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Introduction


  • Abnormal development of the meniscus leads to a hypertrophic and discoid shaped meniscus
    • discoid meniscus is larger than usual
    • also referred to as "popping knee syndrome"
  • Epidemiology
    • incidence
      • present in 3-5% of population
    • location
      • usually lateral meniscus involved
      • 25% bilateral
Classification
 
Watanabe Classification
Type I  • Incomplete

Type II  • Complete

Type III  • Wrisberg (lack of posterior meniscotibial attachment to tibia
 
Presentation
  • Symptoms
    • pain, clicking, mechanical locking 
    • often becomes symptomatic in adolescence
  • Physical exam
    • mechanical symptoms most pronounced in extension
Imaging
  • Radiographs
    • recommended views
      • AP and lateral of knee
    • findings    
      • widened joint space due to widened cartilage space (up to 11mm)
      • squaring of lateral condyle with cupping of lateral tibial plateau
      • hypoplastic lateral intercondylar spine
  • MRI
    • indications
      • study of choice for suspected symptomatic meniscal pathology
    • findings
      • diagnosis can be made with 3 or more 5mm sagittal images with meniscal continuity  ("bow-tie sign")
      • sagittal MRI will show abnormally thick and flat meniscus 
      • coronal MRI will show thick and flat meniscal tissue extending across entire lateral compartment 
Treatment
  • Nonoperative
    • observation
      • indications
        • asymptomatic discoid meniscus without tears  
  • Operative
    • partial meniscectomy and saucerization    
      • indications
        • pain and mechanical symptoms
        • meniscal tear or meniscal detachment
      • technique
        • obtain anatomic looking meniscus with debridement 
        • repair meniscus if detached (Wrisberg variant)
 

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