Meniscal Cysts: Treatment Options and Algorithm

Abstract

Meniscal cysts are commonly seen in the knee. Symptomatic meniscal cysts tend to be located on the lateral side but magnetic resonance imaging studies indicate that medial cysts are more common. Meniscal cysts are commonly associated with horizontal meniscal tears. The arthroscopic management of symptomatic cysts should include debriding the horizontal meniscal tear (if nonrepairable) to fully decompress the cyst and the creation of a 5-mm channel from the joint into the cyst. If a vertical peripheral meniscal tear exists or is created, meniscal repair for appropriately selected cases should be performed.

Keywords

knee - meniscal cysts - arthroscopy

• References

• 1 Ebner A. Ein Fall von Ganglion am Kniegelenks-meniskus. Munch Med Wochenschr 1904; 51: 1737-1739
• 2 Wijnbladh HJ. Ganglion menisci migrans. Bruns' Beitrage zur klinischen. Chirurgie 1938; 167: 177-188
• 3 Hertz J. Cysts of the semilunar cartilage of the knee-joint. J Int Coll Surg 1955; 24 (3 Part 1) 257-264
• 4 Smillie IS. Injuries of the Knee Joint. 3rd ed. Edinburgh and London: E & S Livingstone Ltd; 1962
• 5 Barrie HJ. The pathogenesis and significance of menisceal cysts. J Bone Joint Surg Br 1979; 61-B (2) 184-189
• 6 Smillie IS. Injuries of the Knee Joint. 5th ed. London, UK: Churchill Livingstone Ltd; 1978
• 7 Reagan WD, McConkey JP, Loomer RL, Davidson RG. Cysts of the lateral meniscus: arthroscopy versus arthroscopy plus open cystectomy. Arthroscopy 1989; 5 (4) 274-281
• 8 Hulet C, Souquet D, Alexandre P, Locker B, Beguin J, Vielpeau C. Arthroscopic treatment of 105 lateral meniscal cysts with 5-year average follow-up. Arthroscopy 2004; 20 (8) 831-836
• 9 Ryu RK, Ting AJ. Arthroscopic treatment of meniscal cysts. Arthroscopy 1993; 9 (5) 591-595
• 10 Seger BM, Woods GW. Arthroscopic management of lateral meniscal cysts. Am J Sports Med 1986; 14 (2) 105-108
• 11 Mills CA, Henderson IJ. Cysts of the medial meniscus. Arthroscopic diagnosis and management. J Bone Joint Surg Br 1993; 75 (2) 293-298
• 12 Glasgow MM, Allen PW, Blakeway C. Arthroscopic treatment of cysts of the lateral meniscus. J Bone Joint Surg Br 1993; 75 (2) 299-302
• 13 Passler JM, Hofer HP, Peicha G, Wildburger R. Arthroscopic treatment of meniscal cysts. J Bone Joint Surg Br 1993; 75 (2) 303-304
• 14 Burk Jr DL, Dalinka MK, Kanal E , et al. Meniscal and ganglion cysts of the knee: MR evaluation. AJR Am J Roentgenol 1988; 150 (2) 331-336
• 15 Tasker AD, Ostlere SJ. Relative incidence and morphology of lateral and medial meniscal cysts detected by magnetic resonance imaging. Clin Radiol 1995; 50 (11) 778-781
• 16 Tyson LL, Daughters Jr TC, Ryu RK, Crues III JV. MRI appearance of meniscal cysts. Skeletal Radiol 1995; 24 (6) 421-424
• 17 Campbell SE, Sanders TG, Morrison WB. MR imaging of meniscal cysts: incidence, location, and clinical significance. AJR Am J Roentgenol 2001; 177 (2) 409-413
• 18 Tschirch FT, Schmid MR, Pfirrmann CW, Romero J, Hodler J, Zanetti M. Prevalence and size of meniscal cysts, ganglionic cysts, synovial cysts of the popliteal space, fluid-filled bursae, and other fluid collections in asymptomatic knees on MR imaging. AJR Am J Roentgenol 2003; 180 (5) 1431-1436
• 19 De Smet AA, Graf BK, del Rio AM. Association of parameniscal cysts with underlying meniscal tears as identified on MRI and arthroscopy. AJR Am J Roentgenol 2011; 196 (2) W180-W186
• 20 De Maeseneer M, Shahabpour M, Vanderdood K, Machiels F, De Ridder F, Osteaux M. MR imaging of meniscal cysts: evaluation of location and extension using a three-layer approach. Eur J Radiol 2001; 39 (2) 117-124
• 21 Anderson JJ, Connor GF, Helms CA. New observations on meniscal cysts. Skeletal Radiol 2010; 39 (12) 1187-1191
• 22 Warren LF, Marshall JL. The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am 1979; 61 (1) 56-62
• 23 Guermazi A, Hayashi D, Roemer FW , et al. Cyst-like lesions of the knee joint and their relation to incident knee pain and development of radiographic osteoarthritis: the MOST study. Osteoarthritis Cartilage 2010; 18 (11) 1386-1392
• 24 Pisani AJ. Pathognomonic sign for cyst of the knee cartilage. Arch Surg 1947; 54 (2) 188-190
• 25 Pinar H, Boya H, Satoglu IS, Oztekin HH. A contribution to Pisani's sign for diagnosing lateral meniscal cysts: a technical report. Knee Surg Sports Traumatol Arthrosc 2009; 17 (4) 402-404
• 26 Macmahon PJ, Brennan DD, Duke D, Forde S, Eustace SJ. Ultrasound-guided percutaneous drainage of meniscal cysts: preliminary clinical experience. Clin Radiol 2007; 62 (7) 683-687
• 27 Park HJ, Lee SM, Choi JA, Park NH, Kim HS, Park SI. Preoperative localization of cystic lesions in the knee using ultrasound-guided injection of indigo carmine. J Clin Ultrasound 2010; 38 (6) 305-308
• 28 Seymour R, Lloyd DC. Sonographic appearances of meniscal cysts. J Clin Ultrasound 1998; 26 (1) 15-20
• 29 Rutten MJ, Collins JM, van Kampen A, Jager GJ. Meniscal cysts: detection with high-resolution sonography. AJR Am J Roentgenol 1998; 171 (2) 491-496
• 30 Kocher MS, Klingele K, Rassman SO. Meniscal disorders: normal, discoid, and cysts. Orthop Clin North Am 2003; 34 (3) 329-340
• 31 Chang A. Imaging-guided treatment of meniscal cysts. HSS J 2009; 5 (1) 58-60
• 32 Lu KH. Arthroscopic meniscal repair and needle aspiration for meniscal tear with meniscal cyst. Arthroscopy 2006; 22 (12) e1-e4
• 33 Pujol N, Bohu Y, Boisrenoult P, Macdes A, Beaufils P. Clinical outcomes of open meniscal repair of horizontal meniscal tears in young patients. Knee Surg Sports Traumatol Arthrosc 2013; 21 (7) 1530-1533
• 34 Tudisco C, Meo A, Blasucci C, Ippolito E. Arthroscopic treatment of lateral meniscal cysts using an outside-in technique. Am J Sports Med 2000; 28 (5) 683-686
• 35 Ahn JH, Wang JH, Yoo JC, Kim SK, Park JH, Park JW. The modified outside-in suture: vertical repair of the anterior horn of the meniscus after decompression of a large meniscal cyst. Knee Surg Sports Traumatol Arthrosc 2006; 14 (12) 1288-1291
• 36 Howe TS, Koh JS. Arthroscopic internal marsupialization of meniscal cysts. Knee 2007; 14 (5) 408-410
• 37 El-Assal M, Mostafa M, Abdel-Aal A, El-Shafee M. Arthroscopy alone or in association with open cystectomy: in treatment of lateral meniscal cysts. Knee Surg Sports Traumatol Arthrosc 2003; 11 (1) 30-32
• 38 Sarimo J, Rainio P, Rantanen J, Orava S. Comparison of two procedures for meniscal cysts. A report of 35 patients with a mean follow-up of 33 months. Am J Sports Med 2002; 30 (5) 704-707