Summary

Endoscopic Extra-articular Medial Parameniscal Cyst Excision- Our Experience

Abstract

Parameniscal cysts are usually very small and asymptomatic, although some of them can present with a painful mass or snapping knee. Owing to their frequent association with horizontal meniscal tears, arthroscopic partial meniscectomy of the involved part of meniscus and intra-articular cyst drainage has become the most accepted procedure. However, arthroscopic cyst decompression through partial meniscectomy to the meniscocapsular junction to expose the communication between the cyst and the knee joint may sacrifice some of the healthy parts of the meniscus especially when meniscal tear is peripheral. Moreover, internal drainage may not be an adequate treatment for a cyst larger than 5 cm in size or a multiloculated cyst. Hence excision of the cyst may be a more appropriate treatment option in these situations. We herein describe the details of endoscopic resection of medial extra-articular cysts of the knee in our series of 5 patients. Steps include placement of a portal 2.5cm to 3cm superior to the cyst and another portal inferiorly with the help of a Wissinger rod taking care not to penetrate the cyst wall. The viewing and working portals can be interchanged. After delineation of the cyst wall with an RF probe, it is either removed in toto or following decompression. This technique is indicated in symptomatic medial extra-articular cysts of the knee with peripheral or no tear of the medial meniscus, especially if the cysts are large and multiloculated.