Young Children with a Bucket-Handle Tear to the Discoid Lateral Meniscus Successfully Treated Using Arthroscopic Saucerization and Repair: Two Case Reports

Abstract

Observations of a symptomatic discoid lateral meniscus in young children are infrequent. The objective of this report was to demonstrate the use of arthroscopic saucerization and repair for treating a bucket-handle tear of a lateral discoid meniscus in two young children. Two young children (a 28-month-old girl and a 5-year-old boy) presented with a bucket-handle tear of the complete type lateral discoid meniscus. Both patients received arthroscopic saucerization and repair. A full knee extension under a long leg cast was applied for one month after surgery. The two patients were able to achieve a full range of motion of their operated knees without limping or presenting an antalgic gait at the third month after surgery. Both patients and their parents felt satisfied with the treatment at the 2- and 3-year follow-ups, respectively. Our results demonstrated that arthroscopic saucerization and repair seems to be an effective treatment for bucket-handle tears of the lateral discoid meniscus in young children-even those younger than 3 years old. We reported the youngest case (a 28-month-old girl) in comparison with the findings from a literature review.

Keywords: arthroscopy; bucket-handle tear; discoid meniscus; meniscus repairment; saucerization.

Figure 1

Preoperative MRI of the affected knees for the two cases. (A) coronal and (B) sagittal planes for the case of the 28-month-old girl. (C) coronal and (D) sagittal planes for the case of the 5-year-old boy. Both lateral menisci revealed increased thickness and flattening, loss of the natural bow-tie configuration, and a peripheral tear in the posterior horn. The white arrow indicates the peripheral tear site. MRI: magnetic resonance imaging.

Figure 2

Arthroscopic findings for the 28-month-old toddler. A complete discoid lateral meniscus was found after reduction (A). A bucket-handle tear to the lateral meniscus was repaired by employing inside-out techniques using No. 0 PDS II sutures (Ethicon, Johnson & Johnson, Somerville, MA, USA) after saucerization (B). A—anterior cruciate ligament; T—lateral tibial plateau; F—lateral femoral condyle; *—lateral meniscus; black arrow—meniscus repaired using No. 0 PDS II sutures.

Figure 3

MRI of the affected knees for the two cases at the 6-month follow-up. (A) coronal and (B) sagittal planes for the case of the 28-month girl. (C) coronal and (D) sagittal planes for the case of the 5-year-old boy. A triangular lateral meniscus without a retear was found in both cases. MRI—magnetic resonance imaging.