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Prediction of the Peripheral Rim Instability of the Discoid Lateral Meniscus in Children by Using Preoperative Clinicoradiological Factors

Kang, Michael Seungcheol MD*; Kim, Jong-Min MD, PhD; Park, Soo-Sung MD, PhD*; Bin, Seong-Il MD, PhD

doi: 10.1097/BPO.0000000000001370
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Background: The discoid lateral meniscus (DLM) in children often presents peripheral rim instability (PRI) and is susceptible to tear or subluxation, which manifests symptoms and leads to a poor prognosis. We aimed to investigate the association between preoperative clinical and MRI findings and the intraoperative findings of PRI.

Methods: Children and adolescents aged younger than 16 years who underwent surgical treatment for DLM were retrospectively reviewed. Cases of bucket-handle tear were not included because they would confound the stability of the peripheral rim. Total 60 knees from 47 children were included. PRI was additionally subdivided based on the location, such as anterior, middle, and posterior, during the investigation.

Results: In multivariate analyses, both central (inward) (P=0.004) and external (outward) (P=0.029) displacement of lateral meniscal margin, and peripheral tear of the anterior body (P=0.022) were significant predictors of PRI, regardless of the location. The predictive factors for PRI based on each location were female gender (P=0.004), subjective symptom of clicking sound (P=0.023), and central displacement of the anterior meniscal margin (P=0.034) for anterior PRI; flexion contracture >10 degrees (P=0.017) and peripheral tear of the middle body (P<0.001) for middle PRI; and central displacement of the posterior meniscal margin (P=0.036) and peripheral tears of the anterior (P=0.029) and middle bodies (P=0.047) for posterior PRI.

Conclusions: We evaluated the preoperative clinical and MRI findings that predict PRI of pediatric DLM. Displacements of the DLM, not only centrally (inward) but also externally (outward), seem to be significant predictive factors for PRI. Furthermore, some clinical findings were associated with PRI, even predicting the locations. Although the actual surgical procedure should be determined by meticulous probing during arthroscopy, preoperative prediction of the presence and location of PRI would help decrease the risk of oversight during surgery.

Level of Evidence: Level III—Diagnostic Study.

*Department of Orthopedic Surgery, Asan Medical Center Children’s Hospital

Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea

There has been no external source of support or funding for this research.

The authors declare no conflicts of interest.

Reprints: Seong-Il Bin, MD, PhD, Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil Songpa-gu, Seoul 05505, Republic of Korea. E-mail: sibin@amc.seoul.kr.

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