Purpose of Study. A description of a procedure to stabilize symptomatic complete discoid menisci with medium term results. Methods and Results. Children with mechanical symptoms of lateral meniscal instability were assessed by MRI scan. In those with a lateral discoid meniscus an arthroscopic examination was performed to identify the presence of tears and confirm the radiological diagnosis. No incomplete or Wrisberg variant types were encountered. An antero-lateral arthrotomy was performed. The anterior horn of the meniscus was mobilized and traction sutures inserted. Flexion and extension of the knee whilst traction was applied led to delivery of the anterior horn into the wound. After confirmation of position with image intensifier a groove was fashioned in the anterior aspect of the cartilaginous portion of the proximal tibial epiphysis. Typically three titanium bone anchors with non absorbable sutures were placed in the base of the groove. The anterior horn of the meniscus was drawn into the groove and anchored with sutures. Active range of motion exercises were encouraged but a canvas knee immobilizer was employed whilst walking for the first six weeks. Four boys and three girls underwent meniscopexy performed at a mean age of 9.4 years (range 5.7 to 12.4 years). Follow up was at a mean of 4.9 years. At last follow up no patient reported symptoms of locking or pain. No patient has required revision surgery but one girl had a subsequent meniscopexy procedure on the opposite knee. Five of the children have had Lysholm scores performed at last follow up averaging 93.5 (80 to 100 points). Conclusion. Complete lateral discoid menisci in children can be rendered asymptomatic in the medium term by re-tensioning the anterior horn

Discoid meniscus (DM) is a congenital variant of the knee joint that involves morphological and structural deformation, with potential meniscal instability. The prevalence of the Discoid Lateral Meniscus (DLM) is higher among the Asians than among other races, and both knees are often involved. Meniscal pathology is widely prevalent in the adult population, secondary to acute trauma and chronic degeneration. The true prevalence in children remains unknown, as pathologies such as discoid menisci often go undiagnosed, or are only found incidentally. A torn or unstable discoid meniscus can present with symptoms of knee pain, a snapping or clicking sensation and/or a decrease in functional activity, although it is not known if a specific presentation is indicative of a torn DM. While simple radiographs may provide indirect signs of DLM, magnetic resonance imaging (MRI) and arthroscopy is essential for diagnosis and treatment planning. Asymptomatic patients require close follow-up without surgical treatment, while patients with symptoms often require surgery. Partial meniscectomy is currently considered the treatment of choice for DLM. For children are more likely to achieve better results after partial meniscectomy

Introduction and Aims: A number of x-ray appearances have been identified as indicative of discoid menisci. None are reliable or statistically significant. The purpose of this paper is to identify a reliable radiographic sign, diagnostic of the discoid lateral meniscus. Method: The anteroposterior view radiographs of 14 knees in 13 patients with arthroscopically proven discoid meniscus were studied. Ages ranged from 11 to 26, with a mean age of 18.4 ± 4.84 years, right to left ratio 9/5, male to female ratio 8/5. Fifteen normal knees in 14 people were used as a control group, age from 11 to 30, mean age 16.20 ± 6.41, right to left ratio 8/7, male to female ratio 6/8. The parameters measured were: Lateral Joint Space (LJS); Height of the Lateral Tibial Spine (LTS); change of the Medial Tibial Spine (MTS); Height of Fibular Head (HFH); changes of the Edge of the Lateral Tibial Plateau (ELTP), cupping of the lateral tibial plateau, and squaring of the lateral femoral condyle. Results: There was no significant difference between the two groups in LJS, height of LTS, cupping of the lateral tibial plateau, and squaring off of the lateral femoral condyle. There was a difference between the two groups in HFH which was statistically significant at an absolute value of p = 0.033, but not significant in normalised value p = 0.056. The medial tibial spine was sharpened in three patients. There were 12 positive changes on ELTP out of 14 patients (85.71%) in the discoid group, while only one positive of 15 (6.67%) in the normal group, and the difference between the two groups was statistically significant at p< 0.01. The diagnosis parameters were Sensitivity (Se) = 85.71%, Specificity (Sp) = 93.33%, Positive predictive value (PV+) = 92.31%, Negative predictive value (PV−) = 87.50%, Correct rate (ñ) = 89.66%. The typical change on the edge of lateral tibial plateau is sharpening and/or formation of a spur. Conclusion: Sharpening with spur formation on the edge of lateral tibial plateau is a diagnostic radiological sign of a discoid lateral meniscus

Aims: To evaluate whether in children with knee pathology there is any correlation between clinical diagnosis, magnetic resonance imaging and arthros-copy. Methods: Between 1993 and 2001 children age 3-16 years old, who presented in the orthopaedic clinics of our institution with knee pathology were included in this study. All of them underwent MRI investigation. Their history, physical examination and clinical diagnosis were ascertained from their case notes. Some of these children underwent arthroscopic surgery of the knee and findings were also recorded. Clinical data, MRI find-ings and arthroscopic findings were computerised and analysed. Results: were analysed and compared in the following 3 groups: a) clinical data versus MRI findings, b) clinical data versus arthroscopic findings and c) MRI report versus arthroscopic findings. Comparisons were rated in one of three categories: total agreement, partial agreement or total disagreement. Partial agreement was defined as the partial correlation of findings. Results: 130 children (131 knees, one bilateral) were included in this study. The mean age was 8.5 years (range 3-16). 81 were male and 49 were female, ratio 1.7:1. 38 (30%) patients underwent arthroscopy. 43 (33%) of the MRI scans were reported as normal. Lesions reported on MRI included meniscal and ACL tears, osteochondritis dessicans, osteochondral fractures and discoid lateral meniscus. Overall, the results between the comparison of the 3 groups are summarised as follows:. Conclusion: In this study 1/3 of the knee MRI were normal and there was only 26% of total agreement between the clinical and MRI findings. Further more in 50% of cases that underwent arthroscopy, there was no correlation of arthroscopic and MRI findings.This study supports the view that knee MRI investigation in children may not provide a reliable diagnosis and guidance in children with knee pathology

To evaluate whether in children with knee pathology there is any correlation between clinical diagnosis, magnetic resonance imaging and arthroscopy. Between 1993 and 2001 children age 3–16 years old, who presented in the orthopaedic clinics of our institution with knee pathology were included in this study. All of them underwent MRI investigation. Their history, physical examination and clinical diagnosis were ascertained from their case notes. Some of these children underwent arthroscopic surgery of the knee and findings were also recorded. Clinical data, MRI findings and arthroscopic findings were computerised and analysed. Results were analysed and compared in the following 3 groups: a) clinical data versus MRI findings, b) clinical data versus arthroscopic findings and c) MRI report versus arthroscopic findings. Comparisons were rated in one of three categories: total agreement, partial agreement or total disagreement. Partial agreement was defined as the partial correlation of findings. 130 children (131 knees, one bilateral) were included in this study. The mean age was 8.5 years (range 3–16). 81 were male and 49 were female, ratio 1.7:1. 38 (30%) patients underwent arthroscopy. 43 (33%) of the MRI scans were reported as normal. Lesions reported on MRI included meniscal and ACL tears, osteochondritis dessicans, osteochondral fractures and discoid lateral meniscus. Overall, the results between the comparison of the 3 groups are summarised as follows:. In this study 1/3 of the knee MRI was normal and there was only 26% of total agreement between the clinical and MRI findings. Further more in 50% of cases that underwent arthroscopy, there was no correlation of arthroscopic and MRI findings. This study supports the view that knee MRI investigation in children may not provide a reliable diagnosis and guidance in children with knee pathology