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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.

Researchers At Scottish Rite For Children Awarded Grant From National Institutes Of Health For Clubfoot Genetics Research

Researchers At Scottish Rite For Children Awarded Grant From National Institutes Of Health For Clubfoot Genetics Research

by | Jan 17, 2023 | Research & Innovation

Researchers at Scottish Rite for Children and UT Southwestern Medical Center were recently awarded a grant from the National Institutes of Health (NIH) that will bring new opportunities to discover genetic causes of clubfoot. Clubfoot is a complex foot deformity where one or both feet are turned inward and pointed downward. At Scottish Rite, two nonoperative treatment methods are provided to children with clubfoot, though at times, surgical management may be required.
 
A research team at Scottish Rite, led by Jonathan J. Rios, Ph.D., is investigating the genetic basis of clubfoot. In 2021, Dr. Rios’ team published the largest genetic association study for clubfoot, which included analysis of approximately 8 million genetic markers in more than 8,000 individuals. As part of this effort, his team identified the first gene, FSTL5, associated with clubfoot using this approach. Using similar strategies, Carol Wise, Ph.D., Director of Basic Science Research at Scottish Rite, has led studies discovering genes associated with adolescent idiopathic scoliosis. “This award reflects the expertise of our research staff and the organization’s commitment to research excellence, a combination that enables continued discoveries of the genetic basis for pediatric orthopedic conditions treated at our institution,” Dr. Wise says.

Dr. Rios’ new award will utilize whole-genome sequencing to discover genetic causes of clubfoot. As part of this award, the Gabriella Miller Kid’s First Program will sequence the entire genomes of 407 individuals from 85 families with clubfoot. “The Gabriella Miller Program is a unique opportunity to apply comprehensive genomic technologies to tackle unanswered questions in the field and to discover genetic causes of pediatric orthopedic disorders,” Dr. Rios says. The new Kids First Project on Congenital Clubfoot, led by Dr. Rios, is a collaboration with Dr. Jacqueline Hecht, Associate Dean of Research at the McGovern Medical School at UTHealth Houston.

This is the second Gabriella Miller Project awarded to Dr. Rios. In 2016, the Gabriella Miller Project awarded Drs. Rios and Wise’s study of adolescent idiopathic scoliosis, which included whole-genome sequencing of 598 individuals from 168 families. “Scoliosis and clubfoot are the most frequent orthopedic conditions treated at Scottish Rite,” says Scottish Rite Chief of Staff Daniel J. Sucato, M.D., M.S. “Genetic and basic research is fundamental to improving how we care for children, and ‘big data’ studies such as these allow our scientists to tackle new research questions that will advance our understanding of these conditions.” Learn more about research at Scottish Rite for Children and the Scottish Rite for Children Molecular Genetics research team. Jonathan J. Rios, Ph.D., is the co-director of Molecular Genetics at Scottish Rite, as well as an associate professor in the McDermott Center for Human Growth and Development and the Departments of Orthopaedic Surgery and Pediatrics and is a member of the Simmons Comprehensive Cancer Center at The University of Texas Southwestern Medical Center (UT Southwestern). Carol Wise, Ph.D., is the Director of Basic Research at Scottish Rite and is a professor in the McDermott Center for Human Growth and Development and the Departments of Orthopaedic Surgery and Pediatrics at UT Southwestern. Daniel J. Sucato, M.D., M.S., is the Chief of Staff at Scottish Rite and is a professor in the Department of Orthopaedic Surgery at UT Southwestern.

Get to Know our Staff: Emily Lachmann, Clinical Research

Get to Know our Staff: Emily Lachmann, Clinical Research

by | Dec 14, 2022 | Scoliosis & Spine

Each year, our team seeks out college students interested in pursuing a career in medicine. Clinical Orthopedic Research Assistants (CORA) are hired at Scottish Rite for Children to assist our experts in performing clinical research tasks and collaborating on research projects. CORA staff are also mentored by our experts and given valuable advice and guidance for their future. Each CORA staff member specializes in a specific area of study and works with the experts in that department, receiving a well-rounded experience in their field of interest.

What inspired you to apply for the CORA/MSRF position?
After deciding to take a gap year before medical school, I was unsure about what I wanted to do. I applied for the CORA program because this position encompassed everything that I was searching for to prepare me for medical school from taking on research projects, working with a physician mentor, having lots of shadowing opportunities and getting experience with patients.

Have you always been interested in medicine and/or research?
I have always been interested in medicine, but my interest in research did not develop until my undergraduate years at Baylor University. During that time, I worked for a principal investigator that was developing a phone application to detect early stages of retinoblastoma (eye cancer) in children. This really opened my eyes to the impact of research, particularly in pediatrics, where we have the power to change children’s lives. I am so grateful to continue this type of work at Scottish Rite for Children.

What is it like working at Scottish Rite for Children?
Working at Scottish Rite has beyond exceeded my expectations. The staff here are so kind, and everyone truly values the mission of the organization to give children back their childhood. From my first day, the research team and the clinic staff were so welcoming and wanting to help me succeed in this new role. Specifically, the members of the Spine Research team have gone above and beyond to teach me the skills I need to be a successful researcher and future physician. Although Scottish Rite is made up of many different departments, it is clear that we are one big team.

Can you share a few sentences about someone at Scottish Rite who has been a mentor to you and how they have impacted your experience? What project are you working on with that mentor?
Dr. Amy L. McIntosh was the first mentor I worked with, and she was quick to make an impact on me. I was unaware of her impact at the time, but after learning more about her, I feel privileged to have her as a mentor. Her work as the Director of Clinical Safety, her passion to support women in STEM and her lead as the principal investigator to one of our largest scoliosis studies is inspiring to someone who is starting their career in medicine. When I am down in the clinic, Dr. McIntosh is always very welcoming and constantly inviting me to shadow with her. She takes the time to show me X-rays so that I can learn and better my understanding of complex conditions. In addition to working closely with her on the Early Onset Scoliosis study, Dr. McIntosh gave me the opportunity to work with her on a manuscript about reducing patient narcotic usage after scoliosis surgery, which recently got accepted to a pediatric anesthesia journal!

How do you think this experience will impact your career path?
The CORA program gave me invaluable experiences that were both helpful toward my immediate goal of medical school and will be helpful toward my long-term career goals. The experience working with patients, learning how to collaborate with principal investigators, and understanding the ins and outs of clinical research will have endless benefits. All these experiences have grown my confidence in communicating with patients and the various medical teams, applying to medical school and in my abilities as a researcher.

What progress have you made toward your career goal since beginning the program?
Since beginning this program, I have been accepted to medical school and will be attending UT Southwestern, Class of 2027. Also, I have had the opportunity to be an author on multiple abstracts and publications, one of which recently just got accepted by a pediatric anesthesia journal!

What is your favorite project that you are currently working on or have worked on at Scottish Rite?
My work on the Early Onset Scoliosis Study is my favorite and most rewarding project. The children are the most resilient and sweet. Getting to see and work with these patients and their families is the highlight of my day. It is so rewarding and fun to share the research process with them and to educate them on the impact research can have for future children.

What advice do you have for future CORA/MSRF participants?
Be thankful for this opportunity! Scottish Rite for Children is such a special place filled with the most supportive staff. Be a good team player, work hard and always put the patients first!

What is one thing most people don’t know about you?
I love playing sports and am extremely competitive! Last year, I broke my finger playing flag football. (I am also an orthopedic patient myself!)

Anything else you would like to add?
This program is not just a job. The CORA program does lots of fun activities outside of work, too! For example, we put together a relay team to take down the doctors at the Dallas Marathon this December!

If you are interested in a career in medicine and plan to take a year or two after college before applying to medical school, learn more about becoming a clinical orthopedic research assistant (CORA) on our careers page. Applications for June 2023 positions are being accepted through spring of 2023.

If you are in medical school and are interested in a research opportunity, learn more about becoming a medical student research fellow (MSRF) on our careers page.

Moment of Impact: Keeping Young Athletes SAFE

Moment of Impact: Keeping Young Athletes SAFE

by | Nov 28, 2022 | Sports Medicine

Article previously published in Rite Up, 2022 – Issue 3.

What if you could prevent a sports injury before it happens? That is exactly what the experts in the Center for Excellence in Sports Medicine at Scottish Rite for Children aim to achieve. Led by Sophia Ulman, Ph.D., the SAFE (Sports-specific Assessment and Functional Evaluation) program uses 3D motion capture technology — the same technology used to create special effects in movies and video games — to assess injury risk by studying the movements of young athletes.

The goal of the SAFE program is to develop injury prevention tools that will reduce sport-related injuries in young athletes here and beyond, creating a new standard of care. “Current injury prevention methods are falling short, as sports injuries in young athletes are skyrocketing,” Ulman says. “We are the first to use machine learning techniques to assess a young athlete’s risk for injury by considering risk factors such as movement characteristics, demographics, sports participation characteristics, psychological measures, nutrition, and sleep patterns.”

Uninjured athletes are invited to the Scottish Rite’s Movement Science Laboratory, where they are fitted with reflective markers. The markers are used to collect the athlete’s movement patterns to evaluate their mobility, speed, agility, and power in 3D. Participants are asked to jump, squat, run, pivot, and perform sport specific movements like penalty kicks, layups, or back handsprings. “The data is analyzed to learn more about how young athletes move and to determine if certain movement patterns lead to future sports injuries that would require treatment,” Ulman says.

The SAFE program has tested the movements of approximately 340 athletes across sports, such as baseball, basketball, gymnastics, softball, track, and more. “After initial testing, we follow athletes for one year and note if any athlete experiences an injury,” Ulman says. “This data is helping us compare the movements of athletes who remained healthy versus athletes who were subsequently injured to determine what may have led to the injury.”

Researchers at Scottish Rite have already identified findings that might help predict injury risk in young athletes. “We have found that current tools for assessing injuries of the knee may be unreliable in some instances,” Ulman says. “Current methods commonly rely on 2D video to assess injury risk, but our research using 3D modeling is identifying potential risk factors that the 2D assessment cannot.” Through this innovative program, Scottish Rite researchers collaborate with medical professionals and sports medicine experts across the field to advance the treatment of young athletes throughout the country.

The SAFE program is poised to change the way health care professionals assess athletes for injury risk and, best of all, will help keep young athletes in the game.

To learn more about Movement Science, please call 469-515-7160 or email MSL.Frisco@tsrh.org.

Read the full issue.

Concussion Balance Study

Concussion Balance Study

by | Oct 10, 2022 | Sports Medicine

Learn how we use our Movement Science Lab to evaluate balance testing in sport-related concussion management.

Balance testing is commonly used to assess impairment and recovery after a sport-related concussion in the clinic setting. Measuring imbalances while going through various stances combined with both a firm and foam surface can provide valuable information in the evaluation of a concussion. Scottish Rite’s study, recently published in Brain Injury, was designed to look at how balance performance differed from diagnosis to return-to-play among athletes recovering from a concussion. A standardized test called the Balance Error Scoring System (BESS) is easy to perform in a clinic setting, but it may not provide the level of detail needed for a research study evaluating balance after sustaining a sport-related concussion. By conducting balance testing using the Movement Science Lab’s force plates, or special areas built into the flooring that are sensitive to the weight and force applied, researchers could correlate the BESS results with a highly objective center-of-pressure (COP) measure.

Principal investigator and director of movement science Sophia Ulman, Ph.D., explains the differences between these tests. “The BESS is a subjective test that requires clinical training and practice,” she says. “Alternatively, the force plate used to assess COP provides very specific, multidimensional measures that allow for discrimination of small differences in balance performance.”

It has been well established that there is an increased risk of prolonged symptoms as well as potential for compounding injuries if an athlete returns to play too soon after a sport-related concussion. Although balance is not the only measure used to determine readiness for sport, the proper assessment of balance is an important factor in this decision making. After reviewing data for these two tests in 40 patient-subjects, our team noted that the commonly used BESS test may not provide the information needed to assist with balance assessment as symptoms improved.

What does this mean for providers managing sport-related concussions?

Despite the volume of studies on the topic, the Sports Medicine team is continuing to learn about managing sport-related concussions in young and growing athletes. Pediatric sports medicine physician Shane M. Miller, M.D., says, “Until there is a better test to use in the clinical setting, we will continue to use tests like the BESS to do our best to assess balance improvement and identify the right time to return athletes to their sport. I suspect this will be a conversation for many years.”

The study, “Improvement in balance from diagnosis to return-to-play initiation following a sport-related concussion: BESS scores vs center-of-pressure measures,” was published in July 2022 in Brain Injury, the journal of the International Brain Injury Association.