Operative versorgung kindlicher meniskusläsionen: Indikation und ergebnisse

Finding the correct indication for the surgical treatment of meniscus lesions in children remains demanding as they often do not adequately describe their symptoms and the clinical examination in these patients can be difficult. 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 chronic knee laxities. They usually occur on the medial meniscus in the presence of a chronic insufficiency of the anterior cruciate ligament (ACL). Surgical options are partial meniscectomy, total meniscectomy or meniscus repair with the fundamental principle of preserving the greatest amount of meniscus tissue to minimize subsequent articular cartilage degeneration. Partial meniscectomy has been reported to provide good short-term results. In the long-term, the results are characterized by early degenerative changes. Meniscus repair leads to clinically satisfactory results in the majority of patients even if the tear is not fully healed. In the mid-term and long-term recurrent tear rates of 20-30% have been reported in the literature for adults but larger series presenting rerupture rates in children have not yet been published. Finally, the ACL status has to be considered in the decision-making process on whether a resection or a reconstruction should be done. In chronic ACL deficiency, the percentage of reparable tears decreases. On the other hand, high healing rates have been reported for meniscus repair combined with ACL reconstruction.