Arthroscopic Saucerization and Repair of the Lateral Discoid Meniscus

Abstract

Surgical treatment of the symptomatic discoid lateral meniscus has undergone a paradigm shift since recognition of the development of accelerated osteoarthritis with subtotal meniscectomies. Current strategies have shifted towards meniscus preservation, and meniscoplasty is considered the gold standard treatment. Meniscoplasty with saucerization of the meniscus recreates the standard crescent shape for improved shock absorption, load transmission, and joint stability. As the discoid lateral meniscus is also associated with intrasubstance degeneration and meniscus tears, concomitant meniscus repair should be performed in line with efforts for meniscus preservation. In this manuscript, we detail our saucerization technique, considerations for meniscus repair, and tips to achieve a successful outcome. Key Concepts: • The discoid lateral meniscus should be judiciously assessed during arthroscopy as symptoms from the discoid lateral meniscus can be due to hypermobility or from tears. • Meniscus saucerization should retain 8 mm of residual peripheral meniscus for function preservation for good mid- to long-term outcomes. • Meniscus repair should be used to address tears and instability in the discoid lateral meniscus. • Repair of the posterior horn of the lateral meniscus must be performed cautiously when using the all-inside repair device via the anterolateral portal due to proximity of the device to posterior neurovascular structures, especially in the small pediatric knee. • Meniscus-based sutures can be used to treat horizontal tears associated with intrasubstance degeneration in children and adolescents.