total disc meniscectomy

Discoid meniscus total resection is used for the treatment of congenital discoid meniscus. The discoid meniscus is a rare form of meniscus malformation with an incidence of approximately 1% of the lateral discoid meniscus and a medial incidence of 0 to 0.3%. According to Watanabed's classification method, the outer discoid meniscus is divided into a complete type, an incomplete type and a Wrisberg type according to the extent of the lateral tibial plateau and the presence or absence of a normal posterior meniscus attachment. Complete and incomplete, common, disc-shaped, with a posterior tibial attachment of the meniscus. Wrisberg ligament-type meniscus, no posterior tibial attachment, only the meniscus-femoral ligament (Wrisberg ligament) connection, this type of meniscus can be disc-shaped, or not disc-shaped. A well-attached complete or incomplete disc-shaped meniscus tear is best treated with subtotal meniscectomy or active debris discectomy. After the sick child removes the symptomatic meniscus, the blood supply in the immature meniscus can be increased. With the growth and development, the residual meniscus edge can adapt to change, eventually producing a stable, healthy and functional half moon. board. For the Wrisberg ligament-type discoid meniscus, due to the lack of posterior tibial attachment, a full meniscus resection should be performed. If only a full meniscus is removed, the remaining unstable meniscus edge will cause clinical symptoms. Rosenberg et al introduced a case of Wrisberg ligament-type discoid meniscus. After undergoing arthroscopic discectomy, the marginal attachment was reconstructed. After 12 months, arthroscopy was healed. The short-term effect was satisfactory due to follow-up. Short time, it is not certain whether this method can be an ideal alternative to meniscus total resection for children. The operation of the discoid meniscus is a good choice through arthroscopic techniques. If the physician does not have the arthroscopic meniscus resection technique, or has no arthroscopic equipment, open distal joint surgery can also achieve better long-term results. Treating diseases: meniscus injury Indication Discoid meniscus total resection is suitable for unstable congenital discoid meniscus (Wrisberg ligament type). Contraindications Stable, complete, incomplete congenital discoid meniscus. Preoperative preparation Regular preoperative examination. Surgical procedure Bruser anterolateral approach surgery: 1. The knee is fully flexed so that the foot is placed on the operating table. The skin incision, which originates from the patellar ligament, is laterally outward along the joint space and ends at the line connecting the proximal tibia and the lateral femoral condyle. Cut the subcutaneous tissue of the skin. When the knee is fully flexed, the direction of the tendon bundle should be parallel to the incision and the tendon bundle is cut along the fiber direction. 2. The traction of the lateral collateral ligament is revealed to protect the lateral inferior genicular artery between the temporal collateral ligament and the posterolateral aspect of the meniscus. The synovium was dissected and the tibia was retracted to the midline with a meniscus retractor. The lateral meniscus was seen, and the first 1/3 of the lateral meniscus was dissected with a small scalpel, and then clamped with Martin cartilage forceps. The front of the free meniscus was continuously pulled, and the mid-1/3 of the meniscus was freed from the attachment of the joint capsule at its edge with a meniscus resection knife. Care should be taken when separating the posterior horn of the meniscus, as the diaphragm is here to pass between the meniscus edge and the joint capsule. Cutting the diaphragm tendon may result in severe knee instability. Pull the front of the meniscus, ring free lateral meniscus to the diaphragmatic hole. 3. Bend your knees and place your foot on the opposite knee to apply the varus stress firmly. In this position, the lateral joint space can usually be enlarged by 3 to 5 mm. The internal rotation of the foot and the lower leg allows the lateral tibial plateau to move forward, further changing the field of view. Continue to gently pull the front of the free meniscus into the intercondylar fossa, and cut the attachment of the posterior edge of the lateral meniscus with a meniscus knife under direct vision to completely remove the lateral meniscus. 4. Knee-knit 90° suture the synovial membrane, joint capsule, and the knee joint is sutured to suture the deep fascia. Close the wound. complication 1. Postoperative intra-articular hemorrhage and chronic synovitis Postoperative intra-articular hemorrhage and chronic synovitis are the most common complications after meniscal resection. Postoperative knee joint activity is too early, before the limb muscles get enough tension and strength to load, the intra-articular hemorrhage will persist, which can lead to chronic synovitis. 2. Synovial membrane Uncommon, but in severe intra-articular hemorrhage and chronic synovitis swelling, synovial spasm can occur due to the traction and rupture of the synovial and joint capsule sutures. The over-extension brake is 7 to 10 days, and the crucible is usually closed. 3. Postoperative infection Postoperative infection is the most serious complication after meniscal resection. Puncture irrigation, surgical drainage, and arthroscopic irrigation and debridement can be performed according to the severity.