Abstract
Arthroscopic partial menisectomy followed by cyst decompression is currently recommended for treatment of a meniscal cyst. However, it is doubtful whether partial menisectomy should be performed on cysts communicating with the joint in cases without a meniscal tear on its surface since meniscal function will be sacrificed. In this report, a meniscal cyst arising from the posterior horn of the medial meniscus without meniscal tear on its surface was resected using an arthroscopic posterior trans-septal approach. A 59 year-old male presented to our hospital with popliteal pain when standing up after squatting down. Magnetic resonance imaging revealed a multilobulated meniscal cyst arising from the posterior horn of the medial meniscus extending to the posterior septum with a grade 2 meniscal tear by Mink's classification. The medial meniscus was intact on the surface on arthroscopic examination. The meniscal cyst and posterior septum were successfully resected using a posterior trans-septal approach without harming the meniscus. This is the first report on a meniscal cyst being resected using an arthroscopic posterior trans-septal approach with a 9-month follow-up period.
Highlights
Selective menisectomy followed by decompression of the cyst is commonly performed in arthroscopic treatment of a meniscal cyst [1,2,3]
A meniscal cyst arising from the posterior horn of the medial meniscus was resected under arthroscopy, without menisectomy, using a posterior trans-septal approach
The use of a 70-degree arthroscope can help the visualization of the posterior compartment, the whole area of the septum cannot be visualized since the camera head of an arthroscope is too near the septum from an anterior intercondylar approach
Summary
Selective menisectomy followed by decompression of the cyst is commonly performed in arthroscopic treatment of a meniscal cyst [1,2,3]. A meniscal cyst arising from the posterior horn of the medial meniscus was resected under arthroscopy, without menisectomy, using a posterior trans-septal approach. This is the first report on resection of a meniscal cyst using an arthroscopic posterior transseptal approach. Viewing from the posteromedial portal, proliferated synovial tissues expanding from the posterior horn of the medial meniscus to the posterior septum were found (Fig 2-A). A meniscal tear was not found the posterior edge of the medial meniscus was carefully examined by a probe after cyst resection (Fig 2-B). An MRI examination 9 months after the operation revealed that the meniscal cyst had disappeared and abnormal intensity inside the medial meniscus decreased (Fig 3-A,B). The patient’s popliteal pain disappeared completely during the 9-month follow-up period
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