While historically, the treatment of discoid meniscus was complete meniscectomy, often performed through open arthrotomies, longer-term follow-up studies revealed subsequent degenerative changes in the lateral compartment. Management techniques have therefore moved toward more minimally invasive arthroscopic methods, with an emphasis on three principles: (a) creation and preservation of a near-anatomic peripheral meniscal rim through debridement of any excess central meniscal tissue, which is referred to as “saucerization” or partial meniscectomy; (b) repair of any intrasubstance tears that may originate or extend into the area of the peripheral rim; and (c) stabilization of any deficient or absent meniscocapsular attachments that cause abnormal meniscal mobility or instability. Rather than the historical goal of simply removing the source of any mechanical symptoms, modern techniques are directed toward the goal of a functional, stable residual meniscus that provides sufficient long-term shock absorption, stability for the lateral femoral condyle, and articular cartilage protection.

After creation of a standard inferolateral arthroscopic viewing portal and introduction of the 3.5- mm arthroscope, the inferomedial working portal should be made under arthroscopic visualization with use of a spinal needle with the knee in the figure-of-4 position to optimize portal location. Attention should be paid toward allowing access of instruments to all parts of the lateral compartment, which often requires a slightly more superior and more medial portal position, compared to that used in other routine arthroscopic knee procedures. Some authors have described use of a 2.7- mm arthroscope for children under 6 years old, but we have found the 3.5-mm arthroscope favorable over the small-joint instruments, even in children as young as 2 to 3 years old, provided extra care is taken to avoid iatrogenic chondral injury through gentle, controlled movements in the smaller child’s joint space. Saucerization is achieved with a combination of different instruments, including low-profile meniscal basket punches, arthroscopic scissors, shavers, and meniscal knives that are used to contour the meniscus. Reshaping of the meniscus may require simple excision of central, redundant discoid tissue or occasionally may require more advanced restructuring and repositioning of the meniscus to fill peripheral deficiencies, which may be referred to as “meniscoplasty.” With particularly thick complete discoid menisci, saucerization may be more easily started with the leg flexed to 90 degrees with some mild varus stress, changing to a figure-of-4 position once enough space has been created to introduce instruments safely into the lateral compartment space. A side-biter or angled basket punch can be helpful for the midbody resection. For the anterior horn, back biters and meniscal knives may be helpful. Arthroscopic shavers can smooth the remaining edges and remove debris. A meniscal remnant of 6 to 8 mm circumferentially is ideal. Increased retear rates have been associated with leaving larger meniscal remnants after saucerizations.