What’s the Diagnosis – Case 111
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Findings Bone is present within the posterior horn of the lateral meniscus (PHLM) in this patient who has had a previous ACL reconstruction and a long standing disruption of the graft (not shown here). There is otherwise abnormal signal in the PHLM which is likely a tear, full thickness cartilage loss of the posterior aspect of the lateral femorotibial compartment, and associated subchondral sclerosis of the plateau. Additionally noted are multiple calcific/ossific densities about the anterior apsect of the lateral tibial plateau.
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Diagnosis: Meniscal Ossicle Meniscal ossicles are foci of bone that are present within the meniscus and have a shape that conforms to the meniscus. Their etiology has been debated as degenerative, post traumatic, and congenital/developmental. The most favored diagnosis at this time is post traumatic given their frequent position within the posterior horn medial meniscus and frequent association with ACL injuries and cartilage wear. The recognition of the ossicle as compared to otherwise a potential loose body or avulsion fracture is probably the most important point. Although there are reports of surgery for a meniscal ossicle that more so relates to surgery to an underlying meniscal tear and not the ossicle per se. The anterior ossification/calcification in this case is likely post traumatic and not within the meniscus.
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References Meniscal Ossicle: Posttraumatic Origin and Association With Posterior Meniscal Root Tears. Rakesh Mohankumar, Andrew Palisch, Waseem Khan, Lawrence M. White, William B. Morrison. American Journal of Roentgenology. 2014;203: 1040-1046. 10.2214/AJR.13.11821 Meniscal ossicles. Kato, Y., Oshida, M., Saito, A. et al. J Orthop Sci (2007) 12: 375. doi:10.1007/s00776-007-1140-3 The Meniscal Ossicle Revisited: Etiology and an Arthroscopic Technique for Treatment. Ole A.Raustol M.D.,Kornelis A.Poelstra M.D., Ph.D. AnnikarChhabra M.D., David R.Diduch M.D. Arthroscopy: The Journal of Arthroscopic & Related Surgery.Volume 22, Issue 6, June 2006, Pages 687.e1-687.e3
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