The development of cysts in connection with the external semilunar cartilage of the knee-joint

Abstract

IN my work in the orthopredic department of Salford Royal Hospital I have now met with three instances in which cystic changes had occurred in the external semilunar cartilage. The condition has been recorded previously by several German observers. In 1904 Ebnerl reported one case in great det,ail ; in 1906 Schmidt2 recorded a case, and in 1918 Riede13 described 6 cases upon which he had operated. Eden4 also reported 2 cases in 1911. I n 1909 Mr. Furnivall, who was then a member of the honorary staff of the London Hospital, told me of a recent example and referred t o another case with which he had dealt. He presented a specimen to the museum of the Royal College of Surgeons. I have examined this specimen, which shows precisely the same condition as is seen in my own cases.The museum catalogue describes it as follows : " The chief portion of a right semilunar cartilage removed by operation from the knee-joint. Projecting from the outer attached border there is a somewhat hemispherical swelling which extends for about half a n inch along the cartilage and attains a maximum eminence of half a n inch. As seen in the divided surfaces, the swelling consists of a series of well-defined spaces which, in the recent state, were filled with a thick, transparent, ntucoid material. The smallest spaces appear as clefts between the bundles of white fibrous tissue a t the periphery of the fibrocartilage, and seem to have arisen from a mucoid softening of the tissues and not in any way t o be connected with the attached portions of synovial membrane. From a man, age 30, who slipped and fell, injuring the right knee four months before coming under observation. About a month later he noticed a swelling on the outer side of the joint; this slowly increased and troubled him in walking; i t was especially uncomfortable at night and in the morning, without ever causing actual pain. On examination, there was found a swelling as large as a small filbert over the region of the external semilunar cartilage, just in front of the external lateral ligament : it was fixed to, and moved with, the tibia, and was unaffected by contraction of the biceps. The movements of the joint were smooth, and the other structures of the knee were normal. There was no affection of any other joint, and there was no history of gout or rheumatism. The parts shown were removed by longitudinal incision over the swelling." Tllc swelling was wholly inside the capsule of the joint. The wound healed by first intention, and the function of the joint was afterwards perfect." Fig. 261 shows a drawing which Mr. Sewell has made of this specimen. The clinical history of all the cases seems t o be similar; all have a history of a n injury, iisually not severe, with gradually increasing pain and lameness, and with the development of

Cysts of the Semilunar Cartilage of the Knee:A Light and Electron Microscopic Study

“…Others regard meniscial cysts as the result of degenerative changes of collagen followed by necrosis of cells and accumulations of acid mucopolysaccharides. There a r e authors (Blanco et al 1953 andOllerenshaw 1921) that postulate that meniscial cysts originate from congenital inclusion of synovial rests or from traumatic cleavages of the fibrocartilaginous tissue with subsequent penetration of synovial cells and joint fluid into the meniscus. Other authors believe that the meniscial cysts represent ganglia that originated as a result of a degenerative process and that the accumulation of acid mucopolysaccharides represents secretory activity of certain connective tissue cells (King 1940) or synovial cells displaced into the fibrocartilaginous tissue (Albert & Keller 1953).…”

Cystic Changes in a Lateral Semilunar Cartilage in a Boy of 5 Years

“…The German view was that these cysts were due to a process of degeneration occurring in the cartilage and caused by deficient nutrition following trauma. Ollerenshaw (1921Ollerenshaw ( , 1929Ollerenshaw ( and 1935 postulated the view that the cysts were embryological in origin, developing from pre-existing spaces in the cartilage and described the lining cells as being endothelial.…”

A contribution to Pisani’s sign for diagnosing lateral meniscal cysts: a technical report

“…However, ganglion cysts, inflamed bursa around the knee, synovial inflammation, arthritic spurs, loose bodies, meniscal tears, and tumors should be considered in the differential diagnosis [1, 3, 6, 8, 10, 11, 13]. The most common localization for a meniscal cyst is the peripheral portion of the mid‐third of the lateral meniscus [3, 5]. The mass is usually palpable at the level of the joint line, most prominent while the knee is in 20–30° of flexion, being firmly fixed to underlying tissues and not mobile in subcutaneous tissues [7].…”