Variation in Arthroscopic Treatment of Discoid Lateral Meniscus and Postoperative Restrictions in Children: Results of a Multicenter Meniscus Study Group Survey

Background: Because of congenital abnormal collagenous structures and peripheral attachments, discoid lateral meniscus (DLM) is often associated with tears and instability and a risk of premature compartmental articular degeneration. Typically, surgery is indicated for symptomatic patients. Several surgical techniques have been described in the literature, but no studies have examined surgeon variation. Purpose: To determine the intersurgeon agreement for DLM surgical planning and postoperative restriction after arthroscopic assessment. Study Design: Cross-sectional study. Methods: Sixteen orthopaedic surgeons from an international pediatric meniscus study group were shown 4 different videos of a DLM arthroscopic procedure. Each surgeon completed a survey for each arthroscopic video. The survey included questions about operative planning, such as peripheral rim preservation, repair and stabilization technique, and postoperative restrictions. Descriptive statistics were used to characterize the variables collected. Results: One of the 4 arthroscopic videos showed a complete discoid meniscus with no instability or tearing. For this specific meniscus, consensus was generally good, with 87.5% to 93.8% agreement for all the categories, except peripheral rim preservation, with 31.3% agreement. However, for the other 3 videos with tears and/or instability, consensus was generally low. Depending on the categories, the highest percentage of intersurgeon agreement varied between 25.0% and 62.5%, while being >50% only 2 of 27 times. Conclusion: Agreement regarding the surgical technique and postoperative rehabilitation among surgeons with experience in the treatment of DLM is poor in the event of tears and instability, which represent the greatest technical challenges with the most significant functional effect. Given the relative rarity of the condition and the implications on a child's long-term joint health, prospective, comparative multicenter studies regarding treatment algorithms and outcomes are warranted.