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Does a Discoid Meniscus Injury Need Surgery?

Does a Discoid Meniscus Injury Need Surgery?

by | Apr 25, 2023 | Sports Medicine

A discoid meniscus is an abnormally shaped piece of cartilage found in the knee joint, and due to its shape, twisting knee movements can sometimes cause it to tear. When determining whether treatment for this injury is necessary, it is important to consider why, when and how the condition was discovered.

What is a meniscus?
The round end of the femur (thigh bone) sits on the flat top of the tibia (shin bone) to make up the knee joint. The femur is supported by the meniscus, which is composed of two soft “c” shaped cartilage structures. They act like soft cushions that help support the knee joint. The one that sits on the inner side is called the medial meniscus, and the one on the outer side is called the lateral meniscus.

What is a discoid meniscus?
Instead of having the typical “c” shape, a discoid meniscus forms as a solid piece, like a disc or a Frisbee®. The tissue grows thicker and larger than a normal meniscus and also has an abnormal texture, which makes it more likely to cause problems.

What causes a discoid meniscus?
A discoid meniscus is a congenital (at birth) defect and does not grow into the normal shape. This defect is not caused by trauma (i.e., an accident) or an injury. One to two out of every 100 children have a discoid meniscus. The condition is found more often in boys.

A discoid meniscus cannot be prevented. As the child grows, injuries and/or changes in the alignment of the hip, knee and ankle may cause symptoms.

What are the symptoms?
A discoid meniscus does not always cause symptoms. It may go unnoticed until symptoms begin. Symptoms can include pain, popping or snapping, limping, inability to bear weight (stand or walk) and inability to straighten the knee.

How is a discoid meniscus diagnosed?
A thorough history and physical examination are used to diagnose a discoid meniscus. Common findings on the outside of the knee (lateral joint line) include a bulge that can be seen or a “snap” that can be felt and heard.
X-rays are used to look at the alignment of the bones in the knee and leg. Other imaging, such as an MRI, may be used to look at the condition of the meniscus and other tissues in the knee.

What is the treatment?
For children who do not have symptoms or if they have a “clunk” when they move their knee, yet do not experience pain or difficulty conducting daily activities, no treatment is needed.

Early symptoms, such as swelling and pain, can be managed by resting, elevating the leg and other common strategies for knee injuries, such as ice and anti-inflammatory medications.

Surgical treatment is needed if there is a concern regarding the development of the knee with a large discoid or when symptoms begin to interrupt daily activities.

A knee arthroscopy, a type of minimally invasive surgery, may be recommended. The goal of surgery is to improve the shape of the meniscus and remove any loose or extra tissue that may cause the joint to become stuck. Rehabilitation and a slow return to sports may be necessary after surgery to change the shape of the meniscus.

A discoid meniscus increases the risk of a meniscal tear, and therefore, the condition is often found when evaluating an MRI of the knee after an injury. In these cases, treatment may be recommended to improve the shape of the meniscus. This can be done at the same time as surgery for other problems diagnosed in the knee.
What is the long-term outlook?

A discoid meniscus should not prevent normal daily activities or participation in sports. Diagnosis and management of symptoms can reduce the risk of further damage in the knee joint and prevent long-term problems. Regular follow-up to monitor the growth and health of the developing joint is very important after diagnosis, even if treatment is not needed in the early stages.

An important initiative of the Center for Excellence in Sports Medicine team at Scottish Rite for Children is a quality improvement registry designed to learn about the care and outcomes of treatment for discoid meniscus, among other conditions. This multi-center collection of data is led by pediatric orthopedic surgeon and director of clinical research Henry B. Ellis, M.D., is called the Sports Cohort Outcomes Registry (SCORE).

“This large collection of data allows us to compare surgery findings and outcomes across different age groups. The data set is unlike any other and will help to define care for this condition and many others. Early results were shared at the Pediatric Research in Sports Medicine annual meeting in 2022 and have already shaped more studies and better patient care.”        
– Henry B. Ellis, M.D.

Each institution in the SCORE group may take care of a handful of patients with this condition each year. The compiled data, reviewing nearly 300 patients and their outcomes helps to provide better education to patient-families, improve surgical decision-making and setting better expectations for outcomes.

Differences in the appearance of the meniscus as well as the ability for the meniscus to be repaired were apparent. In younger patients, the meniscus:

  • Is larger and covers more of the bone.
  • May have loose, unstable edges.
  • Is more likely able to be repaired.

These early findings help pediatric orthopedic surgeons know what to expect and how to counsel parents about who may or may not need surgery. Ultimately, the registry will be able to provide standard outcome expectations which will further improve the patient experience and outcomes.

Sports Medicine Team from Scottish Rite for Children Had Strong Presence at PRiSM 2023

Sports Medicine Team from Scottish Rite for Children Had Strong Presence at PRiSM 2023

by | Feb 15, 2023 | Research & Innovation

The sports medicine team from the Scottish Rite for Children Center for Excellence in Sports Medicine recently attended the 10th Annual Pediatric Research in Sports Medicine (PRiSM) society meeting in Denver, Colorado. Several of our team are founding members in this group leading the way in pediatric sports medicine research.

Medical director of clinical research Henry B. Ellis, M.D., says, “Most conferences are designed to gather one discipline, but this one is inclusive. Scottish Rite had an impressive presence not only in attendance, but also with most of the 23 staff who attended actively contributing.” The Scottish Rite team included sports medicine physicians, pediatric orthopedic surgeons, a radiologist, advanced practice providers, physical therapists, researchers, psychologists and more. Many of them presented and led discussions about important care and treatment techniques for young athletes.

The three-day meeting included a variety of formats for collaboration and learning. Our team presented results from studies at the podium and during poster sessions where authors held conversations with attendees about the projects. The program also included a variety of didactic sessions designed to inform the participants of available evidence on a topic while stimulating discussion for future research.

Some of the noteworthy accomplishments of our team include:

  • Our director of Movement Science Sophia Ulman, Ph.D., had an active role in multiple aspects of the meeting. Ulman hosted a program with other movement science experts teaching best practices on applying motion capture in return to sports decision making. Bioengineer Alex Loewen, M.S., and Ben Johnson, P.A.-C., presented a study on measuring changes in pelvic tilt before and after hip surgery. Ulman and Loewen shared another study designed to improve accuracy of trunk testing across movement science labs. Additionally, biomechanist Ashley Erdman, B.S., M.B.A., presented results of a ballerina survey on pointe readiness.
  • Perfectly aligned with her passion, Ulman officially assumed responsibility as chair of the Injury Prevention Research Interest Group and provided her peers with the latest research updates on using movement science to facilitate sports injury prevention protocols.
  • Musculoskeletal ultrasound expert and sports medicine physician Jacob C. Jones, M.D., RMSK, gave a report on the state of pediatric musculoskeletal ultrasound to the society attending the conference. His specialty in this methodology solidified him as the top choice to address the group with the latest and greatest in the use of musculoskeletal ultrasound for pediatric sports medicine patients. Additionally, Jones presented a poster addressing the use of diagnostic musculoskeletal ultrasound in gymnasts.
  • Shane M. Miller, M.D., concluded his two-year term as chair of the PRiSM Concussion Research Interest Group. This means he led collaborative efforts with others from around the country to improve the identification and treatment of concussions in young athletes and to create a better understanding of the condition. In addition to this national collaboration, our team worked on other concussion projects. Jones shared results of a study on concussions in young athletes, comparing injuries by position in soccer players.
  • Elbow and shoulder injuries in throwing athletes continue to be a concern for pediatric sports medicine experts across the country. Sports surgery pair Philip L. Wilson, M.D., and Chuck Wyatt, M.S., CPNP, RNFA, shared results from several projects aimed at improving all aspects of care in two upper extremity scientific sessions. In addition to sharing results of Scottish Rite studies on elbow injuries in young athletes, Wilson shared results from a multi-center group focused on clavicle fractures called FACTS.
  • Three of our physical therapists, Jessica Dabis, P.T., D.P.T., O.C.S., Katie Holehouse, P.T., D.P.T., CSCS, and Jacob Landers, P.T., D.P.T., O.C.S., CSCS, presented projects at the meeting.
  • Our sports psychologists Emily Stapleton, Psy.D., and Emily Gale, Ph.D., presented on mental health screening tools and the presentation of suicidality in young athletes.
  • One of our student interns Sarp Sahin was one of five students awarded a grant from PRiSM to attend and present at the conference. As an undergrad at Washington and Lee University, Sarp was proud to present a novel project that he has been working on since high school. His efforts were recognized by sports medicine clinicians and appreciated by many.

The sports medicine staff’s expertise was shared with other sports medicine clinicians around the country to improve care for young athletes near and far. In return, our team learned valuable information that will impact how we care for young athletes at Scottish Rite. With 23 staff members from the Scottish Rite Sports Medicine team attending, we had a well-rounded, multi-disciplinary representation, and the team returned inspired to continue to contribute to the future of the field of pediatric sports medicine.

Learn more about our Sports Medicine team.

Does my child need surgery to fix a clavicle fracture?

Does my child need surgery to fix a clavicle fracture?

by | Sep 28, 2022 | Sports Medicine

Pediatric orthopedic surgeons Henry B. Ellis, M.D., and Philip L. Wilson, M.D., along with colleagues from the multicenter study group Factors Associated with Clavicle Treatment Study (FACTS) have published another set of findings in the American Journal of Sports Medicine. This group, like many others in pediatric orthopedics and sports medicine, merges the experiences and data from across institutions to provide the best evidence for care in the pediatric population. This group focuses their efforts on collarbone (clavicle) fractures and injuries in children and adolescents.

Here are some highlights from the publication. You can also visit the journal’s website to read the full article.

  • Midshaft clavicle fractures most often occur in adolescents, yet, most medical evidence is in adults until now.
  • More than 400 patients (10 to 18 years) with 100% displaced clavicle fractures were included in the study.
  • After two years, there was no difference in outcomes between those that had surgery and those that did not.
  • Those who underwent surgery had more nerve damage (loss of sensation on their chest wall) and more second surgery to remove plates and screws.
  • The study conclusion states, “Surgery demonstrated no benefit in patient-reported quality of life, satisfaction, shoulder-specific function or prevention of complications after completely displaced clavicle shaft fractures in adolescents at two years after injury.”

So, the answer to the question, “Does my child need surgery to fix a clavicle fracture?” is not yes. But, that also does not mean it is no. The study describes the general experience of a large group patients who have and have not had surgery for this condition. The individualized assessment of the patient is still important and necessary, but the study does show that there is not an obvious answer that applies to all patients. “This work is new and very important for the growing body of evidence in caring for this population,” Ellis says. “We can confidently tell families that one path is not yet obviously better than another.” In our individualized patient care, it is important for us to provide evidence-based recommendations, and in our research, we aim to define the recommendations.

This study, Two-Year Functional Outcomes of Operative vs Nonoperative Treatment of Completely Displaced Midshaft Clavicle Fractures in Adolescents: Results from the Prospective Multicenter FACTS Study Group, was published in the American Journal of Sports Medicine in September 2022.

World-Renowned Hip Care

World-Renowned Hip Care

by | May 3, 2022 | General News, Hip Disorders

Scottish Rite for Children’s Center for Excellence in Hip has a long tradition of providing the highest-quality medical care to thousands of children, from newborns to adolescents and young adults. Led by director and pediatric orthopedic surgeon Harry Kim, M.D., M.S., the team provides a coordinated and comprehensive approach to care that brings together hip specialists from orthopedics, radiology, physical therapy, psychology and more. This multidisciplinary team approach allows us to offer a broad spectrum of operative and nonoperative care options to preserve, improve and repair the native hip joint. At the Forefront of Innovation  Our experts are committed to advancing clinically important research to provide the best care to our patients. Several of the center’s research projects have led to revolutionary, life-changing results. Patients who had evaluation and treatment at our center have the opportunity to participate in large patient registries to allow for evaluation of treatment outcomes for a variety of conditions. These studies lead to new insight and significant improvement as our team modifies treatment algorithms based on these results. In addition, doctors and researchers are involved in multicenter hip research groups with peers at top-tier institutions around the country. They regularly collaborate to discuss the latest innovations and treatment techniques regarding patients diagnosed with pediatric hip conditions and injuries. Movement Science Laboratory The accredited movement science laboratory is an integral part of the treatment of our patients. The multidisciplinary team of engineers and kinesiologists use leading-edge technology to evaluate and identify joint motion, net joint forces, muscle activity, strength, foot plantar pressures and oxygen consumption. These analyses guide the development of individualized treatment plans for our patients and support research. The clinical research team partners with movement science to study the changes experienced with surgical intervention to ensure each patient continues to maintain improved hip functions. Multidisciplinary Complex Hip Clinic This clinic brings all of our hip experts together in one clinic to review and evaluate each patient in person together. The history, physical examination and images are evaluated, and various options are discussed for treatment. The multidisciplinary approach also includes experts in the fields of physical therapy, psychology, pain management and nursing. A comprehensive diagnostic (if necessary) and treatment plan is then developed specifically for each patient. If surgical treatment is necessary, the full range of procedures are available with the experts in the field to include hip preservation surgery (both open and arthroscopic options) as well as the potential for utilizing total hip arthroplasty (replacement) when appropriate. This clinic occurs every month and only those patients requiring this multidisciplinary approach are included. Patients may request to be seen in this clinic. Hip Team All of our pediatric orthopedic surgeons are board certified in orthopedic surgery and also completed a fellowship in pediatric orthopedics. Several of our medical staff have a particular interest in treating and studying pediatric and adolescent hip conditions. Harry Kim, M.D., M.S. 
  • Special interest in treating patients with Perthes disease, adolescent and young adult avascular necrosis, and developmental dysplasia of the hip (a member of International Hip Dysplasia Institute).
  • Leader and chair of the International Perthes Study Group – multicenter research study focused on advancing the care of children diagnosed with Perthes disease.
  • Extensive basic and clinical research on Perthes disease and avascular necrosis.
Daniel J. Sucato, M.D., M.S. 
  • Special interest in treating adolescent patients with various hip conditions including hip dysplasia, adolescents and young adults with Perthes disease, slipped capital femoral epiphysis and femoroacetabular impingement.
  • A member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR) study. A multi-center project that analyzes hip function and pain, quality of life and other factors on patients who undergo hip preservation surgeries.
Henry B. Ellis, M.D. 
  • Special interest in treating femoral acetabular impingement, labral tears and other sport-related injuries and conditions in the hip.
  • Involved in multi-center research projects with a special interest in hip arthroscopy.
  • A member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR) study.
David A. Podeszwa, M.D. 
  • Special interest in treating patients with hip dysplasia, slipped capital femoral epiphysis and femoroacetabular impingement.
  • A member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR) study.
William Z. Morris, M.D. 
  • Special interest in treating patients with hip dysplasia, slipped capital femoral epiphysis and femoroacetabular impingement.
  • Extensive clinical research in the pediatric and adolescent developing hip with expertise in the pathogenesis of slipped capital femoral epiphysis and femoroacetabular impingement.
Corey S. Gill, M.D. 
  • Special interest in treating infants with hip dysplasia and patients with cerebral palsy with various hip disorders/dysplasia.
  • Other common hip conditions seen include slipped capital femoral epiphysis, Perthes disease, transient synovitis of the hip, osteoid osteoma and proximal femur cysts.
Learn more about the Center for Excellence in Hip.
Study Looks at Re-Injury Rate After ACL Reconstruction in Young Athletes

Study Looks at Re-Injury Rate After ACL Reconstruction in Young Athletes

by | Apr 12, 2022 | Dyslexia & Learning Disorders

Wrapping up his third year as a medical student at UT Southwestern Medical School, Craig Kemper, B.B.A., has participated in several projects with the Center for Excellence in Sports Medicine research team. Kemper was the lead author on a project looking at athletes who were back to sport after an anterior cruciate ligament (ACL) tear and reconstruction that was recently presented at the 39 annual meeting of the Mid-America Orthopaedic Association. The organization comprises orthopedic surgeons from 20 states, including Texas.

After surgery for the “primary” ACL tear, as many as 1 in 4 young athletes re-tear the reconstructed ACL or the ACL in the other knee. The rate for these “secondary” ACL tears in young athletes is a concern for researchers and clinicians in pediatric sports medicine. This review included patients seen over three years at Scottish Rite for Children for an ACL tear and reconstruction to determine whether participation in multiple sports protects against re-injury.

The 145 patients in the study were

  • an average age of 14 years.
  • 50% male, 50% female.
  • > 50% reported playing only one sport (single-sport athletes)
    • Most played soccer.
    • On average, these athletes returned to sports in fewer days than multi-sport athletes.

Kemper says young athletes continue to feel pressured to choose one sport at earlier ages to “not be left behind.” Many recommend multi-sport participation to help an athlete develop varied skills and protect from overuse injuries unique to growing children, including apophysitis and osteochondritis dissecans.

“We give this advice, but we aren’t sure if it applies to this population regarding re-injury after an ACL reconstruction,” says co-author and Medical Director of Clinical Research, Henry B. Ellis, M.D. “The time out of sports is already so long for an ACL tear, we are eager to learn all the variables that contribute to re-injury rates. Other studies have looked at surgical techniques, but this one looks at sport-participation and time to return-to-play.”

Although single-sport athletes were cleared to return to sports in a shorter time than multi-sport athletes, the analysis found no difference in the rate of secondary ACL injuries within two years of follow-up for this group. “Results like this are still helpful and give direction for future projects,” says Ellis. “More importantly, they help me as a pediatric orthopedic surgeon know how to counsel my patients.”

 

SINGLE-SPORT ATHLETES NOT EXPERIENCING INCREASE IN SECONDARY TEAR INCIDENCE DESPITE EARLIER CLEARANCE, Craig Kemper, B.B.A., K. John Wagner, III, B.S., Connor M. Carpenter, B.B.A., David E. Zimmerhanzel, B.S., Philip L. Wilson, M.D., Henry B. Ellis, M.D.

Learn more about ACL injuries on our website.