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Yong Seuk Lee - One of the best experts on this subject based on the ideXlab platform.

  • the condylar cutoff sign quantifying lateral femoral condylar hypoplasia in a complete Discoid Meniscus
    Clinical Orthopaedics and Related Research, 2009
    Co-Authors: Yong Seuk Lee, Jae Chul Park
    Abstract:

    We describe the condylar cutoff sign, a radiographic sign in knees with a Discoid lateral Meniscus, for diagnosis of complete Discoid Meniscus. We retrospectively reviewed tunnel-view radiographs of 100 patients (100) knees including 50 with complete Discoid lateral Meniscus and 50 with normal menisci. All patients were 18 years of age or older. All of the knees were arthroscopically examined. We developed a method to measure the prominence of the femoral condyle adjacent to the intercondylar notch on a tunnel view of the knee. The prominence ratio, the ratio of the medial and lateral condylar prominence, was compared and analyzed. The measurements were performed by three observers on two separate occasions to determine reliability. The intraobserver and interobserver variability study revealed high reliability with correlation coefficients ranging from 0.86 to 0.99. Using a cutoff ratio of 0.8, we observed a major difference between the two groups and found the ratio had 76% sensitivity, 96% specificity, 95% positive predictive value, and 80% negative predictive value in every set of measurements. The sign has high specificity and reliability but might not apply to younger patients.

  • Bilateral symptomatic Discoid medial Meniscus: report of three cases.
    Knee surgery sports traumatology arthroscopy : official journal of the ESSKA, 2007
    Co-Authors: Byung Ill Lee, Yong Seuk Lee, Sai Won Kwon, Sung Woo Choi, Ki Hyun Cho, Yong Jin Kwon
    Abstract:

    Discoid medial Meniscus is very rare and bilateral Discoid medial Meniscus is extremely rare. We report symptomatic bilateral Discoid Meniscus with abnormal attachment to anterior cruciate ligament (ACL) in three patients and we think that our report is a combination of very rare conditions. The patients had symptoms in both sides and we performed magnetic resonance imaging (MRI) and operated five knees. The operation methods were different by the condition of menisci.

Mininder S Kocher - One of the best experts on this subject based on the ideXlab platform.

  • symptomatic Discoid Meniscus in children and adolescents a review of 470 cases
    Journal of Pediatric Orthopaedics, 2021
    Co-Authors: Catherine A Logan, Lyle J Micheli, Frances A Tepolt, Sophia D Kocher, Aliya G Feroe, Mininder S Kocher
    Abstract:

    BACKGROUND Discoid Meniscus is a congenital variant, typically involving the lateral Meniscus, that comprises a spectrum of meniscal shapes and degrees of instability in an estimated 1% to 15% of the population. The purpose of this study was to describe the clinical and operative course of a large cohort of children and adolescents patients with symptomatic lateral Discoid Meniscus. METHODS Medical records of 470 knees with symptomatic lateral Discoid Meniscus in 401 patients ages 18 years or younger diagnosed at a single institution between 1991 and 2016 were reviewed retrospectively for patient characteristics, treatment course (nonoperative and/or operative), and complications. Surgical reports were reviewed in the operative group. RESULTS The series included 401 patients of mean age 11.6 years (range: 1 mo-18.9 y), of which 222 (55%) were female, and 69 (17%) had bilateral involvement. Of 470 knees, 83 (18%) were initially managed nonoperatively. Of these, 32 knees (39%) failed nonoperative management and were converted to surgical treatment at a median of 7.9 months (interquartile range: 4.0-15.1). In total, 419 knees were managed surgically with saucerization (partial meniscectomy) with or without meniscal repair/stabilization; 84 knees (20%) required at least one concurrent nonmeniscal procedure. Discoid Meniscus tears were reported in 264/419 knees (63%) intraoperatively; horizontal cleavage tears were most common. Reoperation was required for 66/379 cases (17%) with clinical follow-up, at a median of 19.6 months (range: 9.2-34.9) after index saucerization; 60/379 cases (16%) had ongoing pain and/or mechanical symptoms at final follow-up. CONCLUSION With a failure rate of 39% (32/83 knees), nonoperative management for Discoid lateral Meniscus frequently convert to surgical treatment. During surgery, Meniscus tearing and instability are common and should be anticipated. Postoperatively, 33% (126/379) of knees with clinical follow-up underwent either reoperation, or had ongoing symptoms of the knee at final follow-up. Discoid mensical retear is the most common complication (94%, 62/66) prompting repeat surgery, and should be discussed with families before the index operation. LEVEL OF EVIDENCE Level IV-descriptive case series.

  • long term minimum 15 year follow up after lateral Discoid Meniscus rim preservation surgery in children and adolescents
    Journal of Pediatric Orthopaedics, 2021
    Co-Authors: Laura A B Lins, Lyle J Micheli, Kathryn A Williams, Brian W Yang, Saritha Sankarankutty, Sophia D Kocher, Aliya G Feroe, Mininder S Kocher
    Abstract:

    BACKGROUND Discoid Meniscus is a congenital variant typically affecting the lateral Meniscus of the knee. Historically, surgical intervention when symptomatic consisted of total meniscectomy; however, after degenerative changes were observed, current treatments now focus on rim preservation with arthroscopic saucerization and meniscal repair for instability, when indicated. The purpose of our study was to examine long-term patient-reported outcomes of lateral Discoid Meniscus (LDM) treated with meniscal-preserving techniques. METHODS Ninety-eight patients treated arthroscopically for LDM at a single institution at a minimum of 15 years ago were retrospectively identified and contacted by mailers and telephone to participate. Subjective functional outcomes and patient satisfaction data were collected using a questionnaire that included the validated International Knee Documentation Committee Subjective Knee Evaluation Form, Lysholm Score, Marx Activity Rating Scale, Tegner Activity Score, and Western Ontario and McMaster University Osteoarthritis Index Osteoarthritis Index. Patient and surgical characteristics and patient-reported outcomes were summarized by mean and SD, median and interquartile range (interquartile range), or frequency and percent, as appropriate. RESULTS Of the 46 patients contacted (response rate of 46/98 eligible), 25 (54%) completed the questionnaires. The mean (±SD) age at initial surgery was 10.8 (±3.4) and 30.3 (±3.7) years at final follow-up. The mean (±SD) follow-up time from initial surgery was 19.5 (±2.8) years (range, 16 to 27). Patient-reported outcomes included: International Knee Documentation Committee 77.4±17.2, Lysholm 78.6±21, Western Ontario and McMaster University Osteoarthritis Index 7.6±11.3, Tegner Activity 7 (of 10), and Marx Activity Rating Scale 8 (of 10). Eleven (44%) cases underwent subsequent LDM-related surgery on the ipsilateral knee(s). There were no cases of total knee replacement. CONCLUSIONS Overall, patient-reported outcomes were favorable at a minimum of 15-year follow-up after rim-preserving saucerization of LDM. While two thirds of patients were satisfied with their surgical outcomes, nearly half of patients underwent revision saucerization with or without meniscal repair. Subsequent long-term follow-up studies with objective outcome measures are important to further elucidate the natural history of LDM and understand how rim-preserving procedures may prevent the development of degenerative processes. LEVEL OF EVIDENCE Level IV-case series, prognostic study.

  • surgical management of medial Discoid Meniscus in pediatric and adolescent patients
    Journal of Pediatric Orthopaedics, 2021
    Co-Authors: Aliya G Feroe, Lyle J Micheli, Kathryn A Williams, Sophia D Kocher, Zaamin B Hussain, Kristen L Stupay, Mininder S Kocher
    Abstract:

    BACKGROUND Medial Discoid Meniscus (MDM) is an exceedingly rare anatomic abnormality that presents similarly to other meniscal pathologies. Symptomatic MDM is typically managed arthroscopically with mixed short-term and long-term outcomes, although the existing knowledge about MDM is limited. The purpose of this study was to describe the presentation and surgical treatment of MDM in pediatric and adolescent patients. METHODS Medical records of 12 knees with MDM in 8 pediatric and adolescent patients treated between 1991 and 2016 were reviewed retrospectively for patient characteristics, clinical manifestations, radiographic findings, operative techniques, and surgical outcomes. RESULTS Of the 446 knees diagnosed arthroscopically with Discoid menisci, lateral Discoid Meniscus was noted in 434 knees (97.3%) and MDM was present in 12 knees (2.7%). The MDM series included 8 patients of mean age 13.8 years (range: 7.8 to 19.8), of which 5 were males (63%), and 4 (50%) had bilateral involvement. Of the 11 knees with available clinical records, all cases presented symptomatically (pain, mechanical symptoms); 10 (91%) had concurrent physical exam findings. On intraoperative examination, Discoid morphologies were described as complete in 4/8 knees (50%) or incomplete in 4/8 (50%), with associated instability in 6/12 (50%). Meniscal tears were reported in 9 cases (75%)-primarily, horizontal cleavage tears. Saucerization was performed in 11 knees (92%), with medial meniscal repair in 7 (58%), when indicated. Retear of the medial Meniscus occurred in 4/11 knees (36%) at a mean of 25.8 months postoperation; 2 knees required revisions. One knee developed arthrofibrosis and underwent arthroscopic lysis of adhesions. CONCLUSIONS MDM is a rare diagnosis, representing 3% of all Discoid menisci, with a nonspecific clinical manifestation. Operative management of symptomatic MDM typically involves saucerization and meniscal repair, when indicated, for concurrent tears. Symptom resolution is common short-term, but long-term outcomes include recurrent meniscal tears. Subsequent observational studies are important to evaluate long-term outcomes, such as arthritic changes, with the advancement of arthroscopic techniques for meniscal preservation. LEVEL OF EVIDENCE Level IV-retrospective case series.

  • long term Discoid Meniscus arthroscopic treatment follow up study
    Pediatrics, 2020
    Co-Authors: Laura A B Lins, Mininder S Kocher, Brian W Yang, Saritha Sankarankutty
    Abstract:

    Purpose Discoid Meniscus is a congenital variant that usually affects the lateral Meniscus of the knee. In the past, surgical intervention consisted of total meniscectomy. However, because degenerative changes were noted in total meniscectomy patients, current treatments now focus on rim preservation with arthroscopic saucerization or partial meniscectomy. The purpose of our study was to examine subjective long term outcomes of treating Discoid menisci arthroscopically with rim preservation techniques. Methods Ninety-eight patients who were treated arthroscopically for Discoid Meniscus at our institution 15 or more years ago were …

  • Discoid lateral Meniscus in children diagnosis management and outcomes
    Journal of The American Academy of Orthopaedic Surgeons, 2017
    Co-Authors: Mininder S Kocher, Catherine A Logan, Dennis E Kramer
    Abstract:

    Discoid Meniscus is a congenital variant of the knee joint that typically involves abnormal morphology and potential instability of the lateral Meniscus. Some Discoid menisci have abnormal peripheral attachments and are unstable. Discoid menisci are prone to tearing secondary to increased thickness, poor tissue quality, and instability. Patients may or may not be symptomatic. Torn or unstable Discoid menisci cause mechanical symptoms, pain, and swelling. Symptomatic patients in whom nonsurgical management fails most frequently are treated with arthroscopic surgery. Historically, complete meniscectomy has successfully alleviated symptoms but has resulted in poor midterm results, with degenerative changes to the knee joint. Current treatment emphasizes the saucerization of the Meniscus, with removal of the central disk and retention of the peripheral crescent. Peripheral meniscal repair is performed when instability is present. Short-term results are good; however, degenerative changes have been reported at intermediate follow-up.

Sungjae Kim - One of the best experts on this subject based on the ideXlab platform.

  • the fate of the contralateral knee in patients with a lateral Discoid Meniscus
    Arthroscopy, 2019
    Co-Authors: Sangwoo Jeon, Yong-min Chun, Sungjae Kim, Chonghyuk Choi, Min Jung, Seokhwan Jin, Sunghwan Kim
    Abstract:

    Purpose To analyze the survivorship of the lateral Meniscus (LM) in the contralateral knee after surgery for symptomatic torn Discoid lateral Meniscus (DLM) and to determine its associated factors. Methods Two hundred ninety-six patients who underwent arthroscopic meniscectomy for torn symptomatic DLM were reviewed retrospectively. Patients were classified into subgroups based on demographic, clinical, and radiologic variables. The survivorship analysis of the LM on the contralateral knee was calculated using the Kaplan-Meier method, and comparison among the subgroups was conducted using the log-rank test. The predicted prognostic factors associated with survivorship were determined using Cox proportional hazard regression analysis. Results Of the 296 patients, 51 (17%) had arthroscopic surgery in the contralateral knee during the study period. The group ≥40 years old had significantly worse survival than the group Conclusions Patients with a lateral Discoid Meniscus have a risk of a similar condition in the contralateral knee. Increased risks of symptomatology are associated with age and degenerative changes. Level of Evidence Level IV, retrospective uncontrolled case series.

  • single leaf partial meniscectomy in extensive horizontal tears of the Discoid lateral Meniscus does decreased peripheral meniscal thickness affect outcomes mean four year follow up
    Knee, 2016
    Co-Authors: Sewon Lee, Yong-min Chun, Sungjae Kim, Chonghyuk Choi, Min Jung, Joonwoo Han, Sunghwan Kim
    Abstract:

    Abstract Background To evaluate whether single-leaf partial meniscectomy in horizontal tears along the entire Discoid lateral Meniscus has any advantages in clinical and radiological results compared with other meniscectomies in Discoid lateral Meniscus. Methods A total of 145 patients with a horizontal tear pattern in symptomatic lateral Discoid Meniscus were retrospectively reviewed. Twenty-seven patients had undergone full-extent single-leaf partial meniscectomy (group A), 60 had undergone conventional partial meniscectomy (saucerization) maintaining peripheral meniscal height (group B), and 58 patients had undergone total meniscectomy (group C). Each patient was evaluated with the Lysholm knee score, International Knee Documentation Committee (IKDC) subjective grading, and modified Kellgren–Lawrence grade in plain radiography at their last follow-up. Results Group C had inferior functional results to groups A and B on the Lysholm knee score and IKDC subjective score. There was no significant difference between groups A and B. Group C fared significantly worse than groups A and B (p = 0.003, p  Conclusion With regard to clinical and radiological evaluations in lateral Discoid Meniscus tears, the full-extent single-leaf partial meniscectomy group had no adverse results compared with the total meniscectomy group and was not significantly different compared to the conventional partial meniscectomy group. Study design Cohort study. Level of evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence

  • bilateral Discoid medial menisci incomplete type in one knee and complete type in opposite knee
    Knee, 2006
    Co-Authors: Sungjae Kim, Youngjin Seo
    Abstract:

    A Discoid medial Meniscus is a relatively rare pathology of the knee joint. And bilateral cases are even more rare. In the review of the literature by the authors, Only 13 cases of bilateral medial Discoid menisci have been reported. We present one case of bilateral Discoid medial menisci. One knee had an incomplete type verified by both magnetic resonance imaging (MRI) and arthroscopy. The other knee showed a complete type of medial Discoid Meniscus in MRI. Therefore, we suggest that similar pathology in the contralateral knee should be suspected, even if the patient is asymptomatic, if a complete or incomplete Discoid medial Meniscus is identified.

  • radiographic knee dimensions in Discoid lateral Meniscus comparison with normal control
    Arthroscopy, 2000
    Co-Authors: Sungjae Kim, Seong Hwan Moon, Sang Jin Shin
    Abstract:

    We reviewed the knee radiographs of 68 cases of arthroscopically proven Discoid lateral Meniscus, including 42 cases of complete type and 26 cases of incomplete type Discoid lateral Meniscus. Knee radiographs of 70 cases that had no arthroscopic evidence of pathology of the Meniscus were used as controls. We excluded patients who had significant trauma history and who were under 16 years of age or over 60 years to avoid measuring radiographs of skeletally immature or degenerative knees. The absolute values and relative normalized values of specific knee dimensions, such as a squared-off appearance of the lateral femoral condyle, widened femorotibial joint space, cupping of the lateral tibial plateau, obliquity of the lateral tibial plateau articular surface, high fibular head, and hypoplasia of the lateral intercondylar spine, were compared between the patients with Discoid lateral Meniscus and the normal controls. Among those dimensions, high fibular head and widened lateral tibiofemoral joint space showed statistically significant differences between the Discoid lateral Meniscus group and normal control group. We suggest that these findings would be useful in screening lateral Discoid Meniscus on plain radiography.

  • intraarticular anatomic variants associated with Discoid Meniscus in koreans
    Clinical Orthopaedics and Related Research, 1998
    Co-Authors: Sungjae Kim, Yuntae Lee, Dongwook Kim
    Abstract:

    From July 1990 through June 1994, 106 knees (102 patients) were treated for Discoid Meniscus. Fifteen knees (15 patients) were associated with other intraarticular anatomic variants. There were eight knees (8 patients) with anomalous insertion of the anterior horn of the medial Meniscus into the anterior cruciate ligament, and seven knees (7 patients) with anterior expansion of the anterior portion of the anterior cruciate ligament below the anterior tibial margin. Among the latter, one patient also had anterior transposition of the anterior insertion of the medial Meniscus, while obliteration of the popliteal hiatus was seen in another patient. The Discoid menisci were reshaped in 13 knees (13 patients), totally resected in one knee, and in one patient the Discoid Meniscus was treated with repair of a peripheral tear and reshaping. Followup ranged from 24 to 54 months (average, 37 months) after surgery. The results were excellent in eight knees, good in five knees, and fair in two knees as graded using the Ikeuchi scale. These anatomic variants, other than the Discoid Meniscus, did not seem to be related to the patient's symptoms.

Daniel W Green - One of the best experts on this subject based on the ideXlab platform.

  • decline in clinical scores at long term follow up of arthroscopically treated Discoid lateral Meniscus in children
    Knee Surgery Sports Traumatology Arthroscopy, 2018
    Co-Authors: Jonathan D Haskel, Scott A Rodeo, Tyler J Uppstrom, David M Dare, Daniel W Green
    Abstract:

    The purpose of this study was to examine the long-term clinical outcomes of arthroscopic partial meniscectomy for the treatment of Discoid lateral Meniscus in children. A previous study identified 34 consecutive patients that underwent arthroscopic meniscal saucerization by one of the two surgeons between 1997 and 2002. Patients were asked to complete several outcomes questionnaires and were given the opportunity to receive a knee exam performed by their treating surgeon. Of the 34 eligible patients, 21 agreed to participate. Seventeen patients (19 knees) had greater than 2-year follow-up, with an average follow-up of 11.0 years (range 3.4–16.6 years). Average age at the time of surgery was 9.3 years. Average IKDC, Kujala, and Lysholm scores at follow-up were 82.8 ± 28.9, 86.6 ± 15.2, and 83.7 ± 18.6, respectively. In addition, median Marx and Tegner scores were 5 (range 0–14) and 6 (range 3–8), respectively. Stratifying the Lysholm scores revealed outcomes that were 45.4% “excellent”, 16.7% “good”, 25.0% “fair”, and 16.7% “poor”. In total, 36.8% (7 of 19) of knees underwent at least one subsequent surgical procedure. There were no significant associations between outcome scores and Discoid type, meniscal stability, location of instability, or age at time of surgery. The results of the current study suggest that clinical outcome scores decline over time in patients treated arthroscopically for symptomatic Discoid Meniscus. Compared to our previous study with 2-year follow-up, there is an increased incidence of knee pain and mechanical/functional limitations. The overall modest, long-term results of this study illustrate the need for improved operative treatments for symptomatic Discoid Meniscus in children to prevent progressive, long-term clinical decline in these patients.

  • arthroscopic treatment of symptomatic Discoid Meniscus in children classification technique and results
    Arthroscopy, 2007
    Co-Authors: Christopher R Good, Daniel W Green, Matthew H Griffith, Andrew W Valen, Roger F Widmann, Scott A Rodeo
    Abstract:

    Purpose: The purpose of this study was to review the operative results of children and young adults treated arthroscopically for symptomatic Discoid lateral menisci. Methods: The medical records and radiographic studies of 27 consecutive patients (30 knees) who underwent arthroscopic treatment for symptomatic Discoid Meniscus between 1998 and 2002 were reviewed. Results: The mean patient age was 10.1 years (range, 3 to 20 years), with 19 female and 8 male patients. The mean duration of symptoms before surgery was 13.9 months, with 28 knees (93%) having pain and 20 knees (67%) having mechanical symptoms. All patients were treated arthroscopically. Arthroscopic saucerization was successful in 28 of 30 knees. In 2 cases with large complex tears meniscal salvage was not possible and a complete arthroscopic meniscectomy was performed. Operative classification of the menisci revealed 22 complete (4 Wrisberg type) and 8 incomplete Discoid menisci, with meniscal tears being present in 23 of 30 (77%). Meniscal instability was noted in 77% of knees (23 of 30), with anterior horn instability in 53% (n = 16), posterior instability in 16% (n = 5), and combined anterior and posterior instability in 6% (n = 2). All cases of anterior horn instability were treated with an outside-in arthroscopic repair technique, whereas all cases of posterior horn instability were treated with meniscal repair via an inside-out arthroscopic technique. Twenty-one patients (23 knees) had full follow-up of greater than 1 year. For these 21 patients, the mean length of follow-up was 37.4 months (range, 12 to 77 months), and at final follow-up, all patients exhibited full knee flexion beyond 135°. Three patients reported residual knee pain, and four reported intermittent mechanical symptoms. At final follow-up, 2 patients felt that their activity level remained partially limited. Conclusions: Our results show the short-term efficacy of arthroscopic saucerization and repair to the capsule in selected cases of symptomatic Discoid menisci. On the basis of this experience and other recent reports documenting a high rate of anterior horn instability, an arthroscopic classification system for Discoid lateral menisci is proposed. Menisci are classified as complete or incomplete Discoid and are then subclassified based on the presence of instability as a result of deficient capsular attachment and, finally, based on the location of the absent capsular attachment. Level of Evidence: Level IV, therapeutic case series.

  • Discoid lateral Meniscus in children
    Current Opinion in Pediatrics, 2002
    Co-Authors: Bryan T Kelly, Daniel W Green
    Abstract:

    The Discoid Meniscus is the most common abnormal meniscal variant in children. It is most likely a congenital deviation and usually occurs laterally. The Discoid shape results in greater coverage of the tibia and usually is associated with increased thickness of the Meniscus that may lead to abnormal shearing forces across the knee joint. The Watanabe classification divides this anomaly into three distinct types: complete, incomplete, and Wrisberg ligament. The complete and incomplete types are often asymptomatic; unless symptomatic, they generally should be left alone. Tears should be treated with resection back to a stable rim. The Wrisberg ligament type is a hypermobile Meniscus secondary to a lack of posterior tibial attachment. This type may or may not be associated with an abnormal shape and may appear in childhood as a classic snapping knee syndrome. These children complain of intermittent popping and snapping within the knee that clinically manifests as a dramatic audible and visible adjustment of the knee with each flexion and extension. Treatment of a symptomatic Wrisberg ligament type requires surgical repair of the posterior disruption. Saucerization of the remaining Meniscus may be required to protect the repair from abnormal shear forces.

Youngjin Seo - One of the best experts on this subject based on the ideXlab platform.