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Discoid Meniscus Treatment

Discoid Meniscus Treatment. Mehran Soleymanha ( Ass. Prof. GUMS , Knee surgery fellowship, SBUMS, Akhtar Hospital). I.O.A Meeting – Tehran – Aug .25.2016. Watanabe Classification. Type I: complete disc-shaped meniscus Type II: incomplete semi-lunar- shaped meniscus

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Discoid Meniscus Treatment

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  1. Discoid Meniscus Treatment MehranSoleymanha (Ass. Prof. GUMS , Knee surgery fellowship, SBUMS, Akhtar Hospital) I.O.A Meeting – Tehran – Aug .25.2016

  2. Watanabe Classification Type I: complete disc-shaped meniscus Type II: incomplete semi-lunar- shaped meniscus Type III: Wrisberg type (hyper-mobile meniscus) Watanabe M, Takeda S, Ikeuchi H. Atlas of arthroscopy. Tokyo: Igaku-Shoin, 1978;88.

  3. Discoid Meniscus • Complete – Incomplete • Stable – Unstable • anterior instability • posterior instability Good CR, et al. Arthroscopic treatment of symptomatic discoid meniscus in children: classification, technique, and results. Arthroscopy. 2007;23(2):157-63.

  4. Signs & symptoms Symptoms Signs • Joint line tenderness ----- 61% • Clunk ------------------- 26% • Limited extension ------- 24% • Locked knee ------------ 18% • McMurray’s test --------- 14% • Pain --------- 66% • Limping ----- 48% • Giving way --- 37% • Locking ------ 33% • Snapping ----- 17% Asik M. et al. Discoid lateral meniscus: diagnosis and results of arthroscopic treatment. Knee Surg Sport Traumatol Arthrosc. 2003;11(2):99-104.

  5. O’Connor’s classification of discoid lateral meniscus ruptures simple horizontal Combined horizontal, longitudinal rupture transverse rupture multiple rupture central rupture Shahriaree H, O’Connor’s textbook of arthroscopic surgery. Lippincott, Philadelpia, 1984, 318-321

  6. Treatment • Found incidentally – observe • Type I or II not torn/stable • Arthroscopic saucerization to rim of 6-8 mm • Type I or II torn/unstable • Saucerization followed by repair Christopher S. New Modalities for the Pediatric Discoid Meniscus. Columbia University Medical Center Childrens Hospital of New York. 2015.

  7. Technical consideration • patient positioning, equipment and technical portals: • Leg hang over the operation table • tourniquet pressure --------- 250 mm Hg • general anesthesia • standard 4.5 mm , 30 ̊ arthroscop -------- from 4 years • arthro-pressure pump ---------- maximum 40 mm Hg • 3.5 mm shaver • arthroscopic knife (Beaver knife) Beautifula P and Verdonk R.Thacnical of meniscoplasty and meniscal repair in children. The meniscuse. 2010.

  8. Technicalconsideration • Clinical notes: • Highly demanding arthroscopic procedure • Lateral portal ------- more proximal and lateral placement • Medial portal ------ using an outside to inside needle

  9. 4. Inferior and superior aspect probing

  10. 5. Peripheral rim inspection 6. Anterior part incision with knife

  11. Technical consideration • Clinical notes: • 7. Debridement of central horizontal tears • 8. Remove the unstable leaf The Meniscus. Editors: Beaufils, Philippe, Verdonk, René 2010; 247-267

  12. 9. Leaving a 6-8 mm peripheral substance • 10. Final peripheral stability testing ( posterior & anterior ) • 11. Suture for instability ---------- outside-in or all-inside Beautifula P and Verdonk R.Thacnical of meniscoplasty and meniscal repair in children. The meniscuse. 2010.

  13. Complete discoid meniscus with anterior instability • arthroscopic saucerization • (B) outside-in repair technique.

  14. Complete discoid meniscus with posterior instability that was treated with arthroscopic saucerization and inside-out repair technique.

  15. complications • Insufficient anterior resection anterior knee pain • persistent instability snapping symptoms • Osteochondritis dissecans in LFC • Instrument breakage

  16. Thank you

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