Summary

Surgical repair of discoid meniscus tears in pediatric patients demonstrates favorable outcomes with a low rate of reoperation at mid-term follow up.

Abstract

Background

Discoid menisci are often asymptomatic until a tear occurs. Symptomatic discoid meniscus tears present with varied and complex patterns that require nuanced surgical management. Current treatment approaches typically involve arthroscopic saucerization and repair, with a growing emphasis on meniscal preservation to maintain anatomic integrity and joint function. Despite the increasing use of these techniques, there is a paucity of comprehensive data on outcomes following meniscus repair in this population. The purpose of this study is to evaluate outcomes of surgical repair in pediatric patients with symptomatic discoid menisci.

Methods

A single-institution retrospective review was conducted on consecutive pediatric patients who underwent surgical treatment for discoid meniscus tears between July 2014 and July 2024. Inclusion criteria were age less than 18 years, symptomatic discoid meniscus treated with repair, and a minimum 12-month follow-up. Charts were reviewed to collect data on laterality, tear location, pattern, and repair technique (inside-out, outside-in, all-inside, or hybrid). Hybrid repairs utilized more than one technique. The primary outcome was revision meniscus surgery. Chi-square tests were used to compare categorical variables.

Results

44 patients met inclusion criteria. 25 patients (56.8%) were females and the mean age at surgery was 12.55 ± 2.69 years. Mean follow-up was 47.89 ± 26.06 months. 38 tears (86.4%) involved the lateral meniscus, 2 (4.5%) involved the medial meniscus, and 4 (9.1%) involved both medial and lateral menisci. Tear patterns included complex (23 patients, 52.3%), bucket-handle (6 patients, 13.6%), horizontal (11 patients, 25.0%), vertical (2 patients, 4.5%), and radial (2 patients, 4.5%).
Repair techniques included 22 hybrid repairs (50.0%), 10 all-inside repairs (22.7%), 7 inside-out repairs (15.9%), and 5 outside-in repairs (11.4%). In addition to meniscus repair, saucerization was performed in 33 cases (75.0%). Four patients (9.1%) had concomitant cruciate ligament reconstruction. Bone marrow stimulation was implemented in 23 cases (52.3%). Five of 44 patients (11.4%) underwent revision surgery. Bone marrow stimulation was associated with a significantly lower rate of revision surgery (p=0.0019). There were no significant differences in age, sex, tear pattern, medial or lateral meniscus involvement, tear location, repair technique, concomitant saucerization, or concomitant cruciate ligament reconstruction between patients who required revision surgery and those who did not.

Conclusions

Surgical repair of discoid meniscus tears in pediatric patients demonstrates favorable outcomes with a low rate of reoperation at mid-term follow up. The use of bone marrow stimulation at the time of surgery may have potential benefits in decreasing reoperation rates and improving surgical outcomes.