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Orthopaedic Sports Medicine- Orthobullets > Meniscal Cysts > Flashcards

Meniscal Cysts Flashcards

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1
Q

Meniscal Cysts

A

local collection of synovial fluid within or adjacent to the meniscus

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2
Q

Incidence of Meniscal Cysts

A
  • no studies

- 1-4% of knee MRI

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3
Q

Demographics

A
  • MC a/w meniscal tear

- no trend in age

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4
Q

Location

A
  1. Perimeniscal cysts

2. Parameniscal cysts

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5
Q

Perimeniscal Cysts

A
  • small lesions of fluid within the meniscus

- Medial > lateral (2:1)

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6
Q

Medial Perimeniscal Cysts- Location

A

posterior horn

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7
Q

Lateral Perimeniscal Cysts-Location

A

anterior horn or mid-portion

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8
Q

Parameniscal Cysts- eponym

A

Baker’s Cysts

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9
Q

Parameniscal Cysts

A
  • extruded fluid outside the meniscus (MC)

- usually located btw SM and medial head of gastroc

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10
Q

Meniscal Cysts- Mechanism of Injury

A
  • mensical tear fxns as a 1 way valve

- synovial fluis extrudes and then concentrates to form gel-like material

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11
Q

Parameniscal Cysts- Pathoanatomy

A

horizontal and complex tears usually

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12
Q

Perimeniscal Cysts- pathoanatomy

A

radial or vertical tears

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13
Q

Meniscal Cysts- Associated Conditions

A
  • articular cartilage injury

- ACL tear

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14
Q

Meniscus Anatomy- Composition

A
  • fibroelastic cartilage
  • interlacing netwerk of collagen, proteoglycan and cellular elements
  • composed of 65-75% water
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15
Q

what is the main type of collagen in meniscus

A

90% type 1 collagen

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16
Q

Medical Meniscus- shape

A

stretched out, C-shape with triangular cross section

17
Q

Lateral Meniscus- shape

A
  • more circular in shape

- covers a larger articular surface compared to medial

18
Q

Medial Meniscus- blood supply

A
  • medial inferior genicular artery

- supplies peripheral 20-30%

19
Q

Lateral Meniscus- blood supply

A
  • lateral inferior vehicular artery

- supplies peripheral 10-25%

20
Q

Synovial Fluid- blood supply

A
  • central 75% of meniscus ‘ receive nutrition through diffusion
21
Q

Symptoms

A
  • asymptomatic
  • pain-localized to M/L joint line or back of knee
  • Mechanical sx- locking and clocking
  • delayed or intermittent knee swelling
  • weakness/claudication (NV impingement)
22
Q

Examination

  1. inspection
  2. palpation
  3. motion
A
  1. popliteal mass-best visualized in extension
  2. joint line tenderness/palpable mass
  3. crepitus
23
Q

Radiographs

A

should be normal in young pt with an acute meniscal injury or cyst

24
Q

MRI- indication

A

most sensitive diagnostic test for meniscal cyst or tear

25
Q

MRI- findings

A
  • cysts with bright T2 signal
  • necrotic tissue, nerve sheath tissue and pus can all resemble cysts on T2-weighted MRIS
  • IV contrast enhancement may be needed
26
Q

Treatment- Non-operative Mgmts

A
  1. rest, NSAIDS, rehab

2. aspiration and steroid injection

27
Q

Treatment- rest, NSAIDS, rehabilitation

A

Indications
- First line for small perimeniscal and parameniscal cysts

Outcomes
-trial of medical therapy to observe patients pain response

28
Q

Treatment- Aspiration and steroid injection

A

Indications
- isolated baker’s cysts in young pt

Technique

  • cysts drainage
  • u/s guided injection into the cysts

Outcomes
- poor outcomes in older degenerative meniscal tears with associated cysts

29
Q

Treatment- Operative

A
  1. Arthroscopic debridement, cyst decompression and meniscal resection
  2. cyst excision using open posterior approach
30
Q

Treatment- Arthroscopic debridement, cyst decompression and meniscal resection

A

Indications
-perimensical with an associated tear that is not amendable to repair (i.e. complex, degenerative, radial tear)

Technique

  • decompress cyst completely
  • perform partial meniscectomy

Outcome
- incomplete meniscal resection may lead to recurrence

31
Q

Treatment- Cyst excision using open posterior approach

A

Indications
-symptomatic parameniscal cysts

Outcomes
-incomplete resection may lead to recurrence

32
Q

Technique for Cyst excisions using open posterior approach?

A
  • patient prone
  • curved incision over popliteal fossa
  • Interval- medial head gastric and SM
  • sharp dissection of cysts margins to joint capsule

Orthopaedic Sports Medicine- Orthobullets (3 decks)

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