Arthroscopic Management of Meniscal Cysts: A Systematic Review

Figures & data

Table 1 Summary of Studies Included in Systematic Review

Study Name	Study Type	Total Cysts, Population	History of Trauma	Cyst Localization	Surgical Technique	Coexisting Meniscal Tears/Morphology	Mean Follow Up Time/Clinical Outcomes	Incidence of Meniscal Cyst Recurrence
Chang et al, 2016^Citation40	Randomized Controlled Trial Level of Evidence: II	n=241 (mean age: 36.8 ± 12.5 years) 135 males, 106 females	89/241 (37%)	Unspecified	Arthroscopic Decompression (n=129) Arthroscopic Excision (n=112)	241/241 (100%) Horizontal – 167/241 (69%) Complex–51/241 (21%) Radial –3/241 (1%) Bucket-Handle- 7/241 (7%) Peripheral Vertical – 13/241 (5%)	Change in Lysholm: 18.2 ± 4.1 (decompression) 17.0 ± 4.1 (excision) Postoperative VAS: 1.9 ±0.7 (decompression) 2.0 ± 0.6 (excision)	Decompression −25/129 (19%) Excision – 5/112 (4%) P<0.001
Ryu et al, 1993^Citation46	Case Series Level of Evidence: IV	n=18 (mean age 28 ys) 13 males, 5 females	10/18 (56%)	Medial meniscus- 8/18 (44%) Lateral meniscus- 10/18 (56%)	Arthroscopic decompression	Horizontal cleavage tear- 18/18 (100%)	Mean follow up: 26 months Return to baseline level of activity: 18/18 (100%) Full Resolution of symptoms - 16/18 (89%)	No recurrence
El-Assal et al, 2003^Citation11	Case Series Level of Evidence: IV	n=27; 26 patients (mean age: 29 yrs) 21 males, 5 females	15/27 (55%)	Unspecified	Arthroscopic Decompression (n=22) Arthroscopic Excision (n=5)	27/27 (100%) Horizontal- 12/27 (44%) Complex – 8/27 (30%) Transverse- 7/27 (26%)	Mean follow up: 58 months Asymptomatic w/ no recurrence- 10/27 (37%) Minimal symptoms – 12/27 (44%) Fair (definite cyst recurrence) – 3/27 (11%) Poor (significant pain) – 2/27 (7%)	3/27 (11.11%) –unspecified whether in the decompression or open excision group
Bombaci et al, 2016^Citation12	Case Series Level of Evidence: IV	n=8 (mean age= 36.13 yrs) 6 males, 2 females	5/8 (62.5%)	Medial meniscus- 1/8 (12.5%) Lateral meniscus- 7/8 (87.5%)	Arthroscopic Decompression (n=4) Arthroscopic decompression w/ supplementary extraarticular drainage (n=4)	Horizontal tears- 7/8 (87.5)	Mean Follow up: 27.3 months Change in VAS: Preoperative- 6 Postoperative- 1.55 Change in Lysholm: Preoperative- 64.75 Postoperative- 93.1	6 patients underwent follow up MRI: Cyst recurrence: 2/6 (33%)
Glasgow et al, 1993^Citation41	Case Series Level of Evidence: IV	n= 72; 69 patients (mean age 34.5 yrs) 49 males, 20 females	Not specified	Lateral meniscus- 72/72 (100%)	Arthroscopic decompression (n=72)	72/72 (100%) Simple Horizontal Cleavage (Type I): 30/72 (42%) Radial split plus cleavage tear (Type II): 23/72 (32%) Complex “parrot beak” plus cleavage tear: 15/72 (21%) Discoid: 4/72 (6%)	Mean follow up: 34 months Excellent: 42/72 (58%) Good: 22/72 (31%) Fair: 3/72 (4%) Poor: 5/72 (7%)	3/72 (4%)
Haklar et al, 2014	Case Series Level of Evidence: IV	n=20 (mean age: 41 ± 11.1 yrs) 13 males, 7 females	Unspecified	Lateral meniscus	Arthroscopic decompression	Unspecified	Mean follow up: 37.5± 18.8 months Postoperative Lysholm: 96.2 ± 7.59	No incidence of cyst recurrence
Howe et al, 2007	Case Series Level of Evidence: IV	n=8 (mean age: 37.2 ± 11.4 yrs) 4 males, 4 females	0/8 (0%)	Lateral meniscus- 6/8 (75%) Medial meniscus −2/8 (25%)	Arthroscopic decompression (n=8)	Unspecified meniscal tears - 6/8 (75%)	Mean follow up: 39.1, S.D. 26.4 months Change in Tegner scores: Preoperatively- 5.4 ± 1.9 Postoperative −5.1 ± 2.1 Postoperative Lysholm score: 94.4 ± 5.4	No incidence of cyst recurrence
Hulet et al, 2004	Case Series Level of Evidence: IV	n=105; 103 patients (mean age 33 yrs) 80 males, 23 females	33/105 (31%)	Lateral meniscus- 105/105 (100%)	Arthroscopic decompression (n=91) Additional percutaneous drainage (n=14)	105/105 (100%) Horizontal cleavage- 30/105 (28.5%) Horizontal cleavage plus radial split – 30/105 (28.5%) Radial split – 31/105 (29%) Complex lesion – 10/105 (10%) Vertical tear- 4/105 (4%)	Mean follow up: 5 years Postoperative Results: Excellent (No pain, swelling full ROM and RTS)- 64% Good (Occasional pain, no swelling, full ROM, RTS at lower level)- 23% Fair (Pain with strenuous activity, with or without swelling, and return to modified athletics)- 6% Poor (Pain with most activities, swelling, catching/locking of knee, no RTS)- 7% Patient Satisfaction: Very satisfied- 82/105 (78%) Satisfied- 17/105 (16%) Disappointed- 6/105 (6%) Return to sports at the same level- (77%) Return to sports at lower level (16%)	7/91 (8%)
Keating et al, 1991	Case Series Level of Evidence: IV	n=14	Not reported	Lateral meniscus – 13/14 (92.86%) Medial meniscus- 1/14 (7.14%)	Arthroscopic decompression	Not Reported	Mean follow up: 19 months: Satisfactory postoperative results- 12/14 (86%) Reinjury- 1/14 (7%)	1/14 (7%)
Maffulli et al, 1991	Case Series Level of Evidence: IV	n=38 (mean age 33.2 ± 4.7 yrs)	3/38 (8%)	Lateral meniscus- 38/38 (100%)	Percutaneous decompression (n=21) Arthroscopic Decompression (n=15) Arthroscopic Excision (n=2)	Horizontal meniscus tears – 36/38 (95%)	Mean follow up: 39 months Postoperative patient satisfaction- 33/38 (87%)	4/38 (11%)
Nemec et al, 1994	Case Series Level of Evidence: IV	N=47	Unspecified	Lateral meniscus	Arthroscopic Decompression	Unspecified meniscal tears- 43/47 (91%)	Mean follow up: 44 months	1/47 (2%)
Mills et al, 1993	Case Series Level of Evidence: IV	n=20 (mean age 35 ± 13 yrs) 6 males, 14 females	16/20 (80%)	Medial meniscus- 20/20 (100%)	Arthroscopic decompression (n=7) Open resection (n=12) No resection (n=1)	17/20 (85%) Horizontal cleavage, posterior horn – 7/20 (35%) Bucket handle- 3/20 (15%) Horizontal cleavage, mid meniscus- 2/20 (10%) Degenerate complex, posterior horn – 2/20 (10%) Rim posterior horn −1/20 (5%) Inferior surface, posterior horn- 1/20 (5%) Radial, posterior horn- 1/20 (5%)	Mean follow up: 20 months Postoperative return to baseline activity: 19/20 (95%)	No incidence of cyst recurrence
Passler et al, 1993^Citation1	Case Series Level of Evidence: IV	n=16	Unspecified	Medial meniscus- 2/16 (12.5%) Lateral meniscus- 12/16 (75%) Intraarticular extra-meniscal cyst- 2/16 (12.15%)	Arthroscopic decompression (n=14) Arthroscopic excision (n=2)	14/16 (87.5%) Unspecified meniscal tear- 8/16 (50%) Completely degenerated meniscus- 4/16 (25%) Horizontal meniscal tears- 2/16 (12.5%)	Mean follow up: 18 months	No incidence of cyst recurrence
Parisien et al, 1990,	Case Series Level of Evidence: IV	n=25; (24 patients) (mean age 29.9 yrs)	Unspecified	Medial meniscus- 3/25 (12%) Lateral meniscus- 22/25 (88%)	Arthroscopic decompression (n=25)	25/25 (100%) Unspecified, but most commonly either a horizontal or transverse meniscal tear	Mean follow up: 33.5 months Postoperative patient satisfaction: 23/24 (96%) Return to baseline level of activity: 23/24 (96%) Patients requiring additional arthroscopy: 2/24 (8%)	No incidence of cyst recurrence
Dai et al, 2018	Case Series Level of Evidence: IV	n=33 (mean age: 36.23 ±2.30 yrs) 13 males, 20 females	Not Specified	Lateral Meniscus	Arthroscopic Excision (n= 33)	Not Reported	Mean follow up: 7.5±1.2 months Change in Lysholm (n=33): Preoperative-61.12± 4.35 Postoperative- 91.32± 3.36 Postoperative Outcomes: Excellent- 31/33 (94%) Good- 2/33 (6%)	No Incidence of cysts recurrence
Reagan et al^Citation48	Case Series Level of Evidence: IV	n=32 (31 patients) 20 male, 11 female (Mean age: 28.2 years)	13/32 (40%)	Lateral Meniscus	Arthroscopic Excision (n=20), 12 managed without formal cyst excision	Total with coexisting tears: 27/32 (84%) Horizontal Cleavage 6/27 (22%) Parrot Beak tear 6/27 (27%) Radial Tear 12/27 (44%) Flap Tear 2/27 (7%) Discoid with tear 1/27 (4%)	Mean follow up: 41 months Postoperative outcomes: Excellent (No pain and swelling, and full ROM and RTS at lower level) – 10/20 (50%) Good (Mild discomfort, no swelling, full ROM and RTS at lower level)–6/20 (30%) Fair (Pain with strenuous activity, w/ or w/o swelling, return to modified athletics – 4/20 (20%) Poor (Constant pain, swelling, locking/catching, no RTS) - (0%)	Unspecified
Iorio et al, 2019	Case Series Level of Evidence: IV	n= 18 (mean age 40 ± 15.1 yrs 13 males, 5 females	4/18 (22%)	Lateral meniscus	Percutaneous Decompression	18/18 (100%) Horizontal-10/18 (56%) Complex- 4/18 (22%) Discoid- 2/18 (11%) Radial- 2/18 (11%)	Mean follow up: 11.6 ± 2.6 years Change in Lysholm scores: Preoperative- 52±16.9 Postoperative- 85±11.9 P<0.01 Change in IKDC score: Preoperative- 49.5 ± 14.7 Postoperative- 67±23.5 P<0.01 No significant change in mean Tegner scores	No incidence of cyst recurrence
Tudisco et al, 2000	Case Series Level of Evidence: IV	n=19 (mean age 33.5 yrs) 10 male, 9 female	12/19 (63%)	Lateral meniscus- 19/19 (100%)	Percutaneous decompression	19/19 (100%) All patients had either a horizontal or radial (or both) meniscal lesion	Mean follow up: 3.3 yrs Postoperative results: Excellent- 8/19 (42%) Good- 9/19 (47%) Fair- 2/19 (11%) RTS at same frequency: 16/19 (84%)	No incidence of cyst recurrence

Figure 1 Preferred reporting items for systematic reviews and meta-analyses (PRISMA) diagram.

Notes: PRISMA figure adapted from Moher D, Liberati A, Altman D, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Journal of clinical epidemiology. 2009;62(10). Creative Commons.³⁶

Table 2 Meniscal Cyst Localization

Study	Lateral Meniscus	Medial Meniscus	Total
Ryu 1993^Citation46	10	8	18
Bombaci 2016^Citation12	7	1	8
Glasgow 1993^Citation41	72	0	72
Haklar 2014^Citation33	20	0	20
Howe 2007^Citation34	6	2	8
Hulet 2004^Citation42	105	0	105
Keating 1991^Citation43	13	1	14
Maffulli 1991^Citation39	38	0	38
Nemec 1994^Citation44	47	0	47
Mills 1993^Citation26	0	20	20
Passler 1993^Citation1	12	2	14
Parisien 1990^Citation45	22	3	25
Reagan 1989^Citation48	32	0	32
Dai 2018^Citation47	33	0	33
Iorio 2019^Citation35	18	0	18
Tudisco 2000^Citation14	19	0	19
Total	454	37	491

Table 3 Summary of Arthroscopic Techniques for Treatment of Meniscal Cysts

Technique	Overview
Arthroscopic Decompression^Citation11,Citation12,Citation33,Citation34,Citation40,Citation41,Citation44	Evacuation of cyst contents into joint cavity. Some studies report marsupialization with creation of a permanent channel or further curettage of cyst wall to reduce the risk of recurrence
Arthroscopic Excision^Citation40,Citation47	Arthroscopic partial meniscectomy with open cystectomy to remove the cyst cavity in its entirety.
Arthroscopy Assisted Percutaneous Decompression^Citation14,Citation15	Decompression of cyst through the percutaneous passage of a large bore needle under arthroscopic visualization

Figure 2 A visual representation of the distribution of morphologies of co-existing meniscal tears in patients with meniscal cysts. Horizontal tears were the most commonly seen morphology on arthroscopy, followed by Complex/“Parrot-Beak”, horizontal + radial, and radial tears.

Table 4 Incidence of Meniscal Cyst Recurrence Across Surgical Techniques

Study	Incidence of Meniscal Cyst Recurrence
Arthroscopic Decompression
Chang 2016^Citation40	25/129	(19.3%)
Ryu 1993^Citation46	0/18	(0%)
Glasgow 1993^Citation41	3/72	(4.2%)
Haklar 2014^Citation33	0/20	(0%)
Howe 2007^Citation34	0/8	(0%)
Hulet 2004^Citation42	7/91	(7.7%)
Keating 1991^Citation43	1/14	(7.1%)
Nemec 1994^Citation44	1/47	(2.1%)
Mills 1993^Citation26	0/7	(0%)
Passler 1993^Citation1	0/14	(0%)
Parisien 1990^Citation45	11	(0%)
Total	37/445	(8.3%)
Arthroscopic Excision
Chang 2016^Citation40	5/112	(4.5%)
Passler 1993^Citation1	0/2	(0%)
Dai 2018^Citation47	0/33	(0%)
Total	5/147	(3.4%)
Arthroscopy Assisted Percutaneous Decompression
Iorio 2019^Citation35	0/18	(0%)
Tudisco 2000^Citation14	0/19	(0%)
Total	0/37	(0%)

Figure 3 (A) Visual representation of subjective postoperative patient outcomes across all techniques in arthroscopic management of meniscal cysts. Overall, 88% of patients undergoing arthroscopic management of meniscal cysts had either “excellent” or “good” subjective results postoperatively. (B) Graphical representation of subjective postoperative patient outcomes by surgical technique after arthroscopic management of meniscal cysts reported as percent of total patients for whom subjective scores were available for each technique.

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