Chinese Experts Consensus and Practice Guideline on Discoid Lateral Meniscus

Abstract

Discoid lateral meniscus (DLM) is the most common congenital variant of the lateral meniscus, which is prone to degeneration and lesions, and often leads to knee osteoarthritis. At present, there is no consensus on the clinical practice of DLM, and this expert consensus and practice guidelines on DLM was developed and approved by Chinese Society of Sports Medicine according to the Delphi method. Among 32 statements drafted, 14 statements were excluded for redundant information, and 18 statements achieved consensus. This expert consensus focused on the definition, epidemiology, etiology, classification, clinical manifestations, diagnosis, treatment, prognosis, and rehabilitation of DLM. Restoring the normal shape, retaining appropriate width and thickness, and ensuring the stability of the remnant meniscus is critical to sustaining the physiological function of the meniscus and preserving the knee. The partial meniscectomy with or without repair should be the first-line treatment when possible, given that the clinical and radiological long-term outcomes of total or subtotal meniscectomy are worse.

Feasibility and efficacy of ultrasound in the diagnosis of discoid lateral meniscus and its classification in children: protocol for a prospective, multicentre, diagnostic test study

“… 33 The Wrisberg meniscus is normal in morphology but differs from DLM in morphology and histology, with only high mobility of the posterior horn, which is inappropriate for classification as a DLM. 33–37 However, the PRS is of great significance for treatment planning and prognostic prediction, and DLM is frequently complicated by a UPR, 4 5 27 which is not considered in the Watanabe classification system. According to the classification of DLM proposed by Klingele et al , 5 the lateral meniscus is categorised into NLM, IDLM and CDLM according to morphology and into SPR-DLM and UPR-DLM according to PRS.…”

“…The Watanabe classification system classifies DLM into IDLM, CDLM and Wrisberg variants 32. Although this classification is simple and widely used, it is imprecise and does not provide sufficient information for guiding treatment or predicting prognosis 33. The Wrisberg meniscus is normal in morphology but differs from DLM in morphology and histology, with only high mobility of the posterior horn, which is inappropriate for classification as a DLM 33–37.…”

“…Although this classification is simple and widely used, it is imprecise and does not provide sufficient information for guiding treatment or predicting prognosis 33. The Wrisberg meniscus is normal in morphology but differs from DLM in morphology and histology, with only high mobility of the posterior horn, which is inappropriate for classification as a DLM 33–37. However, the PRS is of great significance for treatment planning and prognostic prediction, and DLM is frequently complicated by a UPR,4 5 27 which is not considered in the Watanabe classification system.…”

Older age and the presence of intrameniscal signs are risk factors for nonsurgical treatment failure of symptomatic intact discoid lateral meniscus

“…Currently, observation is recommended for asymptomatic DLM, and surgery is recommended for symptomatic DLM with tears [23]. However, it is still unknown whether surgery 1 3 is needed for symptomatic DLM without tears [27]. On the one hand, DLMs are more prone to tearing due to diferences in morphology and tissue structure, and in many cases, more meniscal tissue needs to be removed when tears occur [10,15].…”

“…The prevalence of discoid lateral meniscus (DLM) varies widely by ethnicity and geographic region. It is common in Asian populations, with a higher incidence of approximately 13–16% [23, 27]. DLM is usually asymptomatic but may be symptomatic when tearing occurs [23, 26].…”