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Meniscal Injuries in Children and Adolescents: Diagnosis and Management

Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland.

Isolated meniscal injuries are uncommon in children under the age of 14, but the frequency increases thereafter. Meniscal tears in children are frequently associated with congenital meniscal abnormalities, while those in adolescents are often associated with ligamentous injuries of the knee. The combination of recurrent and often dramatic popping and intermittent episodes of locking has been termed the "snapping knee syndrome." This symptom complex is almost invariably associated with a discoid meniscus. Although double-contrast arthrography has proved to be a reliable diagnostic technique, magnetic resonance imaging is now the modality of choice. Treatment options for meniscal injuries in young patients should reflect a preference for repair over excision. The long-term clinical results of total meniscectomy in children have demonstrated a high incidence of degenerative joint disease. Partial excision may provide better results. The efficacy of meniscus transplantation in the skeletally immature knee, although attractive, is as yet unproved and is therefore not an acceptable treatment option.