- Case report
- Open Access
- Open Peer Review
Medial and lateral discoid menisci: a case report
© Kim and Lubis; licensee BioMed Central Ltd. 2010
- Received: 31 January 2010
- Accepted: 23 August 2010
- Published: 23 August 2010
Discoid menisci on both medial and lateral tibial plateau are very rare abnormalities. We report a 44-year-old woman with bilateral medial and lateral discoid menisci. She also had anomalous insertion of discoid medial meniscus to anterior cruciate ligament, and pathologic medial patellar plica on the right knee. Meniscectomies has been performed for her torn discoid menisci with satisfactory result on the latest follow-up.
- Lateral Meniscus
- Medial Meniscus
- Left Knee
- Joint Space Widening
- Medial Tibial Plateau
In 1889, Young described a lateral discoid meniscus in a cadaver study , whereas medial discoid meniscus was reported at the first time by Cave and Staples in 1941 . However, up to recent years medial discoid meniscus cases were still very rarely reported. The first case of both medial and lateral discoid menisci in the same knee was reported by Jeannopolous in 1950 . Murdoch reported the first case of bilateral medial discoid menisci in 1956 [4, 5] and afterwards bilateral medial discoid menisci are extremely rarely reported [5–14]. We report a case of bilateral medial and lateral discoid menisci. The patient did well postoperatively after both medial menisci were excised in two separate operations.
On the last follow-up, seven years after the first operation and six months after the second operation, patient had no complaint and satisfied with the result. The radiological examination showed that left knee has apparent varus deformity. It could be due to the prior surgery.
Since Young reported a lateral discoid meniscus, many cases have been found. Discoid lateral meniscus is more common among Asians than that among Caucasians [15–17]. The incidence rate of discoid medial menisci reported was from 0.03% to 0.3% [6, 11]. By using MRI, it is now possible to diagnose meniscus condition noninvasively . Blacksin et al.  described the first case of bilateral discoid medial menisci diagnosed using MRI. Yanez-Acevedo reported a case of bilateral discoid lateral menisci and unilateral discoid medial menisci, thus three discoid menisci in an 11-year-old girl .
Dickason has reported the large series of 10 medial discoid menisci in which there was one 22-year-old man with bilateral massive discoid menisci . The incidence of discoid menisci is difficult to be estimated since the rate of asymptomatic patients is high. Yaniv and Blumberg cited that the incidence of discoid meniscus ranges from 0.4% to 17% for the lateral and 0.06% to 0.3% for the medial side.
Lateral discoid menisci with symptomatic tears are well-known lesions that are usually thought to affect mostly children and adolescent [7, 20]. It is also not common for a discoid meniscus to become symptomatic and present with a tear in adulthood [6, 7]. However, in the series of Dickason et al., 62% of the patients were older than 18 years of age . Akgun et al. reported bilateral discoid medial menisci in an adult patient .
Some papers reported bone changes with discoid medial meniscus [8, 21]. Atay et al. , reported the increased concavity of the medial tibial plateau of their bilateral discoid menisci case, and decreased signal intensity of the subchondral medial tibial epiphysis consistent with reactive sclerosis. Weiner et al. , reported depression of the medial tibial plateau followed by complete reformation of the depressed medial tibial plateau after meniscectomy. In our case, we found bilateral increased concavity of the medial tibial plateau, more clearly in the right side, and sclerotic of the right medial tibial plateau on anteroposterior and lateral radiological examination.
Patel believes that the discoid meniscus should be preserved if "severe symptoms are not present" . The technique used in the management included a careful resection of the menisci back to firm, longitudinal fibers . Senior author has described arthroscopic one-piece excision technique for the treatment of symptomatic lateral discoid meniscus .
The result depends on the amount of retained meniscal tissue, the associated lesions, the activity level of the individual, and the length of the follow-up . In general, the results of meniscectomy for discoid meniscus are good. Our patient also had no complain and she has satisfactory with the result of both of her surgeries. However a longer follow-up period is still needed since discoid meniscus has been reported as one of the risk factors for articular cartilage lesions [24, 25]. The duration of symptoms and meniscal shape showed significant relation with articular cartilage lesion .
Written informed consent was obtained from the patient for publication this case report and the images.
- Young RB, Cleland J, MacKay JY: The external semi-lunar cartilage as a complete disc. Memoirs and memoranda in anatomy. 1979, London, Williams and Norgate, 1: 179-80.Google Scholar
- Cave EF, Staples OS: Congenital discoid meniscus: A cause of internal impingement of the knee. Am J Surg. 1941, 54: 371-376. 10.1016/S0002-9610(41)90383-5.View ArticleGoogle Scholar
- Jeannopoulus CL: Observations on the discoid menisci. J Bone Joint Surg Am. 1950, 32: 649-652.Google Scholar
- Murdoch G: Congenital discoid medial semi-lunar cartilage. J Bone Joint Surg Br. 1956, 38: 564-566.PubMedGoogle Scholar
- Schonholtz GJ, Koenig TM, Prince A: Bilateral discoid medial menisci: a case report and literature review. Arthroscopy. 1993, 9: 315-317. 10.1016/S0749-8063(05)80427-X.View ArticlePubMedGoogle Scholar
- Dickason JM, Del Pizzo W, Blazina ME, Fox JM, Friedman MJ, Snyder SJ: A series of ten discoid medial menisci. Clin Orthop. 1982, 168: 75-79.PubMedGoogle Scholar
- Akgun I, Heybeli N, Bagatur E, Karadeniz N: Bilateral discoid medial menisci: an adult patient with symmetrical radial tears in both knees. Arthroscopy. 1998, 14: 512-517. 10.1016/S0749-8063(98)70082-9.View ArticlePubMedGoogle Scholar
- Atay OA, Doral MN, Aydingoz U, Leblebicioglu G: Bilateral discoid medial menisci: association with bone changes in the tibia. Knee Surg Sports Traumatol, Arthrosc. 2001, 9: 217-220. 10.1007/s001670100204.View ArticleGoogle Scholar
- Blacksin MF, Greene B, Botelho G: Bilateral diskoid medial menisci diagnosed by magnetic resonance imaging: a case report. Clin Orthop. 1992, 285: 214-216.PubMedGoogle Scholar
- Kim SJ, Choi CH: Bilateral complete discoid medial menisci combined with anomalous insertion and cyst formation: a case report. Arthroscopy. 1996, 12: 112-115. 10.1016/S0749-8063(96)90231-5.View ArticlePubMedGoogle Scholar
- Min BH, Ha HK, Khang SY: Medial discoid meniscus completely coalesced with the anterior cruciate ligament: a case report. Arthroscopy. 2001, 17: E27-10.1053/jars.2001.23589.View ArticlePubMedGoogle Scholar
- Narvekar A, Acharya A, Shroff M: Bilateral discoid medial menisci with abnormal attachment to the anterior cruciate ligament-a case report. Acta Orthop Scand. 1999, 70: 387-389. 10.3109/17453679908997829.View ArticlePubMedGoogle Scholar
- Pinar H, Akseki D, Karaoglan O, Karaoglan O, Ozkan M, Uluc E: Bilateral discoid medial menisci: a case report. Arthroscopy. 2000, 16: 96-101. 10.1016/S0749-8063(00)90135-X.View ArticlePubMedGoogle Scholar
- Tachibana Y, Yamazaki Y, Ninomiya S: Discoid medial meniscus: a case report. Arthroscopy. 2003, 19: E61-10.1016/S0749-8063(03)00688-1.View ArticleGoogle Scholar
- Choi NH, Kim NM, Kim HJ: Medial and lateral discoid meniscus in the same knee: case report. Arthroscopy. 2001, 17: E9-10.1053/jars.2001.19444.View ArticlePubMedGoogle Scholar
- Kim SJ, Kim DW, Min BH: Discoid lateral meniscus associated with anomalous insertion of the medial meniscus. Clin Orthop. 1995, 315: 234-237.PubMedGoogle Scholar
- Kim SJ, Lee YT, Kim DW: Intraarticular anatomic variants associated with discoid meniscus in Koreans. Clin Orthop. 1998, 356: 202-207. 10.1097/00003086-199811000-00027.View ArticlePubMedGoogle Scholar
- Silverman JM, Mink JH, Deutsch AL: Discoid menisci of the knee: MR imaging appearance. Radiology. 1989, 173: 351-354.View ArticlePubMedGoogle Scholar
- Yanez-Acevedo A: Bilateral discoid lateral menisci and unilateral discoid medial menisci: a case report. Arthroscopy. 2001, 17: 772-775. 10.1053/jars.2001.23585.View ArticlePubMedGoogle Scholar
- Berson BL, Hermann G: Torn discoid menisci of the knee in adults. J Bone Joint Surg Am. 1979, 61: 303-304.PubMedGoogle Scholar
- Weiner B, Rosenberg N: Discoid medial meniscus: association with bone changes in the tibia. J Bone Joint Surg Am. 1974, 56: 171-173.PubMedGoogle Scholar
- Patel D, Dimakopoulos P, Denoncourt P: Bucket handle tear of a discoid medial meniscus. Arthroscopic diagnosis-partial excision. A case report. Orthopedics. 1986, 9: 607-608.PubMedGoogle Scholar
- Kim SJ, Yoo JH, Kim HK: Arthroscopic one-piece excision technique for the treatment of symptomatic lateral discoid meniscus. Arthroscopy. 1996, 12: 752-755. 10.1016/S0749-8063(96)90183-8.View ArticlePubMedGoogle Scholar
- Ding J, Zhao J, He Y, Huangfu X, Zeng B: Risk factors for articular cartilage lesions in symptomatic discoid lateral meniscus. Arthroscopy. 2009, 25: 1423-1426. 10.1016/j.arthro.2009.06.024.View ArticlePubMedGoogle Scholar
- Adachi N, Ochi M, Deie M, Ito Y, Izuta Y: Lateral compartment osteoarthritis of the knee after meniscectomy treated by the transplantation of tissue-engineered cartilage and osteochondral plug. Arthroscopy. 2006, 22: 107-112. 10.1016/j.arthro.2005.10.019.View ArticlePubMedGoogle Scholar
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