The Observation Of Arthroscopic Meniscoplasty Combined With Menascorrhaphy For The Treatment Of Complete Type Of Discoid Meniscus Injury

Background and objectiveDiscoid meniscus is a rare dysplasia of the internal structures of the joint, which is named for the meniscus is thickened and enlarged to be discoid abnormally to a disk shape.And it is easy to rupture caused by the anomalous structural tissue, deformities and the blood supply lacking. At the same time, meniscus will also lead to a lot of clinical symptoms and function changes.The incidence of the two knees are similar, and the attack is usually in bilateral. When the dysplasia happens,the lateral one is common while the interior one is rare, and the teenagers are always the high risk group. Discoid meniscus can be divided into three types, complete type of discoid meniscus, incomplete type and Wrisberg ligament type. They can be diagnosed based on the clinic characteristics and MRI. After the final diagnosis of injury discoid meniscus, surgical treatment is the only reliable method to avoid the joint mobility and decreasing the occurrence of traumatic arthritis. The complete type of discoid meniscus is actually a disc, and the inside part where is big and fat is existing and the thickness of its inner and outer side have little difference so that can make a separation of the femur and tibia. The layer-crack would usually happen after the complete type of discoid meniscus got injury with the tear of the other part. What is worse, there were a few cases in which the patients got the rupture on front and back rake. The complete type of discoid meniscus injury is a problem during the treatment. And the discoid meniscus injury is the common angioplasty which could not remove the clinical symbols and could be stitched difficultly. And it always refers to the discoid meniscus (DM) which is complete in front but lamina tearing in the middle and back. At the same time, the breakage would happen in the ventral horn and(or) the dorsal horn,with the tearing in the other sites.According to the formal clinic practice, Arthroscopy has been the most optimal therapy for the injury of discoid meniscus and can benefit the knee joint. However, it will cause unstable of joint and also will speed up the degeneration of the cartilage. What is worse, it will cause the osteoarthritis. Thus with the development and improvement of the medical technology, the arthroscopic meniscoplasty combined with menascorrhaphy would take the place of the subtotal resection.We explore the result of the meniscoplasty combined with menascorrhaphy under the arthroscope to treat discoid meniscus. This kind of treatment which is under arthroscope can not only keep the biological function of the meniscus to the best,but also can make knee mechanics restored to normal, and the the clinical outcome reach to satisfaction. Thus, arthroscopic meniscoplasty Combined with menascorrhaphy to treat discoid meniscus is an effective one to treat the discoid meniscus.Objects and methodsA total of56complete type of injury discoid meniscus patients that had been treated with of symptomatic treatment in the orthopedics in First Affiliated Hospital, Zhengzhou University from July2007to July2012. Based on the surgery options, these patients are divided into2groups, which are experiment group and control group. In group Ⅰ(experiment group), there are28patients were operated by angioplasty with neoplasty and suture repair under the arthroscope and the number of male is16, and female is12, the age range3to28, the average age is18. And14right knees cases and14left were involved. Then the other28patients in group Ⅱ(control group), volunteered to get the subtotal resection. Those patients include15males and 13females. The mean age was17(range4-29years).11of the patients happened on right knee and17on the left.The patients from different group have the differences on age, gender, symptoms and so on. All of them were all lateral discoid meniscus and the patients all got pain in intra-knee as well. At the same time, the Mcmurray signs of them all read positive.Beside that,27of them are snapping, and there are26of them got the secondary interlocking,15of them got the ankle swelling,6were restricted with their extense function of knee joint,6felt pain when bent,3patients had quadriceps femoral’s atrophic and1lameness were noted in the case in group I. The patients were followed up for8to16months; a mean time was12month. The patients were evaluated for pain, swelling, snap, interlock, activities and rehabilitation of the patients. Observe the postoperative short-term curative effect which was evaluated by Lysholm and IKDC. The result of the surgical treatment is analyzed. The statistics are processed by statistical analysis software SPSS16.0.ResultsAll56patients were successfully be followed up, and all patients were diagnosed as having discoid meniscus. Among the patients in group I, there were6patients’ knee joint synovial got terrible hyperplasia, front layer crack of the meniscus happened on9cases, and10patients got the layer crack on the outer-rear meniscus, and9patiences got complete crack. Beside that,the number of barrels pie tear is6,anterior angle tear is7and relief angle is5and both anterior and relief is10in group I. There were8patients’ knee joint synovial got terrible hyperplasia, front layer crack of the meniscus happened on8cases, and11patients got the layer crack on the outer-rear meniscus, and9patiences got complete crack. The number of barrels pie tear is7, anterior angle tear is5and relief angle is6and both anterior and relief is11in group II. There’s no statistical difference between experiment group and control group observing the injury situation under the arthroscope. When had follow-up visit3month after the surgery, the28patients who were operated by meniscoplasty combined with menascorrhaphy under arthroscope to treat discoid meniscus, there were slight pain and discomfort in1cases and swelling in3cases, knee joint motivation limitation in5cases, Then the patient was relaxed by anesthesia, at the same time,the CPM was used for the functional exercise of knee joint to get recovery. Also2case was noted by quadriceps femoral’s atrophic. Meanwhile,28patients who got the subtotal resection,there were2having slight space pain on knee joint,4were swell, one quadriceps femoral’s atrophic and no patients got the move limitation or discomfort in the knee joint. The last follow-up, the28patients who were operated by arthroscopic meniscoplasty combined with menascorrhaphy to treat discoid meniscus, there were slight pain and discomfort and swelling in1cases, no patients was noted by knee joint motivation limitation and quadriceps femoral’s atrophic. As to the other28patients who got the subtotal resection, there was one cases on slight swelling and2cases on joint pain, no patients got the quadriceps femoral’s atrophic,move limitation or discomfort in the knee joint. All the patients’ activities reach110. For the patients who were operated by meniscoplasty combined with menascorrhaphy under arthroscope to treat discoid meniscus, the Lysholm scores ascended from (45.21±3.91) to (82.93±2.54)3months after the surgery, and (90.75±2.66)6months later,(91.32±2.87)12months later. For the patients who took the subtotal resection, the Lysholm scores ascended from (45.89±3.54) to (90.64±2.64)3months after the surgery, and (90.89±2.56)6months later,(91.14±2.49)12months later. Using SPSS16.0software by matching1test analysis, arthroscopic neoplasty and suture, P>0.05with no difference before the surgery and P<0.05with a difference3months after the surgery; P>0.05with no difference6and12months after the surgery. To make a comparative single factor variance analysis, for the first kind of surgery,6months and12months later surgery have no difference (P=0.484). Differences of the first surgery and the second surgery were found between groups. In the second surgery, there is no difference in two groups among3,6,12months later the surgery (P=0.743, P=0.143, P=0.511). If compare with the pre-surgery, there is differenceConclusionCompared with the traditionary the subtotal resection, arthroscopic surgery for neoplasty and suture can improve the knee function effectively and alleviate symptom obviously. It is a good way to recover the knees with fewer traumas, faster recovery, and lower cost to treat the complete type of discoid meniscus.The result of knee flexibility improvement and the recovery of the whole function satisfy people in the early time after surgery and also can avoid the biology change of the knees that caused by the traditional surgery. Thus, it is regarded as the effective treatment of the complete type of discoid meniscus.