Abstract
Meniscal cysts are common, with a reported prevalence of 1% to 22% for patients undergoing meniscectomy1-4. Parameniscal cysts can extend beyond the articular surface and can enlarge sizably, prompting confusion with soft-tissue tumors. Parameniscal cysts that cause bone erosion, however, are considered rare2,4-6. Physical examination, diagnostic imaging, and aspiration of the cyst can all aid in the diagnosis. We present the case of a patient with advanced medial and patellofemoral compartment osteoarthritis with a large parameniscal cyst that extended distal to the joint line with resultant erosion of the medial aspect of the proximal tibial metaphysis. The associated bone loss was believed to compromise the structural integrity of the medial tibial plateau. The patient underwent combined cyst excision and total knee arthroplasty with a stemmed tibial component. To our knowledge, this degree of bone loss associated with a parameniscal cyst and the treatment necessitated by such loss have not been previously discussed in the literature. The patient was informed that information concerning the case would be submitted for publication, and he consented. An eighty-five-year-old man presented to the orthopaedic clinic with mild pain on the medial side of the right knee during walking. The patient also noted a small mass over the medial aspect of the knee. Physical examination revealed the mass to be soft, nontender, and mobile. Range-of-motion testing showed a 10° flexion contracture with flexion to 115°. The knee was stable to varus and valgus stress. Radiographs of the knee revealed advanced osteoarthritis of the medial and patellofemoral compartments and a normal appearance of the medial tibial metaphysis. Magnetic resonance imaging (MRI) showed a chronic tear in the anterior cruciate ligament (ACL) and a benign-appearing cystic structure, consistent with a parameniscal cyst, which extended from the joint line …
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