Huge intrameniscal cyst successfully treated by open debridement and combined arthroscopic and open repair: a case report

Abstract

Background: Meniscal cysts are not uncommon in clinical practice, with reported incidence rates varying from 1 to 22%. Most meniscal cysts are parameniscal cysts, which are created by extravasation of synovial fluid through the meniscal tear into the adjacent soft tissue. In contrast, intrameniscal cysts in which the fluid collects in the meniscus are very rare. We encountered a teenager with a huge intrameniscal cyst accompanied by a small vertical meniscal tear in the red-white zone of the upper surface of the medial meniscus. A literature search revealed no information regarding the appropriate treatment methods and results for this type of lesion. Case presentation: A 14-year-old boy presented to our outpatient clinic because of right knee pain that had been present for the previous 2 months. The patient participated in Hapkido, but had no specific trauma history. Magnetic resonance imaging revealed a huge intrameniscal cyst located in the central parenchyma of the posteromedial corner of the medial meniscus. In addition, one sagittal slice on MRI revealed a vertical tear in the red-white zone of the upper surface of the medial meniscus. The presence of such a tear accompanied by a huge intrameniscal cyst is very unusual. The patient was treated via arthroscopic inside-out meniscal suture repair and open cystic debridement with additional meniscocapsular suturing. During 4 years of magnetic resonance imaging follow-up, the lesion has completely disappeared and the meniscus has successfully recovered its normal form. Conclusions: Our treatment method may be considered as the first choice for young patients who require surgical treatment for large intrameniscal cysts with accompanying small vertical meniscal tears.

Intrameniscal Cyst—Arthroscopic Open- and Closed-Door Repair Technique

“…In the literature, only a single case has been reported by Kim et al. 4 on an intrameniscal cyst, which was located at the posteromedial corner of the medial meniscus and associated with meniscal tear.…”

“… 3 Isolated intrameniscal cyst with meniscus tear is not yet reported in the literature, and only one case has been reported by Kim et al. 4 in which the patient had an intrameniscal cyst located at the posteromedial corner of the medial meniscus with small-sized meniscus tear, which was treated by combined open debridement and arthroscopic repair. We describe an isolated intrameniscal cyst with intact meniscus managed by an arthroscopic open- and closed-door repair technique.…”

Parameniscal Cyst Arthroscopic Excision by the Modified Fat Pad Approach Can Shorten Recovery Time—A New Surgical Method with Retrospective Study

“…Two common arthroscopic techniques are excision and decompression, and both aim to relieve symptoms. For large or huge cystic lesions, arthroscopic or open excision 17 , 25 , 26 is recommended to reduce the risk of recurrence. The conventional excision may destabilize the meniscus and need the insertion of the suture needle, which may require a longer time to rehabilitation and create microtrauma to cause degenerative change.…”