Discoid meniscus

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Discoid lateral meniscus Scheibenmeniscus.svg
Discoid lateral meniscus

Discoid meniscus is a rare human anatomic variant that usually affects the lateral meniscus of the knee. Usually a person with this anomaly has no complaints; however, it may present as pain, swelling, or a snapping sound heard from the affected knee. Strong suggestive findings on magnetic resonance imaging includes a thickened meniscal body seen on more than two contiguous sagittal slices.

Contents

Description

Photograph of a congenital discoid menisci specimen from the University of Cape Town Pathology Learning Centre teaching collection. CONGENITAL DISCOID MENISCI.jpg
Photograph of a congenital discoid menisci specimen from the University of Cape Town Pathology Learning Centre teaching collection.

The Watanabe classification of discoid lateral meniscus is: (A) Incomplete, (B) Complete, and C) Wrisberg-ligament variant [1] Normally, the meniscus is a thin crescent-shaped piece of cartilage that lies between the weight bearing joint surfaces of the femur and the tibia. It is attached to the lining of the knee joint along its periphery and serves to absorb about a third of the impact load that the joint cartilage surface sees and also provides some degree of stabilization for the knee. There are two menisci in the knee joint, with one on the outside (away from midline) being the lateral meniscus and the inner one (towards midline) the medial meniscus. A discoid meniscus is a congenital anomaly of the knee found in 3% of the population (up to 15% in Asia). It typically affects the lateral meniscus and may be found bilaterally (20%). Instead of the narrow crescent shape, as seen in a normal meniscus above, a discoid meniscus is thickened, and has a fuller crescent shape. In addition, a discoid meniscus does not taper as much towards the center of the joint and is shaped like a disc. The thickness of the meniscus, its diminished vascular blood supply, and in some instances, weak capsular attachment, makes it more prone to tears compared to a normal meniscus. The anomaly in itself is asymptomatic; however, a tear of the meniscus can result in pain, swelling, and snapping in the affected knee. The orthopedic classification of discoid menisci includes: complete, incomplete or Wrisberg-ligament types as depicted here. Coverage of the lateral tibial plateau determines the designation of complete or incomplete. The Wrisberg-ligament type has an abnormal posterior attachment by attaching to part of the posterior cruciate ligament.


Symptoms

Symptom is usually pain in the knee. And when the knee is bent or stretched it makes the sound of bouncing bones.

Diagnosis

Discoid meniscus on coronal proton-density weighted MRI Scheibenmeniskus MRT PDW cor.jpg
Discoid meniscus on coronal proton-density weighted MRI

The transverse diameter of a normal meniscus is approximately 10 to 11 mm; therefore a normal meniscus body will be visible on only 2 slices of a MR with 4-5-mm sagittal slices. A discoid meniscus should be considered if more than two contiguous body segments are present. However, this method may lead to a false negative when evaluating people with the Wrisberg variant of discoid meniscus since it maintains a narrow crescent shape. Coronal and radial images of the meniscus are useful to demonstrate the extension of the aberrant meniscus into the joint as seen here. On coronal images, it is diagnosed when the horizontal measurement between the free margin and the periphery of the body is more than 1.4 cm. [2] Rarely, X-ray may show lateral joint space widening, squaring of the lateral condyle, cupping of the lateral tibial plateau and hypoplasia of the lateral tibial spine that suggest discoid meniscus.


Treatment/Management

In a patient complaining of acute onset knee pain, an X-ray study would be done to rule out any bony pathology such as a fracture. Since it is difficult to diagnose meniscal anomalies with X-ray, an MRI would be necessary to visualize the discoid meniscus. If the patient is asymptomatic and does not complain of significant locking sensation in the knee or pain, treatment is conservative and consists of stretching and strengthening exercises for the quadriceps and hamstring muscles. “In cases where there is significant disability, surgical excision may be needed. When the discoid meniscus is severely damaged, total excision of the meniscus may be necessary. In most cases where the meniscus is still generally intact, a partial excision to preserve the cushioning function may be sufficient.” [3]

See also

Related Research Articles

Knee Region around the kneecap

In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia, and one between the femur and patella. It is the largest joint in the human body. The knee is a modified hinge joint, which permits flexion and extension as well as slight internal and external rotation. The knee is vulnerable to injury and to the development of osteoarthritis.

Tibia Long bone of the lower leg

The tibia, also known as the shinbone or shankbone, is the larger, stronger, and anterior (frontal) of the two bones in the leg below the knee in vertebrates, and it connects the knee with the ankle bones. The tibia is found on the medial side of the leg next to the fibula and closer to the median plane or centre-line. The tibia is connected to the fibula by the interosseous membrane of leg, forming a type of fibrous joint called a syndesmosis with very little movement. The tibia is named for the flute tibia. It is the second largest bone in the human body next to the femur. The leg bones are the strongest long bones as they support the rest of the body.

Posterior cruciate ligament One of four major ligaments of the knee

The posterior cruciate ligament (PCL) is a ligament in each knee of humans and various other animals. It works as a counterpart to the anterior cruciate ligament (ACL). It connects the posterior intercondylar area of the tibia to the medial condyle of the femur. This configuration allows the PCL to resist forces pushing the tibia posteriorly relative to the femur.

Bakers cyst Medical condition

A Baker's cyst, also known as a popliteal cyst, is a type of fluid collection behind the knee. Often there are no symptoms. If symptoms do occur these may include swelling and pain behind the knee, or knee stiffness. If the cyst breaks open, pain may significantly increase with swelling of the calf. Rarely complications such as deep vein thrombosis, peripheral neuropathy, ischemia, or compartment syndrome may occur.

Meniscal cyst is a well-defined cystic lesion located along the peripheral margin of the meniscus, a part of the knee, nearly always associated with horizontal meniscal tears.

Meniscus (anatomy) Fibrocartilaginous part of a bone joint

A meniscus is a crescent-shaped fibrocartilaginous anatomical structure that, in contrast to an articular disc, only partly divides a joint cavity. In humans they are present in the knee, wrist, acromioclavicular, sternoclavicular, and temporomandibular joints; in other animals they may be present in other joints.

The Apley grind test or Apley test is used to evaluate individuals for problems in the meniscus of the knee. The Apley grind test has a reported sensitivity of 97% and a specificity of 87%.

A meniscus transplant or meniscal transplant is a transplant of the meniscus of the knee, which separates the thigh bone (femur) from the lower leg bone (tibia). The worn or damaged meniscus is removed and is replaced with a new one from a donor. The meniscus to be transplanted is taken from a cadaver, and, as such, is known as an allograft. Meniscal transplantation is technically difficult, as it must be sized accurately for each person, positioned properly and secured to the tibial plateau. As of 2012, only a few surgeons have significant volume of experience in meniscus transplantation worldwide.

Medial meniscus

The medial meniscus is a fibrocartilage semicircular band that spans the knee joint medially, located between the medial condyle of the femur and the medial condyle of the tibia. It is also referred to as the internal semilunar fibrocartilage. The medial meniscus has more of a crescent shape while the lateral meniscus is more circular. The anterior aspects of both menisci are connected by the transverse ligament. It is a common site of injury, especially if the knee is twisted.

Lateral meniscus

The lateral meniscus is a fibrocartilaginous band that spans the lateral side of the interior of the knee joint. It is one of two menisci of the knee, the other being the medial meniscus. It is nearly circular and covers a larger portion of the articular surface than the medial. It can occasionally be injured or torn by twisting the knee or applying direct force, as seen in contact sports.

The knee examination, in medicine and physiotherapy, is performed as part of a physical examination, or when a patient presents with knee pain or a history that suggests a pathology of the knee joint.

Stifle joint

The stifle joint is a complex joint in the hind limbs of quadruped mammals such as the sheep, horse or dog. It is the equivalent of the human knee and is often the largest synovial joint in the animal's body. The stifle joint joins three bones: the femur, patella, and tibia. The joint consists of three smaller ones: the femoropatellar joint, medial femorotibial joint, and lateral femorotibial joint.

Lower extremity of femur

The lower extremity of femur is the lower end of the femur in human and other animals, closer to the knee. It is larger than the upper extremity of femur, is somewhat cuboid in form, but its transverse diameter is greater than its antero-posterior; it consists of two oblong eminences known as the lateral condyle and medial condyle.

Meniscal cartilage replacement therapy

Meniscal cartilage replacement therapy is surgical replacement of the meniscus of the knee as a treatment for where the meniscus is so damaged that it would otherwise need to be removed.

Unhappy triad Medical condition of the knee

The unhappy triad, also known as a blown knee among other names, is an injury to the anterior cruciate ligament, medial collateral ligament, and meniscus. Analysis during the 1990s indicated that this 'classic' O'Donoghue triad is actually an unusual clinical entity among athletes with knee injuries. Some authors mistakenly believe that in this type of injury, "combined anterior cruciate and medial collateral ligament disruptions that were incurred during athletic endeavors" always present with concomitant medial meniscus injury. However, the 1990 analysis showed that lateral meniscus tears are more common than medial meniscus tears in conjunction with sprains of the ACL.

Coronary ligament of the knee

The coronary ligaments of the knee are portions of the joint capsule which connect the inferior edges of the fibrocartilaginous menisci to the periphery of the tibial plateaus.

Posterior meniscofemoral ligament

The Posterior meniscofemoral ligament is a small fibrous band of the knee joint. It attaches to the posterior area of the lateral meniscus and crosses superiorly and medially behind the posterior cruciate ligament to attach to the medial condyle of the femur.

Meniscus tear Rupturing of the fibrocartilage strips in the knee called menisci

A tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee called menisci. When doctors and patients refer to "torn cartilage" in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae. Menisci can be torn during innocuous activities such as walking or squatting. They can also be torn by traumatic force encountered in sports or other forms of physical exertion. The traumatic action is most often a twisting movement at the knee while the leg is bent. In older adults, the meniscus can be damaged following prolonged 'wear and tear'. Especially acute injuries can lead to displaced tears which can cause mechanical symptoms such as clicking, catching, or locking during motion of the joint. The joint will be in pain when in use, but when there is no load, the pain goes away.

Transverse ligament of knee

The transverse or [anterior] meniscomeniscal ligament is a ligament in the knee joint that connects the anterior convex margin of the lateral meniscus to the anterior end of the medial meniscus.

The pivot-shift test is one of the three major tests for assessing anterior cruciate injury or laxity, the other two being the anterior drawer and Lachman test. However, unlike the other two, it tests for instability, an important determinant as to how the knee will function. In fact, it is instability, not simply the injury to the anterior cruciate ligament itself, that places the menisci at future risk, and gives rise to the feeling that the "knee is not secure" or "may give out".

References

  1. Neuschwander DC, Dres D, Finney TP:"Lateral meniscal variant with absence of the posterior coronary ligament". Journal of Bone and Joint Surgery American, 1992;74: 1186-1190.
  2. Weissleder, et al.:"Primer of Diagnostic Imaging", Mosby editions, 2003
  3. "Orthoseek | Orthopedic Topics | Discoid Meniscus".