Meniscal Cysts Research Articles

The incidence of meniscal cyst formation following meniscal repair using the all-inside suture anchor device is comparable to conventional techniques.

Post-operative meniscal cyst formation occurs following all-inside device meniscal repair. This study aimed to compare the incidence of cysts in patients who underwent meniscal repair with and without all-inside suture devices. This retrospective study included 227 knees that underwent meniscal repair between 2021 and 2022. The incidence of post-operative meniscal cysts was compared between patients who underwent repair using an all-inside suture anchor device (Group SA) and those who did not use an anchor (Group NA), based on post-operative magnetic resonance imaging (MRI) findings. Risk factors, such as the number of anchors used, were investigated. Using a subgroup analysis, the incidence of meniscal cysts based on the type of device used was investigated. Groups SA and NA comprised 125 and 102 knees, respectively. Group SA had 11 cases of cysts (9% incidence), whereas Group NA had 7 cases (7% incidence), and no statistically significant difference was observed (p = 0.63). Symptomatic cysts were observed in two patients (1.6%) in Group SA, whereas none was observed in Group NA (0%); the difference was not significant (p = 0.50). Factors such as the number of anchors and sutures used and MRI timing were not identified as risk factors. Cyst incidence varied according to anchor type: Stryker AIR+ (4 out of 55, 7%), Smith & Nephew Fast-Fix 360 (7 out of 56, 13%) and Arthrex Fiber Stitch (0 out of 26, 0%), with no significant difference found (p = 0.14). The incidence of cysts in patients undergoing meniscal repair with an all-inside suture anchor device was 9%, showing no significant difference compared with Group NA. Cyst incidence was not affected by device type. Level III, retrospective comparative study.

Fibrin Clot–Augmented Meniscal Repair

Background: Failure rate of meniscal repair can reach 25%. Multiple techniques have been used to increase meniscal healing, notably biological augmentation techniques. One of them is fibrin clot–augmented meniscal repair, which will be described in this video. Indications: This technique is indicated mainly for the lesions with a high failure rate. This includes large, horizontal, and radial tears and even for meniscal cysts, especially in a stable knee. This technique can also be used in revision meniscal suture when failure is no longer an option. Surgical Technique: Fibrin clot is prepared from sterile peripheral venous blood from the patient. A plastic syringe is used to stir the blood in a sterile glass container. The fibrin clot is then formed and washed rigorously with saline solution. Rolling the fibrin clot which is fixed to the syringe allows to give the fibrillar aspect of the clot. The formed fibrin clot is now solid enough to be manipulated and can be fixed to a vicryl suture thread allowing it to enter the knee and be fixed inside the meniscal lesion. The clot is wrapped inside the meniscal lesion with inside-out or outside-in suture technique. Results: We used this technique for multiple types of lesions, like bucket handle meniscal tear, horizontal meniscal cleavage, parrot beak tear, and even in lesions within white-white zone. The postoperative protocol is the same as standard inside-out meniscal repair. This technique has been used in the literature with promising results. Conclusion: The fibrin clot–augmented meniscal repair is a demanding but promising technique. We need further follow-up to confirm its effectiveness. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

The Value of Ultrasound Diagnostic Imaging of Meniscal Knee Injuries Verified by Experimental and Arthroscopic Investigations.

(1) Introduction: Meniscal knee injuries may develop as the result of trauma or overloading. Ultrasound imaging is an observer-dependent modality, meaning that the assessment of structural damage depends on the investigator's experience.. None of the published papers provides a standardized method for ultrasound examination of knee menisci. The main goal of this study is to realize and standardize ultrasound imaging diagnostics of meniscal knee injuries based on individual features of ultrasound presentation and to evaluate the applicability of this modality in clinical practice. (2) Material and methods: This study consisted of two anatomical parts, including a clinical part that started with clinical examination of 50 patients with suspected meniscal knee injuries. After this we performed ultrasound examinations in patients with positive clinical test results, using sonographic confirmation for inclusion in the next stage. Finally, knee arthroscopy by two physicians in an operating room was performed, with procedures documented through photographs and video recordings, and analytic material obtained from patients in the control group documented similarly. (3) Results: In the clinical part of the study, arthroscopic examination revealed 13 longitudinal injuries (corresponding to 36% of all injuries in the group), 14 multidirectional injuries (corresponding to 28% of all injuries), 3 radial injuries (corresponding to 6% of all injuries), and 20 oblique injuries (corresponding to 40% of all injuries). The analysis of the sensitivity and specificity of the diagnostic test in terms of recognizing actual meniscal injuries on the basis of full-thickness or partial-thickness delamination, meniscal cyst oedema, and articular space stenosis revealed that the presence of at least two of these three characteristics was associated with the sensitivity of 88% and the specificity of 86% relative to the number of actual meniscal injuries as seen in arthroscopic examination. (4) Conclusions: Research results confirm that clinical examination combined with ultrasound imaging is a very efficient tool for evaluation of meniscal injuries.

Parameniscal Cyst Arthroscopic Excision by the Modified Fat Pad Approach Can Shorten Recovery Time-A New Surgical Method with Retrospective Study.

Parameniscal cysts can be removed without meniscectomy, but for large or multiloculated meniscal cysts, traditional arthroscopic excision may leave the meniscus unstable. This study aimed to describe a modified fat pad approach for parameniscal cyst arthroscopic excision that retains a stable structure of the synovial margin of the meniscus and to compare the clinical outcomes between the traditional cyst excision and modified excision techniques. Fifty-six patients with parameniscal cysts between 2014 and 2018 were retrospectively included in this study with 28 patients in each group. All patients underwent arthroscopic parameniscal cyst excisions with traditional and modified excision techniques respectively in each group. The International Knee Documentation Committee subjective (IKDC) score, Lysholm score, visual analogue scale (VAS) score, Tegner score, active range of motion (ROM) and time to recover full ROM were used to evaluate the clinical outcomes by using the t-test. The patient population included 21 males and 35 females, with a mean follow-up of 29 months. Of these, 28 patients underwent traditional arthroscopic cyst excisions and meniscal sutures, and 28 patients underwent arthroscopic excisions by the modified fat pad approach. There were no significant differences in the IKDC score, Lysholm score, Tegner score or VAS score between the traditional and modified excision groups at the final follow-up time point. However, the postoperative time to recover full ROM in the modified excision group was significantly lower than those in the traditional excision group (p < 0.05). Arthroscopic excision with the modified fat pad approach yielded a shorter pain phase and less time to recover full ROM during recovery compared with the traditional arthroscopic excision. The new method seemed to be effective, as evidenced by the positive clinical outcomes of patients.

A rare case of extra-synovial and intracapsular ganglion cyst of the knee joint

A 23 year old female presented with knee swelling which was found to be ganglion cyst of the knee with extra synovial and intracapsular origin form the lateral meniscus which was causing pain in extreme extension. The cyst was excised and confirmation was done on histopathology. Ganglion cysts may have following differential diagnoses of ganglion cysts may include synovial chondromatosis, pigmented villonodular synovitis, meniscal or parameniscal cysts, and synovial hemangioma. Which needs good histopathological and radiological correlation. Most common sites of Intra-articular ganglion cysts are in the dorsal wrist, palm, and shoulder but rarely found in the knee joint.

Arthroscopic Intrameniscal Decompression for the Treatment of Lateral Meniscal Cysts

The meniscal cyst is a common complication associated with complex degenerative meniscal tears such as degenerative flaps and horizontal cleavage tears. The current gold standard treatment for this condition is arthroscopic decompression with partial meniscectomy; however, there are three concerns regarding this treatment. First, cases of meniscal cysts commonly involve an intrameniscal location of the degenerative lesion. Second, when there is difficulty in finding the lesion, a so-called “check-valve” is required, and a large-scale meniscectomy is necessary. Thus, postoperative osteoarthritis is a well-known sequela. Third, treatment of a meniscal cyst from the inner edge of the meniscus is indirect and inadequate for reaching the pathological region, as most meniscal cysts are located at the peripheral portion of the meniscus. Therefore, this report describes direct decompression of a large lateral meniscal cyst and repair of the meniscus using decompression with an intrameniscal approach. This technique is simple and reasonable for the purpose of meniscal preservation.

Intrameniscal Cyst—Arthroscopic Open- and Closed-Door Repair Technique

Meniscal cyst is rare and usually is associated with degenerative horizontal meniscus tears. These cysts are parameniscal in nature, as synovial fluid collects due to a check-valve mechanism. Most often, they are located on at the posteromedial aspect of the knee. Various repair techniques had been established in the literature to decompress and repair them. We describe an isolated intrameniscal cyst with an intact meniscus managed by arthroscopic open- and closed-door repair technique.

Do meniscal repairs with meniscus cyst do better than meniscectomy?-a systematic review of meniscal cyst treatment.

This systematic review aims to determine the best modality for the management of meniscal cysts and its associated meniscus tear; whether the meniscal cyst treated via arthroscopy or open methods and whether meniscal debridement or repair achieves better results. This systematic review was performed using PRISMA guidelines. A literature search of PubMed, EMBASE and Cochrane was carried out in July 2020 using the search terms 'meniscal cyst' and 'treatment'. All clinic studies that included filters for papers in the last 20 years, English language, and meniscal cysts found in humans were included. Studies that contained case reports, were in any language other than English, and with subjects that were not humans were excluded. The methodology quality assessment was performed through the modified Coleman methodology score (CMS). A total of 166 results were obtained from PubMed, Cochrane library and EMBASE. Of them, 12 duplicates were identified across the databases and removed from consideration. Six papers were found relevant from EMBASE in which 1 was eventually included in this paper. In total, 12 papers were used in this study. The weighted mean age of the patients was 35.1 years, with total of 523 meniscal cysts, of which 488 of these cysts are associated with meniscal tears (93.31%). The studies included performed cystectomies and/or decompression of meniscal cysts while some left the meniscal cyst alone and dealt with the meniscal lesion instead. All clinical scores showed significant improvement following surgical procedures. Both arthroscopic and open methods can be used for meniscal cysts treatment. Open cystectomy rather than decompression seemed to confer lower risk of cyst recurrences and complications. It is inconclusive to whether meniscal repair or meniscus debridement influenced recurrence and outcome scores. A recommendation for meniscus repair cannot be made due to insufficient high-quality level I or II trials.

Arthroscopic Treatment of Lateral Meniscal Cyst Causing Peroneal Nerve Injury.

Compression of the common peroneal nerve by lateral meniscal cysts is rare. We report a 29-year male patient who complained of a gradually enlarging mass in the right popliteal fossa. He was diagnosed with a lateral meniscal cyst and a common peroneal nerve injury. The patient underwent arthroscopic surgery, including lateral partial meniscectomy and cyst drainage. When followed up at 3 months, the dorsal extensor strength of the right foot recovered to grade 5, and sensation of the distal right lower limb returned to normal. No recurrence of the cyst was found at the last follow-up at 18 months. This is a rare case of common peroneal nerve paralysis caused by a lateral meniscal cyst. Key Words: Meniscal cyst, Common peroneal nerve, Nerve injury.

Arthroscopic Management of Giant Meniscal Cysts Among Young Patients: An Average Three-Year MRI Follow-Up.

ObjectiveTo describe an arthroscopic technique for giant meniscal cyst excision with preservation of the functional meniscus, report the short‐ and medium‐term outcomes, and assess magnetic resonance imaging (MRI) for follow‐up imaging evaluations.MethodsA total of 54 consecutive patients with symptomatic meniscal cysts were admitted to the Second Xiangya Hospital of Central South University between 2014 and 2019. Nine patients with giant meniscus cysts (six females and three males) were included in this study. The age range of the patients was 6–34 years. All patients underwent a complete physical examination, X‐ray, Doppler ultrasound, and MRI of the knee preoperatively. After an arthroscopic diagnosis of a meniscal rupture with a giant meniscal cyst, partial meniscectomy, ablation of the cyst, and suturing of the retainable meniscus were performed. Lysholm and International Knee Documentation Committee (IKDC) scores were used preoperatively and at the most recent follow‐up. Clinical outcomes were classified into four categories: excellent, good, fair, and poor. During the last visit, all patients underwent MRI to assess the recurrence of the cyst and meniscal suture healing.ResultsPreoperative MRI and arthroscopic examination revealed giant meniscal cysts combined with meniscal tears and congenital discoid meniscus, and all giant meniscal cysts occurred in the lateral meniscus. The main types of meniscal tears were horizontal and complex tears. The cysts were unicystic in one case and multicystic in eight cases. The mean size of the cysts on the MRI was 5.86 cm × 2.24 cm × 2.48 cm. The mean follow‐up periods were 37.5 (19–60) months. Clinical outcomes were excellent in six patients and good in three patients. The postoperative scores were significantly improved compared to the preoperative scores (Lysholm: 90.78 ± 4.60 vs. 54.56 ± 7.25; IKDC: 96.2 ± 3.46 vs. 61.69 ± 3.36; p <0.01). No recurrence of the cyst was indicated on the MRI, and there was good healing of the torn meniscus.ConclusionsArthroscopic cystectomy combined with the meniscus suture technique was effective to eradicate residual cyst cavities, and traffic orifices be highly recommended.

Clinical outcomes, healing rate, and presence of peri-meniscal cysts after all-inside meniscal repair in combination with anterior cruciate ligament reconstruction: a prospective comparative study with magnetic resonance imaging assessment.

Meniscal repairs are the most common associated procedures during ACL reconstruction, but they present challenging indications and possible risks of complications or failures. The aim of the present study is to assess the clinical outcomes of all-inside meniscal repairs in the setting of ACL reconstruction. Twenty patients with ACL reconstruction and all-inside meniscal repair were compared to 20 patients with isolated ACL reconstruction. All patients were prospectively evaluated pre-operatively, at fourmonth, and 18-month follow-up with KT-1000, Kira accelerometer for pivot-shift, KOOS, Marx score, and SF-36. Meniscal healing and presence of peri-meniscal cysts were assessed on standardized 1.5-T MRIs performed at 18months. Twenty-one meniscal repairs were performed in 20 patients (81% medial, 19% lateral). At 18months, 48% had complete healing, 38% had incomplete healing, and 14% had no healing. Peri-meniscal cysts were present in 33% of cases. Worst pre-operative KOOS pain (p = 0.0435) and ADL (p = 0 .0201) were present in patients with meniscal lesion, while no differences were present at fourmonths and 18months between patients with or without meniscal repair (p > 0.05). No significant differences were noted stratifying patients according to meniscal healing or cyst presence, except of a lower Qol KOOS subscale in patients with peri-meniscal cysts (p = 0.0430). Meniscal repairs produced good short-term results when performed in combination to ACL reconstruction. Full or partial healing at MRI was present in 86% of cases. One patient out of three developed peri-meniscal cysts.

Comparison of new and old all-inside suture devices in meniscal cyst formation rates after meniscal repair.

We compared the magnetic resonance imaging (MRI)-confirmed cyst formation rate after meniscal tear repair using a new all-inside suture device (N group) versus the older all-inside suture device (O group). Between October 2008 and July 2017, 94 consecutive menisci of 89 patients were diagnosed with meniscal tears and underwent arthroscopic meniscal repair using the all-inside suture device. Five of these patients were lost to follow-up within 12months and were excluded from the study. The remaining 89 menisci were followed up for at least 12months and were included in this retrospective cohort study. Older all-inside suture devices (FasT-Fix, Ultra FasT-Fix) were used until December 2012, while the new all-inside suture device (FasT-Fix 360) was used from January 2013 onwards. Meniscal cysts were detected on T2-weighted fat-suppressed MRI at 12months postoperatively. Multiple logistic regression analysis was used to identify demographic and clinical factors associated with the use of the new all-inside suture device and cyst formation. In total, 36 and 53 menisci were included in the N and O groups, respectively. The incidence of meniscal cysts was significantly greater in the O group (14 out of 53, 26.4%) than in the N group (two out of 36, 5.56%) (P = 0.012). Two patients in the O group had symptomatic cysts that required removal. Multivariate logistic analyses showed that the cyst formation risk significantly decreased after using the new all-inside suture device than the older all-inside suture devices (odds ratio = 0.139; P = 0.04). The MRI-confirmed cyst formation rate after meniscal tear repair was significantly lower using the new than the older all-inside suture devices, indicating that the use of a low-profile device may decrease the cyst formation rate.

Генезис структурно-функціональних порушень та гідростатична модель кісти Бейкера

Вступ. Колінний суглоб оточують різноманітні кістоподібні утворення (КПУ) — бурси, які у нормі клінічно не проявляються. Усі синовіальні порожнини, до яких, зокрема, належать колінний суглоб та бурси, які оточують колінний суглоб, містять синовіальну рідину. Синовіальна рідина є ультрафільтратом плазми крові і складається із білків та інтерстиціальної рідини. У літературі описані бурси, що оточують колінний суглоб, висвітлена ультразвукова класифікація кіст Бейкера залежно від стадії перебігу, яка запропонована І.М. Даниловою [10], та класифікація кістозного переродження меніска, але відсутня інформація щодо патофізіологічних та гістохімічних змін, які відбуваються у КПУ ділянки колінного суглоба, а також відсутня патофізіологічна модель КПУ ділянки колінного суглоба, яка б відображала природу даного захворювання з точки зору фізико-біохімічних процесів. Матеріали та методи. У травматологічному відділенні клініки ­ушкоджень Військово-медичного клінічного центру Північного регіону з початку 2016 року під спостереженням знаходилось 15 пацієнтів із клінічної картиною кістоподібного утворення ділянки колінного суглоба, що підтверджено інструментальними методами обстеженнями: ультразвуковим дослідженням (УЗД), магнітно-резонансною томографією (МРТ) та спіральною комп’ютерною артрографією (СКТА) колінного суглоба. Із них литково-напівперетинчастий бурсит спостерігався у 9 пацієнтів, кісти менісків — у 5 пацієнтів, бурсит переднього відділу колінного суглоба — в 1 пацієнта. Серед пацієнтів 11 чоловіків та 4 жінки. Середній вік пацієнтів становив 43,5 року. Об’єктом дослідження були кістоподібні утворення ділянки колінного суглоба. Усім хворим із КПУ проводили комплексне інструментальне обстеження, яке включало УЗД, СКТА, МРТ, вимірювання внутрішньосуглобового та внутрішньокістозного тисків за допомогою контактного манометра фірми Stryker та надалі — діагностично-лікувальної артроскопії. На основі отриманих даних УЗД проводився розподіл хворих на 4 групи, що базується на процентному відношенню внутрішньопросвітних нашарувань (включень) до загального просвіту КПУ, що дало можливість сформувати нову класифікацію КПУ ділянки колінного суглоба для вибору того чи іншого методу лікування. Результати та обговорення. Для формування та прогресування КПУ має значення підвищений тиск, який становить у середньому 29 мм рт.ст. у положенні згинання та до 58,4 мм рт.ст. у положенні розгинання. Виходячи із попередніх даних, на нашу думку, критичним показником тиску, при якому може настати розрив кісти Бейкера, є тиск більше 60 мм рт.ст. Зазвичай таке ускладнення виникає при тривалому існуванні кісти, коли тривала адсорбція білкових молекул на стінці кісти призводить до адсорбційного зниження міцності та зниження поверхневого натягу — ефект Ребіндера. Висновки. Враховуючи дані біохімічних процесів, УЗД та ендоскопії кіст Бейкера на різних стадіях, ми дослідили, що сама стінка кісти не потовщується, а відбувається пристінкове нашарування білкових молекул із формуванням глобул, які і формують так звану псевдостінку. У подальшому ці нашарування починають формувати перетинки між протилежними стінки, ущільнюватись, що призводить до камерності КПУ. На пізніх стадіях дані нашарування переважають над просвітом КПУ. Запропонована нами класифікація заснована на визначенні процентного відношення внутрішньопросвітних нашарувань до загального просвіту КПУ у двох зрізах та відображає основні морфологічні зміни, що дає можливість визначити оптимальний метод лікування даного кістоподібного утворення та широкого практичного використання у травматології та ортопедії.

Arthroscopic Management of Meniscal Cysts: A Systematic Review.

PurposeThe purpose of this study was to systematically review the outcomes of arthroscopic management of meniscal cysts and to compare the results across the reported surgical techniques.MethodsFollowing the PRISMA methodology, 3 databases (PubMed, Scopus and Web of Science) were searched from inception to June 2021 for randomized controlled trials (RCTs) and observational studies reporting outcomes on patients with meniscal cysts who underwent arthroscopic surgery. The Mixed Methods Appraisal Tool (MMAT) was used to evaluate the study quality.ResultsEighteen studies examining 753 patients (761 meniscal cysts; 92.5% in the lateral meniscus) were included. Overall, 486/736 (66.0%) patients underwent purely arthroscopic decompression, 174/736 (23.6%) received arthroscopic excision, 58/736 (7.9%) received arthroscopy assisted percutaneous drainage, and 18/736 (2.4%) received a combined procedure. The recurrence rate for meniscal cysts was 7.1% across all arthroscopic procedures; 8.3%, 3.4%, and 0% for arthroscopic decompression, arthroscopic excision, and arthroscopy assisted percutaneous drainage, respectively. A total of 79.3% of patients returned to the same level of sport and 85.7% had resolution or minimal knee symptoms after arthroscopic surgery for meniscal cysts. Patient perception of surgical outcomes after any type of arthroscopic surgery for meniscal cysts was reported by 5 studies, with 189/203 (93.1%) reporting satisfaction with their surgical procedure.ConclusionBased on current evidence, arthroscopic management of meniscal cysts yields satisfactory patient outcomes, low cyst recurrence rates and high return to sport rates regardless of the surgical technique. Rates of cyst recurrence were relatively higher with arthroscopic decompression versus excision and percutaneous drainage; however, prospective studies using modern surgical techniques are necessary to better evaluate the surgical outcomes and to compare those with nonoperative modalities, given that a significant proportion of the included articles in this review were relatively outdated.Level of EvidenceSystematic review of level II and IV studies.

Anterior Knee Pain In A Runner

HISTORY: 40 yo F runner with bilateral, right, anterior, aching, intermittent, 3-10/10 knee pain. Wakes at night. Worse with going down stairs, running, fast walking. Better with rest and ibuprofen. ROS negative. PMHx: DVT, PE, depression, endometriosis, sleep apnea. PSHx: C-section, IVC filter. Meds: ibuprofen prn, citalopram, fluticasone nasal spray, Coumadin. FHx: DVT in father. SocHx: +tobacco, no alcohol or drug use; desk job; recreational runner. No recent immobilization/long travel. PHYSICAL EXAMINATION: BMI 38, vitals stable. Knee Exam: No malalignment, bruising, erythema, or obvious swelling; gait normal. Full AROM without pain; + patellar j sign; + patellar crepitus; 5/5 strength without pain; Neurovascularly intact. Negative patellar apprehension; equivocal patellar inhibition. positive patellar grind bilaterally. Full AROM. Negative bounce test, McMurray. Minimal tenderness of medial joint line. Palpable, firm 4cm mass in the right popliteal fossa that is mildly tender to palpation. No overlying skin changes. No ligamentous instability, calf pain, swelling, tenderness, warmth, erythema. Negative Homan’s sign. DIFFERENTIAL DIAGNOSIS: For mass: synovial/baker’s cyst, ganglionic cyst, meniscal cyst, DVT, aneurysm, muscular deformity, soft tissue mass TEST AND RESULTS: -2-view knee x-ray: ill-defined soft tissue sclerosis in the posteomedial right knee which could be a bone forming soft-tissue tumor, Moderate bilateral tricompartmental knee OA. -Knee MRIt: Round, lobular mass measuring 3 x 3 x 3.6 cm adjacent to the distal semimembranosus myotendinous junction. Central ossification and a thin rim of peripheral enhancement.A bone forming tumor, benign or malignant, is a possibility. -Bone tumor surgeon notified and patient seen. Felt unrelated to symptoms and likely secondary to prior trauma. CT knee and CXR. CXR normal. -CT without contrast: Soft tissue calcified lesion medial to the patient's small Baker's cyst partially surrounds the semitendinosus tendon. Tissue sampling is recommended to exclude a matrix forming neoplasm. Knee OA. -Sarcoma Tumor Board: benign; treat underlying knee pain. FINAL WORKING DIAGNOSIS: Benign soft tissue calcified lesion of the knee TREATMENT: symptomatic treatment, quit smoking, weight loss OUTCOME: asymptomatic at 2-months

Acrophyseal growth arrest in a long-term survivor of acute lymphoblastic leukemia

Growth arrest at the secondary growth plate, also known as the acrophysis, is a rare phenomenon with only very few known published case reports. We report on a case of formation of ghost secondary ossification centers at the acrophyses of the knee joint in a 14-year-old female, who survived early childhood acute lymphoblastic leukemia. The patient suffered from severe side effects from both disease and subsequent treatment strategies with a 10-month immobilization period as a consequence at the age of 3 years. The ghost secondary ossification centers were encountered on radiographs and MRI 10 years later, when she presented for evaluation of chronic pain in her left knee related to sports activities, due to a meniscal cyst. Awareness of this phenomenon is nevertheless important, because it seems that endochondral bone growth recovery at the acrophyses might be different from recovery in physes, because we found no concomitant sequelae of growth arrest in the metaphyses.

How to Perform a Giant Parameniscal Cyst Exeresis: Step by Step Technique

Parameniscal cysts are usually small cystic lesions, less than 2 cm in size, found along the meniscal periphery. They are rarely associated with extra-articular palpable mass. Magnetic resonance imaging is the diagnostic method of choice; giant meniscal cysts (>5 cm at its greatest diameter) are very rare, with few cases described in the literature. We describe a step-by-step open exeresis and arthroscopic meniscal suture technique for the treatment of a 9-cm giant parameniscal cyst located on the lateral side of the knee. Treatment of giant meniscal lesions requires caution during dissection and exeresis. Because acute meniscal lesions benefit from meniscal suture rather than meniscectomy, horizontal degenerative lesions may also present excellent results with repair techniques. We conclude that the combination of the open excision of the giant cyst with careful dissection and protection of neurovascular structures, combined with the arthroscopic meniscal suture, is a good strategy to approach such lesions.

Huge intrameniscal cyst successfully treated by open debridement and combined arthroscopic and open repair: a case report

BackgroundMeniscal cysts are not uncommon in clinical practice, with reported incidence rates varying from 1 to 22%. Most meniscal cysts are parameniscal cysts, which are created by extravasation of synovial fluid through the meniscal tear into the adjacent soft tissue. In contrast, intrameniscal cysts in which the fluid collects in the meniscus are very rare. We encountered a teenager with a huge intrameniscal cyst accompanied by a small vertical meniscal tear in the red-white zone of the upper surface of the medial meniscus. A literature search revealed no information regarding the appropriate treatment methods and results for this type of lesion.Case presentationA 14-year-old boy presented to our outpatient clinic because of right knee pain that had been present for the previous 2 months. The patient participated in Hapkido, but had no specific trauma history. Magnetic resonance imaging revealed a huge intrameniscal cyst located in the central parenchyma of the posteromedial corner of the medial meniscus. In addition, one sagittal slice on MRI revealed a vertical tear in the red-white zone of the upper surface of the medial meniscus. The presence of such a tear accompanied by a huge intrameniscal cyst is very unusual. The patient was treated via arthroscopic inside-out meniscal suture repair and open cystic debridement with additional meniscocapsular suturing. During 4 years of magnetic resonance imaging follow-up, the lesion has completely disappeared and the meniscus has successfully recovered its normal form.ConclusionsOur treatment method may be considered as the first choice for young patients who require surgical treatment for large intrameniscal cysts with accompanying small vertical meniscal tears.

Meniscus sutures by arthrotomy fora non-transfixing horizontal lesion associated with a cyst.

Meniscal cysts are rare in Stoller grade II horizontal lesions. Several techniques are described in the literature for their management, without any real gold standard. The objective of this work was to report a series of meniscal sutures associated with cyst resection by arthrotomy. The hypothesis was that the results were satisfactory and comparable with the data in the literature regardless of the technique reported without morbidity added by arthrotomy. This was a monocentric retrospective study on 13 patients, aged 33 on average with a grade II meniscus lesion associated with a cyst (9 lateral and 4 medial menisci). Pre-operative data available was the VAS (5.7/10) and the Lysholm score (61/100). Primary endpoints were as follows: pain (visual analogue scale), global satisfaction, Lysholm functional score, and return to sports and professional activities at a minimum of twoyears. Secondary endpoints were complications, possible recurrence, and/or surgical revision. Recurrences, complications, and surgical recovery were gathered. Patients were evaluated with an average follow-up of 32months. All patients were satisfied or very satisfied. The VAS significantly improved (0.2/10, p < 0.05) as well as the Lysholm score (97/100, p < 0.05). All patients returned to their professional activity: 11 within two months, one within six weeks, and one in the first post-operative week (this patient being a student). Only one patient did not resume pre-operative sport level due to a femoropatellar syndrome, not linked to the meniscal surgery performed. However, only 11 patients resumed their previous sport level (84.6%). No recurrence or surgical revision occurred. The results are good and similar to the literature, confirming the working hypothesis. These results are equivalent to partial meniscectomies and arthroscopic sutures associated with a procedure on the cyst by arthroscopy or arthrotomy. The literature is in favour of a procedure on the cyst. The results confirm the effectiveness of a direct approach suture of non-transfixing meniscal lesions associated with a cyst resection with a good functional recovery, without additional morbidity. The hypothesis was confirmed.

Lateral meniscal cysts: long-term clinical and radiological results of a partial meniscectomy and percutaneous decompressive needling.

The aim of this study was to describe clinical and radiological long-term results of an arthroscopic partial meniscectomy associated with an outside-in decompressive needling of the cyst for lateral parameniscal cyst. Eighteen patients with symptomatic parameniscal cysts treated between April 2002 and September 2009 were retrospectively included in the study. All patients underwent arthroscopic partial meniscectomy (preserving peripheral rim) and needling of the cyst using a 20-gauge needle. Pre- and post-operative IKDC, Tegner, and Lysholm scores were used to evaluate clinical results. Radiological results were obtained from pre- and post-operative radiographies and post-operative MRI scans. Both supine and weight bearing MRI examinations were performed. Kellgren-Lawrence and WORMS scales were used to evaluate osteoarthritis development of the knee. The mean follow-up period was 11.6 ± 2.6 years (range 7-15). Horizontal lesions were found in 56% of patients. All patients fully recovered. Mean Lysholm scores passed from mean pre-operative value 52 ± 16.9 to post-operative 85 ± 11.9 (P < 0.01) and mean IKDC scale score changed from 49.5 ± 14.7 to 67 ± 23.5 (P < 0.01). Mean Tegner scores did not change significantly. Post-operative radiographies showed a Kellgren-Lawrence scale grade 0 in six patients (33%), a grade I in eight (44%), a grade II in three (17%), and a grade III in one patient (6%). No patients were found with a Kellgren-Lawrence scale grade IV. No significant differences with pre-operative radiographies were found (chi-square = 1.867; df = 3; P = 0.60) in osteoarthritis development of the knee. Reported WORMS scores had an average of 12.4 ± 5.1. No recurrence of any cysts was observed. Different treatments for lateral meniscal cysts have been proposed, but proper management of the cyst is still controversial. The results of this study suggest that the outside-in needling of the cyst associated with partial meniscectomy is a highly effective, simple, and repeatable technique. Excellent clinical outcomes were reported at a mean follow-up of 11.6 ± 2.6 years (range 7-15). Imaging evaluation showed no significant evolution to osteoarthritis of the knee. Partial arthroscopic meniscectomy associated with percutaneous decompressive needling of the cyst wall under arthroscopic visualization showed positive clinical and radiological long-term results. Neither traditional radiographies nor innovative standing MRIs showed findings of osteoarthritis.