title: When should the external approach be resorted to in the arthroscopic treatment of perimeniscal cyst?
abstract: BACKGROUND
  Meniscal cysts very often cause meniscal tears and especially when it is peripheral, some of the healthy parts of meniscus might be needlessly sacrificed. In particular conditions, extraarticular approaches might save some menisci. In the present study, we evaluated the conditions which required using the extraarticular approach in addition to the arthroscopic procedure, to maximally preserve the meniscus.
  
  
  METHODS
  Eight patients with perimeniscal cysts were evaluated retrospectively. One cyst was localized within the medial meniscus and seven in the lateral meniscus. The mean age was 36.13 (range; 19-63) years, mean follow-up time, 27.3 (range; 12-47) months. Patients were evaluated by using a Visual Analogue Score (VAS) to measure pain relief and "Lysholm score" to measure functional improvement. In all patients except one, in which the cystic cavity was connected with the joint at the periphery of the meniscus, the cyst was drained from the intraarticular opening. When the cyst was too large (three cases) and in one case where a large amount of meniscus was preserved for reasons mentioned above, additional extraarticular drainage was carried out.
  
  
  RESULTS
  The mean preoperative and postoperative VAS were 6 (range; 2-8) and 1.55 (range; 0-3) (p = 0.00058) and Lysholm scores were 64.75 (range; 48-86) and 93.11 (range; 80-100) (p = 0.0014), respectively.
  
  
  CONCLUSIONS
  In cysts, which have very limited or no connection with the joint on the most peripheral region of the meniscus and/or are larger than the meniscus height, extraarticular drainage of the cyst might produce unnecessary meniscal loss and function. In the extraarticular drainage, scrapping the walls of the cyst, while inspecting with an arthroscope, reduces recurrence of the cyst.
authors.affiliation: Haydarpasa Numune Education and Research Hospital, Orthopaedics and Traumatology Department Uskudar, Istanbul Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Bombaci
authors.affiliation: Haydarpasa Numune Education and Research Hospital, Orthopaedics and Traumatology Department Uskudar, Istanbul Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kuyumcu
authors.affiliation: Hacettepe University, Hand Surgery Department, Hacettepe Ankara Turkey.
authors.forename: Tamer
authors.initials: T
authors.lastname: Coskun
authors.affiliation: Camlıca Erdem Hospital Uskudar, Istanbul Turkey.
authors.forename: Emre
authors.initials: E
authors.lastname: Kaya
keywords: Arthroscopy; Knee; Meniscal cyst; Meniscectomy