In symptomatic discoid lateral meniscus in children, the question is often posed this way:
Is it enough to reshape the meniscus, or is it also necessary to repair it?
The phrasing is intuitive, but it risks being misleading.
Saucerization and repair are not two alternative procedures to choose from in the abstract. Saucerization corrects the abnormal shape of the meniscus; repair becomes necessary when, after reshaping, the peripheral rim remains unstable or has a repairable tear.
A systematic review published in 2026 attempts to organize the findings in pediatric literature and offers a seemingly simple piece of data: isolated saucerization appears to be associated with fewer complications and reoperations than saucerization with repair [1].
But stopping at this interpretation would be a mistake.
The Study: 24 Papers, 1,225 Patients, and 1,401 Knees
Hartman and colleagues included 24 studies published between 2013 and 2023, for a total of 1,225 patients and 1,401 knees. The average age of the children ranged from 8.3 to 13.7 years, and the mean follow-up was between 1.2 and 10.1 years [1].
The surgical strategies analyzed were three:
- isolated saucerization;
- saucerization combined with repair;
- subtotal or total meniscectomy.
All techniques led to a significant improvement in functional scores, particularly the Lysholm score.
Isolated saucerization showed the lowest rate of complications, at 2.7%, and reoperations, at 7.3%. Saucerization with repair had complications in 6.8% of cases and reoperations in 8.9% [1].
At first glance, it would seem that repair adds risk without offering a clear advantage.
But the groups are not truly comparable.
Why More Reoperations After Repair Doesn't Mean Repair Is Wrong
The menisci that are repaired are often the most unstable ones, with peripheral tears, capsular detachments, or more complex patterns.
They are not the same menisci that undergo simple saucerization.
This is the most important point of the paper.
A slightly higher revision rate after repair may reflect the initial severity of the injury, not a negative effect of the repair itself.
This is a classic case of confounding by indication: the most difficult cases receive the most complex treatment and, as a result, have a higher probability of failure or revision.
The correct conclusion, therefore, is not:
“It’s better to avoid repair.”
It is, rather:
Repair should be reserved for truly unstable or torn menisci, because in those cases, preserving the meniscus also means repairing it.
What "Saucerization" Really Means
The discoid meniscus is wider and thicker than normal and occupies a larger portion of the lateral compartment.
When it becomes symptomatic, saucerization is used to reshape it, creating a peripheral rim that is more similar to the physiological one.
The goal is not to remove as much tissue as possible.
It is to leave a sufficiently stable, well-shaped, and functional meniscus.
For years, the classic treatment was total or subtotal meniscectomy. Today, this approach has been largely abandoned in children because the loss of meniscal tissue exposes the joint to cartilage overload and articular degeneration over time.
The modern principle is therefore simple:
preserve as much meniscus as possible, but without leaving behind unstable tissue that will continue to cause symptoms or become torn.
The Decision Is Often Made During Arthroscopy
Magnetic resonance imaging (MRI) is very helpful.
It can recognize the discoid morphology, show an associated tear, and suggest peripheral instability.
But it doesn't always allow for a definitive assessment of the rim's stability.
The final decision is often made during arthroscopy.
After saucerization, the surgeon uses a probe to assess:
- the stability of the peripheral rim;
- any capsular detachment;
- the presence of a vertical or complex tear;
- the quality of the remaining meniscal tissue;
- the ability of the meniscus to stay in place during knee motion.
If the rim is stable, a repair does not necessarily offer an advantage.
If, however, the meniscus lifts, displaces, or has a repairable tear, repair becomes an integral part of meniscal preservation.
The Real Goal Is Not to Reduce Reoperations at All Costs
A lower number of reoperations does not automatically equate to better treatment.
A more extensive meniscectomy may, in some cases, reduce the likelihood of a second arthroscopy in the short term.
But it can increase the risk of cartilage damage in the following years.
This is precisely the limitation of relatively short follow-ups.
Many studies included in the review stop at a few years, whereas the consequences of significant meniscal loss can emerge much later.
A case series with a very long follow-up showed overall good clinical outcomes after preservation treatment, but also a significant proportion of revisions over time [2].
This does not invalidate the conservative principle.
It shows, rather, that a symptomatic discoid meniscus is not always a problem solved once and for all with a single arthroscopy.
When to Operate on a Discoid Meniscus
A discoid meniscus discovered incidentally on an MRI should not be operated on automatically.
Surgical treatment should be considered when consistent symptoms are present, especially:
- persistent pain;
- locking or catching episodes;
- painful snapping;
- limited range of motion;
- recurrent effusions;
- sensation of giving way;
- an associated meniscal tear.
Isolated, asymptomatic snapping does not necessarily equate to a surgical indication.
As always, the radiological finding must be interpreted in conjunction with the clinical picture.
Strengths of the Review
The review includes a large overall sample for a relatively infrequent pediatric condition.
It analyzes not only functional scores but also complications and reoperations.
Furthermore, it confirms the paradigm shift in pediatric meniscal surgery: avoid total meniscectomy whenever possible and preserve the functional peripheral rim.
The paper is also useful for counseling, as it provides concrete numbers to discuss with families.
Limitations Not to Be Ignored
The level of evidence remains low.
The included studies are predominantly retrospective, Level III and IV. There are no randomized trials, and the protocols are very heterogeneous.
Indeed, there are variations in:
- indications for repair;
- amount of residual meniscus;
- repair techniques;
- postoperative rehabilitation;
- duration of follow-up;
- definition of failure and revision.
The most significant limitation, however, is the lack of comparability between groups.
We cannot interpret the 7.3% and 8.9% figures as if they resulted from two treatments applied to the same injury.
The cases that were repaired are often more complex from the outset.
Final Commentary
The question "saucerization or repair?" is only useful up to a point.
The real question is:
after reshaping the meniscus, is what remains stable and functional?
If yes, saucerization may be enough.
If no, repair is not an overtreatment: it is part of the preservation strategy.
The higher number of reoperations observed in repaired cases does not prove that repair is wrong. It more likely indicates that those menisci were more complex from the beginning.
The success of the surgery does not depend on how much of the meniscus is removed.
It depends on how much healthy tissue can be preserved while keeping it stable.
References
[1] Hartman H, Lessiohadi N, Saharan S, Saraf SM, Christiansen M, Mulcahey MK. Outcomes of Saucerization With or Without Repair for Symptomatic Discoid Lateral Meniscus in Pediatric Patients: A Systematic Review. Arthroscopy. Published online July 20, 2026. doi:10.1002/arj.70391. PMID: 42478088.
[2] Kim SJ, Kim DW, Min BH. Long-term outcome of arthroscopic partial meniscectomy with or without repair of discoid lateral meniscus in children. Knee Surg Sports Traumatol Arthrosc. 2012;20(8):1664-1670.
[3] Ahn JH, Lee YS, Ha HC. Arthroscopic partial meniscectomy with repair of the peripheral tear for symptomatic discoid lateral meniscus in children: results of minimum 2 years of follow-up. Arthroscopy. 2008;24(8):888-898.
[4] Good CR, Green DW, Griffith MH, Valen AW, Widmann RF, Rodeo SA. Arthroscopic treatment of symptomatic discoid meniscus in children: classification, technique, and results. Arthroscopy. 2007;23(2):157-163.
Disclaimer: This content is for general informational purposes only. It does not substitute for a medical evaluation.
