Meniscus lesions in children-indications and results

From a clinical point of view, it is sometimes difficult to identify the correct indication for operative treatment of meniscus lesions in pre-pubertal children, because they often do not adequately describe their symptoms, and the clinical examination in these patients can be difficult. In the decision-making process, the differential diagnosis of knee pain in children should always be kept in mind, especially to rule out dramatic conditions such as specific tumour or hip pathologies. Most of the meniscus lesions in children are either traumatic or related to the presence of a discoid lateral meniscus. However, as in adults, meniscus lesions can also be related to ligament injuries. Surgical options are partial meniscectomy, total meniscectomy or meniscus repair, the basic principle being to preserve as much meniscal tissue as possible to minimize subsequent articular cartilage degeneration. Partial meniscectomy has been reported to provide good short-term results. In the long term, the results are compromised by early degenerative changes. Meniscal repair leads to clinically satisfactory results in the majority of patients. In the medium and long-term, recurrent tear rates of 20-30% have been reported in adults. Larger series presenting re-rupture rates in children have not been published yet. Compared to an adult population, anterior cruciate ligament (ACL) injuries are fortunately rare in children. If present, there is a tendency to consider the meniscal status as the most important determining factor for ACL reconstruction, either in the acute or in the chronic setting.