Efficacy of arthroscopic surgery for discoid lateral meniscus injury in knee joint: a single-center, self-control trial

doi:10.3969/j.issn.2095-4344.1034

Abstract

Abstract:

BACKGROUND: Discoid meniscus injury is a rare form of abnormal meniscus morphology with unknown pathogenesis. The complete disc-shaped meniscus is more prone than incomplete disc-shaped meniscus to tearing and adverse reactions such as joint degeneration and osteochondritis. Moreover, its clinical efficacy is not satisfactory. Arthroscopic meniscus surgery can enhance the stability of the meniscus and provide sufficient cushioning pressure to prevent recurrent meniscal tears.

OBJECTIVE: To investigate the efficacy of arthroscopic surgery for discoid meniscus injury in knee joint and analyze risk factors that influence the efficacy of arthroscopic surgery.

METHODS:This single-center, self-control study, will include 196 patients with discoid meniscus injury who will receive arthroscopic meniscus repair (Stryker) from December 2018 to December 2019 at the Department of Sports Trauma and Arthroscopy, First Affiliated Hospital of Anhui Medical University of China. This surgical procedure will include meniscus plasty and subtotal meniscectomy. After surgery, all included patients will be followed up for 6–18 months. Surgical efficacy will be evaluated by Lysholm score. Patients will be divided into an excellent-and-good group (Lysholm score ≥ 85) and a poor group (Lysholm score < 85). This study was approved by the Medical Ethics Committee, First Affiliated Hospital of Anhui Medical University (approval No. PJ2018-02-03) on February 5, 2018. The version of the study protocol is 1.0. Patients and their family members will volunteer to participate in this study. Written informed consent will be obtained from each patient.

RESULTS AND CONCLUSION: The primary outcome measure of this study is the change in excellent-and-good rate of Lysholm score that reflects knee joint function measured at the last follow-up in patients undergoing arthroscopic meniscus surgery. Secondary outcome measures are Lysholm score; Outerbridge grade of chondral lesion; knee joint morphology by magnetic resonance images before surgery and at the last follow-up; age, sex, lesion region, and course of disease before surgery; and incidence of adverse reactions at the last follow-up. Clinical data from 115 patients with discoid meniscus injury (115 knees) who received treatment from April 2015 to September 2016 were retrospectively analyzed. (1) Six to eighteen months of follow-up of 115 patients revealed a significant difference in Lysholm scores before surgery (65.8±9.39) and at the last follow-up (89.15±7.45; P < 0.05). Postoperative Lysholm scores were excellent in 32 patients, good in 61 patients, fair in 18 patients, and poor in 4 patients, with an excellent-and-good rate of 80.9%. There were 93 excellent and good patients and 22 unsatisfied patients. (2) Knee joint infection did not occur in any patient. There were four patients with lateral interstitial pain and two patients with lateral instability of the knee joint. (3) Logistic regression analysis revealed that course of disease, age, and Outerbridge grade of chondral lesion were risk factors that influenced the efficacy of arthroscopic meniscus surgery. Results from this study hope to confirm that arthroscopic surgery for discoid meniscus injury is a definitive treatment technique. Patient age and the degree of chondral lesion are closely related with efficacy, so it is recommended that patients with symptomatic discoid meniscus injury undergo surgery as soon as possible. This trial had been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800019182) on October 30, 2018.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Tissue Engineering, Knee Joint, Arthroscopes

CLC Number:

R459.9
R605

Mai Jianjun, Xu Bin, Tu Jun, Wu Lei. Efficacy of arthroscopic surgery for discoid lateral meniscus injury in knee joint: a single-center, self-control trial[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(4): 532-537.

Figures/Tables 3

References

[1] Lin Z, Huang W, Ma L, et al. Kinematic features in patients with lateral discoid meniscus injury during walking. Sci Rep. 2018;8(1):5053.

[2] Milewski MD, Krochak R, Duarte AJ, et al. Do Age and weightbearing radiographs affect lateral joint space and fibular height measurements in patients with discoid lateral meniscus? Orthop J Sports Med. 2018. doi: 10. 1177/2325967118760534.

[3] Han SB, Babu CP, Choi JH, et al. Regeneration of lateral discoid meniscus after arthroscopic partial meniscectomy in an adult patient. Knee Surg Sports Traumatol Arthrosc. 2018; 26(8):2278-2281.

[4] 郁贤舜,徐斌,徐洪港,等.微创关节镜下手术治疗盘状半月板破裂的疗效分析[J].安徽医药,2013,17(4):582-583.

[5] Bae JH, Lim HC, Hwang DH, et al. Incidence of bilateral discoid lateral meniscus in an Asian population: an arthroscopic assessment of contralateral knees. Arthroscopy. 2012;28(7):936-941.

[6] Patel NM, Cody SR, Ganley TJ. Symptomatic bilateral discoid menisci in children: a comparison with unilaterally symptomatic patients. J Pediatr Orthop. 2012;32(1):5-8.

[7] Moon MS, Kwon KT, Park BK, et al. Long-term results of arthroscopic reshaping for symptomatic discoid lateral meniscus in children. Arthroscopy. 2015;31(5):867-873.

[8] Papadopoulos A, Kirkos JM, Kapetanos GA. Histomorphologic study of discoid meniscus. Arthroscopy. 2009;25(3):262-268.

[9] 孙书宏,张义庚.关节镜手术治疗盘状半月板损伤疗效及影响因素分析[J].华北理工大学学报(医学版),2017,19(5):379-384,390.

[10] Xiang P, Fu Y, Xu SH. Diagnosis and treatment of 4 patients with knee discoid medial meniscus under arthroscopic. Zhongguo Gu Shang. 2017;30(6):566-569.

[11] 王彬,程飚.盘状半月板的研究进展[J]. 中国临床医学, 2014, 21(2):234-236.

[12] 张珂,徐斌,徐洪港,等.成人完全型与不完全型盘状半月板形态的MRI影像学分析[J].中国临床研究,2018,31(4):433-436.

[13] Kalenderer O, Türken MA, Agus H. Surgical treatment of symptomatic discoid medial meniscus in childhood: a case report. J Pediatr Orthop B. 2012;21(4):359-360.

[14] Kramer DE, Micheli LJ. Meniscal tears and discoid meniscus in children: diagnosis and treatment. J Am Acad Orthop Surg. 2009;17(11):698-707.

[15] Sun Y, Jiang Q. Review of discoid meniscus. Orthop Surg. 2011;3(4):219-223.

[16] Kocher MS, Klingele K, Rassman SO. Meniscal disorders: normal, discoid, and cysts. Orthop Clin North Am. 2003;34(3): 329-340.

[17] Huang CZ, Fan WJ, Chen ZW, et al. Application of menisci reformation and repair in the treatment of the discoid meniscus injuries. Zhongguo Gu Shang. 2010;23(6):409-412.

[18] 黄华扬,尹庆水,章莹,等.1310例侧膝关节半月板损伤关节镜下诊治效果分析[J]. 中华外科杂志,2004,42(12):730-732.

[19] Carter CW, Hoellwarth J, Weiss JM. Clinical outcomes as a function of meniscal stability in the discoid meniscus: a preliminary report. J Pediatr Orthop. 2012;32(1):9-14.

[20] Chedal-Bornu B, Morin V, Saragaglia D. Meniscoplasty for lateral discoid meniscus tears: Long-term results of 14 cases. Orthop Traumatol Surg Res. 2015;101(6):699-702.

[21] Fu D, Guo L, Yang L, et al. Discoid lateral meniscus tears and concomitant articular cartilage lesions in the knee. Arthroscopy. 2014;30(3):311-318.

[22] Choi SH, Shin KE, Chang MJ, et al. Diagnostic criterion to distinguish between incomplete and complete discoid lateral meniscus on MRI. J Magn Reson Imaging. 2013;38(2): 417-421.

[23] 孙金鹏,雷光华.盘状半月板对软骨退变影响及不同术式软骨应力变化研究[D].长沙:中南大学,2013.

[24] Kim JH, Bin SI, Lee BS, et al. Does discoid lateral meniscus have inborn peripheral rim instability? Comparison between intact discoid lateral meniscus and normal lateral meniscus. Arch Orthop Trauma Surg. 2018. doi:10.1007/ s00402-018-2987-9.

[25] Koç A, Tokmak TT, Karab?y?k Ö, Türk G. Evaluation of anterior intermeniscal ligament in discoid lateral meniscus cases and presenting the accompanying meniscal pathologies with MRI. Acta Radiol. 2018. doi:10. 1177/0284185118776499.

[26] Lau BC, Vashon T, Janghala A, Pandya NK. The sensitivity and specificity of preoperative history, physical examination, and magnetic resonance imaging to predict articular cartilage injuries in symptomatic discoid lateral meniscus. Pediatr Orthop. 2018;38(9):e501-e506.

[27] 齐滋华,李传福,张晓明,等.膝关节半月板撕裂的MRI诊断[J].实用放射学杂志,2008,24(1):73-75.

[28] 刘颖,杨少峰,陈丽霞.膝骨关节炎患者膝关节功能与生存质量的研究[J].中国康复医学杂志,2009,24(12):1092-1094.

[29] 冯文哲,陆伟,许鉴,等.组织工程化软骨细胞移植修复膝关节大面积全层软骨缺损[J].中国组织工程研究, 2018,22(14): 2152-2156.

[30] 谈绎文,郑昱新,顾新丰,王学宗.关节镜治疗成人外侧盘状半月板的短期疗效及软骨损伤对疗效的影响[J].中国骨与关节损伤杂志, 2017,32(10):1079-1081.