Purpose: The purpose of this study was to compare the midterm outcomes of subtotal/total meniscectomy with those of partial meniscectomy for symptomatic torn discoid lateral meniscus (DLM) in children and evaluate the correlation of chondral wear in the lateral compartment at index surgery with arthritic changes at final follow-up.
Methods: We reviewed 43 knees in 36 patients aged less than 15 years who underwent arthroscopic procedures for torn DLMs between 1999 and 2004. The mean patient age at the time of surgery was 9.5 years (range, 5 to 14 years), and the mean follow-up period was 4.3 years (range, 2.1 to 9.4 years). Of the 43 knees, 23 underwent partial meniscectomy and 20 underwent subtotal/total meniscectomy. The status of the articular cartilage at the time of surgery was analyzed with the Outerbridge grading system, and radiologic arthritic changes of the lateral compartment at final follow-up were evaluated by use of the classification of Tapper and Hoover.
Results: Clinically excellent or good results at final follow-up were observed in 36 of 43 knees (83.7%). There was no difference between the partial and subtotal/total meniscectomy groups in terms of the presence of chondromalacia of the lateral compartment at the time of surgery. Radiologic arthritic changes at final follow-up were significantly more severe in the subtotal/total meniscectomy group than in the partial meniscectomy group (P < .001). We observed a positive linear association between the degree of chondral wear of the lateral tibial plateau at the time of surgery and subsequent development of radiologic signs of arthritic change at last follow-up (rho = .628, P = .027). We also found a correlation between symptom duration and chondromalacia of the lateral tibial plateau (rho = .684, P = .021).
Conclusions: Although there were no differences in clinical results between the partial and subtotal/total meniscectomy groups, partial meniscectomy yielded better radiologic results than subtotal/total meniscectomy for torn DLMs in children. Our findings suggest the need for early diagnosis and greater caution in the treatment of torn DLMs in children.
Level of evidence: Level IV, therapeutic case series.