■盘状外侧半月板(DLM)是半月板最常见的先天性异常。眼泪很常见;治疗往往不是决定性的,经常需要再次手术。
■报告临床表现,物理特性,手术治疗和发现,并发症,以及来自北美多个中心的儿科患者的DLM再次手术。
■案例系列;证据级别,4.
■包括2000年至2020年在9个机构接受有症状的DLM治疗的连续患者。患者数据,出现症状和体征,手术发现,呈现的治疗,和术后并发症,包括再手术率,被收集。报告了连续变量和分类变量的具有范围的平均值和具有比例的计数,分别,并使用卡方检验或Fisher精确检验进行比较。
■总共,纳入784例患者(867膝),诊断时平均年龄为12岁(范围,1-22年),平均随访22.6个月(范围,0-154个月)。常见的术前症状是锁定(33%)和折断(30%)。在手术中,DLM中的眼泪存在于647个膝盖(594个患者[76%]);95个膝盖(11%)有多个眼泪;在140个膝盖中,眼泪延伸到>1区。眼泪,当存在时,在后角(41%)或身体(34%)比前角(25%)更常见。在241个膝盖(28%)中报告了周围边缘不稳定。膝盖后部(15%;P=.0004)和前部(9%;P=.0013)的不稳定性明显高于身体(3%)。泪液型最常见的是复杂(38%)或水平(34%)。333例流泪患者(占所有患者的42%)中的358例膝盖接受了修复(占膝盖的55%)。总共报告了175例并发症,发生在134例患者的139个膝盖(17%);其中116个有并发症的膝盖(83%)有单一并发症,而23(17%)>1。在784名患者中,105例(13%)接受了再次手术,正在接受135个与他们的DLM相关的额外程序。其中,60例(44%)重复关节镜和半月板修剪;40例(30%),关节镜和半月板修复;17(13%),关节软骨手术。
■锁定和折断是常见的症状。超过四分之三的病人有半月板撕裂,它们通常很复杂,位于后面。17%的患者出现并发症,六分之一的并发症患者>1。再次手术通常是针对持续症状或半月板再撕裂。
UNASSIGNED: Discoid lateral meniscus (DLM) is the most common congenital abnormality of the meniscus. Tears are common; treatment is frequently not definitive, often requiring reoperation.
UNASSIGNED: To report the clinical manifestations, physical characteristics, operative treatments and findings, complications, and reoperations of DLM in pediatric patients from multiple centers across North America.
UNASSIGNED: Case series; Level of evidence, 4.
UNASSIGNED: Consecutive patients who underwent treatment for symptomatic DLM at 9 institutions between 2000 and 2020 were included. Patient data, presenting symptoms and signs, surgical findings, treatments rendered, and postoperative complications, including reoperation rates, were collected. Means with ranges and counts with proportions are reported for continuous and categorical variables, respectively, and comparisons were made using either the chi-square or Fisher exact test.
UNASSIGNED: In total, 784 patients (867 knees) were included with a mean age at diagnosis of 12 years (range, 1-22 years) and a mean follow-up of 22.6 months (range, 0-154 months). Common preoperative symptoms were locking (33%) and snapping (30%). At surgery, tears in the DLM were present in 647 knees (594 patients [76%]); 95 knees (11%) had multiple tears; and in 140 knees, tears extended into >1 zone. Tears, when present, were more common within the posterior horn (41%) or body (34%) than the anterior horn (25%). Peripheral rim instability was reported in 241 knees (28%). Significantly more knees had instability posteriorly (15%; P = .0004) and anteriorly (9%; P = .0013) than along the body (3%). Tear type was most commonly complex (38%) or horizontal (34%). A total of 358 knees in 333 patients with tears (42% of all patients) underwent repair (55% of knees with tears). A total of 175 complications were reported, occurring in 139 knees in 134 patients (17%); 116 of these knees with complications (83%) had a single complication, while 23 (17%) had >1. Of the 784 patients, 105 (13%) underwent reoperation, undergoing 135 additional procedures related to their DLM. Of those, 60 (44%) were repeat arthroscopy and meniscal trim; 40 (30%), arthroscopy and meniscal repair; and 17 (13%), an articular cartilage procedure.
UNASSIGNED: Locking and snapping were common presenting symptoms. Over three-quarters of patients had meniscal tears, which were most often complex and located posteriorly. Seventeen percent of patients experienced complications, and a sixth of patients with complications had >1. Reoperation was typically for persistent symptoms or meniscal retear.