Surgical Repair of Symptomatic Wrisberg Variant Discoid Lateral Mensicus with Pull-Out Repair and Capsulodesis

Arthroscopic Belt Capsulodesis Using a Knotless Soft Suture Anchor for Extruded Medial Meniscus

In recent years, degenerative meniscal lesions have received increasing attention as an etiologic factor of knee osteoarthritis. Among various relevant factors, medial meniscal extrusion has been shown to be an independent predictor of the onset and progression of knee osteoarthritis. Therefore, surgical reduction of the extruded medial meniscus to restore meniscal function is key to preventing osteoarthritis of the knee. The arthroscopic centralization technique using knotless anchors has been developed and refined to reduce meniscal extrusion in the posteromedial region of the knee. Although a short-term study has reported favorable outcomes, the technique presents some pitfalls and can be technically challenging. This article describes the rationale and procedure for arthroscopic belt capsulodesis using 2 knotless anchors for reduction of medial meniscal extrusion. The reported procedure is technically simple and efficiently reduces meniscal extrusion by repairing the meniscotibial capsule, and it may be useful in the prevention of osteoarthritic progression.

Effectiveness of capsulodesis in ganglion cysts caused by a medial meniscotibial ligament tear and medial meniscus extrusion

INTRODUCTION AND IMPORTANCE

Meniscotibial ligament (MTL) has received attention as a major meniscus stabilizer. An MTL injury results in instability and extrusion of the meniscus. Cases of knee ganglion cyst formation due to an MTL tear and medial meniscus extrusion (ME) are extremely rare.

CASE PRESENTATION

A 42-year-old female Japanese childcare worker presented painful ganglion cysts on the proximal medial side of her left tibia. An MTL tear and medial ME were thought to be involved in the ganglion formation. Joint fluid flowed through the meniscotibial side of the extruded meniscus into the space between the medial collateral ligament and tibia, where the MTL tear acted as a check valve, forming ganglion cysts. Ultrasonography-guided aspiration of the ganglion was attempted, but ganglion cysts recurred within 1 month. We used an open excision for the ganglion cysts, and arthroscopic capsulodesis was performed to repair the MTL and internalize the medial meniscus to block the inflow route from the intra-articular space.

CLINICAL DISCUSSION

We performed capsulodesis, which repaired the MTL and internalized the medial meniscus to prevent the recurrence of the ganglion cyst. Three months have passed since the surgery, with no recurrence of knee pain or ganglion cysts, indicating good short-term results.

CONCLUSIONS

We encountered a rare case of ganglion cyst formation in the knee joint due to MTL tear and medial ME. Arthroscopic MTL repair and internalization of the meniscus by capsulodesis were effective in treating the ganglion cysts.

Review of the Development of Meniscus Centralization

PURPOSE OF REVIEW

With an aging population, extending healthy life expectancy is a global challenge. Maintaining healthy knee joint function is one of the essential factors to preserve the ability to walk and extend healthy life expectancy. Meniscus centralization was introduced in 2012 as a procedure for meniscus extrusion, one of the causes of knee osteoarthritis (OA). Initially, it was performed only for lateral meniscus (LM) extrusion, and favorable 2-year results were reported in 2016. Gradually, basic studies supporting the effectiveness of meniscus centralization have been reported, and it has also been performed for medial meniscus (MM) extrusion, with some positive results reported. Although the surgical procedures vary among the institutions, the basic concept is to reattach the loosened meniscotibial ligament to the edge of the tibial plateau to re-tension it. This review will discuss the history of development and the current status of meniscus centralization.

RECENT FINDINGS

Current research shows that meniscus centralization is not performed in isolation but is often used as an augmentation along with the conventional repair of meniscus injuries, particularly posterior root tears. Biomechanical studies demonstrated that MM centralization with a posteromedial anchor can better restore meniscus function.

CONCLUSION

Despite its relatively short publication history of just over ten years, meniscus centralization has shown potential as a treatment to curb the progression of knee OA and extend a healthy life. While more evidence is needed, this conclusion underscores the promising role for meniscus centralization, making it a topic of significant interest for knee surgeons and researchers.

Arthroscopic Saucerization of Discoid Lateral Meniscus, With Meniscus Repair as Indicated, Results in Excellent Outcomes in Pediatric Patients Younger Than 12 Years of Age

Purpose

To evaluate the experiences and outcomes of arthroscopic partial meniscectomy in symptomatic non-Wrisberg discoid lateral meniscus in children younger than 12 years old at a single center.

Methods

We retrospectively reviewed the medical records of all pediatric patients who were treated for non-Wrisberg discoid meniscus at our institute between 2013 and 2021. Patients were separated into 2 groups: Patients who underwent partial resection with saucerization (group A) or patients who underwent saucerization, tear repair, and fixation (group B). Clinical outcomes were compared between the 2 groups.

Results

A total of 20 patients (22 knees) were treated for non-Wrisberg discoid meniscus and included in this study. Nine patients underwent partial resection with saucerization (group A) whereas 11 patients underwent saucerization, tear repair, and fixation (group B). The average follow-up was 3 years (range 2-10 years). The results showed that 17 of the 20 patients had excellent outcomes whereas the other 3 had good outcomes after a minimum follow-up of 2 years. The average Knee Injury and Osteoarthritis Outcome Score for Children score was 93.

Conclusions

Arthroscopic saucerization of symptomatic non-Wrisberg discoid lateral meniscus, with additional repair as indicated results in excellent or good outcomes in children younger than 12 years of age.

Level of Evidence

Level III, case-control study.