Meniscal Cysts Research Articles

Cyst following meniscal repair

We present a case of meniscal cyst formation 1year following a successful meniscal repair in a 30-year-old male using a hybrid suture-anchor meniscal repair system. Open excision of the cyst revealed it to be in continuity with the suture-anchor fragments. The patient made an uneventful recovery. Level of evidence V.

Joint line fullness and meniscal pathology.

Background:Meniscal tears have been associated with meniscal cysts and fullness of the knee joint line on physical examination.Hypothesis:Joint line fullness is an accurate, sensitive, and specific test to detect meniscal tears.Study Design:Prospective cohort study.Methods:One hundred consecutive patients undergoing knee arthroscopy were included. All had physical examinations documenting the presence of joint line fullness, joint line tenderness, and the McMurray sign. Arthroscopy was the gold standard for tears. Accuracy, sensitivity, and specificity were calculated and correlated with type of tear. Sixty-one patients had a magnetic resonance imaging preoperatively (the gold standard for determining the presence of a cyst).Results:Meniscal tears were found in 67 patients at arthroscopy. The accuracy, sensitivity, and specificity of joint line fullness were, respectively, 73%, 70%, and 82% in detecting meniscal tears; 68%, 87%, and 30% for joint line tenderness; and 47%, 32%, and 78% for the McMurray sign. The highest positive predictive value for detecting a tear was 88% for joint line fullness, compared with 77% for joint line tenderness and 76% for the McMurray sign. However, joint line fullness did not correlate well with the presence of a cyst, with a low positive predictive value (29%). Of those patients with joint line fullness on physical examination, 89% had a horizontal cleavage component of their tear at arthroscopy.Conclusion:Joint line fullness is an accurate, sensitive, and specific test to detect meniscal tears.Clinical Relevance:The findings support the routine use of joint line fullness during physical examination along with other common tests to improve the accuracy of clinically diagnosing meniscal tears.

Parameniscal Cysts: Is Formal Cyst Decompression Necessary? (SS-31)

Introduction Parameniscal cysts are typically managed by open excision or arthroscopic decompression with concomitant partial meniscectomy. The purpose of this study was to compare a series of patients with parameniscal cysts and associated meniscal tears that were treated with arthroscopic partial meniscectomy and cyst decompression to a series of patients that were treated by arthroscopic partial meniscectomy alone. We hypothesize that patients can be managed with partial meniscectomy alone and achieve a successful clinical outcome. Methods This is a retrospective case controlled study of 25 consecutive patients with a meniscal cyst treated by the senior author between 2003 and 2008. Inclusion criteria were an isolated meniscal tear and parameniscal cyst demonstrated on MRI, no prior knee surgery, and an Outerbridge classification of I/II. Group 1 patients were treated with partial meniscectomy and cyst decompression; Group 2 was treated with partial meniscectomy alone. Variables recorded included age, mechanism of injury, sport/occupation, primary complaint, duration of symptoms, and physical findings. Outcome scores were obtained using the Lysholm knee score. Results Twenty-three patients met the inclusion criteria for this study. There were no significant differences in the demographics between the two groups. The Lysholm knee score was 97.8 with partial meniscectomy and formal cyst decompression, and 93.9 for partial meniscectomy alone. The difference between the two means (3.9) was less than the minimal clinically important difference as described by Briggs et al. Conclusion Our results suggest that formal meniscal cyst decompression is unnecessary. Excellent clinical outcomes can be achieved by treating parameniscal cysts with partial meniscectomy alone and no formal cyst decompression.

Arthroscopic treatment of meniscal cysts in the horse

To describe the clinical symptoms, treatment, and outcome of meniscal cysts in horses. These structures have not been previously described in the literature as a potential cause of lameness in the horse. Meniscal cysts are an uncommon condition of the femorotibial joint but can be a significant cause of lameness. Symptoms can be resolved by arthroscopic excision. Records of horses diagnosed with meniscal cysts and treated by cyst excision and meniscal debridement at 2 surgical practices were reviewed. Clinical outcome was determined by repeat veterinary examination and contact with owner. Seven cases of meniscal cyst were treated with arthroscopic cyst excision and meniscal debridement. Five of 7 horses had lameness attributable to femorotibial joint pathology, while the remaining 2 horses had meniscal cysts found incidentally during diagnostic arthroscopy for the treatment of osteochondritis dissecans of the lateral trochlear ridge of the femur. Five of 6 horses with long-term follow-up were sound and a 7th horse was improved 11 months after surgery. Meniscal cysts, while uncommon, can be associated with progressive lameness in the horse. Surgical excision of the cysts results in resolution or improvement of symptoms, without evidence of recurrence on follow-up examination.

Meniscus Tears in Children

Increased athletic participation by the skeletally immature athlete and a heightened suspicion by physicians have contributed to an increase in the incidence of meniscal injuries in children and adolescents. In young patient, meniscal injury could have long-term consequences, so an understanding of recognition and treatment is essential. We review the anatomy and development of the menisci, review classification and diagnosis of meniscal tears, discuss management options and outcomes of treatment, and focus on discoid lateral meniscus and meniscal cysts.

Intra-Articular Knee Mass in a 51-Year-Old Woman

A 51-year-old woman presented with moderate knee pain refractory to conservative measures. Radiographs revealed a well-defined, but irregularly-shaped ovoid soft tissue density at the posterior superior aspect of the infrapatellar fat pad of Hoffa. On magnetic resonance imaging, the mass was mildly heterogeneous and had intermediate signal in the proton density series and mixed signal intensity on the T2-weighted images. A low-signal rim could be seen around a portion of the lesion. Arthroscopic resection was performed and a vascular stalk was encountered. The differential diagnosis included: ganglion cyst, meniscal cyst, intra-articular lipoma, villous proliferation of the synovial membrane, Hoffa disease, and intracapsular chondroma. Histologic examination revealed a fibrous capsule partially surrounding a benign lipomatous neoplasm containing an abundance of thin- and thick-walled blood vessels with periadventitial myxoid stroma. To our knowledge, this is the first reported case of an intra-articular angiomyxolipoma in the literature. At 8-month follow-up, the patient was asymptomatic with no sign of recurrence. We postulate a low recurrence rate based on the insidious growth rate and benign histological appearance of such lesions. To our knowledge, no other intra-articular lipomatous lesion of the knee has been removed solely with arthroscopic techniques. Further follow-up information is needed to better understand the natural course of these lesions.

Tibial Plateau Cysts at the Meniscal Root Insertions: Incidence and Association

ABSTRACT Background The purpose of this study is to identify a possible relationship between high T2-signal cyst-like foci in the tibial plateau at the meniscal root insertions and meniscal pathology. Methods Institutional review board approval was obtained for this retrospective study. HIPAA compliance was maintained throughout this study. Two radiologists reviewed 200 knee MRI examinations for tibial plateau cysts at the meniscal root insertion sites; meniscal tears and intrameniscal cysts were also noted. The knee MRI examinations were also evaluated for articular cartilage abnormalities of the medial and lateral tibial plateaus. Results Of the 200 knee examinations, 83(41.5%) demonstrated medial meniscal pathology and 47(23.5%) demonstrated lateral meniscal pathology. Twenty (10%) demonstrated cysts in at least one of the described locations; two knees had cysts in two separate locations. four (2%) examinations had cysts at the anterior horn medial meniscal insertion, and all four (100%) had medial meniscal pathology (p = 0.028). Eleven (5.5%) examinations demonstrated cysts at the posterior horn medial meniscal insertion, and eight (72.7%) had medial meniscal pathology (p = 0.031). five (2.5%) examinations demonstrated cysts at the anterior horn lateral meniscal insertion, and one (20%) had lateral meniscal pathology (p = 0.374). Two (1%) examinations demonstrated cysts at the posterior horn lateral meniscal insertion, and one (50%) had lateral meniscal pathology (p = 0.852). Conclusions Cysts at the meniscal insertions are often seen on knee MRI. Cysts located at the insertions of the medial meniscus have a statistically significant association with meniscal pathology. Level of evidence Level II, retrospective study with development of diagnostic criteria on the basis of consecutive patients.

Arthroscopic treatment of a medial meniscal cyst using a posterior trans-septal approach: a case report

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.

Cyst-like lesions of the knee joint and their relation to incident knee pain and development of radiographic osteoarthritis: the MOST study

To determine whether intra- and periarticular cyst-like lesions of the knee are associated with incident knee pain and incident radiographic knee osteoarthritis (OA). The Multicenter Osteoarthritis (MOST) Study is a cohort of individuals who have or are at high risk for knee OA. Using a nested case-control study design, we investigated the associations of cyst-like lesions (Baker's, meniscal and proximal tibiofibular joint (PTFJ) cysts, and prepatellar and anserine bursitides) with (1) incident pain at 15- or 30-month follow-up and (2) incident radiographic OA at 30-month follow-up. Baseline cyst-like lesions were scored semiquantitatively using the Whole Organ Magnetic Resonance Imaging Score (WORMS). Conditional logistic regression models were used to assess the relation between these lesions and the outcomes, adjusting for potential confounding factors (i.e., cartilage loss, meniscal damage, bone marrow lesions, synovitis and joint effusion, which were also scored using WORMS). Incident knee pain study included 157 cases and 336 controls. Prevalence of meniscal and PTFJ cysts in the case group was twice that in the control group [9 (6%) vs 9 (3%) and 9 (6%) vs 10 (3%), respectively]. Incident radiographic OA study included 149 cases and 298 controls. Prevalence of grade 2 Baker's cysts and PTFJ cysts in the case group was approximately four times that in the control group [16(11%) vs 9 (3%) and 6 (4%) vs 3 (1%), respectively]. However, none of the cyst-like lesions was associated with incident pain or radiographic OA after fully adjusted logistic regression analyses and correction of P-values for multiple comparisons. None of the analyzed lesions was an independent predictor of incident knee pain or radiographic OA. Intra- and periarticular cyst-like lesions are likely to be a secondary phenomenon seen in painful or OA-affected knees, rather than a primary trigger for incident knee pain or radiographic OA.

New observations on meniscal cysts

The purpose of this study was to determine the incidence of meniscal cysts, assess the frequency of various magnetic resonance (MR) imaging characteristics, and emphasize radiographic observations not commonly reported. A total of 2,095 consecutive knee MR imaging reports from a 22 month period were retrospectively reviewed for the presence of meniscal cysts. Two musculoskeletal radiologists reviewed the cases where cysts were reported. A meniscal cyst was considered present if abnormally increased signal was identified within an enlarged meniscus (i.e., intrameniscal cyst) or if a loculated fluid-intensity lesion with a clear connection to the adjacent meniscus was identified (i.e., parameniscal cyst). Presence or absence of a meniscal tear, intrameniscal and parameniscal signal intensity, patient age, sex, location of meniscal cyst, presence of discoid meniscus, and size of the parameniscal cyst component were recorded. All knee imaging examinations were performed on a 1.5T MR unit. Imaging findings were correlated with arthroscopic reports when available. A total of 167 cases (8.0%) of meniscal cysts were diagnosed in 161 patients. Of the 167 cysts, 69 (41.3%) were located in the lateral meniscus and 98 (58.7%) in the medial meniscus. In 6 patients (3.7%), meniscal cysts were present in both menisci of the same knee. Twelve (7.2%) meniscal cysts were associated with discoid menisci. Ninety-seven (57.8%) meniscal cysts were associated with meniscal tears. Of the total number of meniscal cysts, 104 (62.3%) had a parameniscal cyst. An isolated intrameniscal cyst was present in 63 (37.7%) cases. One hundred (96%) of the parameniscal cyst components were isointense to fluid on T2-weighted FSE images. All cysts exhibited abnormal intrameniscal signal. Only 14 (8.4%) of the intrameniscal components were isointense to fluid on T2-weighted FSE images. The arthroscopic reports of 88 of the 161 (54.7%) patients were available for review and correlation. A tear extending to the articular surface of the meniscus was reported to be present in 74 of the 88 (84%) arthroscopic examinations. Knowledge of the spectrum of findings and the relative frequency of various MR imaging characteristics as well as common potential pitfalls is important to the accurate diagnosis and management of mensical cysts. In particular, controversy exists as to the incidence of articular surface tears in association with meniscal cysts, with some authors reporting greater than 98% correlation with tears. Only 58% of cysts were associated with an articular surface tear. Ninety six percent of the parameniscal signal was isointense to fluid, only 8% of the intramensical signal was isointense to fluid.

Preoperative localization of cystic lesions in the knee using ultrasound‐guided injection of indigo carmine

To evaluate the feasibility and effectiveness of preoperative localization of cystic lesions in the knee using ultrasound-guided indigo carmine injection. Twenty-three cysts in the knee in 23 patients (M:F = 15:8, mean age, 42 years) were localized preoperatively by ultrasound-guided indigo carmine injection. These included 12 meniscal cysts, 7 popliteal cysts, and 4 ganglion cysts. To stain the lesions, 0.2-3 mL of indigo carmine was injected into the cyst using a 22-gauge spinal needle. After localization, the patient was immediately transferred to the operating room and surgery was performed. Intraoperative findings and arthroscopic images were reviewed. All 23 cysts were stained successfully. Twenty cases were confirmed during arthroscopy and 3 cases were confirmed during excisional surgery. There was no significant bleeding/hematoma or anaphylactic reaction. Four patients felt pain during aspiration before indigo carmine injection. The lesions were stained blue and could be clearly identified by the surgeon and were removed arthroscopically or by open surgery. Preoperative localization of cystic lesions in the knee joint region using ultrasound-guided indigo carmine injection is a feasible technique and can be easily and safely be performed.

Analysis of preliminary clinical results of meniscal allograft transplantation.

Objective The purpose of this study was to report the preliminary outcomes of a series of patients who had undergone allograft meniscus transplantation with a minimum 1-year follow-up. Methods From June 2006 to July 2008,19 consecutive patients underwent meniscus allograft transplantation. Of them, 18 cases were included in this study. There were nine males and nine females. The patients ranged from twenty-one to fifty-two years old, with an average age of 38 years.The injury of anterior eruciate ligament was found in 7patients. There were multiple injury of ligaments of knee and fracture of tibial plateau in 2 pa-tients and one patient. Surgical technique:16 menisci were transplanted using the double bone plug tech-nique, 2 lateral menisci wers fixed using the bone bridge technique. Variable meniscus repair techniques were used for suturing the graft menisci's tim to capsule.The injury of ligament could be repaired stably by a concomitant reconstructive procedure at the time of transplantation or a separate surgery. Results Eighteen patients were followed up. The follow-up time ranged from 16 to 41 months,with the mean of 26 months. The allogrates were assessed by second-look arthroscopy. It comfirmed that 16 cases were normal or nearly nor-mal and two (11%)failed which solved with meniscectomy. Postoperative stiff knee occured in one patient who required arthroscopic arthrolysis. One patient with meniscal cyst underwent conservative treatment. 15 patients were assessed by full subjective evaluation. The mean Lysholm scores had improved from 67 to 85. On IKDC evaluation, two patients were grade A and twelve were grade B, one were grade C. With regard to pain and satisfaction, the average VAS had improved from 6.2 to 2.1. Conclusion Arthrosocpic meniscus transplantation can achieve satisfied subjective and objective clinical outcomes with 89% survival rate over a mean follow-up period of 26 months. Key words: Menisci,tibial; Transplantation,homologous; Endoscopy

An Infected, Extruded Lateral Meniscal Cyst as a Cause of Knee Symptoms

A 62-yr-old male runner with known bilateral knee osteoarthritis presented to a Physical Medicine and Rehabilitation outpatient musculoskeletal practice because of a left lateral knee mass, with associated pain and pressure. The mass was clearly visible and palpable. X-rays revealed his preexisting severe tricompartmental osteoarthritis. Magnetic resonance imaging revealed a lateral meniscal tear with extrusion of the lateral meniscus through the lateral capsule, thus forming a large lateral meniscal cyst (Fig. 1).FIGURE 1: Coronal, T2 MRI image demonstrating extruded lateral meniscal cyst. MRI, magnetic resonance imaging.Initial aspiration of the cyst yielded 2 ml of very viscous fluid without crystals or infection. Repeated aspiration over subsequent months yielded up to 10 ml of similar fluid. Each aspiration improved his pain, pressure, and function. An orthopedist suggested postponing surgery for this cyst until his planned total knee replacement next year. He did well with nonsurgical management until he developed an acute infection of the cyst with associated left leg cellulitis (Fig. 2). It had been multiple months since any local injection/aspiration, and he had no recent systemic illness. Thus, the presumed source of infection was a local abrasion at the skin over the cyst, which had been a recurrent problem. Cyst cultures revealed Staphylococcus aureus with broad susceptibility to antibiotics. Based on possible underlying osteomyelitis at the proximal tibia, he underwent surgical irrigation, debridement, and antibiotic bead placement, in addition to intravenous antibiotics.FIGURE 2: Left knee with enlarged and erythematous lateral mass.Meniscal cysts are relatively uncommon and a rare cause of knee pain or mass, seen in approximately 1% of those undergoing meniscectomies.1 They more commonly arise from the lateral meniscus and are frequently associated with horizontal meniscal tears.2 The cause of meniscal cysts is unknown, but previous trauma may play a role.3 Magnetic resonance imaging is generally sufficient for diagnosis if an associated meniscal tear is visualized. Ultrasound can visualize the cyst, but it is inferior to magnetic resonance imaging for detecting underlying meniscal tears. Without a visualized meniscal tear, tissue diagnosis may be necessary to rule out malignancy.4 Treatment options include needle aspiration/corticosteroid injection vs. more definitive care via either arthroscopic or open surgical excision. An extensive search of the literature fails to reveal any other reports of an extruded meniscal cyst as a site of infection. Musculoskeletal physicians should nonetheless be aware of meniscal cysts and their complications, and diagnostic and treatment options.

Continuing education mri spectrum of medial collateral ligament injuries and pitfalls in diagnosis

The medial collateral ligament (MCL) is made up of different components and spans the medial aspect of the knee. With injuries the superficial or deep and posterior components may be involved. A variety of conditions including MCL bursitis, medial osteoarthritis, medial cellulitis, medial bursitis, medial meniscal cyst, meniscocapsular separation, and retinacular tear may present with high signal surrounding the MCL fibers and simulate an MCL tear.

So-called Lateral Meniscal Cyst: Figure 1.

A meniscal cyst is an outpouching of joint fluid, commonly seen near the lateral meniscus, caused by a tear within the meniscus, whereas neurofibroma is a nerve sheath tumor in the peripheral nervous system. Both have the capability to induce pain …

Development of new SLAP lesion after the arthroscopic, isolated decompression of ganglion cyst of the shoulder

Ganglion cysts of the shoulder are rare, and the pathogenesis is similar to that of meniscal cysts. We present details of two cases of isolated ganglion cyst of shoulder which were treated arthroscopically. Both patients following 1 year after the surgery, complained of nonspecific shoulder pain and magnetic resonance imaging revealed new SLAP lesion which was treated arthroscopically.

Postoperative Pain Management and Acupuncture: A Case Report of Meniscal Cyst Excision

We report a case of pain management after a meniscal cyst excision, with the use of electroacupuncture (EA). There are a few reports which indicate that postoperative pain management is prerequisite for the patient's optimal recovery, but surveys in the UK and the USA have identified an unacceptable prevalence of poor pain control after surgery, which might increase the risk of a chronic pain state. The conventional treatment of postoperative pain includes systemic medications such as opioids, non-steroidal anti-inflammatory drugs and other non-opioid agents. In our case, the rehabilitation lasted for 6 months without significant benefit. After that period our patient was treated with EA. By the end of the first EA session the relief of pain was notable and after a course of 10 treatments the patient reported complete relief of the symptoms with no recurrence during a 2 year follow up period. In conclusion, this might indicate that EA could be useful for postoperative pain management.

Imaging-Guided Treatment of Meniscal Cysts

Meniscal and parameniscal pathology is usually diagnosed through magnetic resonance imaging. The availability of high-frequency high-resolution linear transducers for sonographic detection of peripheral meniscal and parameniscal pathology has made not only the diagnosis but also the treatment of symptomatic parameniscal cysts a more accessible option. This case report illustrates the use of sonographically guided meniscal cyst aspiration and injection as an alternative to surgical treatment in the proper clinical scenario.

A contribution to Pisani’s sign for diagnosing lateral meniscal cysts: a technical report

This article describes modified physical examination maneuvers for diagnosing lateral meniscal cysts. The typical presentation of lateral meniscal cysts usually makes their clinical diagnosis simple, but a wide variation in size may sometimes lead to misdiagnosis. We evaluated the effect of leg rotations on the cystic swelling at 45 degrees of knee flexion. Eleven consecutive patients with positive Pisani's sign were evaluated prospectively. Lateral mid-third joint-line swelling was most prominent at 30-45 degrees of knee flexion. With the knee held at 45 degrees of flexion, the prominence was also inspected during internal and external rotation of the leg. The masses became noticeably more prominent with external rotation, and completely disappeared with internal rotation. With external rotation of the leg, even doubtful lateral meniscal cysts became apparent. Disappearance of the cystic mass with internal rotation further confirms the diagnosis.

半月板嚢腫に対し関節鏡視下嚢腫交通術を行った１例

変形性膝関節症，半月板損傷に合併する半月板嚢腫は，根治的治療のため直視下に嚢腫摘出術を行うと，侵襲が大きく再発もあることより，穿刺などの対症療法が行われることが多い．今回，巨大内側半月板嚢腫に対し，鏡視下半月板切除ならびに嚢腫交通術を行うことで嚢腫の縮小が得られ，嚢腫摘出を行うことなく良好な経過を得たので報告する．症例は，52歳男性．1ケ月前より誘因なく左膝内側の疼痛を伴う腫瘤を認めた．MRIにて左膝内側半月板損傷および，内側の嚢胞性腫瘤を認めた．関節鏡視下に内側半月板後節の水平断裂部を切除後，関節包後壁の連絡孔を色素で確認，拡大させる嚢腫交通術を行った．術後1ケ月で腫瘤は完全に消失した．関節液が関節内から嚢腫内へと一方向にしか流れないcheck valve機構を破綻させることで嚢腫が縮小することを確認できた．半月板断裂を伴う半月板嚢腫に対する関節鏡視下嚢腫交通術は有用であると思われた．