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J Knee Surg 2021; 34(02): 155-163
DOI: 10.1055/s-0039-1693724
Original Article

Understanding the Implications of the Meniscal Ossicle: Patient Presentation, Treatment, and Outcomes

Christopher D. Bernard
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Adam M. McGauvran
2   Department of Musculoskeletal Radiology, Mayo Clinic, Rochester, Minnesota
,
Vishal S. Desai
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Matthew A. Frick
2   Department of Musculoskeletal Radiology, Mayo Clinic, Rochester, Minnesota
,
Christin Tiegs-Heiden
2   Department of Musculoskeletal Radiology, Mayo Clinic, Rochester, Minnesota
,
Christopher L. A. Camp
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Aaron J. Krych
1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Mark S. Collins
2   Department of Musculoskeletal Radiology, Mayo Clinic, Rochester, Minnesota
› Author Affiliations Funding None.
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Abstract

The meniscal ossicle is observed in clinical practice, yet there currently is limited information on its potential clinical significance. The purpose of this study was to assess the clinical presentation, imaging findings, and clinical treatment and outcomes of a series of patients identified as having a meniscal ossicle. An institutional database was reviewed to identify knees with a meniscal ossicle. Clinical presentation, magnetic resonance imaging (MRI), treatment, and outcomes were analyzed. Radiographs were graded using Kellgren–Lawrence (KL) scores. MRIs were reviewed for the presence and location of meniscal ossicles and additional knee pathology. Knee arthroplasty rates were recorded with the remaining patients contacted to obtain final International Knee Documentation Committee (IKDC) and Tegner's scores. Failure was defined as conversion to arthroplasty or failing IKDC score (< 75.4). Forty-five meniscal ossicles in 45 patients (26 males and 19 females) with a mean age of 51 years (standard deviation [SD] = 19.0) were included. Pain was the most common presenting symptom (89%). Forty-two patients (93%) had an associated meniscus root tear on MRI. Eighteen percent of patients that did not have an ossicle on initial imaging subsequently developed an ossicle. Mean KL grades progressed significantly from baseline of 1.84 (SD = 1.0) to 2.55 (SD = 0.93 p < 0.01) on final follow-up. Thirty-nine percent of baseline radiographs showed KL grades of less than 2 compared with only 15% of follow-up radiographs (p = 0.04). Mean IKDC score obtained for patients ≤ 60 at an average follow-up of 3.1 years (SD = 3.2) was 65.2 (SD = 19.0). Eight out of 45 patients (18%) had progressed to total knee arthroplasty (TKA) by latest available follow-up. Sixty-two percent of patients met failure criteria at latest available follow-up. The meniscal ossicle is most commonly found in the posterior horn or root of the medial meniscus and is highly suggestive to be sequelae of a posterior root tear. Therefore, the presence of a meniscal ossicle should alert the orthopaedic surgeon to the high likelihood of the patient having a meniscus root tear. These patients have shown to have poor clinical outcomes and worsening arthritis.

Keywords

meniscal ossicle - meniscus - knee - root tear


Publication History

Received: 25 September 2018

Accepted: 18 June 2019

Article published online:
07 August 2019

© 2019. Thieme. All rights reserved.

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  • References

  • 1 Rohilla S, Yadav RK, Singh R, Devgan A, Dhaulakhandi DB. Meniscal ossicle. J Orthop Traumatol 2009; 10 (03) 143-145
    CrossrefPubMedGoogle Scholar
  • 2 Schnarkowski P, Tirman PF, Fuchigami KD, Crues JV, Butler MG, Genant HK. Meniscal ossicle: radiographic and MR imaging findings. Radiology 1995; 196 (01) 47-50
    CrossrefPubMedGoogle Scholar
  • 3 Mohankumar R, Palisch A, Khan W, White LM, Morrison WB. Meniscal ossicle: posttraumatic origin and association with posterior meniscal root tears. AJR Am J Roentgenol 2014; 203 (05) 1040-1046
    CrossrefPubMedGoogle Scholar
  • 4 Harris HA. Calcification and ossification in the semilunar cartilages. Lancet 1934; 223 (5778): 1114-1116
    CrossrefPubMedGoogle Scholar
  • 5 Jones RW. oberts RE. Calcification, decalcification, and ossification. BJS 1934; 21 (83) 461-499
    CrossrefPubMedGoogle Scholar
  • 6 Burrows HJ. Two cases of ossification in the internal semilunar cartilage. BJS 1934; 21 (83) 404-410
    CrossrefPubMedGoogle Scholar
  • 7 Ogassawara R, Zayni R, Orhant E. et al. Meniscal ossicle in a professional soccer player. Orthop Traumatol Surg Res 2011; 97 (04) 443-446
    CrossrefPubMedGoogle Scholar
  • 8 Bernsetin RM, Olsson HE, Spitzer RM, Robinson KE, Korn MW. Ossicle of the meniscus. AJR Am J Roentgenol 1976; 127 (05) 785-788
    CrossrefPubMedGoogle Scholar
  • 9 Duran S, Çavuşoğlu M, Kocadal O. Ossification of the discoid meniscus: a case report. J Clin Orthop Trauma 2014; 5 (04) 270-273
    CrossrefPubMedGoogle Scholar
  • 10 Berg EE. The meniscal ossicle: the consequence of a meniscal avulsion. Arthroscopy 1991; 7 (02) 241-243
    CrossrefPubMedGoogle Scholar
  • 11 Raustol OA, Poelstra KA, Chhabra A, Diduch DR. The meniscal ossicle revisited: etiology and an arthroscopic technique for treatment. Arthroscopy 2006; 22 (06) 687.e1-687.e3
    CrossrefPubMedGoogle Scholar
  • 12 Yoo JH, Yang BK, Son BK. Meniscal ossicle: a case report. Knee 2007; 14 (06) 493-496
    CrossrefPubMedGoogle Scholar
  • 13 Irrgang JJ, Ho H, Harner CD, Fu FH. Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 1998; 6 (02) 107-114
    CrossrefPubMedGoogle Scholar
  • 14 Briggs KK, Kocher MS, Rodkey WG, Steadman JR. Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee. J Bone Joint Surg Am 2006; 88 (04) 698-705
    PubMedGoogle Scholar
  • 15 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16 (04) 494-502
    CrossrefPubMedGoogle Scholar
  • 16 De Smet AA, Tuite MJ. Use of the “two-slice-touch” rule for the MRI diagnosis of meniscal tears. AJR Am J Roentgenol 2006; 187 (04) 911-914
    CrossrefPubMedGoogle Scholar
  • 17 LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, LaPrade RF. Meniscal root tears: a classification system based on tear morphology. Am J Sports Med 2015; 43 (02) 363-369
    CrossrefPubMedGoogle Scholar
  • 18 Costa CR, Morrison WB, Carrino JA. Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear?. AJR Am J Roentgenol 2004; 183 (01) 17-23
    CrossrefPubMedGoogle Scholar
  • 19 Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 1997; 13 (04) 456-460
    CrossrefPubMedGoogle Scholar
  • 20 Peterfy CG, Guermazi A, Zaim S. et al. Whole-organ magnetic resonance imaging score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage 2004; 12 (03) 177-190
    CrossrefPubMedGoogle Scholar
  • 21 Krych AJ, Reardon PJ, Johnson NR. et al. Non-operative management of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 2017; 25 (02) 383-389
    CrossrefPubMedGoogle Scholar
  • 22 Krych AJ, Johnson NR, Mohan R, Dahm DL, Levy BA, Stuart MJ. Partial meniscectomy provides no benefit for symptomatic degenerative medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 2018; 26 (04) 1117-1122
    PubMedGoogle Scholar
  • 23 Krych AJ, Johnson NR, Mohan R. et al. Arthritis progression on serial MRIs following diagnosis of medial meniscal posterior horn root tear. J Knee Surg 2018; 31 (07) 698-704
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Guermazi A, Hayashi D, Jarraya M. et al. Medial posterior meniscal root tears are associated with development or worsening of medial tibiofemoral cartilage damage: the multicenter osteoarthritis study. Radiology 2013; 268 (03) 814-821
    CrossrefPubMedGoogle Scholar
  • 25 Chung KS, Ha JK, Yeom CH. et al. Comparison of clinical and radiologic results between partial meniscectomy and refixation of medial meniscus posterior root tears: a minimum 5-year follow-up. Arthroscopy 2015; 31 (10) 1941-1950
    CrossrefPubMedGoogle Scholar