Abstract
Purpose of Review
The discoid lateral meniscus is an abnormal variant that can lead to pain and mechanical symptoms. This review aims to summarize the clinical outcomes after surgical management of the discoid lateral meniscus. Procedures included saucerization/meniscectomies, repair, or meniscus allograft transplantation.
Recent Findings
A total of 52 articles were included, consisting of 4,503 patients (4,784 knees). Weighted preoperative and postoperative Lysholm scores were 57.8 and 88.6, respectively, with 100% of studies (27/27) finding a significant improvement in scores postoperatively. Weighted preoperative and postoperative IKDC scores were 59.6 and 87.3, respectively, with 88.9% of studies (8/9) finding a statistically significant improvement in scores. Weighted preoperative and postoperative Tegner scores were 4.8 and 7.3, respectively, with 100% of studies (5/5) finding a statistically significant improvement in scores postoperatively. Weighted preoperative and postoperative VAS scores were 5.3 and 3.2, respectively, with 100% of studies (5/5) finding a statistically improvement in scores postoperatively. Amongst patients with reported values, 209 (6.6%; range 0–23.7%) suffered retears, while there were 290 reoperations (6.0%; range: 0–36.7%). Complications included persistent pain, mechanical symptoms, or swelling (n = 115; 2–4%).
Summary of Findings
Studies to date have reported good outcomes overall following surgical management of the discoid lateral meniscus, with significant improvements in PROMs. However, retear and reoperation rates within the literature have been reported to be as high as 23.7% and 36.7%, respectively.
Supplementary Information
The online version contains supplementary material available at 10.1007/s12178-025-09980-9.
Keywords: Discoid lateral meniscus, Meniscectomy, Saucerization, Patient reported outcome measures, DLM
Introduction
The medial and lateral menisci are C-shaped fibrocartilaginous structures that overlay the tibial surface and provide shock-absorption to the tibiofemoral joint [1]. The discoid meniscus is an abnormal variant in which the meniscus lacks the semilunar shape and is fused in the central area, more often affecting the lateral meniscus. The discoid meniscus may also have a much thicker outer rim compared to a normal meniscus [2]. The Watanabe classification encompasses three types of discoid menisci: Type 1 which is a stable and complete discoid meniscus covering the whole tibial surface, Type 2 which is a stable partial discoid meniscus covering 80% of the tibial surface, and Type 3 (also known as the Wrisberg variant) which is an unstable discoid meniscus attributed to no posterior attachments to the tibial surface [3].
The annual incidence of discoid meniscus variants was found to be 3.2 per 100,000 person-years, with a higher incidence in adolescent males (18.8 per 100,000 person-years) [4]. In the United States alone, the prevalence ranges between 3 to 5%, with an even higher prevalence of up to 15% in Japanese populations [5]. The etiology of discoid meniscus remains undetermined but is assumed to be multifactorial [6].
While many patients with discoid meniscus may be asymptomatic due to adaptation of the knee joint, variations in meniscal anatomical structure can and do alter the biomechanical functions of the meniscus [7]. The symptomatology of a discoid is often influenced by the size/morphology of the discoid meniscus, the level of activity of the patient, and the presence of tears. Discoid menisci are most commonly symptomatic in the pediatric population [7]. Normal functions of the meniscus include load transmission and weight distribution, shock absorption, ball-bearing action, joint stability, as well as support to the articular cartilage [8, 9]. In the case of discoid menisci, these functions are malfunctional resulting in significantly more force transmission to the joint surface, clicking and locking of the knee, knee joint pain, swelling, atrophy, giving way, and effusion[1, 7, 10]. The properties of the discoid meniscus also make it more prone to injury and tearing [2]. Common causes of injury include sports related injuries and age-related degeneration [10].
Treatment options for discoid menisci include non-invasive, conservative options such as use of knee braces and physiotherapy, as well as surgical options if symptoms persist or there are functional limitations [11]. The current gold standard procedure for treating a symptomatic discoid meniscus is an arthroscopic partial meniscectomy with saucerization and meniscal repair for tears that result in instability of the rim [2, 12–14]. The surgical management is often dictated by the extent of tearing and whether or not stabilization of the rim, and sometimes transfer of tissue, is needed. Other surgical strategies that have been reported include partial meniscectomies/saucerization without meniscal repair, complete meniscectomies, meniscoplasty, meniscopexy, and meniscal transplants [15].
However, in regards to the various treatment options, there still remains uncertainty in terms of short and long-clinical outcomes for patients. Variation in surgical techniques such as inclusion of meniscal repair, rim preservation or stabilization as well as the type of surgical procedure may affect surgical outcomes [15–19]. Moreover, patient factors such as age of surgery and duration of symptoms before surgery have also been newly studied with no strong conclusions drawn [20–22].
Therefore, given the increase in literature regarding surgical management for discoid meniscus including a variety of patient, meniscus types, and surgical techniques in recent years this review aims to systematically summarize clinical outcomes following surgical management for discoid menisci.
Materials and Methods
During the conduction and development of this systematic review, principles of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and R-AMSTAR (Revised Assessment of Multiple Systematic Reviews) guidelines were utilized [23, 24].
Search Strategy
Three online databases (MEDLINE, PubMed, EMBASE) were searched post year 2000 to November 6, 2024 to examine literature concerning the surgical management and patient outcomes of discoid meniscus. Search criteria included terms such as “discoid meniscus” and “discoid lateral meniscus”.
The inclusion criteria for this systematic review were as follows: (1) studies published after 2000 outlining management for the discoid lateral meniscus, (2) studies must report retear or surgical reoperation rates or include one of the following patient reported outcome measures: Lysholm, Visual Analogue Scale (VAS), Tegner, International Knee Documentation Committee (IKDC) [25–28], (3) studies with ≥ 10 patients, (4) studies published in the English language, and (5) studies with human patients. The exclusion criteria for this systematic review exclude studies that were: (1) systematic reviews and meta-analyses, (2) review articles, (3) book chapters, (4) commentaries, (5) case reports, (6) studies with < 10 patients, (7) studies dated pre-2000, (8) studies with > 5% of knees undergoing concurrent ligament reconstruction (9) studies not published in English.
Study Screening
Study screening was performed using Covidence (Veritas Health Innovation, Melbourne, Australia).The screening of titles and abstracts using the inclusion and exclusion criteria was performed independently by two authors (PV and RT), and conflicts were settled before full-text screening. Full text screening followed the same procedure, with studies screened independently and conflicts settled by the two authors.
Assessment of Agreement
Inter-reviewer agreement was evaluated using the kappa (κ) statistic during preliminary and full-text screening. A priori classification was as below: κ of 0.91–0.99 was classified almost perfect agreement; κ of 0.71–0.90 was considerable agreement; κ of 0.61–0.70 was high agreement; κ of 0.41–0.60 was moderate agreement; κ of 0.21–0.40 was fair agreement and a κ or ICC value of 0.20 or less was classified as no agreement [29, 30]
Quality Assessment
The methodological quality of included studies were assessed and scored using the MINORS (Methodological Index for Non-Randomized Studies) criteria [31]. Using this criteria, non-randomized studies had a maximum score of 16, with classifications as follows: 0–4 indicating very low quality, 5–7 indicating low quality, 8–12 indicating fair quality, and ≥ 13 indicating high quality. Comparative studies had a maximum score of 24, with classifications as follows: 0–6 indicating very low quality, 7–10 indicating low quality, 11–15 indicating fair quality, 16–20 indicating good quality, and 21–24 indicating very good quality [32].
Randomized controlled trials (RCTs) were assessed for quality according to the Detsky Quality Assessment Scale [33]. According to this criteria, studies were assessed using 14 questions falling within the following categories: (1) randomization, (2) outcome measures, (3) inclusion and exclusion criteria, (4) interventions, and (5) statistical analysis. Each category held equal weight and an additional question was added to the statistical analysis category for negative findings. Therefore, the maximum score was 20 and 21 for positive and negative findings, respectively [34].
Data Abstraction
Data from included articles was abstracted independently by four authors (PV, RT, MH, GK) using Google Sheets (Google LLC, Mountain View, CA, USA). Demographic information such as age and sex, in addition to study characteristics like design, sample size, and pertinent follow up details were extracted. Patient injury and surgical details such as tear pattern and surgical procedure were also reported along with patient reported outcomes (Lysholm, Tegner, VAS, IKDC, KOOS), revision, retear, and complication rates.
Statistical Analysis
Results were presented in a descriptive summary format. Descriptive statistics were calculated and reported including counts and percentages for categorical variables, means, standard deviations (SD) and ranges for normally distributed variables and medians and ranges for non-normally distributed data. All statistics were performed using Google Sheets (Google LLC, Mountain View, CA, USA). If a study analyzed associated statistical parameters, p-values were recorded, with p-values < 0.05 taken as the threshold for statistical significance.
Results
Literature Search and Study Quality
The initial search of databases produced 2,261 articles, with 1,304 articles removed as duplicates. A total of 957 titles and abstracts were screened, with 825 identified as irrelevant. After the resulting 132 full-texts were assessed for eligibility, 52 satisfied the previously mentioned inclusion criteria (Fig. 1). The agreement between reviewers was considerable during the title and abstract screening and full-text screening stages, with kappa values of 0.71 (95%CI 0.65–0.76) and 0.79 (95%CI 0.68–0.89), respectively. The articles in this review consisted of one level I design, two level II designs, sixteen level III designs (eight retrospective cohorts, eight case-controls), and 34 level IV designs (case series). Figure 2 represents the number of publications organized by publication year. The mean MINORS score when transformed into percentage scores was 61.9%, or of fair quality. The Detsky score for the one RCT when transformed to percentage was 66.7%.
Fig. 1.
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram representing a systematic review assessing clinical outcomes after management of the discoid lateral meniscus
Fig. 2.
Bar-chart representing the number of publications looking at surgical management of the discoid lateral meniscus by year
Study Characteristics
A total of 52 articles were included with 4,503 patients and 4,784 knees [11, 18, 22, 35–83] (Table 1). The mean ages ranged from 8.3–46.9 years amongst 48 studies, with a pooled mean age of 23.3 years (range of means: 8.3–46.9) [11, 18, 22, 35–37, 39–56, 58–62, 64–75, 77–83]. A total of 19 studies reported either a mean or median age of less than 18 years [18, 38, 41, 43–46, 53, 58, 60, 62, 66, 68, 70, 73, 75, 77, 77, 84]. The mean age of 16 studies reporting mean age in the pediatric population was 11.6 years (range of means: 8.3–12.9) [41, 43–46, 53, 58, 60, 62, 66, 68, 70, 73, 75, 77, 77, 84]. Females comprised 57.3% (2,469/4,366) of 47 studies reporting patient sex [11, 18, 35–45, 47–54, 56, 58–64, 66–83]. The pooled mean follow-up time was 45.8 months (range of means: 3.3–234 months). Patients lost to follow-up were reported in 48 studies and ranged from 0- 36.3% [11, 18, 22, 35–45, 47–64, 67–69, 71–83]. Only three studies reported on physeal status, with 660 defined as skeletally immature[45, 51, 70].
Table 1.
Demographic data
| Author | Study Design | Number of patients/knees | Female (%) | Mean Age (SD) [range] | Mean Follow-up Months ± (SD) [range] | Lost to Follow-Up (%) | Surgical Procedure | MINORS (%), Detsky |
|---|---|---|---|---|---|---|---|---|
| Ahn (2012) | Case series (IV) | 168/179 | 102 (57%) |
35 [5–70] |
48.9 [24–113] |
92 (35.4%) |
Partial meniscectomy (n=123) Total meniscectomy (n=16) Subtotal meniscectomy (n=30) Partial meniscectomy + repair (n=3) Meniscal repair (n=1) |
43.75% |
| Ahn (2017) | Case control (III) | 202/202 | 135 (66.8%) |
43.1 NOA= 44.2(13.4) [9–55], POA= 41.0 (15.4) [7–59] |
84.9 [65–133] | 19 (9.4%) | Partial meniscectomy (n=202) | 87.50% |
| Bae (2012) | Prospective cohort study (II) | 52/52 | 21 (40.4%) | 25.4 (± 14.5) | 30 (± 5.6) [22–42] | 0 (0%) |
Partial meniscectomy (n=40) Subtotal meniscectomy (n=10) Partial meniscectomy + repair (n=2) |
75.00% |
| Bauwens (2023) | Case series (IV) | 51/60 | 29 (56.9%) | Median: 11[4–17] | Median: 40.8 [24–102] | 3 (5.9%) |
Saucerization (n=3) Saucerization + repair (n=57) |
75.00% |
| Bin (2001) | Case series (IV) | 30/31 | 20 (66.7%) | 29.3 [6–62] | 35 [14–48] | 0 (0%) |
Partial meniscectomy + repair (n=30) Meniscal repair (n=1) |
50.00% |
| Cao (2012) | Case series (IV) | 42/47 | 32 (76.2%) | 31.5 [14–62] | 21 [9–53] | 3 (7.1%) |
Partial meniscectomy (n=37) Total meniscectomy (n=8) Subtotal meniscectomy (n=2) |
37.50% |
| Carter (2012) | Retrospective cohort (III) | 51/57 | 29 (57%) | 11.5 | 15 | 0 (0%) |
Saucerization (n=33) Saucerization + repair (n=24) |
75.00% |
| Dai (2019) | Retrospective cohort (III) | 29/29 | 18 (26%) | 15.8 | 20.6 [12–27] | 3 (9.4%) | Meniscal repair (n=29) | 70.83% |
| Dong (2018) | Case series (IV) | 41/41 | 22 (64.7%) | 11.3 | 36 | 0 (0%) | NR | 56.25% |
| Hagino (2017) | Case series (IV) | 34/39 | 21 (62.8%) | 12.9 [7–15] | 14 [6–47] | 0 (0%) |
Partial meniscectomy (n=10) Subtotal meniscectomy (n=1) Meniscal repair (n=1) Saucerization (n=22) Saucerization + repair (n=5) |
50.00% |
| Hashimoto (2020) | Case control (III) | 103/103 | 63 (61.1%) | 12.1 | 50.4 | 14 (10.7%) |
Subtotal meniscectomy (n=14) Saucerization (n=34) Saucerization + repair (n=55) |
66.67% |
| Haskel (2018) | Case series (IV) | 17/19 | NR | 9.3 | 132 [40.8–199.2] | NR |
Saucerization (n=4) Saucerization + repair (n=15) |
56.25% |
| He (2022) | Case control (III) | 63/63 | 19 (30.1%) | 46.9 (±4.9) | 24 | 0 (0%) | Partial meniscectomy (n=63) | 83.33% |
| Hu (2016) | Case series (IV) | 32/32 | 10 (31.3%) | 32.4 [17–51] | 37.3 [26–47] | 0 (0%) | Meniscal repair (n=32) | 68.75% |
| Jin (2024) | Case control (III) | 29/29 | 11 (37.9%) | 39 | NR | 0 (0%) |
Saucerization (n=7) Saucerization + repair (n=22) |
62.50% |
| Kawashima (2021) | Case series (IV) | 23/26 | 12 (46.2%) | 27.4 [13–45] | 30 [14.4–40.8] | 0 (0%) |
Subtotal meniscectomy (n=10) Saucerization + repair (n=16) |
62.50% |
| Kim (2006) | Case series (IV) | 14/14 | 3 (21.4%) | 27.9 [17–41] | 13.5 | 1 (7.1%) | MAT (n=14) | 50.00% |
| Kose (2015) | Case series (IV) | 48/48 | 27 (56.3%) | 36 | 27.7 | 6 (11.1%) | Partial meniscectomy + saucerization (n=48) | 50.00% |
| Krause (2009) | Case control (III) | 40/48 | 27 (62.8%) | 9 | 59.9 | 0 (0%) |
Partial meniscectomy (n=23) Total meniscectomy (n=2) Subtotal meniscectomy (n=20) Saucerization + repair (n=3) |
79.17% |
| Lee (2013) | Case series (IV) | 58/60 | 35 (58.3%) | 28.9 | 26 | 0 (0%) | Partial meniscectomy (n=60) | 56.25% |
| Lee (2016) | Retrospective cohort (III) | 145/145 | 80 (55.1%) | 40.7 | 48.2 | 19 (9.8%) |
Partial meniscectomy (n=87) Total meniscectomy (n=58) |
70.83% |
| Lee (2018) | Case series (IV) | 66/73 | NR | 22.2 | 120 | 29 (16.1%) | Partial meniscectomy (n=73) | 56.25% |
| Li (2021) | Retrospective cohort (III) | 48/52 | NR | NR | 26 | 0 (0%) |
Partial meniscectomy (n=32) Total meniscectomy (n=6) Partial meniscectomy + repair (n=14) |
83.33% |
| Lins (2021) | Case series (IV) | 25/30 | 17 (68%) | 10.8 | 234 | 88 (36.3%) |
Saucerization (n=20) Saucerization + repair (n=10) |
56.25% |
| Liu (2015) | Case series (IV) | 110/136 | 60 (54.6%) | 22 (±12.77) [6–67] | 22 [18–24] | 0 (0%) |
Partial meniscectomy (n=56) Subtotal meniscectomy (n=52) Partial meniscectomy + repair (n=28) |
62.50% |
| Liu (2019) | Randomized controlled trial (I) | 80/80 | 33 (41.3%) | 34.7 | 6 | 0 (0%) | Meniscal repairs (n=80) | 66.7% |
| Liu (2023) | Case control (III) | 48/53 | 35 (51%) | 10.6 | NR | 0 (0%) | Saucerization + repair (n=53) | 62.50% |
| Logan (2021) | Case series (IV) | 401/470 | 222 (55%) | 11.6 (±4.0) [0.08–18.9] | 19.6 [9.2–34.9] | 40 (9.5%) |
Non-operational (n=51) Saucerization (n=226) Saucerization + repair (n=193) |
43.75% |
| Lu (2007) | Case series (IV) | 57/62 | 43 (75.4%) | 39.5 (±14.17) [14–61] | 3.3 [1.17–6.42] | 6 (10.5%) |
Partial meniscectomy: (n=52) Total meniscectomy: (n=7) Partial Meniscectomy + Repair: (n=3) |
37.50% |
| Lu (2023) | Case series (IV) | 128/128 | 88 (68.7%) | Median: 24.1 | Median: 126.2 | 53 (28.3%) |
Partial meniscectomy (n=75) Total/subtotal meniscectomy (n=33) Meniscus repair (n=20) |
56.25% |
| Ng (2021) | Case series (IV) | 24/24 | 9 (47.5%) | Median: 14 [8–21] | Median: 84 [68–110] | 0 (0%) |
Partial meniscectomy (n=17) Saucerization (n=5) Saucerization + repair (n=2) |
68.75% |
| Okazaki (2006) | Case series (IV) | 27/29 | NR | 17.9 | 192 | 12 (29.3%) | Subtotal meniscectomy (n=29) | 62.50% |
| Papadopoulos (2009) | Case series (IV) | 39/39 | NR | 31.7 (±9.4) [15–58] | NR | NR |
Non-operational (n=3) Partial meniscectomy (n=34) Total meniscectomy (n=1) Subtotal meniscectomy (n=1) |
31.25% |
| Perkins (2021) | Case series (IV) | 30/32 | 15 (50%) | 12 [5–17] | 54 [30–86] | NR | Saucerization (n=32) | 56.25% |
| Ren (2021) | Case control (III) | 59/59 | 39 (66.1%) | 30.9 (±7.1) | 31.3 [24–46] | 9 (7.8%) | NR | 79.17% |
| Rublev (2024) | Case control (III) | 20/22 | 11 (55%) | 8.3 [3.17–11.5] | 36 [24–120] | 0 (0%) |
Partial meniscectomy (n=10) Saucerization + repair (n=12) |
58.33% |
| Sabbag (2019) | Case series (IV) | 59/59 | 27 (45.8%) | 25.7 [4.0–66.0] | 5.6 [2.0–23.7] | 9 (12.9%) |
Partial Meniscectomy (n=24) Meniscus repair (n=11) Saucerization + partial meniscectomy (n=24) |
62.50% |
| Sheasley (2024) | Case series (IV) | 784/867 | 442 (56%) | 12 [1–22] | 22.6 [0–154] | NR |
Specific numbers NOT reported Saucerization: (n=837) Meniscus repair: (n=358) MAT: (n=2) Partial meniscectomy (n=60) |
50.00% |
| Spahn (2003) | Case series (IV) | 195/195 | 72 (37%) | 45.9 (± 13.8) | 12 | 0 (0%) | Partial meniscectomy (n=195) | 75.00% |
| Su (2022) | Retrospective cohort (III) | 48/48 | 35 (17%) | 12.7 | 24 | 0 (0%) |
Saucerization + repair (n=35) Partial meniscectomy + repair (n=13) |
70.83% |
| Talathi (2024) | Retrospective cohort (III) | 41/41 | 13 (31.7%) | 12.9 [7–17] | 25 [8–58] | 15 (26.7%) |
Partial meniscectomy (n=6) Meniscal repair (n=35) |
75.00% |
| Tang (2015) | Case series (IV) | 22/22 | 13 (59%) | 29.8 [21–46] | 24.3 | 0 (0%) | Meniscal repair (n=22) | 62.50% |
| Wasser (2011) | Case series (IV) | 18/20 | 12 (67%) | 9 | 37 | 0 (0%) |
Saucerization (n=10) Saucerization + repair (n=7) Partial meniscectomy + repair (n=3) |
58.33% |
| Wong (2011) | Case series (IV) | 29/32 | 16 (55.2%) | 31.3 (±17.0) [6–64] | 64.5 (±25.9) [36–108] | 0 (0%) |
Subtotal meniscectomy (n=6) Meniscal repair (n=8) Partial meniscectomy (n=18) |
62.50% |
| Yang (2020) | Case series (IV) | 502/502 | 353 (70.3%) | NR | 75.4 [41.0–123.3] | 0 (0%) |
Total meniscectomy (n=76) Saucerization (n=419) Saucerization + repair (n=16) |
56.25% |
| Yoo (2015) | Case series (IV) | 86/100 | 30 (35%) | 10.7 [3.1–17.5] | 56.4 [37.2–130.8] | 0 (0%) |
Partial meniscectomy (n=87) Total meniscectomy (n=13) |
70.83% |
| Yoon (2014) | Case series (IV) | 36/36 | 13 (36%) | 35.8 (±8.05) [21–45] | 37 (±20.02) [24–88] | 0 (0%) | MAT (n=36) | 70.83% |
| You (2023) | Case series (IV) | 50/50 | 39 (78%) | 9.5 (±3.53) [5–14] | 50.6 (±30.84) | 0 (0%) | Saucerization (n=50) | 62.50% |
| Yuan (2024) | Retrospective cohort (III) | 60/60 | 29 (48%) | 35.1 | 6 | 0 (0%) | Meniscal repair (n=60) | 62.50% |
| Zhang (2018) | Case series (IV) | 60/60 | 42 (70%) | 38.8 (±14.63) [11–76] | 12 | 0 (0%) |
Partial meniscectomy (n=24) Meniscal repair (n=36) |
50.00% |
| Zhang (2022) | Prospective cohort (II) | 25/25 | 17 (68%) | 35.9 (±8.7) [24–47] | 83.6 (±6.21) | 0 (0%) | Meniscal repair (n=25) | 68.75% |
| Zhou (2019) | Case series (IV) | 54/54 | 38 (70%) | 42 (±17.8) | 33 [24–48] | 6 (10%) |
Saucerization (n=32) Saucerization + repair (n=22) |
56.25% |
SD standard deviation, MINORS methodological index for non-randomized studies
Injury and Surgical Details
There were a total of 3,269 tears, with 2,701 tears having specific types reported (Table 2). The most common tear-type was a horizontal tear, with 972 (36.0%) total, followed by 665 (24.8%) complex or degenerative tears. The least common tear-types were flap tears, with 77 (2.9%) total. According to the Watanabe classification, the most common type was type I with 1,813 knees (61.5% of 2,949). There were only 64 (2.2%) type III or Wrisberg variants. The mean time from injury to surgery was 27.3 months (range: 3.2–40) amongst 19 studies consisting of 2,107 patients.
Table 2.
Tear types
| Author | Patients/Knees | Total Tears | Wrisberg Classification | Radial or Peripheral | Flap/Oblique/Parrot Beak | Horizontal | Longitudinal/Bucket Handle | Complex/Degenerative/other/unspecified | Other/Unspecified0 |
|---|---|---|---|---|---|---|---|---|---|
| Ahn (2012) | 168/179 | 176 |
Type 1 (n = 87) Type 2 (n = 92) Type 3 (n = 0) |
28 | 2 | 39 | 50 | 57 | 0 |
| Ahn (2017) | 202/202 | 202 | NR | 92 | 28 | 82 | 0 | 0 | 0 |
| Bae (2012) | 52/52 | 52 |
Type 1 (n = 33) Type 2 (n = 19) Type 3 (n = 0) |
3 | 0 | 39 | 8 | 2 | 0 |
| Bauwens (2023) | 51/60 | 12 |
Type 1 (n = 58) Type 2 (n = 2) Type 3 (n = 0) |
0 | 0 | 6 | 6 | 0 | 0 |
| Bin (2001) | 30/31 | 31 |
Type 1 (n = 20) Type 2 (n = 11) Type 3 (n = 0) |
0 | 0 | 31 | 0 | 0 | 0 |
| Cao (2012) | 42/47 | 47 |
Type 1 (n = 22) Type 2 (n = 25) Type 3 (n = 0) |
8 | 0 | 19 | 13 | 7 | 0 |
| Carter (2012) | 51/57 | NR | NR | NR | NR | NR | NR | NR | NR |
| Dai (2019) | 29/29 | 29 |
Type 1 (n = 17) Type 2 (n = 12) Type 3 (n = 0) |
1 | 0 | 7 | 11 | 10 | 0 |
| Dong (2018) | 41/41 | NR |
Type 1 (n = 41) Type 2 (n = 0) Type 3 (n = 0) |
NR | NR | NR | NR | NR | NR |
| Hagino (2017) | 34/39 | 29 |
Type 1 (n = 26) Type 2 (n = 13) Type 3 (n = 0) |
3 | 0 | 9 | 9 | 8 | 0 |
| Hashimoto (2020) | 103/103 | 103 |
Type 1 (n = 96) Type 2 (n = 7) Type 3 (n = 0) |
NR | NR | NR | NR | NR | NR |
| Haskel (2018) | 17/19 | 13 |
Type 1 (n = 9) Type 2 (n = 7) Type 3 (n = 3) |
NR | NR | NR | NR | NR | NR |
| He (2022) | 63/63 | 63 | NR | NR | NR | NR | NR | NR | NR |
| Hu (2016) | 32/32 | 32 |
Type 1 (n = 25) Type 2 (n = 7) Type 3 (n = 0) |
0 | 0 | 0 | 32 | 0 | 0 |
| Jin (2024) | 29/29 | 22 |
Type 1 (n = 21) Type 2 (n = 8) Type 3 (n = 0) |
0 | 0 | 13 | 7 | 2 | 0 |
| Kawashima (2021) | 23/26 | 24 | NR | 3 | 0 | 8 | 6 | 7 | 0 |
| Kim (2006) | 14/14 | NR | NR | NR | NR | NR | NR | NR | 0 |
| Kose (2015) | 48/48 | 26 |
Type 1 (n = 15) Type 2 (n = 33) Type 3 (n = 0) |
5 | 0 | 5 | 11 | 5 | 0 |
| Krause (2009) | 40/48 | 34 |
Type 1 (n = 32) Type 2 (n = 13) Type 3 (n = 3) |
NR | NR | NR | NR | NR | NR |
| Lee (2013) | 58/60 | 60 |
Type 1 (n = 32) Type 2 (n = 28) Type 3 (n = 0) |
19 | 10 | 17 | 4 | 10 | 0 |
| Lee (2016) | 145/145 | 145 | NR | 0 | 0 | 145 | 0 | 0 | 0 |
| Lee (2018) | 66/73 | 73 |
Type 1 (n = 39) Type 2 (n = 34) Type 3 (n = 0) |
8 | 2 | 17 | 10 | 36 | 0 |
| Li (2021) | 48/52 | 52 | NR | NR | NR | NR | NR | NR | NR |
| Lins (2021) | 25/30 | 23 |
Type 1 (n = 5) Type 2 (n = 17) Type 3 (n = 4) Data only available for 26 knees |
2 | 1 | 10 | 2 | 0 | 8 |
| Liu (2015) | 110/136 | NR | NR | NR | NR | NR | NR | NR | NR |
| Liu (2019) | 80/80 | NR | NR | NR | NR | NR | NR | NR | NR |
| Liu (2023) | 48/53 | NR |
Type 1 (n = 35) Type 2 (n = 18) Type 3 (n = 0) |
NR | NR | NR | NR | NR | NR |
| Logan (2021) | 401/470 |
264 Tear types only available for 163 patients |
Type 1 (n = 106) Type 2 (n = 231) Type 3 (n = 40) Data only available for 377 knees |
26 | 7 | 59 | 27 | 44 | 0 |
| Lu (2007) | 57/62 | 62 | NR | 9 | 0 | 19 | 8 | 26 | 0 |
| Lu (2023) | 128/128 | NR | NR | NR | NR | NR | NR | NR | NR |
| Ng (2021) | 24/24 | 19 |
Type 1 (n = 7) Type 2 (n = 16) Type 3 (n = 1) |
NR | NR | 2 (rest of tear types unspecified) | NR | NR | NR |
| Okazaki (2006) | 27/29 | 29 | NR | NR | NR | NR | NR | NR | NR |
| Papadopoulos (2009) | 39/39 | 19 |
Type 1 (n = 23) Type 2 (n = 15) Type 3 (n = 1) |
4 | 0 | 7 | 6 | 2 | 0 |
| Perkins (2021) | 30/32 | 32 | NR | NR | NR | NR | NR | NR | NR |
| Ren (2021) | 59/59 | NR | NR | NR | NR | NR | NR | NR | NR |
| Rublev (2024) | 20/22 | 12 |
Type 1 (n = 21) Type 2 (n = 1) Type 3 (n = 0) |
8 | NR | NR | 3 | NR | 1 |
| Sabbag (2019) | 59/59 | 50 |
Type 1 (n = 15) Type 2 (n = 38) Type 3 (n = 6) |
NR | NR | NR | NR | NR | NR |
| Sheasley (2024) | 784/867 | 723 |
Type 1 (n = 420) Type 2 (n = 281) Type 3 (n = 0) Data available for 701 knees |
53 | 14 | 246 | 85 | 274 | 0 |
| Spahn (2003) | 195/195 | NR | NR | NR | NR | NR | NR | NR | NR |
| Su (2022) | 48/48 | 35 | NR | 4 | 1 | 7 | 7 | 16 | 0 |
| Talathi (2024) | 41/41 | 35 | NR | 4 | 0 | 7 | 7 | 17 | 0 |
| Tang (2015) | 22/22 | NR | NR | NR | NR | NR | NR | NR | NR |
| Wasser (2011) | 18/20 | 15 |
Type 1 (n = 8) Type 2 (n = 9) Type 3 (n = 3) |
1 | 0 | 3 | 8 | 3 | 0 |
| Wong (2011) | 29/32 | 18 (4 specific types NR) |
Type 1 (n = 27) Type 2 (n = 3) Type 3 (n = 2) |
8 | NR | NR | NR | 6 | NR |
| Yang (2020) | 502/502 | 464 |
Type 1 (n = 423) Type 2 (n = 79) Type 3 (n = 0) |
45 | 10 | 154 | 171 | 84 | 0 |
| Yoo (2015) | 86/100 | 91 |
Type 1 (n = 77) Type 2 (n = 23) Type 3 (n = 0) |
Unclear about specific numbers for each Horizontal: (n = 48) Peripheral: (n = 46) Longitudinal (n = 13) Complex (n = 31) Degenerative: (n = 10) |
|||||
| Yoon (2014) | 36/36 | NR | NR | NR | NR | NR | NR | NR | NR |
| You (2023) | 50/50 | NR |
Type 1 (n = 32) Type 2 (n = 17) Type 3 (n = 1) |
NR | NR | NR | NR | NR | NR |
| Yuan (2024) | 60/60 | NR | NR | NR | NR | NR | NR | NR | NR |
| Zhang (2018) | 60/60 | 120 | NR | 60 | NR | 3 | 23 | 11 | 23 |
| Zhang (2022) | 25/25 | NR | NR | NR | NR | NR | NR | NR | NR |
| Zhou (2019) | 54/54 | 54 |
Type 1 (n = 41) Type 2 (n = 13) Type 3 (n = 0) |
5 | 2 | 18 | 6 | 23 | 0 |
NR not reported
A total of 51 studies [11, 18, 22, 35–69, 71–83]specified the number of knees undergoing a given surgical procedure. The most prevalent surgical procedures included isolated partial meniscectomy and saucerization, with 2,271 (57.9%) total procedures, respectively. Total or subtotal meniscectomy was performed in 395 (10.3%) cases. Repair with or without saucerization was performed in 908 (23.2%) knees. Meniscus allograft transplantation was performed in 109 total cases (2.3%). One study consisting of 867 knees, described the number of individual procedures (e.g. 837 saucerizations, 358 meniscus repairs, 60 partial meniscectomies, two MATs), however several patients received multiple procedures and numbers for each combination was not provided [70].
Patient Reported Outcome Measures
A total of 37 [18, 35–37, 39–45, 47–52, 54–64, 67, 71, 74, 75, 77–83] and 43 studies [11, 18, 35–52, 54–58, 58–65, 67, 71, 74, 75, 77–83] reported on preoperative and postoperative Lysholm scores, respectively (Table 3). The mean preoperative scores ranged from 17.5–72.3, with a weighted average of 57.8 amongst 2,432 patients. The mean postoperative scores range from 77.1–93.5, with a pooled value of weighted average of 88.6 amongst 2,566 patients. All 27 studies reporting on statistical significance found significant increase in scores from preoperative to postoperative status (p < 0.05) [18, 35, 37, 40, 42–44, 47–52, 54, 57, 60, 63, 64, 71, 74, 77–83].
Table 3.
Patient reported outcome measures
| Author | Lysholm (SD) [range] | IKDC (SD) [range] | VAS (SD) [range] | Tegner (SD) [range] | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pre | Post | P-value | Pre | Post | P-value | Pre | Post | P-value | Pre | Post | P-value | |
| Ahn (2012) | 72.3 | 88.7 | NR | NR | NR | NR | 2.6 | 1.2 | NR | NR | NR | NR |
| Ahn (2017) | 54.7 | 85.5 | p = 0.009 | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Bae (2012) | 55 | 91 | 0.05 | NR | NR | NR | NR | NR | NR | 2 | 5 | 0.05 |
| Bauwens (2023) | NR | 93.5 | NR | Median: 55 | Median:90 | NR | NR | NR | NR | NR | NR | NR |
| Bin (2001) | 73.1 | 93.6 | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Cao (2012) | 66.8 | 95.3 | 0.05 | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Carter (2012) | 89 | 94 | NR | 82 | 86 | NR | NR | NR | NR | 7 | 6 | NR |
| Dai (2019) | 54.2 | 77.1 | P < 0.0001 | NR | NR | NR | 3.7 | 1.4 | P < 0.0001 | NR | NR | NR |
| Dong (2018) | 61.8 | 85.4 | p < 0.001 | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Hagino (2017) | 63.9 | 92.3 | P < 0.0001 | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Hashimoto (2020) | 65.7 | 97.2 | NR | NR | NR | NR | NR | NR | NR | 6 | 5.1 | NR |
| Haskel (2018) | NR | 83.7 | NR | NR | 82.8 | NR | NR | NR | NR | NR | 6 | NR |
| He (2022) | 59.9 | 93.6 | P = 0.001 | 50.6 | 95 | p = 0.001 | NR | NR | NR | NR | NR | NR |
| Hu (2016) | 39.1 | 90.1 | P < 0.001 | 38 | 91.1 | P < 0.001 | NR | NR | NR | 2.8 | 5.2 | P < 0.001 |
| Jin (2024) | 38.7 | 90.9 | p < = 0.003 | NR | NR | NR | 8.3 | 0.9 | P = 0.001 | NR | NR | NR |
| Kawashima (2021) | 65.6 | 95.1 | p < 0.01 | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Kim (2006) | 71.4 | 91.4 | P < 0.01 | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Kose (2015) | 46.6 | 85.1 | P = 0.0001 | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Krause (2009) | NR | 87.8 | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Lee (2013) | 82.8 | 95.4 | P = 0.000 | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Lee (2016) | 64.9 | 89.7 | NR | 54.9 | 87.5 | NR | NR | NR | NR | 2.4 | 4.6 | NR |
| Lee (2018) | 64.6 | 84.2 | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Li (2021) | 65.3 | 92.7 | P < 0.05 | NR | NR | NR | 2.8 | 0.6 | P < 0.05 | 3 | 6.5 | P < 0.05 |
| Lins (2021) | NR | 78.6 | NR | NR | 77.4 | NR | NR | NR | NR | NR | MEDIAN: 7 | NR |
| Liu (2015) | 77.7 | 96.3 | p < 0.001 | 74.3 | 95.4 | P < 0.001 | NR | NR | NR | NR | NR | NR |
| Liu (2019) | 51.3 | 90.6 | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Liu (2023) | 56.8 | 90.9 | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Logan (2021) | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Lu (2007) | 50 | 89 | P < 0.01 | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Lu (2023) | 77.5 | 91.4 | p = 0.000 | 67.9 | 84.6 | p = 0.000 | 6.8 | 8.5 | P = 0.000 | NR | NR | NR |
| Ng (2021) | 53 | 100 | P < 0.001 | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Okazaki (2006) | NR | NR | NR | NR | 87 | NR | NR | NR | NR | NR | NR | NR |
| Papadopoulos (2009) | NR | 87.5 | NR | NR | 86.6 | NR | NR | NR | NR | NR | NR | NR |
| Perkins (2021) | NR | NR | NR | NR | 96 | NR | NR | NR | NR | 7.3 | 7.3 | NR |
| Ren (2021) | 61.4 | 81 | NR | 57.5 | 78.2 | NR | 5.4 | 3.1 | NR | 4 | 6 | NR |
| Rublev (2024) | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Sabbag (2019) | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Sheasley (2024) | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Spahn (2003) | 17.5 | 83.3 | p < 0.05 | NR | NR | NR | 7.4 | 4.1 | P < 0.05 | NR | NR | NR |
| Su (2022) | NR | NR | NR | 56.2 | 91.8 | 0.06 | NR | NR | NR | NR | NR | NR |
| Talathi (2024) | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Tang (2015) | 63.3 | 82.2 | P < 0.05 | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Wasser (2011) | 67 | 88 | NR | NR | NR | NR | NR | NR | NR | NR | 5.9 | NR |
| Wong (2011) | NR | 92 | NR | NR | 72.3 | NR | NR | 0.6 | NR | NR | 5 | NR |
| Yang (2020) | NR | NR | NR | [26.9–64.9] | [41.4–97.7] | NR | NR | NR | NR | NR | NR | NR |
| Yoo (2015) | 70 | 91.6 | P < 0.001 | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Yoon (2014) | 60 | 78.1 | p < 0.05 | 55.7 | 69.7 | p < 0.05 | 4.5 | 2.7 | P < 0.05 | 3 | 4.3 | P < 0.05 |
| You (2023) | 71.6 | 91.4 | P < 0.001 | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Yuan (2024) | 45.5 | 82.8 | P < 0.05 | 41 | 84 | P < 0.05 | 6.5 | 1.5 | P < 0.05 | 3.3 | 7.8 | P < 0.05 |
| Zhang (2018) | 63.6 | 98.9 | P < 0.001 | 62.3 | 95.7 | P < 0.001 | 3.9 | 3 | P < 0.001 | NR | NR | NR |
| Zhang (2022) | 45.1 | 85.1 | p < 0.001 | NR | NR | NR | NR | NR | NR | NR | NR | NR |
| Zhou (2019) | 64.9 | 94.7 | p < 0.001 | 54.4 | 92.6 | p < 0.001 | NR | NR | NR | NR | NR | NR |
IKDC International Knee Documentation Committee, NR not reported
A total of 12 [41, 47, 48, 56, 60, 63, 67, 72, 78, 80, 81, 83] and 18 studies [11, 22, 41, 46–48, 56, 58, 60, 63, 65–67, 72, 78, 80, 81, 83] reported on preoperative and postoperative IKDC scores, respectively. The mean preoperative scores ranged from 38–82, with a pooled value of 59.6 amongst 915 patients. The mean postoperative scores ranged from 69.7–87.3, with a pooled value of 87.3 amongst 1,089 patients. Eight [47, 48, 60, 63, 78, 80, 81, 83]of nine (88.9%) studies reporting on statistical significance found significant increase in scores from preoperative to postoperative status. The one study not reporting a significant increase had a preoperative and postoperative score of 56.2 and 91.8, respectively (p = 0.06) [84]. A total of 10 [37, 41, 45, 48, 56–58, 66, 78, 80] and 13 studies [11, 37, 41, 45, 46, 48, 56–58, 66, 75, 78, 80] reported on preoperative and postoperative Tegner scores, respectively. The mean preoperative scores ranged from 2.0–7.3 with a pooled value of 4.8 amongst 524 patients. The mean postoperative scores range from 4.3–5.0, with a pooled value of 7.3 amongst 532 patients. All five studies reporting on statistical significance found significant increase in scores from preoperative to postoperative status (P < 0.05) [37, 48, 57, 78, 80].
A total of 10 [36, 42, 49, 57, 63, 67, 71, 78, 80, 81] and 11 studies [11, 36, 42, 49, 57, 63, 67, 71, 78, 80, 81] reported on preoperative and postoperative VAS scores, respectively. The mean preoperative scores ranged from 2.6–8.3, with a pooled value of 5.3 amongst 840 patients. The mean postoperative scores range from 0.6–1.2, with a pooled value of 3.2 amongst 872 patients. All eight studies reporting on statistical significance found significant increase in scores from preoperative to postoperative status (p < 0.05) [42, 43, 49, 57, 63, 71, 78, 80].
There were no studies that reported on either minimally clinical important differences (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB).
Complications
Amongst 4,784 total knees, there were 209 (4.4%) reported retears (range: 0–23.7%) and 290 (6.0%) reoperations (range: 0–36.7%) (Table 4). However, not all studies provided information on if patients had retears or reoperations. Only 3,190 knees had reported retear statuses for a total of 6.6%. Similarly, only 3,415 knees had reported reoperation statuses for a total of 8.5%. There were six studies consisting of 1,537 knees that reported a retear rate of equal to or greater than 10% (range: 10.3–28%) [11, 38, 42, 62, 69, 70, 75]. Only one study consisting of 59 patients reported a retear rate of above 20% [69]. There were eight studies consisting of 1,598 knees that reported a reoperation rate greater than 10% (range: 10–36.7%) [38, 46, 55, 58, 62, 69, 70, 75]. Four of these studies with a total of 181 knees reported a reoperation rate of greater than or equal to 20% [46, 55, 58, 69], with three reporting rates greater than or equal to 30% amongst 122 knees [46, 55, 58].
Table 4.
Retear/reoperation rate
| Author | Retear rate (n, %) | Reoperation rate (n, %) | Complications |
|---|---|---|---|
| Ahn (2012) | 0 (0%) | 0 (0%) | 0 |
| Ahn (2017) | 0 (0%) | 0 (0%) | 0 |
| Bae (2012) | 0 (0%) | 0 (0%) | 0 |
| Bauwens (2023) | 11 (18.3%) | 10 (16.7%) |
Septic arthritis (n = 1), Partial ACL (n = 1) |
| Bin (2001) | 0 (0%) | 0 (0%) | 0 |
| Cao (2012) | 0 (0%) | 0 (0%) |
Pain (n = 1), Hemarthrosis (n = 1) |
| Carter (2012) | 3 (5.3%) | 3 (5.3%) | Mechanical symptoms (n = 3) |
| Dai (2019) | 3 (10.3%) | NR | 0 |
| Dong (2018) | NR | NR | NR |
| Hagino (2017) | 2 (5.1%) | 2 (5.1%) | OCD (n = 2, 5.1%) |
| Hashimoto (2020) | NR | 3 (2.9%) | OCD (n = 8, 7.8%) |
| Haskel (2018) | NR | 7 (36.7%) |
Pain (n = 9, 47.4%), Mechanical symptoms (n = 2, 10.5%), Arthrofibrosis (n = 1, 5.3) |
| He (2022) | NR | NR | NR |
| Hu (2016) | NR | NR | Unhealed steal edge (n = 4, 12.5%) |
| Jin (2024) | NR | NR | NR |
| Kawashima (2021) | NR | NR | Delayed healing (n = 3, 12%) |
| Kim (2006) | 1 (7.1%) | 1 (7.1%) | 0 |
| Kose (2015) | 0 (0%) | 0 (0%) | 0 |
| Krause (2009) | NR | NR | NR |
| Lee (2013) | 0 (0%) | 0 (0%) | 0 |
| Lee (2016) | NR | NR | Total meniscectomy had higher progression of OA—Otherwise 0 |
| Lee (2018) | NR | 24 (32.9%) | NR |
| Li (2021) | NR | NR | NR |
| Lins (2021) | NR | 11 (36.7%) | NR |
| Liu (2015) | NR | NR | NR |
| Liu (2019) | NR | NR | NR |
| Liu (2023) | NR | NR | NR |
| Logan (2021) | 62 (13.2%) | 66 (14.0%) |
Parameniscal cyst (n = 1, < 1.0%), Pain and mechanical symptoms (n = 51, 16%—379), Instability (n = 19, 28.8%) |
| Lu (2007) | NR | NR | NR |
| Lu (2023) | NR | NR | NR |
| Ng (2021) | 0 (0%) | 0 (0%) | 0 |
| Okazaki (2006) | NR | 1 (3.5%) |
OA: (n = 2, 5%), OCD: (n = 1, 2.5%) |
| Papadopoulos (2009) | NR | NR | NR |
| Perkins (2021) | NR | 3 (9.4%) | NR |
| Ren (2021) | NR | NR | Swelling (n = 11, 1.7%) |
| Rublev (2024) | 1 (4.6%) | 1 (4.6%) | NR |
| Sabbag (2019) | 14 (23.7%) | 14 (23.7%) | NR |
| Sheasley (2024) | 100 (11.5%) | 135 (15.6%) |
Persistent symptoms (n = 36, 4%), ACL tear (n = 1, 0.2%), OCD (n = 4, 0.4%), PFS (n = 3, 0.4%), Arthrofibrosis (n = 9,1%) |
| Spahn (2003) | NR | NR | DVT (n = 2, 1.0%) |
| Su (2022) | 0 (0%) | 0 (0%) | 0 |
| Talathi (2024) | 0 (0%) | 0 (0%) | 0 |
| Tang (2015) | 0 (0%) | 0 (0%) | 0 |
| Wasser (2011) | 2 (10%) | 2 (10%) | OCD (n = 1, 5.5%) |
| Wong (2011) | 5 (15.6%) | NR | Decreased range (< > 115): n = 2, 6.3% |
| Yang (2020) | 0 (0%) | 0 (0%) | 0 |
| Yoo (2015) | 5 (5%) | 7 (7%) | Pain with strenuous sport activity (n = 8, 9.3%) |
| Yoon (2014) | 0 (0%) | 0 (0%) | 0 |
| You (2023) | 0 (0%) | 0 (0%) | 0 |
| Yuan (2024) | NR | NR | NR |
| Zhang (2018) | NR | NR | NR |
| Zhang (2022) | 0 (0%) | 0 (0%) | 0 |
| Zhou (2019) | 0 (0%) | 0 (0%) |
Pain (n = 3, 5.6%), Swelling (n = 2,, 3.7%) |
OCD osteochondritis dissecans, ACL anterior cruciate ligament, PFS patellofemoral syndrome, NR not reported
Thirteen studies consisting of 1,829 pediatric knees reported on retear rates, with 189 retears (10.3%; range: 0–18.3%) [18, 38, 41, 42, 44, 62, 68, 70, 73, 75, 77, 79, 84]. Seventeen studies consisting of 2,011 pediatric knees reported on reoperation rates, with 251 reoperations (12.5%; range: 0–36.8%) [18, 22, 38, 41, 44–46, 58, 62, 66, 68, 70, 73, 75, 77, 79, 84].
Persistent pain, mechanical symptoms, or swelling was noted in 115 patients (2.4%). Development of Osteochondritis Dissecans (OCD) lesions, arthrofibrosis, and delayed healing was reported in 16 (0.3%), 10 (0.2%), and seven (0.1%) cases. Deep vein thrombosis (DVT) was reported in two cases (0.04%).
Discussion
The primary finding of this review was that patients generally reported significant improvement in pain and function postoperatively after surgical management of a symptomatic discoid lateral meniscus, however some studies reported retear and reoperation rates to be as high as 23.7% and 36.7%.respectively.
The most common tear types reported in this review were horizontal and complex types, respectively. This finding is consistent with that of the current literature. One recent systematic review reported that horizontal tears were more frequent in the pediatric population, while complex and degenerative tears were more prevalent in the adult population [85]. Given the increased stress placed on the joint as patients get older and increase their levels of activities,complex tears are expected [85]. The common surgical option performed was partial meniscectomy and saucerization, which has been reported to have favourable outcomes relative in the long-term relative to that of subtotal or total meniscectomy [19]. Unfortunately, several studies included outcomes for patients undergoing multiple different procedures (e.g. meniscectomy, saucerization, repair, etc.) without separation, preventing the ability to be able to stratify results by surgery. Only three studies evaluated patients undergoing meniscectomy with and without repair. One study compared 33 patients with saucerization alone and 24 with combined procedures reporting no significant differences in PROMs and retear rates at a mean follow-up time of 15 months [41]. Another two studies also found no differences in PROMs between groups, with one study reporting a mean follow-up time of 30 months [50], and one reporting a minimum follow-up time of 60 months [51]. Regarding rim preservation, generally it is considered that 6–8 mm of rim should be conserved when doing saucerization of meniscectomy, as reported by some of the studies included in this review [18, 41, 66]. There was a lack of studies that focused on the Wrisberg variant of the discoid lateral meniscus, where the posterior horn of the lateral meniscus is mobile and subluxed. Unfortunately, the majority of studies investigating this subsection of patients consist of only case reports or very small case series (< 10 patients) [86, 87]. In these cases repair should be attempted to stabilize the meniscus [86, 87].
Functional scores via PROMs improved in nearly all studies reporting values. It has been suggested that postoperative PROMs for arthroscopic management of the discoid lateral meniscus may surpass that of other knee procedures, including ACLR or other ligament repair, and knee arthroplasty [58]. Patients undergoing surgery for discoid lateral meniscus tend to be younger, therefore, given their increased vascularity and healing potential, this may be a rationale for such excellent functional outcomes [58]. However, the mean follow-up time of this review was approximately four years postoperative, therefore, it is possible that longer outcome data may be more variable. A previous systematic review comparing outcomes of the discoid lateral meniscus with meniscus repair and meniscectomy found similar functional outcomes as per PROMs, re-affirming that this patient population does well regardless of treatment in the short to intermediate-term. One reason for the significant improvements in PROMs in the discoid meniscus populations is likely because patients tend to have debilitating symptoms at a young age due to increased meniscal thickness and size, which can significantly limit function before surgical management with saucerization or meniscectomy [70]. Unfortunately, there were no studies that reported on MCID, PASS, or SCB, to help distinguish if surgical intervention resulted in clinically significant improvements in outcomes or if different surgical interventions vary in terms of their clinical significance. It is recommended that future long-term large studies report on clinically significant outcomes.
Failure rates are an important outcome to assess after arthroscopic management of the discoid meniscus. Primary repair in general has a higher failure rate than other meniscus procedures such as meniscectomy or saucerization, therefore the relatively lower amount of repair procedures relative to the other suggest a possible reason for an overall lower number of retears and reoperations in this review. Furthermore, only 209 confirmed retears could be due to reporting bias amongst studies that failed to disclose the number of patients that suffered a re-injury. Therefore, it is more important to look at the upper limits of the ranges for these outcomes, as the true retear and reoperation rate is likely higher. The largest case series on this topic consisting of over 700 patients reported a reoperation rate of 12%. When focusing on knees with a retear rate greater than 10%, the total number of knees from these studies consisted of nearly half of knees with reported retear rates, again suggesting that the true retear rate after surgery for the discoid lateral meniscus is likely much higher. Of the studies with over 30% reoperation rates, 66.7% were within pediatric cohorts, therefore it is possible that the pediatric cohort may be at a higher risk for retears and reoperations. However, more research is needed to evaluate this. One potential reason for reoperation is the higher prevalence of OCD with a discoid meniscus due to excessive stress at the articular surface with motion, especially in adolescents [88]. Other reasons as listed in this review include persistent pain and mechanical symptoms. Future large prospective studies and RCTs are recommended to fully outline the failure and reoperation rates in this patient population after arthroscopic treatment.
The primary limitation of this review is the lack of high quality data, as the majority of studies were small case series that were retrospective in nature. Therefore there is significant potential for bias including reporting bias that may under-represent the failure rates of arthroscopic management of the discoid meniscus via saucerization or meniscectomy with or without repair. Data were not pooled due to the lack of because of the lack of level l and II evidence. Furthermore, few studies separated the outcomes for different surgical procedures, making it difficult to compare treatment options. Despite this, there has been an increase in studies publishing reporting outcomes following surgical management of discoid meniscus in recent years involving larger sample sizes of patients with almost all studies reporting significant increases in functional outcome via PROMs postoperative, suggesting promising results fort these patients following various surgical procedures in the short to intermediate term.
Conclusion
Studies to date have reported good outcomes overall following surgical management of the discoid lateral meniscus, with significant improvements in PROMs. However, retear and reoperation rates within the literature have been reported to be as high as 23.7% and 36.7%, respectively.
Key References
- Logan CA, Tepolt FA, Kocher SD, Feroe AG, Micheli LJ, Kocher MS. Symptomatic Discoid Meniscus in Children and Adolescents: A Review of 470 Cases. J Pediatr Orthop. 2021;41:496–501.
- ○ Retrospective review from 470 knees with symptomatic discoid lateral meniscus from over 25 years, reporting a 33% reoperation rate of patients who underwent surgical management. This review is one of the largest cohorts in the study
- Sheasley JA, Kirby JC, Niu EL, Gopalan M, Carsen S, Stinson ZS, et al. Characteristics and Outcomes of Operatively Treated Discoid Lateral Meniscus in Pediatric and Young Adult Patients: A Multicenter Study. Am J Sports Med. 2024;52:2758–63.
- ○ Multicenter study from nine different institutions over 20 years comprising the largest cohort of patients with a discoid lateral meniscus, outlining the most frequent types of tears in addition to the reoperation rate from over 700 patients.
- Yang S-J, Ding Z-J, Li J, Xue Y, Chen G. Factors influencing postoperative outcomes in patients with symptomatic discoid lateral meniscus. BMC Musculoskelet Disord. 2020;21:551.
- ○ Over 500 patients including demonstrating the safety of arthroscopic treatment of the discoid lateral meniscus, also reporting that male sex, low body mass index, age, and symptom duration are conducive to better postoperative outcomes.
Supplementary Information
Below is the link to the electronic supplementary material.
Author Contribution
All authors contributed substantially to the preparation of the manuscript. All authors reviewed the final manuscript.
Funding
No funding was received.
Data Availability
No datasets were generated or analysed during the current study.
Declarations
Ethics Statement
This manuscript was compliant with ethical standards, no human patients were involved in this manuscript.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Competing interests
The authors declare no competing interests.
Footnotes
Level of Evidence
Level IV
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Data Availability Statement
No datasets were generated or analysed during the current study.