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Li T, Li R, Shu Y, Li Y, You M, Li Q. Parameniscal Cyst Arthroscopic Excision by the Modified Fat Pad Approach Can Shorten Recovery Time-A New Surgical Method with Retrospective Study. Orthop Surg 2023; 15:3075-3082. [PMID: 37771120 PMCID: PMC10694003 DOI: 10.1111/os.13876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/20/2023] [Accepted: 07/29/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Tao Li
- Department of OrthopaedicsOrthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Ran Li
- Department of Rehabilitation MedicineWest China Hospital, Sichuan UniversityChengduChina
| | - Yi Shu
- Department of RadiologyWest China Hospital, Sichuan UniversityChengduChina
| | - Yinghao Li
- Department of OrthopaedicsOrthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Mingke You
- Department of OrthopaedicsOrthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Qi Li
- Department of OrthopaedicsOrthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
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Thor JEH, Lim GYC, Hui JHP, Lee DYH. Do meniscal repairs with meniscus cyst do better than meniscectomy?-a systematic review of meniscal cyst treatment. ANNALS OF JOINT 2022; 8:8. [PMID: 38529257 PMCID: PMC10929322 DOI: 10.21037/aoj-22-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/22/2022] [Indexed: 03/27/2024]
Abstract
Background 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. Methods 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). Results 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. Conclusions 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.
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Affiliation(s)
- Jessica Eng Hsia Thor
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore, Singapore
| | - Gennie Yan Cen Lim
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore
| | - James Hoi Po Hui
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Dave Yee Han Lee
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
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Li H, Li Z, Li Q, Mei L, Pierre BS, Abdullenur A, Huang T, Wang W, Mao X, Zhu W. Arthroscopic Management of Giant Meniscal Cysts Among Young Patients: An Average Three-Year MRI Follow-Up. Orthop Surg 2022; 14:1743-1750. [PMID: 35818343 PMCID: PMC9363751 DOI: 10.1111/os.13374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 04/20/2022] [Accepted: 05/20/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To 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. Methods A 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. Results Preoperative 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. Conclusions Arthroscopic cystectomy combined with the meniscus suture technique was effective to eradicate residual cyst cavities, and traffic orifices be highly recommended.
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Affiliation(s)
- Hongxing Li
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Orthopaedic, The Central Hospital of Shaoyang, Shaoyang, China
| | - Zhiling Li
- Center of Health Management, The Central Hospital of Shaoyang, Shaoyang, China
| | - Quanchao Li
- Department of Orthopaedic, The First People's Hospital of Changde city, Changde, China
| | - Lin Mei
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Bigiriman Simon Pierre
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ayub Abdullenur
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tianlong Huang
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wanchun Wang
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xinzhan Mao
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Weihong Zhu
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
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Haratian A, Bolia IK, Hasan LK, Fathi A, Solaru S, Homere A, Petrigliano FA, Weber AE. Arthroscopic Management of Meniscal Cysts: A Systematic Review. Orthop Res Rev 2021; 13:123-139. [PMID: 34557043 PMCID: PMC8455512 DOI: 10.2147/orr.s321893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/06/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Aryan Haratian
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Laith K Hasan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Amir Fathi
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Samantha Solaru
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Andrew Homere
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
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Orsini NG, Favreau H, Eichler D, Ollivier M, Bonnomet F, Ehlinger M. Meniscus sutures by arthrotomy for a non-transfixing horizontal lesion associated with a cyst. INTERNATIONAL ORTHOPAEDICS 2020; 44:1071-1076. [PMID: 31993712 DOI: 10.1007/s00264-020-04491-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/20/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION 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. MATERIALS AND METHODS 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 two years. Secondary endpoints were complications, possible recurrence, and/or surgical revision. Recurrences, complications, and surgical recovery were gathered. RESULTS Patients were evaluated with an average follow-up of 32 months. 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. DISCUSSION 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. CONCLUSION 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.
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Affiliation(s)
- Nicolas Girodano Orsini
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg cedex, France
| | - Henri Favreau
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg cedex, France
| | - David Eichler
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg cedex, France
| | - Matthieu Ollivier
- Département de Chirurgie Orthopédique, Hôpital Sainte-Marguerite, Hôpital Universitaire de Marseille, 270 boulevard Sainte Marguerite, 13009, Marseille, France
| | - François Bonnomet
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg cedex, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg cedex, France.
- Laboratoire ICube, équipe MMB, CNRS, Illkirch, France.
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Lui TH. Endoscopic Resection of Medial Extra-articular Cysts of the Knee. Arthrosc Tech 2017; 6:e461-e466. [PMID: 28580268 PMCID: PMC5443617 DOI: 10.1016/j.eats.2016.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 11/08/2016] [Indexed: 02/03/2023] Open
Abstract
Although most of the parameniscal cysts are very small and asymptomatic, some of them can present with a painful mass or snapping knee. Because parameniscal cysts are almost always associated with horizontal meniscal tears, arthroscopic partial meniscectomy of the involved part of meniscus and intra-articular cyst drainage has become the most accepted procedure. However, arthroscopic cyst decompression through partial meniscectomy to the meniscocapsular junction to expose the communication between the cyst and the knee joint may sacrifice some of the healthy parts of the meniscus especially when meniscal tear is peripheral. Moreover, internal drainage may not be an adequate treatment for a cyst larger than 5 cm in size or a multiloculated cyst. The excision of the cyst is a more appropriate treatment option in these situations. The purpose of this Technical Note is to describe the details of endoscopic resection of medial extra-articular cysts of the knee. This technique is indicated in symptomatic medial extra-articular cysts of the knee with peripheral or no tear of the medial meniscus, especially if the cysts are large and multiloculated.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China
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