Arthroscopic Management of Meniscal Cysts: A Systematic Review

Aryan Haratian, Ioanna K Bolia, Laith K Hasan, Amir Fathi, Samantha Solaru, Andrew Homere, Frank A Petrigliano, Alexander E Weber USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USACorrespondence: Alexander E WeberUSC Epstein Family Center for Sports Medicine at Keck Medicine of USC, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033, USAEmail weber.ae@gmail.comPurpose: The purpose of this study was to systematically review the outcomes of arthroscopic management of meniscal cysts and to compare the results across the reported surgical techniques.Methods: Following the PRISMA methodology, 3 databases (PubMed, Scopus and Web of Science) were searched from inception to June 2021 for randomized controlled trials (RCTs) and observational studies reporting outcomes on patients with meniscal cysts who underwent arthroscopic surgery. The Mixed Methods Appraisal Tool (MMAT) was used to evaluate the study quality.Results: Eighteen studies examining 753 patients (761 meniscal cysts; 92.5% in the lateral meniscus) were included. Overall, 486/736 (66.0%) patients underwent purely arthroscopic decompression, 174/736 (23.6%) received arthroscopic excision, 58/736 (7.9%) received arthroscopy assisted percutaneous drainage, and 18/736 (2.4%) received a combined procedure. The recurrence rate for meniscal cysts was 7.1% across all arthroscopic procedures; 8.3%, 3.4%, and 0% for arthroscopic decompression, arthroscopic excision, and arthroscopy assisted percutaneous drainage, respectively. A total of 79.3% of patients returned to the same level of sport and 85.7% had resolution or minimal knee symptoms after arthroscopic surgery for meniscal cysts. Patient perception of surgical outcomes after any type of arthroscopic surgery for meniscal cysts was reported by 5 studies, with 189/203 (93.1%) reporting satisfaction with their surgical procedure.Conclusion: Based on current evidence, arthroscopic management of meniscal cysts yields satisfactory patient outcomes, low cyst recurrence rates and high return to sport rates regardless of the surgical technique. Rates of cyst recurrence were relatively higher with arthroscopic decompression versus excision and percutaneous drainage; however, prospective studies using modern surgical techniques are necessary to better evaluate the surgical outcomes and to compare those with nonoperative modalities, given that a significant proportion of the included articles in this review were relatively outdated.Level of Evidence: Systematic review of level II and IV studies.Keywords: systematic review, meniscal cyst, arthroscopic surgery, outcomes