Anterior Cruciate Ligament Ruptured Concomitant Meniscus Discoid in Young Patient: A Rare Case Report
DOI:
https://doi.org/10.26911/theijmed.2023.08.03.09Abstract
Background: Abnormalities of the human meniscus, including discoid meniscus, double-layered meniscus, and ring-shaped meniscus, have been reported. The prevalence of discoid meniscus is extremely rare, with an incidence of 0.9%－2.4% in the Asian population. Traditionally, discoid meniscus concomitant anterior cruciate ligament (ACL) ruptures are extremely rare cases. The aim of this study is to discuss a rare case to provide diagnosis and management properly by using arthroscopy.
Case Presentation: A 21-year-old male Balinese, complained of pain in his right knee after fast walking for two months and an unstable knee in the past 1 year ago. On physical examination, the range of motion was limited due to the pain for flexion of more than 90°. Special tests such as Lachman test positive, and Anterior drawer test positive. The patient had medial joint line tenderness, and a McMurray test elicited pain on the medial joint line. Meanwhile, an MRI examination of the right knee showed a discoid medial meniscus with a horizontal cleavage tear and a discoid lateral meniscus with an incomplete tear. We performed a partial meniscectomy of the incomplete discoid medial meniscus and resection of the pathologic medial patellar plica. We performed surgical reconstruction of the ACL ruptured after the meniscus was repaired.
Results: We presented a 21-year-old male with discoid meniscus concomitant ACL rupture to his right knee. After the patient was performed with partial meniscectomy of the incomplete discoid medial meniscus and resection of pathologic medial patellar plica following surgical reconstruction of the ACL ruptured. The patient had no limitation of motion or pain 1 year after the operation and he had no complaints and was satisfied with the result by radiograph.
Conclusion: We concluded that This rare case of medial discoid meniscus concomitant with the ACL rupture must be reconstructed. The treatment of discoid meniscus should consider its tear pattern and whether it is symptomatic. With the development of arthroscopic techniques, the treatment of discoid meniscus has gradually changed from total meniscectomy or partial meniscectomy.
Keywords: anterior cruciate ligament, meniscus, discoid, knee, arthroscopy.
Correspondence: I Gusti Ngurah Wien Aryana. Department of Orthopaedic & Traumatology, General Central Hospital of I.G.N.G Ngoerah Central Hospital/ Faculty of Medicine, Udayana University, Bali, Indonesia. Email: wienaryanaortho@gmail.com. Mobile: +62811-385-263.
Indonesian Journal of Medicine (2023), 08(03): 317-324
https://doi.org/10.26911/theijmed.2023.08.03.09
References
Arnold MP, van Kampen A (2000) Symptomatic ring-shaped lateral meniscus. Arthroscopy: J. Arthrosc. Relat. Surg. 16(8): 852–854. Doi: 10.1053/jars.-2000.8244.
Chernchujit B, Prasetia R (2017). Both Posterior Root Lateral-Medial Meniscus Tears with Anterior Cruciate Ligament Rupture: The Step-by-Step Systematic Arthroscopic Repair Technique. Arthrosc Tech. 6(5): e1937–e1943. Doi 10.10-16/j.eats.2017.07.018.
Clark CR, Ogden JA (1983) Development of the menisci of the human knee joint. Morphological changes and their potential role in childhood meniscal injury. J Bone Joint Surg Am. 65(4): 538–47.
Fujii M, Furumatsu T, Miyazawa S, Tanaka T, Inoue H, Kodama Y, Ozaki T. (2017) Formation of ring-shaped lateral meniscus following anterior cruciate ligament reconstruction: A case report. Int J Surg Case Rep. 31: 229–232. Doi: 10.1-016/j.ijscr.2017.01.060.
Jeannopoulos CL (1950) Observations on discoid menisci. J Bone Joint Surg Am. 32(3): 649–52.
Kaplan EB (1957) Discoid lateral meniscus of the knee joint; nature, mechanism, and operative treatment. J Bone Joint Surg Am. 39(1): 77–87.
Kim Jun Ho, Ahn JH, Kim Joo Hwan, Wang JH. (2020) Discoid lateral meniscus: importance, diagnosis, and treatment. J Exp Orthop. Doi: 10.1186/s40634-02-0-00294-y.
Kim SJ, Lubis AM (2010) Medial and lateral discoid menisci: a case report. BMC Sports Sci Med Rehabil. 2(1): 21. Doi: 10.1186/1758-2555-2-21.
Kim Y-G, Ihn J-C, Park S-K, Kyung HS. (2006) An arthroscopic analysis of lateral meniscal variants and a comparison with MRI findings. Knee Surg Sports Traumatol Arthrosc. 14(1): 20–26. Doi: 10.1007/s00167-005-0629-6.
Kramer DE, Micheli LJ (2009) Meniscal Tears and Discoid Meniscus in Children: Diagnosis and Treatment. J Am Acad Orthop Surg. 17(11): 698–707. Doi:10.5435/00124635-200911000-0-0004.
Lee YS, Teo SH, Ahn JH, Lee OS, Lee SH, Lee JH (2017). Systematic Review of the Long-term Surgical Outcomes of Discoid Lateral Meniscus. J. Arthrosc. Relat. Surg. 33(10): 1884–1895. Doi: 10.1016/j.arthro.2017.04.006.
Perkins CA, Busch MT, Christino MA, Williamson SC (2021) Saucerization and Repair of Discoid Lateral Menisci with Peripheral Rim Instability: Interme-date-term Outcomes in Children and Adolescents. J Pediatr Orthop 41(1): 23–27. Doi: 10.1097/BPO.00000000-00001695.
Ryu K, Iriuchishima T, Oshida M, Saito A, Kato Y, Tokuhashi Y, Aizawa S (2015). Evaluation of the morphological variations of the meniscus: a cadaver study. Knee Surg Sports Traumatol Arthrosc. 23(1): 15–19. Doi: 10.1007/s00167-013-2612-y.
Samoto N, Kozuma M, Tokuhisa T, Koba-yashi K (2002). Diagnosis of discoid lateral meniscus of the knee on MR imaging. Magnetic Resonance Imaging. 20(1): 59–64. Doi: 10.1016/S073-0-725X(02)00473-3.
Schonholtz GJ, Koenig TM and Prince A (1993). Bilateral discoid medial menisci: A case report and literature review. J. Arthrosc. Relat. Surg. 9(3): 315–31Doi: 10.1016/S0749-8063(05)80427-X.
Smillie IS (1948). The congenital discoid meniscus. J Bone Joint Surg Br. 30(4): 671–82.
Taschdjian MO (1990). Pediatric Orthopedics (ed. P Saunders). 2nd ed.
Yamaguchi N, Chosa E, Tajima T, Morita Y, Yokoe T (2022). Symptomatic discoid lateral meniscus shows a relationship between types and tear patterns and between causes of clinical symptom onset and age distribution. Knee Surg Sports Traumatol Arthrosc. 30-(4): 1436–1442. Doi: 10.1007/s00167-021-06635-3.
