discoid menisci.pptx presentation doccum

1. Discoid meniscus

2. Objectives
1. Introduction
2. Epidemiology
3. Etiology
4. Presentation
5. Pathology
6. Imaging
7. Treatment

3. Introduction
• A discoid meniscus is the abnormal development of the meniscus
leading to a hypertrophic and discoid shaped meniscus.
• Diagnosis can be suspected on radiographs with (squaring of lateral
condyle with cupping of lateral tibial plateau) but require MRI for
confirmation (3 or more 5mm sagittal images with meniscal
continuity).
• Treatment is generally observation for patients who are asymptomatic.
Arthroscopic meniscectomy and saucerization may be indicated for
patients with continued pain and mechanical symptoms.

7. Epidemiology
• Incidence
• Common
• Present in 3-5% of population
• Anatomic location
• Usually lateral meniscus involved
• 25% bilateral

8. Etiology
• Pathophysiology
• Failure of apoptosis in utero

11. Presentation
• Symptoms
• Pain, clicking, mechanical locking
• Often becomes symptomatic in adolescence
• Physical exam
• Mechanical symptoms most pronounced in extension

12. Pathology
• Discoid menisci have decreased collagen fibers and loss of normal
collagen orientation, which predisposes them to intradiscal/meniscal
mucoid degeneration.

13. Imaging
• Radiographs
• Recommended views
• AP and lateral of knee
• Findings
• Widened joint space (up to 11mm)
• Squaring of lateral condyle
• Cupping of lateral tibial plateau
• Hypoplastic lateral intercondylar spine

17. Imaging
• MRI
• Indications
• Study of choice for suspected symptomatic meniscal pathology
• Findings
• Diagnosis can be made with 3 or more 5mm sagittal images
with meniscal continuity ("bow-tie sign")
• 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

18. Treatment
• Nonoperative
• Observation
• Indications
• Asymptomatic discoid meniscus without tears

19. Treatment
• Operative
• Partial meniscectomy and saucerization
• Indications
• Pain and mechanical symptoms
• Meniscal tear or meniscal detachment
• Technique
• Obtain anatomic looking meniscus with debridement
• Repair meniscus if detached (wrisberg variant)
• Meniscal instability is frequently present
• Recent literature suggest anterior horn instability is most common