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Mini-Athrotomy for Children with Lateral Discoid Menisci May Be Somewhat Better than Arthroscopy

Inside of your knee are are 2 pieces of cartilage (meniscus for one, menisci for more than one) that support and cushion the knee joint itself. Normally, they are a half-moon or C-shaped. The lateral meniscus, the one along the outside of the knee, and sometimes, the shape is more disc-like than curved and this can cause a popping sensation in the knee and pain in some people. In children, it can cause problems because the disc-shape is thicker than the C shape.

The authors of this study wanted to compare the results of a procedure called a mini-arthrotomy with one called arthroscopy. An arthrotomy is an open incision into the joint, while an arthroscopy uses very small incisions to insert long instruments and a camera, to do the surgery.

Researchers followed 40 children, who among them had 48 knees with lateral discoid meniscus. The children had either part or all of the meniscus removed by mini-athrotomy or arthroscopy. Seventeen children (20 knees) made up Group 1 (mini-arthrotomy) and 23 children (28 knees) made up group 2 (arthroscopy). Before surgery, the children had tried bracing the knee, restricting activities, and doing strengthening exercises. The surgery was done if the pain and popping or snapping didn't get better after trying these other treatments within six months, or earlier if the knee began to lock or there was persistent pain and swelling.

After the surgery, the patients were tested on their range of motion in their knee, limp, pain, stair climbing, and so on. X-rays and magnetic resonance images (MRIs) from before surgery were compared to those from after surgery.

The results showed that there weren't any outstanding differences between the two surgeries, although there was a slight advantage seen with the mini-arthrotomy. The authors suggested that this might be because of the small size of the joint, making it more difficult for the surgeon to see with the arthroscope and the mini-arthrotomy allows the surgeon to see the whole joint all at once.

References: Fabian Gotz Krause, MD et al. Mini-Arthrotomy for Lateral Discoid Menisci in Children. In Journal of Pediatric Orthopaedics. March 2009. Vol. 29. No. 2. Pp. 130 to 136.

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