Ultrasound‐Guided Treatment of Extrusive Medial Meniscopathy: A 3‐Step Protocol

Abstract

Medial knee pain is commonplace in clinical practice and can be related to several pathologic conditions: ie, medial plica syndrome, saphenous nerve entrapment, pes anserine syndrome, medial collateral ligament injury, and medial meniscus disorders. Ultrasound (US) imaging represents a valuable first‐line diagnostic approach to adequately visualize the superficial structures in the medial compartment of the knee to easily plan for prompt treatment. Currently, the management of chronic degenerative diseases involving the menisci, and causing their extrusion, consists of surgery (arthroscopic partial meniscectomy). This procedure often allows only a partial resolution of pain and functional impairment. In the pertinent literature, US‐guided interventions for the medial meniscus are proposed, mainly to decrease pain and inflammation or to induce regeneration. Likewise, this Technical Innovation describes in detail the US findings of medial extrusive meniscopathy and also illustrates a novel US‐guided technique to treat the bursa of the medial collateral ligament, the extruded fragment of the medial meniscus, and the synovial parameniscal recesses simultaneously.

Ultrasound‐Guided Perimeniscal Injections

“…The current surgical consensus is that intact meniscal tissue should be preserved as much as possible to avoid the degenerative results that may follow its removal 17 . Because conservative treatment is now the first‐line choice in symptomatic meniscal tears, meniscal pain is routinely treated with activity modification, quadriceps strengthening, anti‐inflammatory or analgesic medications, and intra‐articular or meniscus‐targeted injections 7,11‐13 . Thus, the objectives of the present study were to determine the accuracy of US‐guided perimeniscal injections by using cadaveric specimens, and then to evaluate the safety and preliminary clinical outcome of this technique in the treatment of meniscal pain.…”

“…In particular, there is a lack of description of the precise anatomical target that is referred to as either “parameniscal area,” “perimeniscal area,” or “meniscus wall” in the previously published case series 11,12 . Other authors even combine during the same procedure perimeniscal injection with meniscal needling and intrameniscal injection 13 . Thus, the objectives of the present study were first to describe the anatomical target and precise technique of US‐guided perimeniscal injections with confirmation of accuracy using cadaveric specimens, and then to evaluate the safety and preliminary clinical outcome of this injection technique in the treatment of meniscal pain.…”

Anatomy and ultrasound imaging of the tibial collateral ligament: A narrative review

“…Based on the aforementioned microanatomical architecture of the TCL‐MMC, the authors suggest performing a comprehensive sonographic assessment of the medial compartment of the knee checking point‐by‐point the following anatomical elements. Needless to say, each and every structure should be evaluated in both longitudinal and transverse scans (with focused sono‐palpation) in light of the clinical findings (Ricci & Özçaka 2020).…”

“…Herein, the size and location of the synovial bursa are extremely variable involving the proximal/distal segment or the ligament throughout its length (De Maeseneer et al, 2001). In patients with medial meniscus extrusion and/or medial osteophytes (Video S11; Figure S1), TCL bursitis is often related to extra friction within the interface between the superficial and deep layers (Ricci et al, 2020; 39: 805–810). If clinically indicated, the synovial bursa can be injected under US guidance (Coll et al, 2022; Jose et al, 2011; Ricci et al, 2020; 39: 805–810).…”

“…Medial knee pain is a common condition in clinical practice and the combination of physical and ultrasound (US) examinations (Ricci et al, 2020 Pain Med) is widely considered as the first diagnostic approach in this clinical scenario. In the pertinent literature, standardized sonographic protocols to assess different knee compartments have been clearly described (De Maeseneer, Marcelis, et al, 2014; De Maeseneer, Shahabpour, et al, 2014; Özçakar et al, 2015; Ricci & Özçakar, 2019).…”