%

Arthroscopic inferior leaf meniscectomy of the involved anterior horn in the lateral meniscus horizontal tear via an accessary extreme far anteromedial portal

Guo,

Yang,

Wang

et al. 2024

BMC Musculoskelet Disord

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“…repair vs meniscectomy/conservative treatment) and small sample sizes across included studies. Moreover, there have been 11 studies performed since the publication of this review [2, 3, 10, 26, 32, 43, 49, 52, 54, 59, 60]. With an increasing body of research published on the surgical treatment of HCTs over the past 5 years, an updated systematic review is warranted.…”

Section: Introductionmentioning

confidence: 99%

The repair of horizontal cleavage tears yields higher complication rates compared to meniscectomy: a systematic review

Shanmugaraj

Tejpal

Ekhtiari

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose Horizontal cleavage tears of the meniscus (HCTs) are primarily degenerative in nature, and, however, can be the result of trauma. Such tears account for 12-35% of all tear patterns and can be treated by partial meniscectomy or arthroscopic repair. The purpose of this review was to systematically assess the outcomes and complications for patients undergoing the surgical treatment of HCTs. Methods This review has been conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses. The electronic databases PubMed, MEDLINE, and EMBASE were searched from data inception to December 30, 2018 for articles addressing the surgical treatment of HCTs. The Methodological Index for Non-randomized Studies was used to assess study quality. Data are presented descriptively. Results Overall, 23 studies were identified, comprising of 702 patients (708 knees) with a mean age of 36.6 ± 9.9 years and a mean follow-up of 33.6 ± 19.6 months. The majority of patients were treated with a partial meniscectomy (59.0%), followed by repair (32.8%) and total meniscectomy (8.2%). Both meniscectomy and repair patients had improvements which surpassed minimal clinically important differences with regard to clinical (e.g. pain, function, daily living) and radiographic outcomes. The overall complication rate was 5.1%, primarily involving patients undergoing meniscal repair (12.9% of all knees undergoing a repair). Conclusion Although meniscal repair theoretically may provide improvement in biomechanical loading, patients undergoing repair had higher complication rates than those undergoing partial meniscectomy. Clinicians should consider the available implants in determining which tear patterns to repair and future studies with long-term follow-up are needed to investigate complications (e.g. secondary meniscal procedures) as well as the potential for delay in the development of osteoarthritis. Level of evidence Level IV.

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“…In terms of knee osteoarthritis (OA) after discoid lateral meniscus (DLM) surgeries, previous long‐term studies regarding the outcomes of total and subtotal meniscectomies for DLM revealed high rates of osteoarthritic changes on postoperative radiographs [1, 18, 23, 26]. Although arthroscopic meniscal saucerization [10, 22, 24, 28, 29] with meniscal repair of peripheral detachments [2, 3, 5] is the gold‐standard treatment, it cannot completely prevent meniscal extrusion or chondromalacia of the lateral compartment [5].…”

Section: Introductionmentioning

confidence: 99%

Predictive factors for developing osteochondritis dissecans after surgery for discoid lateral meniscus are younger age and shorter meniscal width

Mochizuki

Tanifuji

Satō

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose This study aimed to identify the predictive factors for postoperative osteochondritis dissecans (OCD) in juvenile and adolescent knees with discoid lateral meniscus (DLM). Methods In total, 242 patients with symptomatic DLM who underwent surgery were identiied. Inclusion criteria were set as follows: (1) age ≤ 17 years with an open growth plate, (2) follow-up magnetic resonance imaging, and (3) absence of preoperative OCD. Consequently, 52 patients were retrospectively investigated. Average age during surgery, body mass index (BMI), and follow-up duration were 12 years [95% conidence interval (CI) 11-13], 19.2 kg/m 2 (95% CI 18.4-20.1), and 27.3 months (95% CI 20.9-33.7), respectively. Age, sex, sports activities, BMI, symptomatic OCD in other joints, postoperative rehabilitation, preoperative shift of DLM by Ahn's classiication, surgical procedures (saucerization alone or with stabilization, and subtotal meniscectomy), and postoperative meniscal width were analyzed as possible predictive factors. Results Postoperatively, 42 patients without OCD and 10 with OCD were observed. In univariate analysis, younger age [odds ratio (OR) 1.5; p = 0.003], subtotal meniscectomy (OR 6.3; p = 0.027), and shorter meniscal width (OR 2.7; p = 0.005) were predictive factors for postoperative OCD. Multivariate analysis demonstrated that younger age (OR 1.6; p = 0.009) and shorter meniscal width (OR 1.5; p = 0.003) were predictive factors. Conclusions To prevent postoperative OCD after DLM surgeries, achieving stabilization with adequate meniscal width is necessary for juvenile knees. Level of Evidence III.

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Arthroscopic minimum saucerization and inferior-leaf meniscectomy for a horizontal tear of a complete discoid lateral meniscus: Report of two cases

Abstract: HighlightsArthroscopic minimum saucerization and inferior-leaf meniscectomy at 2-year follow-up.Preserving more than 10 mm width could obtain excellent clinical outcomes.Leaving more meniscal tissue might prevent meniscal extrusion.

Cited by 6 publications

References 21 publications

Arthroscopic inferior leaf meniscectomy of the involved anterior horn in the lateral meniscus horizontal tear via an accessary extreme far anteromedial portal

Arthroscopic inferior leaf meniscectomy of the involved anterior horn in the lateral meniscus horizontal tear via an accessary extreme far anteromedial portal

The repair of horizontal cleavage tears yields higher complication rates compared to meniscectomy: a systematic review

Predictive factors for developing osteochondritis dissecans after surgery for discoid lateral meniscus are younger age and shorter meniscal width

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