What is the reason of the high fibular head in the Discoid Lateral Meniscus?
ESSKA Academy. Lee S. 05/09/18; 218210; P15-1463
Sang Hak Lee
Sang Hak Lee
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Objectives: Characteristic findings of discoid lateral meniscus (DLM) on plain radiographs are often subtle, but include a widened lateral joint line, squaring of the lateral femoral condyle, cupping of the lateral tibial plateau, mild hypoplasia of the tibial spine and high fibular head. Although high fibular head is most common finding among them, the cause of high fibular head has been rarely studied. The aim of this study was to assess the causative factors associated with high fibular head in symptomatic DLM patients.

Methods: This prospective cohort study included 87 patients who underwent arthroscopic surgery for complete DLM and 80 patients of normal patients. The plain radiographs were analyzed the height of fibular head from the anteroposterior view and angle of fibular head from the lateral view. The type of fibular head was classified with two types whether angle is more than 10º in lateral view (type II) or not (type I). On the MRI evaluation, the obliquity angle of fibular head, and the thickness and the type of Wrisberg ligament were examined. Based on the MRI and plain radiographic findings, the correlation among the fibular height, angle of fibular head and type and thickness of Wrisberg ligament was analyzed. The multivariate regression analysis was performed to predict the fibular height with the angle and type of fibular, thickness and type of Wrisberg ligament. Receiver-Operating Characteristic (ROC) curves were plotted to evaluate diagnostic efficacy for the DLM with typical findings.

Results: The DLM group had a significantly lower mean height of fibular (11.1 mm) than did the normal group (14.9 mm)(p<0.0001). The DLM group had a significantly larger mean angle of fibular head (19.1°) than did the normal group (15.4°)(p<0.0001). The angle of fibular head was the only factor that associated with the height of fibular in DLM group with multivariate regression analysis. Moreover, the type 2 of fibular head was associated with high fibular head. (OR : 3.0, p=0.007) There were no associations between high fibular head and type or thickness of Wrisberg ligaments. The 70.5% of sensitivity and 77.0% of specificity was found with the height of fibular less than 13.6mm to detect DLM. The 64.4% of sensitivity was found with the angle of fibular head more than 17.7° to detect DLM.

Conclusions: The fibular head of the discoid group was significantly higher in anteroposterior view and larger angle in lateral view than that of the normal group. The high fibular head was associated with larger angle of fibular head in lateral view and type of fibular head.

knee, discoid lateral meniscus, fibular head, Wrisberg ligament, plain radiograph
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