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The Running Doc encourages runners to try conservative measures before opting for surgery to repair meniscus cysts. Tears such as the one former New York Giants defensive end Osi Umenyiora suffered in a preseason game in 2008 usually have to be treated more aggressively.
Dear Running Doc:
I run 25 miles a week and all of a sudden I developed pain on the medial joint line of my knee; no injury.
As a 30-year-old female, running is a big part of my life, so I went to see my family doctor’s favorite orthopaedic surgeon, who examined me and did an MRI. He says I have a meniscal cartilage cyst and no tear.
Since I cannot run on this he recommends arthroscopic surgery. I am not sure I understand what this is, how I got it and what the treatment options are.
Please help me be an informed patient since my doctor seems to not have time to answer these questions. –Amy H., Prescott, Arizona.
Thanks for the question Amy. That’s why I have this column — to help exercisers such as you make informed decisions about their sports injuries.
I have seen many of these cartilage cysts in my practice. Runners seem to develop these cysts from trauma (after a fall) or just from the daily pounding on the roads that running shoes with little cushion to absorb the shock within the knee joint can inflict.
As you know, the meniscus is a shock absorbing cartilage in the knee between the upper bone (the femur) and the lower bone. A meniscal cyst is a well defined fluid- filled struction on the outside margin of the meniscus. It is usually seen on the lateral side but can be seen on the medial side as well.
What usually happens is a horizontal tear in the meniscus allows fluid to be extruded and a walled- off structure to form.
On physical examination when the examiner palpates the joint line, he/she can feel this swelling and the patient will say “that’s it.”
MRI will confirm the diagnosis of cartilage cyst. One must distinguish on exam that a pes anserai bursitis or another structure is not the cause of the patient’s pain because cysts may or may not be painful.
It sounds like your diagnosis is clear. Treatment options are not so clear. There are conservative measures you can start with and work up to surgery.
Sometimes a topical NSAID (such as Voltarin Gel) is all you may need. Sometimes physical therapy to strengthen the muscles around the joint and electric stimulation and ultrasound may alleviate the problem.
With cartilage cysts that won’t go away, more aggressive treatments may be necessary. Realize there is probably a horizontal tear not seen on MRI and that is why the fluid extruded. Surgery with decompression of the cyst and addressing the horizontal tear may be necessary. PRP (platelet rich plasma) injection is an experimental tool that might be a non-surgical alternative to surgery; more multi-center studies are needed to be sure this works. But PRP has promise and the only downside in trying this to avoid surgery is the cost, which is not reimburseable by insurance.
I wish you luck. Let me know what treatment you decide on and how you are doing.
LEWIS G. MAHARAM, M.D.
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Lewis G. Maharam is one of the world’s most extensively credentialed and well-known sports health experts. Better known as Running Doc™, Maharam is author of Running Doc’s Guide to Healthy Running and is past medical director of the NYC Marathon and Rock ‘n’ Roll Marathon series. He is medical director of the Leukemia & Lymphoma Society’s Team in Training program. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.
