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AHUGEHETEROGENOUSMEDIALPARAMENISCALCYSTOFTHEKNEEJOINT:ARARECASEREPORT

PraveenB,Siddarth,AkbarDr.PraveenKumarBirruRDTHospital,Bathalapalli

RURALDEVELOPMENTTRUSTVincentFerrerandAnneFerrer-1969LocatedinAnantapur(dt).AndhraPradesh.IndiaRDT-FVFToimprovequalityoflifeofruralpeople350bedhospital14bedorthopaedicunitCasehistorySunithaa31yearoldfemale–pain&swellingovermedialaspectofrightknee—since3yearsShecouldn’trecallanyhistoryoftraumaProgressiveinnaturePainworsenedwithincreasedactivityPhysicalexaminationAvisibleswellingofapprox12x8cmMasswasnottendertopalpation.Activerangeofmotion-extensiontoneutralandflexionto120degreesPositiveMcMurraysmediallyNoligamentinstabilityMRIofRightkneeMRIReportMrishowedalargeheterogenousparameniscalcyst(5.4x3.2)arisingfromposteromedialaspectofmedialjointline.Horizontaltearatthemiddlehornofmedialmeniscusextendingintothemeniscocapsularjunction.ManagementArthroscopicmenisectomyandopencystectomyThroughmedialapproach–alargeswellingof5x3cmwhichiscysticinconsistencywasencountered–carefullyseperated–anothersmallswelling3x2cmwhichissoftinconsistency,notedbeneaththelargeswelling.BoththeseswellingsareencasedinasheathHistopathologyFibrocollagenouscystwallwithdegeneratemucoidmaterial.SmallswellinghasathickcystwallandscantymucoidmaterialLargeswellinghasathincystwallwithabundantmucoidmaerial.HPsectionoflargeswellingPostoperativeRehabilitationCommencedafter48hrsfollowingsurgeryIsometricquadricepsexercisesfollowedbyrangeofmotionexercisesHomeexerciseprogramconsistedofstrengtheningofquadriceps,hamstringsandgluteals.At8weeks,shehadafullrangeofmotion(0degto130deg)andpainfree.DiscussionMeniscalcystsoccurwhensynovialfluideencystedWhentheyextendbeyondthemarginsofmeniscus–parameniscalcystsMedialparameniscalcystsaretypically0.3to9mmindiameter5%ofkneeMRstudiesClinicalpresentationPresentwithpalpablesofttissueswellingwithorwithoutkneepainTerminalrestrictionofrangeofmotionPositiveMcMurraysandApleyscompressiontestTestingpassiveflexionandkneeextensionwithendrangeoverpressurePISANISIGNIn1947,DrPisanipathognomonicsign–31casesofmeniscalcysts.

“Ahemisphericalcysticmassdisappearedintokneejointonacuteflexionandreappearedonacuteextensionofkneereachingitsmaximumdimensionatapoint25–30degreesshortofcompleteextension”.

PisaniAJ.Pathognomonicsignsforcystsofthekneecartilage.ArchSurg.1947;54:188-190.Pisanisignwasalsoexaminedin11consecutivepatientswithlateralkneeswellingmostprominentat30to45degreesofkneeflexionandarthroscopicallyconfirmedlateralparameniscalcysts.MichaelS.Crowell,Cystsoflateralmeniscus.TheInternationalJournalofSportsPhysicalTherapy|Volume8,Number3|June2013|Page340HistopathologyBarreperformedhistopathologicstudies-insight-cystetiologyIn112cysts,hedemonstratedameniscaltearwithhorizontalcomponentaswellastractthatprovidedanexchangeoffluidbetweenjointandcyst.BarrieHJ.Thepathogenesisandsignificanceofmeniscalcysts.JBoneJointSurgBr.1979;61:184-189.DiagnosisPlainradiographs-firstlineimagingmodalityMRI–confirmsthediagnosis“Acriticalsizeofthemeniscaltear,12mmalongthecircumferentialaxisasidentifiedusingMRI,isadiscriminationvalueforparameniscalcystformation”.

Chia-chunwu,Parameniscalcystformationinthekneeisassociatedwithmeniscaltearsize:AnMRIstudy.TheKnee.December2013Volume20,Issue6,Pages

556–561ManagementDiagnosticarthroscopytodeterminethemeniscaltearPartialmenisectomyandArthroscopiccystpressionIn1955,McGeheeandCameron

reportedthesurgicalremovalofa6-cmsymptomaticparameniscalcystina68-year-oldwomanwithnoevidenceofameniscaltear.McGeheeFO,CameronBM.Largecystofthemedialmeniscusofthekneejoint:reportofacase.

JBoneJointSurgAm.1955;37(6):1281-1283.

In2003,Kurianetal

reportedacaseofa7-cmasymptomaticmedialparameniscalcystina58-year-oldmanwithanobliqueposteriorhornmedialmeniscaltear.Inbothcases,theparameniscalcystswereopenlyexcised.

KurianJ,SchindlerOS,HussainA.Medialmeniscalcystoftheknee-anunusualpresentation:acasereport.

JOrthopaedicSurgery.

2003;11(2):234-236.ConclusionParameniscalcystsoccurrelativelyinfrequent.HeterogenecityoftheparameniscalcystisnotreportedintheliteratureMRIistheinvestigationofchoice.Arthroscopicmenisectomyandcystpression/opencyst

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