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Characteristics and Outcomes of Operatively Treated Discoid Lateral Meniscus in Pediatric and Young Adult Patients: A Multicenter Study
The American Journal of Sports Medicine ( IF 4.2 ) Pub Date : 2024-09-02 , DOI: 10.1177/03635465241272393
Jennifer A Sheasley 1 , Julia C Kirby 2 , Emily L Niu 3 , Maya Gopalan 4 , Sasha Carsen 5 , Zachary S Stinson 6 , Craig J Finlayson 7 , Marie-Lyne Nault 8 , R Jay Lee 9 , Brian M Haus 10 , Daniel W Green 11 , John A Schlechter 12 , Jennifer Beck 13 , Benton Heyworth 14 , Tyler Stavinoha 15 , Jie C Nguyen 1 , Gregory A Schmale 4, 16
Affiliation  

Background:Discoid lateral meniscus (DLM) is the most common congenital abnormality of the meniscus. Tears are common; treatment is frequently not definitive, often requiring reoperation.Purpose:To report the clinical manifestations, physical characteristics, operative treatments and findings, complications, and reoperations of DLM in pediatric patients from multiple centers across North America.Study Design:Case series; Level of evidence, 4.Methods:Consecutive patients who underwent treatment for symptomatic DLM at 9 institutions between 2000 and 2020 were included. Patient data, presenting symptoms and signs, surgical findings, treatments rendered, and postoperative complications, including reoperation rates, were collected. Means with ranges and counts with proportions are reported for continuous and categorical variables, respectively, and comparisons were made using either the chi-square or Fisher exact test.Results:In total, 784 patients (867 knees) were included with a mean age at diagnosis of 12 years (range, 1-22 years) and a mean follow-up of 22.6 months (range, 0-154 months). Common preoperative symptoms were locking (33%) and snapping (30%). At surgery, tears in the DLM were present in 647 knees (594 patients [76%]); 95 knees (11%) had multiple tears; and in 140 knees, tears extended into >1 zone. Tears, when present, were more common within the posterior horn (41%) or body (34%) than the anterior horn (25%). Peripheral rim instability was reported in 241 knees (28%). Significantly more knees had instability posteriorly (15%; P = .0004) and anteriorly (9%; P = .0013) than along the body (3%). Tear type was most commonly complex (38%) or horizontal (34%). A total of 358 knees in 333 patients with tears (42% of all patients) underwent repair (55% of knees with tears). A total of 175 complications were reported, occurring in 139 knees in 134 patients (17%); 116 of these knees with complications (83%) had a single complication, while 23 (17%) had >1. Of the 784 patients, 105 (13%) underwent reoperation, undergoing 135 additional procedures related to their DLM. Of those, 60 (44%) were repeat arthroscopy and meniscal trim; 40 (30%), arthroscopy and meniscal repair; and 17 (13%), an articular cartilage procedure.Conclusion:Locking and snapping were common presenting symptoms. Over three-quarters of patients had meniscal tears, which were most often complex and located posteriorly. Seventeen percent of patients experienced complications, and a sixth of patients with complications had >1. Reoperation was typically for persistent symptoms or meniscal retear.

中文翻译:


儿童和年轻成人患者盘状外侧半月板手术治疗的特点和结果:一项多中心研究



背景:盘状外侧半月板(DLM)是半月板最常见的先天性异常。流泪是常事;治疗常常不是确定的,常常需要再次手术。目的:报告来自北美多个中心的 DLM 儿科患者的临床表现、身体特征、手术治疗和结果、并发症和再次手术。研究设计:病例系列;证据级别,4。方法:纳入 2000 年至 2020 年间在 9 个机构连续接受有症状 DLM 治疗的患者。收集患者数据、症状和体征、手术结果、治疗方法以及术后并发症(包括再次手术率)。分别针对连续变量和分类变量报告具有范围的平均值和具有比例的计数,并使用卡方检验或 Fisher 精确检验进行比较。结果:总共纳入了 784 名患者(867 膝),平均年龄为诊断时间为 12 年(范围:1-22 年),平均随访时间为 22.6 个月(范围:0-154 个月)。常见的术前症状是锁定(33%)和折断(30%)。手术时,647 名膝关节(594 名患者 [76%])出现 DLM 撕裂; 95 个膝盖(11%)有多处撕裂;在 140 个膝盖中,撕裂延伸至 >1 区域。如果存在眼泪,则后角 (41%) 或身体 (34%) 内比前角 (25%) 更常见。 241 例膝关节 (28%) 报告有外周边缘不稳定。与身体上 (3%) 相比,后部 (15%;P = .0004) 和前部 (9%;P = .0013) 不稳定的膝盖明显更多。最常见的撕裂类型是复杂撕裂(38%)或水平撕裂(34%)。 333 名撕裂患者(占所有患者的 42%)总共 358 个膝盖接受了修复(55% 的膝盖有撕裂)。总共报告了 175 种并发症,发生在 134 名患者的 139 个膝关节(17%);这些出现并发症的膝盖中,有 116 个 (83%) 存在单一并发症,而 23 个 (17%) 则有 >1。在 784 名患者中,105 名 (13%) 接受了再次手术,并接受了 135 项与 DLM 相关的额外手术。其中,60 例(44%)接受了重复关节镜检查和半月板修剪; 40(30%),关节镜和半月板修复术; 17 例 (13%) 是关节软骨手术。结论:锁定和折断是常见的症状。超过四分之三的患者有半月板撕裂,这种撕裂通常很复杂并且位于后部。 17% 的患者出现并发症,六分之一的并发症患者出现>1。再次手术通常是针对持续症状或半月板后退。
更新日期:2024-09-02
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