This 1982 case series by Dickhaut and DeLee characterized 18 patients with discoid lateral meniscus identified during 347 consecutive arthroscopies. The paper defines the critical clinical distinction between the complete type (intact posterior tibial attachment, usually asymptomatic) and the Wrisberg-ligament type (no posterior tibial attachment, universally symptomatic). It established the treatment algorithm that still guides management today.
When a child presents with a painless audible knee snap that worsens near full extension, think Wrisberg-ligament type discoid meniscus until proven otherwise. This paper established that the snapping-knee syndrome in children is reliably caused by posterior horn hypermobility from absent tibial attachment — and that total meniscectomy is the required fix.
When you find a discoid lateral meniscus incidentally during arthroscopy in an adult, do not resect it. The complete type with intact peripheral attachments is asymptomatic in 83% of cases and should be left alone.
When the complete type does have a symptomatic tear with central instability, saucerization (partial meniscectomy preserving the peripheral rim) is sufficient. The distinction from the Wrisberg-ligament type. Where even a preserved rim remains unstable. Is what drives the operative decision.
This paper is why we examine the posterior tibial attachment of every discoid meniscus with a probe before deciding on partial versus total resection.
This 1982 case series by Dickhaut and DeLee characterized 18 patients with discoid lateral meniscus identified during 347 consecutive arthroscopies. The paper defines the critical clinical distinction between the complete type (intact posterior tibial attachment, usually asymptomatic) and the Wrisberg-ligament type (no posterior tibial attachment, universally symptomatic). It established the treatment algorithm that still guides management today.
When a child presents with a painless audible knee snap that worsens near full extension, think Wrisberg-ligament type discoid meniscus until proven otherwise. This paper established that the snapping-knee syndrome in children is reliably caused by posterior horn hypermobility from absent tibial attachment — and that total meniscectomy is the required fix.
When you find a discoid lateral meniscus incidentally during arthroscopy in an adult, do not resect it. The complete type with intact peripheral attachments is asymptomatic in 83% of cases and should be left alone.
When the complete type does have a symptomatic tear with central instability, saucerization (partial meniscectomy preserving the peripheral rim) is sufficient. The distinction from the Wrisberg-ligament type. Where even a preserved rim remains unstable. Is what drives the operative decision.
This paper is why we examine the posterior tibial attachment of every discoid meniscus with a probe before deciding on partial versus total resection.