Can early diagnosis and partial meniscectomy improve quality of life in patients with lateral discoid meniscus?
OBJECTIVE
To evaluate clinical and radiographic mid-term outcomes and improvement in quality of life in pediatric patients affected by LDM and who underwent partial or total/subtotal meniscectomy.


METHODS
28 patients (12 M, 16 F), mean age 8.3 years old (range: 6-13) affected by LDM with symptoms and/or meniscal tears, mean follow up: 2 years and 4 months (range: 24-52 months). Symptoms included: pain, swelling, articular block, limitation to knee extention, meniscal instability and formation of meniscal cysts. 23 patients treated with partial meniscectomy, 5 by total/subtotal meniscectomy. All of them have been clinically evaluated using the Ikeuchi scale and the POSNA questionnaire; for radiological evaluation we used the Tapper-Hoover grading scale.


RESULTS
Ikeuchi: In 23 patients underwent partial meniscectomy: 21 excellent and 2 good; in 5 patients underwent total/subtotal meniscectomy: 1 excellent, 2 good and 2 average. POSNA presurgical mean score: partial meniscectomy: 70 (range 66.8-73.6), total/subtotal meniscectomy: 58.7 (56.9-62.2). POSNA presurgical mean score: partial meniscectomy: 92.4 (range 88.7-98), total/subtotal meniscectomy: 81.2 (range 78.3-85.6). Tapper-Hoover: in 23 patients underwent partial meniscectomy: 17 were classified grade I, 5 grade II, 1 grade III; in 5 patients underwent total/subtotal meniscectomy: 2 were classified grade II and 3 grade III. These ones evidenced further signs of chondromalacia on articular surfaces, in the lateral area of knee joint.


CONCLUSIONS
Significant improvement in quality of life, evidenced in all patients (p = 0.048 in those underwent total/subtotal meniscectomy, p = 0.011 in those underwent partial meniscectomy), but especially in patients who underwent partial meniscectomy with absence of meniscal tears (p = 0.033), supports how important can be early diagnosis of LDM in childhood. We assert that early diagnosis and conservative treatment (partial meniscectomy) could reduce risks in development of chondromalacia, in those patients affected by LDM, because of its association with better clinical, radiographic and in quality of life mid-term results.
Universitary Department of Anatomic, Histologic, Forensic and Locomotor Apparatus Sciences - Section of Locomotor Apparatus Sciences, Policlinico Umberto I, Sapienza University of Rome.
P
P
Persiani
M
M
Mariani
M
M
Crostelli
D
D
Mascello
O
O
Mazza
F M
FM
Ranaldi
L
L
Martini
C
C
Villani
D000293:Adolescent; D001182:Arthroscopy / Q000379:methods*; D002648:Child; D000013:Congenital Abnormalities / Q000175:diagnosis; D003560:Cysts / Q000601:surgery; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000601:surgery; D007593:Joint Instability / Q000209:etiology / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008592:Menisci, Tibial / Q000002:abnormalities / Q000601:surgery*; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome