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TEMs 5
TEMs 5
Background: The ultrastructure of the normal menisci has been thoroughly investigated and found to correlate with meniscal
tears. Although discoid menisci are accepted to have the same composition as their normal counterparts, to our knowledge, no
study in the literature has investigated this issue.
Purpose: To investigate the ultrastructure of the discoid menisci and compare it with nondiscoid menisci.
Study Design: Descriptive laboratory study.
Methods: Meniscal biopsies were taken from 12 patients who were operated for meniscus tear and diagnosed with discoid
meniscus and from 6 patients who were operated for meniscal tear and did not have a diagnosis of discoid meniscus. The sam-
ples were examined with transmission electron microscopy.
Results: The study group demonstrated a decrease in the number of collagen fibers compared with the control group. Also, the
homogeneous course of the collagen fibers observed in the control group was replaced by a heterogeneous course in the study
group.
Conclusion: The ultrastructure of the discoid meniscus is different from the normal menisci.
Clinical Relevance: This difference may contribute to the vulnerability of the discoid meniscus to tears.
Keywords: discoid menisci; transmission electron microscopy; ultrastructure; meniscal tears
The discoid-shaped meniscus in humans is a morphologic resulting in increased stress to the meniscal tissue.14
anomaly of the normal meniscus and was described as early Because the relationship between arrangement of collagen
as 1889.16 It is a frequent finding in the Asian population, fibrils and meniscal tears is known, we thought that the
with an incidence of about 20%, whereas in whites, it occurs composition of the discoid menisci might be another impor-
in less than 0.5% of the population.11 It has been shown that tant factor predisposing to tears. Therefore, we performed a
discoid lateral meniscus is associated with an increased inci- study to investigate the ultrastructure of discoid-shaped
dence of either lateral or medial meniscus tears, ranging menisci and compare it with normal counterparts.
between 38% and 88%, and the usual treatment is partial
meniscectomy.4,5,7,10-13 It is thought that the tears in discoid
menisci are attributable to abnormal shape and thickness
MATERIALS AND METHODS
*Address correspondence to Ozgur Ahmet Atay, MD, Department of Patients who were operated between September 2003 and
Orthopedics & Traumatology, Hacettepe University School of Medicine, December 2005 with the diagnosis of discoid menisci were
06100 Ankara, Turkey (e-mail: oaatay@hacettepe.edu.tr). included in the study. The study group was composed of
No potential conflict of interest declared. patients who were operated with the diagnosis of lateral dis-
The American Journal of Sports Medicine, Vol. 35, No. 3 coid meniscus and an associated lateral meniscal tear (Table
DOI: 10.1177/0363546506294678 1). The control group was composed of patients who under-
© 2007 American Orthopaedic Society for Sports Medicine went knee arthroscopy because of knee pain associated with
475
476 Atay et al The American Journal of Sports Medicine
TABLE 1
Demographic Details and Pathological
Findings of the Study Group
Figure 3. Electron micrograph showing decreased collagen Figure 6. Electron micrograph showing a few collagen fibers
fibers (arrows) with a heterogeneous course in a patient with (arrows) in a local area of a patient with incomplete discoid
an incomplete discoid meniscus (original magnification meniscus (original magnification ×20 000).
× 20 000).
RESULTS
DISCUSSION
Figure 5. Electron micrograph showing collagen fibers A discoid knee meniscus was first described more than a
(arrows) with a homogeneous course in the control group century ago.16 It was shown to occur in both the medial and
(original magnification ×20 000). lateral compartments with several different morphologic
478 Atay et al The American Journal of Sports Medicine
characteristics.2,3,7 Since the first detailed examination by Therefore, we performed our study on partial-thickness
Smillie12 in 1948, there has been an ongoing debate about the biopsy specimens. This precludes speculating about the
exact pathologic alterations and cause of this discoid shape. architecture of the menisci. Another limitation to this
Smillie12 suggested that the discoid menisci are attributable study might be that we had to use biopsy specimens from
to the persistence of a normal fetal stage; however, anatomi- the symptomatic menisci. Analysis of a discoid meniscus
cal studies did not demonstrate a disk-shaped fibrocartilage that is free of any tear would be the ideal approach and
during fetal development.6,9,12 Kaplan9 suggested that the might demonstrate a different result; however, this is not
discoid shape developed secondary to the abnormal meniscal possible for ethical reasons. Therefore, we analyzed the
motion attributable to lack of attachment to tibia. Regardless intact portions of discoid menisci that were free of any
of the theories that are used to explain the development of tears and might be considered as normal.
the discoid menisci, it has been shown that discoid lateral
meniscus is associated with an increased incidence of either
CONCLUSION
lateral or medial meniscus tears, ranging between 38% and
88%.11 However, it is impractical to screen asymptomatic To our knowledge, this is the first study of the ultrastruc-
patients for meniscal abnormalities; therefore, the true inci- ture of the discoid lateral meniscus. This study revealed
dence of discoid menisci and their lifetime risk of tear in the that ultrastructure of the discoid lateral meniscus signifi-
general population remain undefined. cantly differs from that of the normal meniscus. The colla-
Arthroscopic studies have demonstrated an association gen fibrils are decreased in number and do not show the
between discoid lateral menisci and meniscal tears and cys- normal orientation. Both of these factors may contribute to
tic degeneration.1,11,14 Discoid meniscus tears may occur in the increased incidence of tears in discoid menisci.
any of the patterns described for normal menisci, includ-
ing longitudinal, transverse, flap, and complex tears. It is
REFERENCES
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