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(A) Fibular head height. (B) Lateral joint space width. (C) Tibial spine height. (D) Obliquity of the lateral tibial plateau. (E) Cupping of the lateral tibial plateau. (F) Width of distal femur.
Source publication
Background
Several radiographic parameters have been associated with a discoid lateral meniscus. However, limited information is available regarding the radiographic findings of a discoid meniscus in the pediatric population.
Purpose
To determine the effect of age and weightbearing (WB) on radiographic parameters associated with discoid lateral me...
Context in source publication
Context 1
... knee parameters were measured as described by Kim et al 13 : FHH, lateral joint space width (LJSW), tibial spine height (TSH), obliquity of the lateral tibial plateau (OLTP), cupping of the lateral tibial plateau (CLTP), and width of dis- tal femur (WDF) (Figure 1). FHH was defined as the distance from the lateral tibial plateau to the apex of the fibular head, LJSW as the width between the lateral femoral condyle and the lateral tibial plateau, TSH as the height of the lateral tibial spine from the tibial plateau, OLTP as the angle between the lateral tibial plateau and the tibial spine, CLTP as the height from the imaginary tibial joint line to the proximal limit of the lateral tibial plateau, and WDF as the distance between the most prominent edge of the medial femoral condyle to the most prominent edge of the lateral femoral condyle. ...
Citations
... The use of skeletal findings is especially problematic in younger children, as the radiographic appearance of the knee changes significantly throughout childhood until skeletal maturity is reached. [20][21][22] Previous studies have assessed the use of these radiographic features in the diagnosis of DLM, [20][21][22][23][24][25][26][27][28][29][30] but few have focused specifically on pediatric patients. [20][21][22][23] Findings between studies vary considerably. ...
... The use of skeletal findings is especially problematic in younger children, as the radiographic appearance of the knee changes significantly throughout childhood until skeletal maturity is reached. [20][21][22] Previous studies have assessed the use of these radiographic features in the diagnosis of DLM, [20][21][22][23][24][25][26][27][28][29][30] but few have focused specifically on pediatric patients. [20][21][22][23] Findings between studies vary considerably. ...
... [20][21][22] Previous studies have assessed the use of these radiographic features in the diagnosis of DLM, [20][21][22][23][24][25][26][27][28][29][30] but few have focused specifically on pediatric patients. [20][21][22][23] Findings between studies vary considerably. Differences in lateral joint space height (LJSH), fibular head height (FHH), and the condylar cutoff sign (in skeletally mature knees) have been repeatedly demonstrated between patients with DLM and normal menisci. ...
Background: Debate persists regarding the utility of plain film radiography in the diagnosis of discoid lateral meniscus, especially in children. The purpose of this study was to assess various radiographic measurements between healthy children and those with discoid lateral meniscus while controlling for other patient characteristics. Methods: Plain radiographs of 55 pediatric patients with discoid lateral meniscus were matched by age and sex to 55 controls with healthy knees as verified by magnetic resonance imaging. Each radiograph was evaluated for the following parameters: lateral joint space height (both in the central and medial portions of the compartment), medial joint space height, fibular head height, lateral tibial spine height, femoral inter-epicondylar distance, lateral tibial plateau obliquity, and chordal distance of the femoral condyle (medial and lateral). Results: In univariate analysis, children with discoid lateral meniscus had higher median lateral joint space heights (p<0.001) and lower fibular head height (p=0.001) than controls. No other radiographic measurements were significantly different. When adjusting for covariates in regression analysis, the presence of discoid lateral meniscus was predictive of a higher lateral joint space heights and lower fibular head height, however, age was also significantly predictive in these models. Conclusions: On plain radiographs, lateral joint space heights and fibular head height are associated with discoid lateral meniscus. However, many previously reported measurements were not predictive. The practical utility of these parameters may be complicated by the impact of age. Advanced imaging is recommended to confirm the diagnosis of discoid lateral meniscus.
... 1 The role of bony morphology in discoid meniscus has also been studied in a limited capacity using mostly radiographs and, more recently, magnetic resonance imaging (MRI). 5,8,11,12,18,22 MRI has the benefit of offering a more comprehensive picture of the 3-dimensional structure and thus gives a more accurate geometrical representation. Among patients with a discoid meniscus, radiographic findings have reported a larger tibial eminence width, a smaller lateral slope angle, hypoplasia of the femoral condyle, increased fibular head height, a squared-off appearance of the lateral femoral condyle (LFC), and a wider lateral tibiofemoral joint space. ...
... Among patients with a discoid meniscus, radiographic findings have reported a larger tibial eminence width, a smaller lateral slope angle, hypoplasia of the femoral condyle, increased fibular head height, a squared-off appearance of the lateral femoral condyle (LFC), and a wider lateral tibiofemoral joint space. 5,8,11,18 MRI findings thus far have confirmed findings of LFC hypoplasia and a high obliquity of the posterior lateral tibial plateau. 12,22 Using geometrical findings from MRI can be an important supplement to radiographic diagnoses and can potentially identify additional aspects of bony morphology for clinicians to look for in radiographs for the diagnosis of lateral discoid meniscus. ...
Background:
Lateral discoid meniscus accounts for most meniscal tears in children 10 years of age and younger. The role of bony morphology in discoid meniscus has been previously studied in a limited capacity using radiographs.
Purpose:
To use magnetic resonance imaging to measure features of the femoral condyles and tibial plateaus in patients with discoid meniscus to assess potential determinants of symptoms and subsequent surgery and to compare with matched controls to investigate age-related changes in bony features.
Study design:
Cross-sectional study; Level of evidence, 3.
Methods:
After institutional review board approval, detailed morphology of the femoral condyles and tibial plateau was measured in 177 patients (3-18 years of age; 56% female) with confirmed lateral discoid meniscus. Measurements from 269 participants (3-18 years of age; 55% female) with asymptomatic knees were used as controls. Two-way analysis of variance with Holm-Šídák post hoc was used to compare measurements between discoid menisci and matched controls. Independent t tests were used to compare aspects of bony morphology within the discoid meniscus cohort.
Results:
Compared with controls, patients with a lateral discoid meniscus had a larger bicondylar width and notch width (7- to 10-year-old and 15- to 18-year-old age groups; P < .05), larger tibial plateau width (11- to 14-year-old and 15- to 18-year-old age groups; P < .001), and smaller lateral (P < .02) and coronal (P < .02) tibial slopes across all age groups. Among patients with a discoid meniscus, larger bicondylar width, larger tibial plateau width, larger notch width, and a flatter lateral femoral condyle were associated with pain (P < .005) and lateral meniscal tears (P < .02). Larger notch width and notch width index were also associated with subsequent surgery (P < .05).
Conclusion:
There are clinically significant abnormalities in bony morphology in patients with a discoid meniscus, including larger femoral condyles and tibial plateaus and a flatter tibial plateau. Additionally, femoral size, femoral curvature, and tibial plateau size may influence the likelihood of knee pain, meniscal tear, and need for surgery. These findings highlight the importance of bony morphology in discoid meniscus pathophysiology in children and adolescents. Such measurements may also aid radiographic detection of discoid meniscus and guide decisions regarding the timing of potential surgical intervention.
... It has been reported that patients with DLM have characteristic bone morphology in many studies using radiographic findings [24][25][26][27][28][29][30][31] and magnetic resonance (MR) imaging findings [32][33][34]. It has been reported that bone morphology differs with age in DLM patients [25,32], and different bone morphology changes with bone maturation between DLM and normal meniscus [34,35]. ...
Purpose
To determine the effect of saucerization surgery on knee joint morphology associated with a complete discoid lateral meniscus (DLM) using magnetic resonance (MR) imaging.
Methods
This retrospective study included cases had undergone saucerization surgery for symptomatic DLM between 2007 and 2022. All cases were divided into two by age group: < 12 (U13) and > 13 (O13). The cases in the match group were randomly selected from preoperative cases in the O13 group matched with the age at the final follow-up (F/U) of cases in the U13 group. The following morphological parameters were evaluated using MR images preoperatively and at the final postoperative F/U in each group: anterior obliquity of the lateral tibial plateau (AOLTP), posterior obliquity of the lateral tibial plateau (POLTP), and the lowest point of the lateral femoral condyle (LPLFC). Each parameter was compared between the U13 preoperative (pre-OP) group and the O13 pre-OP group, the preoperative and final follow-up in the U13, and the U13 group at the final F/U and the match group preoperatively.
Results
A total of 77 cases were evaluated. 31 cases were in the U13 pre-OP group and 46 were in the O13 pre-OP group. With a minimal F/U of 2 years, 27 cases in the U13 group and 36 in the O13 group were included. The mean F/U period was 4.6 years in the U13 group and 3.2 years in the O13 group. 32 cases were included in the match group. In the match group, the inclination of the POLTP was significantly larger (P = 0.042) and the LPLFC was more lateral (P = 0.0034) than at the final F/U in the U13 group.
Conclusions
Saucerization surgery for DLM in juvenile patients can prevent progression to the characteristic bone morphology DLM. These results could help the surgeon making the decision when the surgery would be performed for symptomatic DLM patients.
Level of evidence
Retrospective comparative study; level of evidence, 3.
... Although radiographic findings are useful for DLM screening [12][13][14][15][16][17][18][19], results tend to be inconsistent [12,15,[17][18][19][20]. Our aim in this study was to differentiate knee joint morphology between patients with and without a DLM, as a function of skeletal maturity, using MR imaging. ...
... Although radiographic findings are useful for DLM screening [12][13][14][15][16][17][18][19], results tend to be inconsistent [12,15,[17][18][19][20]. Our aim in this study was to differentiate knee joint morphology between patients with and without a DLM, as a function of skeletal maturity, using MR imaging. ...
... Therefore, in the control group, the LPLFC was located more medially than in the DLM group, regardless of skeletal maturity (Fig. 5), indicating that a DLM shifts the LPLFC laterally. Interestingly, while some studies investigating the morphology of the lateral femoral condyle with plain radiographs found no significant differences in knee joint morphology associated with a DLM [17,19], others reported a hypoplasia of the lateral femoral condyle, confirmed on MR imaging or arthroscopy [13,18,19,23,29]. Considering that the menisci increase joint congruity and are responsible for load transmission across the knee joint [30], lateralization of the LPLFC associated with a DLM would result in poor joint congruity. ...
Introduction:
A discoid lateral meniscus (DLM) is associated with increased risk for meniscal tears and progression of knee joint osteoarthritis. Our aim was to differentiate knee joint morphology between patients with and without a DLM, as a function of skeletal maturity, using magnetic (MR) imaging.
Materials and methods:
This was a retrospective analysis of MR images of the knee for 110 patients, 6-49 years of age. Of these, 62 were in the open physis group (38 with a DLM) and 48 in the closed physis group (23 with a DLM). The following morphological parameters were measured: anterior obliquity of the lateral tibial plateau (AOLTP), posterior obliquity of the lateral tibial plateau (POLTP), the lowest point of the lateral femoral condyle (LPLFC), and the posterior lateral condylar angle (PLCA).
Results:
Regardless of skeletal maturity, a DLM was associated with a greater inclination of the POLTP, lateralization of the LPLFC, and smaller PLCA (p < 0.001 for all compared to that of the control group). In the DLM group, the inclination of the AOLTP and the POLTP were significantly smaller (p < 0.001) and the LPLFC was more lateral (p < 0.001) in the closed physis group than in the open physis group. In the control group, the inclination of the POLTP was larger (p < 0.001) and the PLCA smaller (p = 0.019) in the open than in the closed physis group.
Conclusions:
We identified a characteristic knee morphology among patients with a complete DLM using MR imaging, which was observed before physeal closure and persisted after skeletal maturity was attained. We also noted lateralization of the LPLFC in the presence of a DLM, with an increase in lateralization with skeletal maturation.
Level of evidence:
Case-control study, III.
... Several reports have described the characteristic findings of a DLM on plain radiographs [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. These findings include a widened lateral joint line, squaring of the lateral femoral condyle, cupping of the lateral tibial plateau, an elevated fibular head, a widened tibial eminence, a condylar cut-off sign based on quantitative evaluation of lateral femoral condylar hypoplasia, and obliquity of the lateral tibial plateau. ...
... However, these characteristic bone morphologic findings are measured by two-dimensional measuring tool though the bone morphologic changes may actually be three-dimensional. Although several studies have shown that radiographic findings are useful in screening for a DLM [3, 4, 6-8, 10, 12, 15], the results of each parameter are not consistent [3,7,9,10,12,15]. Magnetic resonance (MR) imaging plays an important role in the diagnosis of a DLM [16,17]. ...
... Several previous studies have shown that the obliquity of the lateral tibial plateau was smaller on plain radiographs in patients with a DLM [7,9,12]. However, Choi et al. [3] reported the opposite result, and some studies have shown no significant difference in the obliquity of the lateral tibial plateau between patients with a DLM and those with a normal meniscus [10,15]. The reason for the discrepancies among these results is that the drawn lines might have differed because the studies employed two-dimensional Content courtesy of Springer Nature, terms of use apply. ...
PurposeThe characteristic two-dimensional bone morphology in patients with a discoid lateral meniscus (DLM) has been described. However, the associated three-dimensional imaging findings have not been characterized. This study was performed to identify differences in the knee bone morphology between juvenile patients with a DLM and those with a normal meniscus using magnetic resonance (MR) imaging.Methods
The DLM group comprised 33 consecutive juvenile patients (33 knees) with a complete DLM, and the control group comprised 24 juvenile patients (24 knees) with normal menisci on the basis of MR imaging findings. Each MR image was evaluated to determine the anterior obliquity of the lateral tibial plateau (AOLTP), posterior obliquity of the lateral tibial plateau (POLTP), lowest point of the lateral femoral condyle (LPLFC), posterior lateral condylar angle (PLCA) and posterior medial condylar angle (PMCA). Statistical analyses were performed to determine the differences between the two groups.ResultsThe POLTP was significantly larger, the LPLFC was significantly more lateral, and the PLCA was significantly smaller in the DLM group than in the control group (p < 0.001, p < 0.001 and p < 0.001 respectively). However, there was no statistically significant difference in the AOLTP or PMCA between the two groups (p = 0.429 and p = 0.148, respectively).Conclusions
Hypoplasia of the lateral femoral condyle and posterior lateral tibial plateau is recognized in juvenile patients with a complete DLM on coronal and axial MRI images.Level of evidenceDiagnostic study, Level III.
... 64 Los signos radiográficos más frecuentes son: aumento del espacio articular lateral (hasta 11 mm), aumento de la altura de la cabeza del peroné, hipoplasia de la espina tibial lateral, oblicuidad de la meseta tibial lateral, apariencia cuadrada del cóndilo femoral lateral, ahuecamiento de la meseta tibial lateral y el condylar cutoff sign en la proyección de túnel (Figura 3). [65][66][67] Ultrasonido El ultrasonido es una técnica económica y confiable en manos de un especialista experimentado. 68 Los criterios ecográficos para el diagnóstico de un menisco discoide incluyen: ausencia de una forma triangular normal, presencia de tejido meniscal grueso y anormalmente alargado, y aparición de un patrón central heterogéneo. ...
... Subchondral bone sclerosis was more common in the medial compartment. Milewski et al. found that increased lateral joint space width on weightbearing radiograph was associated with DLM [24] . We assume widened lateral joint space might be responsible for developing varus inclination (Fig 3). ...
Purpose: To investigate the effect of discoid lateral meniscus (DLM) on cartilage damage of the medial and lateral compartments of the knee in middle-aged patients.
Methods: We analyzed data from 44 patients (54 knees) with symptomatic discoid lateral meniscus (DLM group) and 30 patients (30 knees) with a non-discoid lateral meniscus tear (control group). All patients were over 40 years old. We compared the tibiofemoral angle (TFA) and cartilage injury rate between the two groups. We further classified DLM group patients based on dysmorphic features of the menisci (DLM type), presence/absence of meniscal tear, and symptom durations, then analyzed whether these parameters could affect the number of cartilage injuries in the knee medial and lateral compartments.
Results: DLM group showed higher TFA values (2.18°±2.86°) than control group (0.84°±1.35°, P=0.002), and a higher occurrence of medial compartment cartilage damage (P=0.003). Within the DLM group, patients with cartilage damage showed higher BMI than those without cartilage damage (P=0.009 for medial compartment and P=0.001 for lateral, respectively). We found that having symptoms for more than 6 months was associated with cartilage damage in the lateral compartment (P=0.021), but not the medial compartment (P=0.858). Neither presence/absence of a meniscal tear, nor DLM type affected cartilage injury rate in either the medial or lateral compartment (P>0.05).
Conclusion: Varus inclination caused by DLM could lead to cartilage injury in the medial compartment in middle-aged patients, but may not reduce the occurrence of chondral damage in the lateral compartment. Rather, lateral compartment chondral damage in patients with DLM was mainly related to symptom duration.
... The last followup time of for outcome measurements is 6-18 months, and the time interval between data collection is large.(2) Regarding DLM in the small-sample-size retrospective study, a normal control group containing patients without meniscus injury should be included. ...
Discoid meniscus is the most common congenital variant of the meniscus. Its variability in pathology leads to a spectrum of clinical presentations in patients. Treatment must be tailored to the specific pathology of the discoid meniscus. Imaging studies such as radiographs and magnetic resonance imaging can be useful in confirming the diagnosis, but may be the most accurate in determining specific pathology. Thorough intraoperative evaluation of the discoid is critical to appropriate surgical management. Rim preservation and repair is preferred to prevent degenerative changes in the knee.
