Arthroscopic Treatment of Lateral Meniscal Cysts Using an Outside-In Technique

Abstract

This paper describes 19 cases of lateral meniscal cysts treated arthroscopically using an outside-in technique. In all patients, a horizontal or radial lesion (or both) of the meniscus was present. After the meniscal lesion was arthroscopically removed, the cyst was decompressed both from inside and percutaneously from outside with a motorized instrument introduced through a transmeniscal approach. The follow-up ranged from 2 to 5 years with an average of 3.3 years. On the basis of the evaluation scale developed by Cerullo et al. (1991), the results were rated excellent or good in 17 patients and fair in 2. No patient had cyst recurrence. The computed tomography follow-up examination, done in 10 of the 19 patients after an average of 3 years, showed a good remodeling of the meniscus. One of the two patients with a fair result had hypermobility of the posterior horn of the lateral meniscus due to the resection of the meniscal tissue overlying the popliteus tendon, whereas the other had pain and patellar crepitation owing to a preexisting patellofemoral abnormality.

Tibiofemoral Contact Mechanics With Horizontal Cleavage Tears and Treatment of the Lateral Meniscus in the Human Knee: An In Vitro Cadaver Study

“…Horizontal cleavage tears of the meniscus are most common in the medial meniscus, but also occur in the lateral meniscus [11,26,32,35]. Horizontal cleavage tears in either compartment can cause symptomatic meniscal cysts [13,18,25,42]. It is unknown what effect a horizontal cleavage tear or partial resection of the tear will have on contact mechanics of the lateral meniscus; in particular, given the different morphologic features of the lateral tibial plateau and larger amount of translation of the lateral meniscus, we wondered whether the biomechanics of lateral horizontal cleavage tears would differ from those reported in medial horizontal cleavage tears [30].…”

Comparison of Two Procedures for Meniscal Cysts: A Report of 35 Patients with a Mean Follow-up of 33 Months

“…Good results after open excision of the cyst combined with arthroscopic examination, 6,9 an entirely arthroscopic treatment, 3,7,10 and an outside-in technique 12 have been reported. In our series of 35 patients, excellent or good results were achieved in 85% of the patients (30 of 35), and the results were similar whether an open excision combined with an arthroscopic examination or an entirely arthroscopic procedure was used.…”

Meniscal Cysts: Treatment Options and Algorithm

“…Approximately 87% of patients rated their results as either excellent or good. 8 Some authors 32,34,35 have advocated arthroscopic techniques other than decompression through the meniscal tear. Tudisco et al described a technique in which the lateral meniscus was arthroscopically debrided back to a stable rim.…”

“…Tudisco et al described a technique in which the lateral meniscus was arthroscopically debrided back to a stable rim. 34 The cyst is then decompressed from the outside-in by percutaneously inserting a curette or motorized shaver into the cystic cavity followed by suturing the tract closed from the outside.…”

“…32 In an effort to preserve an otherwise stable meniscus while decompressing a cyst, Howe and Koh 36 used a technique of an arthroscopic internal marsupialization of the meniscal cyst. In contrast to the outside-in technique of Tudisco et al, 34 they created a 5-mm channel through the knee capsule adjacent to the cyst. This equalized the pressures between the cyst and intra-articular compartment and avoids decompression through the meniscal tear itself.…”