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Discoid meniscus

Dr Andrew Dixon ◉ and A.Prof Frank Gaillard ◉ ◈ et al.

Discoid menisci are those that have a body that is too wide, usually affecting the lateral meniscus. They are incidentally found in 3-5% of knee MRI examinations.

On this page:

Article:

Epidemiology
Clinical presentation
Pathology
Radiographic features
Treatment and prognosis
Related articles
References

Images:

Cases and figures

Epidemiology

Discoid menisci are congenital, frequently bilateral (up to 50%) and have been reported in twins, although no genetic locus has been identified ². There is a higher prevalence in Asians without any gender predilection ⁷. Lateral discoid meniscus is far more common than medial discoid meniscus, with the latter being rare.

Clinical presentation

Although frequently asymptomatic, discoid menisci are prone to cystic degeneration with subsequent tear. Clinical presentation may therefore be either incidental or with pain, locking or a 'clunk'.

Pathology

Discoid menisci have decreased collagen fibers and loss of normal collagen orientation, which predisposes them to intrameniscal mucoid degeneration ⁷.

Classification

Classification is based on the degree of peripheral attachments to the tibial plateau, and the shape of the meniscus itself:

complete vs incomplete
- 80% coverage of the tibial plateau is often used as the cut-off between incomplete and complete ⁷
stable vs unstable
- stable: normal peripheral attachments with an intact posterior meniscofemoral ligament
- unstable (also known as a Wrisberg variant): lack or tear of a posterior meniscocapsular (in particular meniscopopliteal) ligaments with an attachment only from the meniscofemoral ligament of Wrisberg ⁴
anterior or posterior mega horn

Radiographic features

Plain radiograph

Radiographs may well suggest the diagnosis with the widening of the lateral joint space and cupping of the lateral tibial plateau, which is normally flat or even slightly convex. Additionally, there may be associated hypoplasia of the lateral tibial spine.

MRI

On coronal imaging, a meniscal body width of 15 mm or more is typically considered diagnostic of discoid morphology. Alternatively, a ratio of the minimal meniscal width to the maximal tibial width of more than 20% may be used ^7,8.

On sagittal imaging, the body of the lateral meniscus is normally only seen on two adjacent slices. A discoid meniscus is usually present if the meniscal body is seen on three or more standard sagittal slices - the opposite of the absent bow tie sign.

Treatment and prognosis

Ideally, the meniscus is preserved with conservative management. If this is unsuccessful, then partial or total resection may be carried out.

Complications

meniscal tears
intrasubstance mucinous degeneration
early bony degenerative change

Quiz questions

References

Anatomy: Lower limb

skeleton of the lower limb
joints
- hip joint
  - ligaments
  - additional structures
  - ossification centers
- knee joint
- tibiofibular joints
  - proximal tibiofibular joint
  - distal tibiofibular syndesmosis
- ankle joint
  - regional anatomy
    - medial ankle
    - lateral ankle
    - anterior ankle
  - ligaments
    - medial collateral (deltoid) ligament
    - lateral collateral ligament
    - additional structures
    - ankle bursae
      - retrocalcaneal bursa
      - subcutaneous calcaneal bursa
    - ossification centers of the ankle
  - variants
    - ball and socket ankle joint
- foot joints
  - subtalar joint
    - articulations
      - talocalcaneal joint
    - ligaments
    - associated structures
  - mid-tarsal (Chopart) joint
    - talonavicular joint
    - calcaneocuboid joint
  - tarsometatarsal (Lisfranc) joint
    - ligaments
      - Lisfranc ligament
  - intermetatarsal joint
  - metatarsophalangeal joint
  - interphalangeal joint
spaces of the lower limb
- adductor canal
- femoral sheath
  - femoral canal
    - femoral ring
- femoral triangle (contents mnemonic | boundaries mnemonic)
- foot subdivisions
- popliteal fossa (mnemonic)
- tarsal tunnel (mnemonic)
- triangular space of cruciate ligaments
muscles of the lower limb
- muscles of the pelvic group
  - inner hip group
    - iliopsoas muscle
  - gluteal region
    - gluteal muscles
    - tensor fasciae latae muscle
  - lateral rotator group
- muscles of the thigh
- muscles of the leg
  - anterior compartment of the leg
  - posterior compartments of the leg
    - superficial posterior compartment of the leg (calf)
      - triceps surae
        
        medial and lateral heads of the gastrocnemius muscle
        
        soleus muscle
        accessory soleus muscle
      - plantaris muscle
      - calcaneal tendon
    - deep posterior compartment of the leg
  - lateral compartment of the leg
    - peroneus brevis muscle
    - peroneus longus muscle
- muscles of the foot
  - dorsal muscles
    - extensor hallucis brevis muscle
    - extensor digitorum brevis muscle
  - plantar muscles
    - 1st layer
    - 2nd layer
      - quadratus plantae muscle
      - lumbrical muscles
    - 3rd layer
    - 4th layer
      - dorsal interossei muscles
      - plantar interossei muscles
- accessory muscles
  - accessory peroneal muscles
vascular supply
- arterial supply of the lower limb
- venous drainage of the lower limb
  - deep system
    - common femoral vein
      - femoral vein
        
        deep femoral vein
        
        popliteal vein
        
        peroneal vein
        
        posterior tibial vein
        
        anterior tibial vein
  - superficial system
    - great saphenous vein
      - dorsal venous plexus
    - small saphenous vein
      - vein of Giacomini
innervation of the lower limb
- lumbar plexus (mnemonic)
  - femoral nerve
    - saphenous nerve
  - obturator nerve
- sacral plexus
  - sciatic nerve (motor distribution)
    - common peroneal nerve
      - superficial peroneal nerve
      - deep peroneal nerve
    - tibial nerve
lymphatics

Article information

rID: 1226

System: Musculoskeletal

Section: Anatomy

Tag: knee, variant

Synonyms or Alternate Spellings:

Discoid menisci

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Cases and figures

Case 1: STIR coronalCase 1: STIR coronal

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Case 2Case 2

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Case 3: coronal PDCase 3: coronal PD

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Case 4 Case 4

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Case 5: with tearCase 5: with tear

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Case 6Case 6

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Case 7Case 7

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