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Physical therapy with a focus on concentric knee strengthening
11%
289/2751
Non-weightbearing for 6 weeks
3%
74/2751
Arthroscopic saucerization of the lateral meniscus and/or meniscal repair
84%
2317/2751
Open lateral meniscectomy
1%
21/2751
Arthroscopic microfracture treatment of the defect on the lateral femoral condyle
33/2751
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The history, radiographs, and MRI are consistent with a diagnosis of discoid lateral meniscus. Surgery for discoid menisci is indicated for persistent pain or motion loss in order to prevent further meniscal damage. The classification system most widely used for discoid meniscus is that of Watanabe et al (Illustration A), who described three types of discoid lateral menisci based on arthroscopic appearance. In this classification, discoid menisci with normal peripheral attachments are either type I (complete) or type II (incomplete). Type III discoid menisci, the so-called Wrisberg ligament type, are described as lacking posterior capsular attachments with the exception of the posterior meniscofemoral ligament, thus producing the classic “snapping knee” syndrome. Complete meniscectomy of discoid lateral meniscus is avoided due to the development of early degenerative changes. Most authors now recommend repair of a detached posterior or peripheral attachment, with saucerization of the discoid morphology depending on the underlying meniscal shape and presence of a meniscal tear. Klingele et al found that 28.1% of patients in their series of discoid menisci had peripheral rim instability, and instability was more common in patients with a complete discoid morphology and in younger patients. Illustration: A. Complete discoid lateral meniscus (Type I); B. Incomplete discoid; C. Wrisberg variant which lacks capsular attachments (Type III) and may be either complete or incomplete. Incorrect Responses: 1. Strengthening in physical therapy will not address the mechanical symptoms or the lack of extension. 2. Non-weightbearing will not lead to healing of a unstable or torn discoid meniscus. 4. Open lateral meniscectomy is largely historical and should be avoided due to the development of early degenerative changes. 5. No chondral lesion is seen.
3.8
(29)
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