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      When should the external approach be resorted to in the arthroscopic treatment of perimeniscal cyst?

      research-article
      1 , * , 1 , 2 , 3
      SICOT-J
      EDP Sciences
      Knee, Meniscal cyst, Meniscectomy, Arthroscopy

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          Abstract

          Introduction: Meniscal cysts very often cause meniscal tears and especially when it is peripheral, some of the healthy parts of meniscus might be needlessly sacrificed. In particular conditions, extraarticular approaches might save some menisci. In the present study, we evaluated the conditions which required using the extraarticular approach in addition to the arthroscopic procedure, to maximally preserve the meniscus.

          Methods: Eight patients with perimeniscal cysts were evaluated retrospectively. One cyst was localized within the medial meniscus and seven in the lateral meniscus. The mean age was 36.13 (range; 19–63) years, mean follow-up time, 27.3 (range; 12–47) months. Patients were evaluated by using a Visual Analogue Score (VAS) to measure pain relief and “Lysholm score” to measure functional improvement. In all patients except one, in which the cystic cavity was connected with the joint at the periphery of the meniscus, the cyst was drained from the intraarticular opening. When the cyst was too large (three cases) and in one case where a large amount of meniscus was preserved for reasons mentioned above, additional extraarticular drainage was carried out.

          Results: The mean preoperative and postoperative VAS were 6 (range; 2–8) and 1.55 (range; 0–3) ( p = 0.00058) and Lysholm scores were 64.75 (range; 48–86) and 93.11 (range; 80–100) ( p = 0.0014), respectively.

          Discussion: In cysts, which have very limited or no connection with the joint on the most peripheral region of the meniscus and/or are larger than the meniscus height, extraarticular drainage of the cyst might produce unnecessary meniscal loss and function. In the extraarticular drainage, scrapping the walls of the cyst, while inspecting with an arthroscope, reduces recurrence of the cyst.

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          Most cited references18

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          The pathogenesis and significance of menisceal cysts.

          H Barrie (1979)
          From a total of 1571 surgically excised menisci, 112 (7.1 per cent) were found by gross and microscopic examination to contain one or more cysts. All of these cysts were associated with tears, either primarily horizontal or with a horizontal component. Tracks were often demonstrable leading from the tear to the cysts, and in some cases of osteoarthritis, detritus of bone could be found in their periphery. It is concluded that the cysts are fuelled by synovial fluid. The relationship of cysts to "myxoid" change of the meniscus is discussed.
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            Arthroscopic treatment of 105 lateral meniscal cysts with 5-year average follow-up.

            To evaluate meniscal damage and the midterm clinical outcome, we performed a retrospective review of 105 lateral meniscal cysts that were treated arthroscopically at our institution. Retrospective review. From a series of 8,100 knee arthroscopies, 122 patients (1.5%) with 124 lateral meniscal cysts were selected. Eight of the patients were lost to follow-up and 11 patients had associated pathology; therefore, 105 lateral meniscal cysts on stable knees were included in this study. Average follow-up was 5 years (range, 1 to 12.5 years). The mean age was 33 years (range, 12 to 69 years). All patients had presented with tenderness over the joint line with a palpable mass. All cases were treated arthroscopically and all patients underwent a complete physical examination before surgery and at last follow-up. Radiographic evaluation was available at final follow-up for 68 cases. All patients had a meniscal tear at the time of surgery and 60 (57%) had a horizontal cleavage component. For meniscal tears, arthroscopic partial lateral meniscectomy was performed in 104 cases and meniscal repair in 1 case. For cysts, intra-articular debridement was performed in 91 cases and open cystectomy in 14. Eleven cysts recurred and a second arthroscopy was required. The clinical results, including those cases with recurrent cysts, were excellent or good in 87% of cases. Osteoarthritis following treatment for meniscal cysts occurred in 9% of cases. When there was a cyst and no other intra-articular damage, the prognosis was excellent. For lateral meniscal cysts, arthroscopic partial meniscectomy with intra-articular debridement yields predictable results. Level IV.
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              Arthroscopic treatment of meniscal cysts

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                Author and article information

                Journal
                SICOT J
                SICOT J
                sicotj
                SICOT-J
                EDP Sciences
                2426-8887
                2016
                20 April 2016
                : 2
                : ( publisher-idID: sicotj/2016/01 )
                : 19
                Affiliations
                [1 ] Haydarpasa Numune Education and Research Hospital, Orthopaedics and Traumatology Department Uskudar, Istanbul Turkey
                [2 ] Hacettepe University, Hand Surgery Department, Hacettepe Ankara Turkey
                [3 ] Camlıca Erdem Hospital Uskudar, Istanbul Turkey
                Author notes
                [* ]Corresponding author: bombacih@ 123456hotmail.com
                Article
                sicotj150155 10.1051/sicotj/2015046
                10.1051/sicotj/2015046
                4849224
                27163108
                32a10af4-f0fd-4abd-bba8-ddc80d288f7c
                © The Authors, published by EDP Sciences, 2016

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 October 2015
                : 22 December 2015
                Page count
                Figures: 4, Tables: 1, Equations: 0, References: 17, Pages: 5
                Categories
                Knee
                Original Article

                knee,meniscal cyst,meniscectomy,arthroscopy
                knee, meniscal cyst, meniscectomy, arthroscopy

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