Medial meniscal cyst as a cause of painful erosion of the tibial plateau

Arthroscopic Management of Meniscal Cysts: A Systematic Review

Purpose

The 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.

Methods

Following 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.

Results

Eighteen 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.

Conclusion

Based 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nonoperative modalities, given that a significant proportion of the included articles in this review were relatively outdated.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 Evidence

Systematic review of level II and IV studies.

The prevalence and characteristics of osseous erosions associated with parameniscal cysts on knee MRI

OBJECTIVES

To determine the prevalence and characteristics of erosions associated with parameniscal cysts (PMCs) and to evaluate the profile of the associated meniscal tears MATERIALS AND METHODS: PACS database was reviewed for knee MRI scans performed over a 5-year period identifying those with PMCs in patients aged 18 years and above. The scans with PMCs were evaluated for the presence of associated osseous erosions. These erosions and PMCs were then analyzed.

RESULTS

The search revealed 6773 knee MRI examinations, of which 555 had confirmed PMCs. There were 7 PMC-associated erosions for a prevalence of 1.3% (95% CI 0.6, 2.6). All erosions involved the proximal tibia. Three of 7 erosions had underlying marrow edema, and 4 out of 7 had an overhanging margin. The mean dimension of all PMCs was 13 mm (SD = 11). The mean dimension of PMCs associated with erosions was 38 mm (SD = 22), while that of PMCs without erosions was 12 mm (SD = 10) (P < 0.001, Wilcoxon rank sum test). Ninety-three percent (95% CI 90.5, 94.8) of PMCs had associated meniscal tears, most commonly of the horizontal type (57%). All PMCs with underlying erosions were associated with meniscal tears, most commonly complex type tears (5/7).

CONCLUSION

Erosions can rarely be associated with contiguous parameniscal cysts (PMCs). These cysts are significantly larger compared with those without underlying erosions.