運動醫(yī)學未翻

Doesdiscoidmedialmeniscusaffectlowerlimbalignment?Dr.AhmedWaly,MDAlexandriaUniversityVeryRareAnomaly1956Murdochbilateralmedialdiscoidmenisci1950Jeannopolousmedialandlateraldiscoidinthesameknee1941CaveandStaplesmedialdiscoidmeniscusYoung

lateraldiscoidmeniscus1889Becauseofitsthickness,themeniscusmaybreakdowninmidsubstance,producingahorizontalcleavagetear.PathologyCompressionstrainRotatorystrainAnteroposteriorstrainClinicalPictureStableUnstableTearNosymptomsValgoidkneeFlexiondeformitySnappingkneeLockedkneeMedialpainEffusionlockingAccordingtoAHMMinsertion:Anteriorcruciateligament(ACL)typeTransverseligamenttypeCoronaryligamenttypeInfrapatellarfoldtypeClassificationAccordingtoShape:CompletepleteUnstable10%onlyEnlargedmedialfemorotibialjointlineCuppingofthemedialtibialplateauXraySagittal:continuitybetweentheanteriorandposteriorhornson3consecutive5mmsagittalslicesCoronal:showinganabnormallythickmeniscus,sometimesextendingasfarastheintercondylargrooveMRIisthebestmeansofconfirmingdiagnosisandexploringforassociatedmeniscallesionsBilaterallityMedialplicaDepressionofthetibialplateauMeniscalcystDiscoidlateralmeniscusonthesameknee.AssociatedPathologyThemostfrequentanomaliesareassociatedwithanomalousinsertionoftheACL(ACLtype)SurgicalindicationsOnlysymptomaticlesionsshouldbeoperatedonModesoftreatmentTotalmeniscectomyPartialmeniscectomyMeniscoplasty=routinepartialmeniscectomy+reshapethemeniscustorestoreasemilunarshapeTreatmentMenisectomyorMeniscoplastyrestoresemilunarmeniscuswithhomogenousstressdistribution.Howeveritisnotanormalmeniscus,itremainsthickandliabletosnappingandtear…..DoesDiscoidMedialDifferThanLateral?MedialTearseasilybecauseit’sthicker,largerandmorefixedMedialassociatedwithbothsagittalandcoronalplanedeformitiesbecauseit’smorethickSnappingmorecommonwithlateralbecauseitismoremobileThepresentstudyreportsourexperienceinaseriesofSEVENkneeswithsymptomaticdiscoidmedialmeniscus.InallofthemcoronalandsagittalalignmentwerecalculatedbeforeandafterMeniscoplasty.AIMOFTHESTUDY7kneesin5patients(4male,1female)Meanageof15.5years(range,13to19yrs.)LysholmscoreMeanfollow-upof13months(range,9to22months)

prospectivecaseseriesstudiesAllpatientshadvalgoidkneedeformitybetween2-7.5degrees.Therewasaflexiondeformitybetween5-12degrees.Patientsandmethods

Case1Case2Case3Case4Case5GenderMaleMaleFemaleMaleMaleSideaffectedRtBilateralLtBilateralLtAge191314.51615Valgusdeformity56.76.772.32.55.5Flexiondeformity966125510Tenderjointline+++++++Effusion+--+++-Timebetweendiagnosis&op3m2m2.5m20days4m5m3mMMtearCentralcleavageCentralcleavageCentralcleavageCentralcleavageCentralcleavageCentralcleavageCentralcleavageLysolumscore69565654656563AssociatedMedialplica--Medialplica&hypertrophiedfatpadMedialplicaMedialplica-AHMMblendwithACLACLACLIntermeniscalligamentACLACLACLPlainweight-bearingX-rays:IncreasemedialjointspaceWholelowerlimbscanogram:ValgusFTAinallcases.From2-7.5degreesMRIfound:Torncompletediscoidmedialmeniscus(cleavagetear)inthesevenknees,InallcaseslateralmeniscuswasnormalPatientsandmethodsSurgery:MeniscoplastyRemovingcentralpartandconservingtheperipheralpart(atleast6-8mm)ofthemeniscus,soastorestoreasemilunarshape.Anyunstablemeniscalfragmentsweredissected.Completeweight-bearingwasallowed.Afteronemonthfollow-up,afulllimbscanogramwasdonetoassessmechanicalaxisdeviationandvalgusdeformity.PatientsandmethodsResultsValgusdeformityFlexiondeformityLysholmscoreSIGNIFICANTIMPROVEMENTfrommeanof6.3degreesto0degreesPOComplicationsSIGNIFICANTIMPROVEMENTfrommeanof7.5degreesto0degreesPOSIGNIFICANTIMPROVEMENTfrommeanof64pointsto93pointsPONOcomplications13yoldmaleBilateraldiscoidmedialmeniscusBilateralvalgoidkneeBilateralflexiondeformityCase1Bilatvalgus6.7degFlexdeformitybilat6degLysholmscore56preopCase1Case1videoLtsideoperated:

NoflexiondeformityNovalgusLysholmscore94Rtside:residualFD6deg,valgus6.7degCase116ymaleBilateraldiscoidmedialmeniscusBilateralvalgusdeformity2.3and2.5degreesBilateralflexiondeformityof5degreesTenderjointlineandkneeeffusionCase2BilateralcentralcleavagetearAssociatedmedialplicabilaterallyAHMMwereattachedtoACLbilaterallyCase2