Mid-term effectiveness of arthroscopy and conservative treatment for symptomatic discoid lateral meniscus in middle-aged and elderly patients_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Shunjie , WANG Lingcheng , YOU Mingke , YANG Shuoyao , XUE Yang ,  CHEN Gang

Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

CHEN Gang, Email: drchengang@hotmail.com

Keywords：

Arthroscopy; conservative treatment; symptomatic discoid lateral meniscus; the middle-aged and elderly

DOI：

10.7507/1002-1892.202208064

Video：

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Objective To compare the mid-term effectiveness of arthroscopy versus conservative treatment on symptomatic discoid lateral meniscus (SDLM) in middle-aged and elderly patients. Methods The clinical data of 118 middle-aged and elderly patients (154 knees) with SDLM who received arthroscopy or conservative treatment between June 2014 and May 2016 were retrospectively analyzed, including 76 patients (96 knees) in the arthroscopy group (group A) and 42 patients (58 knees) in the conservative treatment group (group B). There was no significant difference in age, gender, and body mass index between the two groups (P>0.05). Compared with group B, the symptoms duration in group A was longer, the incidences of discoid lateral meniscus injury and mechanical symptoms were higher, and the visual analogue scale (VAS) score and Lysholm score before treatment were worse, with significant differences (P<0.05). VAS score and Lysholm score before and after treatment were recorded and compared. Results The patients in both groups were followed up 60-74 months, with an average of 66.3 months. The follow-up time of group A and group B was (65.9±3.5) months and (67.0±4.0) months respectively, with no significant difference (t=–1.615, P=0.109). At last follow-up, in either group A or group B, the VAS score and Lysholm score significantly improved when compared with those before treatment (P<0.05). The differences of VAS score and Lysholm score in group A before and after treatment were significantly better than those in group B (P<0.05). Conclusion Arthroscopy and conservative treatment have a satisfactory mid-term effectiveness on SDLM in middle-aged and elderly patients. However, the improvement of symptoms and function of arthroscopy was significantly better than that of conservative treatment. For middle-aged and elderly SDLM patients with invalidated conventional treatment for 6 months, severe clinical symptoms, long duration of symptoms, and combined with mechanical symptoms, arthroscopy should be given priority even if they are complicated with early osteoarthritis.

Citation： YANG Shunjie, WANG Lingcheng, YOU Mingke, YANG Shuoyao, XUE Yang, CHEN Gang. Mid-term effectiveness of arthroscopy and conservative treatment for symptomatic discoid lateral meniscus in middle-aged and elderly patients. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(1): 6-11. doi: 10.7507/1002-1892.202208064 Copy

1.	Tudisco C, Botti F, Bisicchia S. Histological study of discoid lateral meniscus in children and adolescents: Morphogenetic considerations. Joints, 2021, 7(4): 155-158.
2.	Papadopoulos A, Kirkos JM, Kapetanos GA. Histomorphologic study of discoid meniscus. Arthroscopy, 2009, 25(3): 262-268.
3.	Aydın Kabakçı AD, Büyükmumcu M, Akın D, et al. Morphological structure and variations of fetal lateral meniscus: the significance in convenient diagnosis and treatment. Knee Surg Sports Traumatol Arthrosc, 2019, 27(10): 3364-3373.
4.	Tapasvi S, Shekhar A, Eriksson K. Discoid lateral meniscus: current concepts. J ISAKOS, 2021, 6(1): 14-21.
5.	Good CR, Green DW, Griffith MH, et al. Arthroscopic treatment of symptomatic discoid meniscus in children: classification, technique, and results. Arthroscopy, 2007, 23(2): 157-163.
6.	Kushare I, Klingele K, Samora W. Discoid meniscus: Diagnosis and management. Orthop Clin North Am, 2015, 46(4): 533-540.
7.	Kim JH, Ahn JH, Kim JH, et al. Discoid lateral meniscus: importance, diagnosis, and treatment. J Exp Orthop, 2020, 7(1): 81. doi: 10.1186/s40634-020-00294-y.
8.	Yang SJ, Zhang MZ, Li J, et al. A reliable, ultrasound-based method for the diagnosis of discoid lateral meniscus. Arthroscopy, 2021, 37(3): 882-890.
9.	Rohren EM, Kosarek FJ, Helms CA. Discoid lateral meniscus and the frequency of meniscal tears. Skeletal Radiol, 2001, 30(6): 316-320.
10.	Sun H, Zhang W, Liu F, et al. Single-cell RNA sequencing reveals the cell types heterogenicity of human discoid lateral meniscus cells. J Cell Physiol, 2022, 237(5): 2469-2477.
11.	Sabbag OD, Hevesi M, Sanders TL, et al. High rate of recurrent meniscal tear and lateral compartment osteoarthritis in patients treated for symptomatic lateral discoid meniscus: A population-based study. Orthop J Sports Med, 2019, 7(7): 2325967119856284. doi: 10.1177/2325967119856284.
12.	Smuin DM, Swenson RD, Dhawan A. Saucerization versus complete resection of a symptomatic discoid lateral meniscus at short- and long-term follow-up: A systematic review. Arthroscopy, 2017, 33(9): 1733-1742.
13.	Chen G, Zhang Z, Li J. Symptomatic discoid lateral meniscus: a clinical and arthroscopic study in a Chinese population. BMC Musculoskelet Disord, 2016, 17: 329. doi: 10.1186/s12891-016-1188-3.
14.	Englund M, Haugen IK, Guermazi A, et al. Evidence that meniscus damage may be a component of osteoarthritis: the Framingham study. Osteoarthritis Cartilage, 2016, 24(2): 270-273.
15.	Badlani JT, Borrero C, Golla S, et al. The effects of meniscus injury on the development of knee osteoarthritis: data from the osteoarthritis initiative. Am J Sports Med, 2013, 41(6): 1238-1244.
16.	Englund M. The role of the meniscus in osteoarthritis genesis. Rheum Dis Clin North Am, 2008, 34(3): 573-579.
17.	Ohnishi Y, Nakashima H, Suzuki H, et al. Arthroscopic treatment for symptomatic lateral discoid meniscus: The effects of different ages, groups and procedures on surgical outcomes. Knee, 2018, 25(6): 1083-1090.
18.	Kose O, Celiktas M, Egerci OF, et al. Prognostic factors affecting the outcome of arthroscopic saucerization in discoid lateral meniscus: a retrospective analysis of 48 cases. Musculoskelet Surg, 2015, 99(2): 165-170.
19.	Logan CA, Tepolt FA, Kocher SD, et al. Symptomatic discoid meniscus in children and adolescents: A review of 470 cases. J Pediatr Orthop, 2021, 41(8): 496-501.
20.	Habata T, Uematsu K, Kasanami R, et al. Long-term clinical and radiographic follow-up of total resection for discoid lateral meniscus. Arthroscopy, 2006, 22(12): 1339-1343.
21.	Yang SJ, Ding ZJ, Li J, et al. Factors influencing postoperative outcomes in patients with symptomatic discoid lateral meniscus. BMC Musculosk Disord, 2020, 21(1): 551. doi: 10.1186/s12891-020-03573-y.
22.	Yim JH, Seon JK, Song EK, et al. A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med, 2013, 41(7): 1565-1570.
23.	Katz JN, Shrestha S, Losina E, et al. Five-year outcome of operative and nonoperative management of meniscal tear in persons older than forty-five years. Arthritis Rheumatol, 2020, 72(2): 273-281.
24.	Cameron JC, Saha S. Meniscal allograft transplantation for unicompartmental arthritis of the knee. Clin Orthop Relat Res, 1997, (337): 164-171.
25.	中华医学会骨科学分会关节外科学组. 骨关节炎诊疗指南 (2018年版). 中华骨科杂志, 2018, 38(12): 705-715.
26.	Barnds B, Morris B, Mullen S, et al. Increased rates of knee arthroplasty and cost of patients with meniscal tears treated with arthroscopic partial meniscectomy versus non-operative management. Knee Surg Sports Traumatol Arthrosc, 2019, 27(7): 2316-2321.
27.	Yang SJ, Li J, Xue Y, et al. Multivariate ordered logistic regression analysis of the postoperative effect of symptomatic discoid lateral meniscus. Arch Orthop Trauma Surg, 2021, 141(11): 1935-1944.
28.	Sihvonen R, Englund M, Turkiewicz A, et al. Mechanical symptoms as an indication for knee arthroscopy in patients with degenerative meniscus tear: a prospective cohort study. Osteoarthritis Cartilage, 2016, 24(8): 1367-1375.
29.	Sihvonen R, Englund M, Turkiewicz A, et al. Mechanical symptoms and arthroscopic partial meniscectomy in patients with degenerative meniscus tear: A secondary analysis of a randomized trial. Ann Intern Med, 2016, 164(7): 449-455.
30.	Siemieniuk RAC, Harris IA, Agoritsas T, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. Br J Sports Med, 2018, 52(5): 313. doi: 10.1136/bjsports-2017-j1982rep.
31.	Siemieniuk RAC, Harris IA, Agoritsas T, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ, 2017, 357: j1982. doi: 10.1136/bmj.j1982.
32.	Nazari G, MacDermid J. Appraisal of clinical practice guideline: Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. J Physiother, 2020, 66(1): 60. doi: 10.1016/j.jphys.2019.10.007.
33.	Guo W, Liu S, Zhu Y, et al. Advances and prospects in tissue-engineered meniscal scaffolds for meniscus regeneration. Stem Cells Int, 2015, 2015: 517520. doi: 10.1155/2015/517520.
34.	Petty CA, Lubowitz JH. Does arthroscopic partial meniscectomy result in knee osteoarthritis? A systematic review with a minimum of 8 years’ follow-up. Arthroscopy, 2011, 27(3): 419-424.
35.	Luyten FP, Denti M, Filardo G, et al. Definition and classification of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc, 2012, 20(3): 401-406.
36.	Krych AJ, Carey JL, Marx RG, et al. Does arthroscopic knee surgery work? Arthroscopy, 2014, 30(5): 544-545.
37.	Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet, 2019, 393(10182): 1745-1759.
38.	Hart HF, Crossley KM, Felson D, et al. Relation of meniscus pathology to prevalence and worsening of patellofemoral joint osteoarthritis: the multicenter osteoarthritis study. Osteoarthritis Cartilage, 2018, 26(7): 912-919.
39.	Christoforakis J, Pradhan R, Sanchez-Ballester J, et al. Is there an association between articular cartilage changes and degenerative meniscus tears? Arthroscopy, 2005, 21(11): 1366-1369.
40.	Melrose J. The knee joint loose body as a source of viable autologous human chondrocytes. Eur J Histochem, 2016, 60(2): 2645. doi: 10.4081/ejh.2016.2645.
41.	Zamber RW, Teitz CC, McGuire DA, et al. Articular cartilage lesions of the knee. Arthroscopy, 1989, 5(4): 258-268.
42.	Persson F, Turkiewicz A, Bergkvist D, et al. The risk of symptomatic knee osteoarthritis after arthroscopic meniscus repair vs partial meniscectomy vs the general population. Osteoarthritis Cartilage, 2018, 26(2): 195-201.
43.	Karpinski K, Müller-Rath R, Niemeyer P, et al. Subgroups of patients with osteoarthritis and medial meniscus tear or crystal arthropathy benefit from arthroscopic treatment. Knee Surg Sports Traumatol Arthrosc, 2019, 27(3): 782-796.
44.	Pedersen JR, Roos EM, Thorlund JB, et al. Cutoff values to interpret short-term treatment outcomes after arthroscopic meniscal surgery, measured with the knee injury and osteoarthritis outcome score. J Orthop Sports Phys Ther, 2021, 51(6): 281-288.
45.	MacFarlane LA, Yang H, Collins JE, et al. Relationship between patient-reported swelling and magnetic resonance imaging-defined effusion-synovitis in patients with meniscus tears and knee osteoarthritis. Arthritis Care Res (Hoboken), 2019, 71(3): 385-389.
46.	Zhang H, Cai D, Bai X. Macrophages regulate the progression of osteoarthritis. Osteoarthritis Cartilage, 2020, 28(5): 555-561.
47.	Li ZM, Li M. Improvement in orthopedic outcome score and reduction in IL-1β, CXCL13, and TNF-α in synovial fluid of osteoarthritis patients following arthroscopic knee surgery. Genet Mol Res, 2017, 16(3). doi: 10.4238/gmr16039487.

1. Tudisco C, Botti F, Bisicchia S. Histological study of discoid lateral meniscus in children and adolescents: Morphogenetic considerations. Joints, 2021, 7(4): 155-158.
2. Papadopoulos A, Kirkos JM, Kapetanos GA. Histomorphologic study of discoid meniscus. Arthroscopy, 2009, 25(3): 262-268.
3. Aydın Kabakçı AD, Büyükmumcu M, Akın D, et al. Morphological structure and variations of fetal lateral meniscus: the significance in convenient diagnosis and treatment. Knee Surg Sports Traumatol Arthrosc, 2019, 27(10): 3364-3373.
4. Tapasvi S, Shekhar A, Eriksson K. Discoid lateral meniscus: current concepts. J ISAKOS, 2021, 6(1): 14-21.
5. Good CR, Green DW, Griffith MH, et al. Arthroscopic treatment of symptomatic discoid meniscus in children: classification, technique, and results. Arthroscopy, 2007, 23(2): 157-163.
6. Kushare I, Klingele K, Samora W. Discoid meniscus: Diagnosis and management. Orthop Clin North Am, 2015, 46(4): 533-540.
7. Kim JH, Ahn JH, Kim JH, et al. Discoid lateral meniscus: importance, diagnosis, and treatment. J Exp Orthop, 2020, 7(1): 81. doi: 10.1186/s40634-020-00294-y.
8. Yang SJ, Zhang MZ, Li J, et al. A reliable, ultrasound-based method for the diagnosis of discoid lateral meniscus. Arthroscopy, 2021, 37(3): 882-890.
9. Rohren EM, Kosarek FJ, Helms CA. Discoid lateral meniscus and the frequency of meniscal tears. Skeletal Radiol, 2001, 30(6): 316-320.
10. Sun H, Zhang W, Liu F, et al. Single-cell RNA sequencing reveals the cell types heterogenicity of human discoid lateral meniscus cells. J Cell Physiol, 2022, 237(5): 2469-2477.
11. Sabbag OD, Hevesi M, Sanders TL, et al. High rate of recurrent meniscal tear and lateral compartment osteoarthritis in patients treated for symptomatic lateral discoid meniscus: A population-based study. Orthop J Sports Med, 2019, 7(7): 2325967119856284. doi: 10.1177/2325967119856284.
12. Smuin DM, Swenson RD, Dhawan A. Saucerization versus complete resection of a symptomatic discoid lateral meniscus at short- and long-term follow-up: A systematic review. Arthroscopy, 2017, 33(9): 1733-1742.
13. Chen G, Zhang Z, Li J. Symptomatic discoid lateral meniscus: a clinical and arthroscopic study in a Chinese population. BMC Musculoskelet Disord, 2016, 17: 329. doi: 10.1186/s12891-016-1188-3.
14. Englund M, Haugen IK, Guermazi A, et al. Evidence that meniscus damage may be a component of osteoarthritis: the Framingham study. Osteoarthritis Cartilage, 2016, 24(2): 270-273.
15. Badlani JT, Borrero C, Golla S, et al. The effects of meniscus injury on the development of knee osteoarthritis: data from the osteoarthritis initiative. Am J Sports Med, 2013, 41(6): 1238-1244.
16. Englund M. The role of the meniscus in osteoarthritis genesis. Rheum Dis Clin North Am, 2008, 34(3): 573-579.
17. Ohnishi Y, Nakashima H, Suzuki H, et al. Arthroscopic treatment for symptomatic lateral discoid meniscus: The effects of different ages, groups and procedures on surgical outcomes. Knee, 2018, 25(6): 1083-1090.
18. Kose O, Celiktas M, Egerci OF, et al. Prognostic factors affecting the outcome of arthroscopic saucerization in discoid lateral meniscus: a retrospective analysis of 48 cases. Musculoskelet Surg, 2015, 99(2): 165-170.
19. Logan CA, Tepolt FA, Kocher SD, et al. Symptomatic discoid meniscus in children and adolescents: A review of 470 cases. J Pediatr Orthop, 2021, 41(8): 496-501.
20. Habata T, Uematsu K, Kasanami R, et al. Long-term clinical and radiographic follow-up of total resection for discoid lateral meniscus. Arthroscopy, 2006, 22(12): 1339-1343.
21. Yang SJ, Ding ZJ, Li J, et al. Factors influencing postoperative outcomes in patients with symptomatic discoid lateral meniscus. BMC Musculosk Disord, 2020, 21(1): 551. doi: 10.1186/s12891-020-03573-y.
22. Yim JH, Seon JK, Song EK, et al. A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med, 2013, 41(7): 1565-1570.
23. Katz JN, Shrestha S, Losina E, et al. Five-year outcome of operative and nonoperative management of meniscal tear in persons older than forty-five years. Arthritis Rheumatol, 2020, 72(2): 273-281.
24. Cameron JC, Saha S. Meniscal allograft transplantation for unicompartmental arthritis of the knee. Clin Orthop Relat Res, 1997, (337): 164-171.
25. 中华医学会骨科学分会关节外科学组. 骨关节炎诊疗指南 (2018年版). 中华骨科杂志, 2018, 38(12): 705-715.
26. Barnds B, Morris B, Mullen S, et al. Increased rates of knee arthroplasty and cost of patients with meniscal tears treated with arthroscopic partial meniscectomy versus non-operative management. Knee Surg Sports Traumatol Arthrosc, 2019, 27(7): 2316-2321.
27. Yang SJ, Li J, Xue Y, et al. Multivariate ordered logistic regression analysis of the postoperative effect of symptomatic discoid lateral meniscus. Arch Orthop Trauma Surg, 2021, 141(11): 1935-1944.
28. Sihvonen R, Englund M, Turkiewicz A, et al. Mechanical symptoms as an indication for knee arthroscopy in patients with degenerative meniscus tear: a prospective cohort study. Osteoarthritis Cartilage, 2016, 24(8): 1367-1375.
29. Sihvonen R, Englund M, Turkiewicz A, et al. Mechanical symptoms and arthroscopic partial meniscectomy in patients with degenerative meniscus tear: A secondary analysis of a randomized trial. Ann Intern Med, 2016, 164(7): 449-455.
30. Siemieniuk RAC, Harris IA, Agoritsas T, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. Br J Sports Med, 2018, 52(5): 313. doi: 10.1136/bjsports-2017-j1982rep.
31. Siemieniuk RAC, Harris IA, Agoritsas T, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ, 2017, 357: j1982. doi: 10.1136/bmj.j1982.
32. Nazari G, MacDermid J. Appraisal of clinical practice guideline: Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. J Physiother, 2020, 66(1): 60. doi: 10.1016/j.jphys.2019.10.007.
33. Guo W, Liu S, Zhu Y, et al. Advances and prospects in tissue-engineered meniscal scaffolds for meniscus regeneration. Stem Cells Int, 2015, 2015: 517520. doi: 10.1155/2015/517520.
34. Petty CA, Lubowitz JH. Does arthroscopic partial meniscectomy result in knee osteoarthritis? A systematic review with a minimum of 8 years’ follow-up. Arthroscopy, 2011, 27(3): 419-424.
35. Luyten FP, Denti M, Filardo G, et al. Definition and classification of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc, 2012, 20(3): 401-406.
36. Krych AJ, Carey JL, Marx RG, et al. Does arthroscopic knee surgery work? Arthroscopy, 2014, 30(5): 544-545.
37. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet, 2019, 393(10182): 1745-1759.
38. Hart HF, Crossley KM, Felson D, et al. Relation of meniscus pathology to prevalence and worsening of patellofemoral joint osteoarthritis: the multicenter osteoarthritis study. Osteoarthritis Cartilage, 2018, 26(7): 912-919.
39. Christoforakis J, Pradhan R, Sanchez-Ballester J, et al. Is there an association between articular cartilage changes and degenerative meniscus tears? Arthroscopy, 2005, 21(11): 1366-1369.
40. Melrose J. The knee joint loose body as a source of viable autologous human chondrocytes. Eur J Histochem, 2016, 60(2): 2645. doi: 10.4081/ejh.2016.2645.
41. Zamber RW, Teitz CC, McGuire DA, et al. Articular cartilage lesions of the knee. Arthroscopy, 1989, 5(4): 258-268.
42. Persson F, Turkiewicz A, Bergkvist D, et al. The risk of symptomatic knee osteoarthritis after arthroscopic meniscus repair vs partial meniscectomy vs the general population. Osteoarthritis Cartilage, 2018, 26(2): 195-201.
43. Karpinski K, Müller-Rath R, Niemeyer P, et al. Subgroups of patients with osteoarthritis and medial meniscus tear or crystal arthropathy benefit from arthroscopic treatment. Knee Surg Sports Traumatol Arthrosc, 2019, 27(3): 782-796.
44. Pedersen JR, Roos EM, Thorlund JB, et al. Cutoff values to interpret short-term treatment outcomes after arthroscopic meniscal surgery, measured with the knee injury and osteoarthritis outcome score. J Orthop Sports Phys Ther, 2021, 51(6): 281-288.
45. MacFarlane LA, Yang H, Collins JE, et al. Relationship between patient-reported swelling and magnetic resonance imaging-defined effusion-synovitis in patients with meniscus tears and knee osteoarthritis. Arthritis Care Res (Hoboken), 2019, 71(3): 385-389.
46. Zhang H, Cai D, Bai X. Macrophages regulate the progression of osteoarthritis. Osteoarthritis Cartilage, 2020, 28(5): 555-561.
47. Li ZM, Li M. Improvement in orthopedic outcome score and reduction in IL-1β, CXCL13, and TNF-α in synovial fluid of osteoarthritis patients following arthroscopic knee surgery. Genet Mol Res, 2017, 16(3). doi: 10.4238/gmr16039487.

Chinese Journal of Reparative and Reconstructive Surgery

Mid-term effectiveness of arthroscopy and conservative treatment for symptomatic discoid lateral meniscus in middle-aged and elderly patients

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