When a discoid meniscus, most commonly involving the lateral meniscus, tears, it is necessary to perform treatment on it due to symptoms from the tear. In most instances, the meniscus is very thin and degenerative when it does tear and a good portion of it needs to be resected. Attempts should be made to try to reconstitute a normal outline of the lateral meniscus by “saucerizing” the edges to try to leave some normal meniscal tissue behind.
In some rare instances, a very thick discoid meniscus may tear at the capsular junction, where there is still a blood supply. In most cases, this is at the far anterior or posterior horns of the discoid meniscus. In these circumstances, since the remaining meniscus is still intact, attempts should be made at a repair of the meniscus.
Due to the degenerative nature of the discoid meniscus in general, we perform inside out sutures, rather than all inside devices, to try to secure the meniscus into the best position in these circumstances.
In patients who require a resection or saucerization of a discoid lateral meniscus, they should be followed closely to make sure that they do not have any development of knee arthritis. This is because the lateral meniscus can absorb up to 70% of the shock of the lateral compartment. Therefore, patients are advised to notify their physicians or return for an evaluation if they have any pain or swelling with activities, which is a common sign of early onset arthritis. Patients also should be followed with standing radiographs to look for joint space narrowing, and osteophyte (bone spur) formation. In patients who are malaligned, especially for genu valgus alignment, who have a lateral meniscus resected, the use of an un-loader brace may be required, particularly if the patient’s growth plates are still open.
A well-guided physical therapy protocol is essential to maximize outcomes after a meniscus surgery repair. It is important for the patient to follow the protocol, avoid participating in certain high impact, contact, or twisting activities, and to closely follow the rehabilitation program recommended to maximize their surgical outcomes.
Dr. LaPrade recommends patients who have discoid meniscus surgery repairs to avoid deep squatting, sitting cross-legged or performing any heavy lifting for a minimum of four months post-op to give the posterior horn of the meniscus the best chance for healing. For concurrent meniscal root repairs or radial repairs, the rehabilitation process is slowed significantly to maximize the chance of healing. In these circumstances, a postoperative MRI may be necessary to verify the meniscus has healed.
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