MB BULLETS Step 1 For 1st and 2nd Year Med Students. disk-shaped or discoid meniscus is a common normal variant that is seen in 0.8–3.0% of the popula-tion and that is manifested by a wider than normal meniscal body [1–4]. This results in a thickened meniscus that covers more of the lateral tibia (shin bone) than a normal meniscus. People with discoid meniscus may go through their entire lives and never experience any problems. If horizontal cleavage tear extends to capsule, may have to place sutures directly above and below meniscus to create "haybail" suture to compress leaflets together, Suture can be absorbable monofilament or nonabsorbable suture, Ideal suture configuration will involve vertical mattress sutures above and below meniscus, Amount of sutures will vary depending on size of unstable portion of meniscus. 2) VIDEOS - only Orthobullets Technique Videos count. Discoid meniscus is a congenital anatomic variant seen almost exclusively on the lateral (outer) side of the knee. One end of the suture passing device will be exiting through the medial arthroscopic portal. A 12-year-old basketball player reports frequent and moderately painful popping in his left knee during his games. His knee exam is unremarkable. Discoid menisci are congenital, frequently bilateral (up to 50%) and have been reported in twins, although no genetic locus has been identified 2.There is a higher prevalence in Asians without any gender predilection 7.. Lateral discoid meniscus is far more common than medial discoid meniscus, with the latter being rare. An 11-year-old soccer player presents with a 6 month history of snapping and discomfort along the lateral joint line of the knee. 6 The condition is typically asymptomatic and, therefore, is infrequently diagnosed. Sufferers experience great pains and stiffness and in addition they can even become incapable of getting around and of performing the simplest movements. A discoid meniscus causes pain, stiffness, and swelling of the knee. In this episode, Dr. Raymond H. Kim reviews the high-yield topics of Meniscal Injury & Discoid Meniscus from the Sports section. Prescribes and manages non-operative treatment . ortho BULLETS. The axillary nerve is a risk with low posterior (7 o'clock) portals. Arthritis can take many forms and its causes are not yet clear. 110 plays. There is no obvious instability or tenderness and he had normal patellar tracking. rasp the lateral meniscus and the capsular edges to promote bleeding, Place cannula through lateral portal to allow easy needle passage, May need to establish an accessory portal inferior to standard lateral portal to optimize needle trajectory, Insert needles sequentially through the cannula and retrieve posterior to capsule, Place in vertical mattress fashion above and below meniscus, Most cases can be done on outpatient basis. New to Orthobullets? discoid meniscus is larger than usual. There are a few needle options. He denies any past history of pain, clicking, or locking. New to Orthobullets? Insert needle through skin, capsule and meniscus at desired location. "Discoid menisci occur in 3-5% of the population. At this point, one end of the suture will be through the meniscus and emerging percutaneously through skin on the outside of the knee and the other end will still be coming out the arthroscopic portal. Copyright © 2021 Lineage Medical, Inc. All rights reserved. MB BULLETS Step 1 For 1st and 2nd Year Med Students. Abnormal development of the meniscus leads to a hypertrophic and discoid shaped meniscus. MB BULLETS Step 2 & 3 For 3rd and 4th Year Med Students. ORTHO BULLETS Orthopaedic Surgeons & Providers Knee immobilizer and non weight bearing for 6 weeks, Abnormal development of the meniscus leads to a hypertrophic and discoid shaped meniscus, Discoid Lateral Meniscus Saucerization and Stabilization, Type in at least one full word to see suggestions list, Saucerization of a discoid lateral meniscus, Knee & Sports⎜Meniscal Injuries & Discoid Meniscus (ft. Dr. Raymond H. Kim). Epidemiology. (OBQ07.129) 10 It is the most common meniscal variant in children. Agenesis of the anterior cruciate ligament. Retrieve out the medial portal with arthroscopic grasper (preferably a crab claw type grasper). The goal of surgery is to contour the discoid lateral meniscus to resemble a normal meniscus. An AP radiographs is shown in Figure A. Sequential sagittal MRI images of the lateral compartment of the knee are shown in Figure B. meniscal tear functions as a one-way valve. Pass suture passer through needle and retrieve through arthroscopic portal in similar fashion. Discoid Lateral Meniscus Saucerization and Stabilization. 7 The most frequent symptom is pain that usually begins with a minor trauma. Usually a person with this anomaly has no complaints; however, it may present as pain, swelling, or a snapping sound heard from the affected knee. standing at 20 degrees of knee flexion on the affected limb, the patient twists with knee external and internal rotation with positive test being discomfort or clicking. also referred to as "popping knee syndrome". He has no associated pain and denies trauma. [] The surgical procedure performed was arthroscopic partial meniscectomy alone (22 knees), partial meniscectomy with repair (18 knees), or subtotal … 3. ORTHO BULLETS Orthopaedic Surgeons & Providers The most commonly used is a straight spinal needle and a flexible suture passing device. Sports⎜Meniscal Injuries & Discoid Meniscus (ft. Dr. Raymond H. Kim) by The Orthobullets Podcast • A podcast on Anchor. meniscal tears are common in young patients with sports-related injuries and older patients as a degenerative condition. Discoid meniscus. • Wrisberg (lack of posterior meniscotibial attachment to tibia, 3 or more 5mm sagittal images with meniscal continuity, obtain anatomic looking meniscus with debridement, meniscal instability is frequently present, recent literature suggest anterior horn instability is most common, Spontaneous Osteonecrosis of the Knee (SONK), Osgood Schlatter's Disease (Tibial Tubercle Apophysitis), Anterior Superior Iliac Spine (ASIS) Avulsion, Anterior Inferior Iliac Spine Avulsion (AIIS), Concussions (Mild Traumatic Brain Injury), also referred to as "popping knee syndrome", mechanical symptoms most pronounced in extension, study of choice for suspected symptomatic meniscal pathology, sagittal MRI will show abnormally thick and flat meniscus, coronal MRI will show thick and flat meniscal tissue extending across entire lateral compartment, Symptomatic cases may reveal underlying meniscus tear, asymptomatic discoid meniscus without tears. Dr. Kim is an Adult Reconstruction Orthopedic Surgeon at the Steadman Clinic in Colorado. 3. Diagnosis of a discoid meniscus begins with a thorough medical history and physical examination. He is otherwise healthy, with no birth or developmental issues. Meniscus tears are among the most common knee injuries. Examination shows a 10 degree loss of active extension. failure of apoptosis in utero. Place a broad retractor anterior to gastroc muscle to maintain exposure and protect neurovascular structures during needle passage. He can elicit the sensation when moving his knee from flexion into full extension. synovial fluid … Over 200,000 physicians learn and collaborate together in our online community. A 6-year-old boy complains of a 'clunking' sensation in his left knee. New to Orthobullets? High-resolution coronal images allowed more graphic depiction of the abnormally wide meniscus. Sometimes repairs (suturing/stitching) of meniscus is necessary to correct the meniscus, and this can only be assessed during surgery. Join for free. . Ideally, the needle emerges at a place that is 2-4 mm apart from the first location. He is evaluated and the decision is made to proceed with arthroscopic saucerization. Athletes, particularly those who play contact sports, are at risk for meniscus tears. Load a suture onto the end of the suture passer that is outside the arthroscopic portal. OCD lesions are found most commonly in the posterolateral aspect of the medial femoral condyle. (OBQ05.166) parameniscal cysts (e.g., baker cysts) extruded fluid outside the meniscus (most common) usually located between semimembranosus and medial head of gastrocnemius. Physical therapy with a focus on concentric knee strengthening, Arthroscopic saucerization of the lateral meniscus and/or meniscal repair, Arthroscopic microfracture treatment of the defect on the lateral femoral condyle. ... Discoid lateral meniscus: importance, diagnosis, and treatment. Epidemiology. Some tear types may allow WBAT with knee in full extension, Also variable but will typically be restricted to no more than 90 degrees of motion for 4-6 weeks post op to minimize cam rollback stresses from lateral femoral condyle on meniscus repair, Will typically commence 1-2 weeks after surgery. discoid meniscus on radiograph tibial spine hypoplasia, widening of the lateral joint line or flattening of the lateral femoral condyle on AP view. . They are usually lateral and may be bilateral in 25-50%. Trochlear OCD lesions are rarest location and commonly missed on plain radiographs. Some patients may experience the feeling that their knee is giving away. MB BULLETS Step 1 For 1st and 2nd Year Med Students. mechanism of injury. The Hefti Classification is used for describing MRI findings of OCD Lesions. An 8-year-old boy was playing at school and took a direct blow to his knee causing pain and swelling. MB BULLETS Step 2 & 3 For 3rd and 4th Year Med Students. Load the other end of the suture on the suture passer and pull passer back through meniscus such that both ends of the suture are through the meniscus and exiting percutaneously through the skin. 11/6/2019. At this point, the suture passing device will be percutaneously placed through the skin, capsule and meniscus. However, this patient’s MRI below demonstrates an osteochondritis dissecans lesion on the lateral femoral condyle. Orthobullets Techniques are largerly incomplete at this time, and will see rapid improvement as they are updated by experts in the field over the coming months. (SBQ13PE.9) Strong suggestive findings on magnetic resonance imaging includes a thickened meniscal body seen on more than two contiguous sagittal slices. Insert needle through skin, capsule and meniscus at desired location. Joint disease is a debilitating disease characterized by the swelling of the joints. Bluntly dissect down to capsule and retrieve all sutures through this incision. Discoid lateral meniscus is a congenital condition that is estimated to occur in 4% to 5% of the population 1-4 but has been shown to be as high as 13% in Asian populations. His pediatrician ordered an MRI which is shown in Figure A. diagnosis whenever a discoid lateral meniscus is identified because making this elusive diag-nosis may prove immensely useful for the orthopedic surgeon. Discoid meniscus is a rare human anatomic variant that usually affects the lateral meniscus of the knee. The Join for free. Mastery Trigger: Check the "Mark Skill as Read" under each Step. Variable and depends on tear type, rehab progress, etc. Discoid Lateral Meniscus Saucerization and Stabilization, ACL Reconstruction in Skeletally Immature, ACL Reconstruction - Quadriceps Tendon Autograft, MPFL Reconstruction - Pediatric and Adolescent, Medial Retinacular Plication (Modified Insall ), Osteochondral Plug Allograft Transfer of the Knee, horizontal cleavage/intrasubstance degeneration, Presence of associated lateral femoral condyle OCD, straight, up-angled, curved right and left punches, back-biting punches, Consider small arthroscope in young patient, standard OR table with or without leg holder, leg hangs off side of bed for portal creation, Figure 4 position for work in lateral compartment, assess the stability of the posterior horn, body and anterior horn of the lateral meniscus, instability is present in any portion of the lateral meniscus if it can be translated halfway across the tibial plateau in a respective direction, Sometimes there is no apparent attachment between the capsule and meniscus and other times the attachment appears attenuated, use a probe to measure the amount of peripheral meniscus that will be intact after saucerization, the most reliable instrument to use for saucerization is an arthroscopic punch, supplement with angled biters to remove any abnormal tissue anteriorly, measure the remaining rim frequently with a probe, at least 6 - 8 mm of tissue of the lateral meniscus should be left intact, rasp the knee capsule and the meniscal edge to stimulate bleeding. The most commonly used is a straight spinal needle and a flexible suture passing device. Discoid Meniscus Ligament injury ACL Tear ... Orthobullets Team Knee & Sports - Meniscal Injury; Listen Now 18:18 min. The patient was referred to your office for a consultation.

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