Guidelines on the Diagnosis and Treatment of Lateral Meniscal Lesions: A Consensus Statement by the Chinese Society of Sports Medicine

Abstract

Background: The lateral meniscus is a unique structure of the knee joint, and its anatomy, function, pathological process, and treatment are distinct from those of the medial meniscus. To date, no consensus on the management of lateral meniscal lesions has been published, and clinical decision-making is challenging. To facilitate this, consensus and practice guidelines for lateral meniscal lesions were developed and endorsed by the Chinese Society of Sports Medicine. Study Design: Consensus statement. Methods: This project followed the Delphi approach to the consensus process, involving steering, rating, and peer review groups. A total of 61 experts in the fields of sports medicine and arthroscopic surgery were invited to participate in the compilation of a consensus statement on lateral meniscal lesions. (The discoid lateral meniscus was addressed by separate consensus.) To begin, the steering group drafted a set of questions and replies regarding lateral meniscal lesions. An online panel discussion was then held to provide initial agreement and comments on the statements, followed by a round of anonymous voting. Results and feedback were sent to the steering group for a second draft. A second round of voting was then held, and each statement was discussed during a combined meeting of the steering and rating groups. Finally, a consensus draft was evaluated by a review group. Results: Fifty-three questions and answers addressing lateral meniscal lesions were drafted, and 20 statements were excluded because of redundant information during the first round of voting. Ultimately, 33 statements were completed, 9 of which were unanimous. Conclusion: This expert consensus process focused on the anatomy, function, pathological processes, and treatment of lateral meniscal lesions. Accepted recommendations in these areas can assist doctors and therapists in standardizing the management of related pathology. The consensus statement indicates that certain types of lateral meniscal tears that were previously considered irreparable can be repaired. Preservation of the lateral meniscus should be the first-line treatment whenever possible, because the long-term clinical and radiological outcomes are worse after partial meniscectomy.

Magnetic Resonance Imaging Indirect Signs for Anterior Instability of the Lateral Meniscus in Pediatric and Adolescent Patients

“…Anterior instability (AI) or hypermobility of the lateral meniscus (LM) is a potentially debilitating disorder for young patients that is likely underdiagnosed 1–4 . AI can result from a peripheral vertical pattern tear or congenital absence or laxity of meniscocapsular attachments along the anterior horn, especially in the case of discoid LM 5–8 .…”

“…AI can result from a peripheral vertical pattern tear or congenital absence or laxity of meniscocapsular attachments along the anterior horn, especially in the case of discoid LM 5–8 . Disruption of the anterior root, such as a radial tear or avulsion at the anterior root attachment, may also result in progressive meniscal extrusion and instability 4,9,10 . The overall incidence of meniscus tear is estimated at 60 per 100,000, with males exceeding females, however, given the presence of asymptomatic tears, this may be an underestimate 11 .…”