Berkay Yalçınkaya; Ahmet Furkan Çolak; Murat Kara

doi:10.12701/jyms.2025.42.38

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Intrameniscal ossicle: an overlooked cause of knee pain: Berkay Yalçınkaya, Ahmet Furkan Çolak, Murat Kara; Journal of Yeungnam Medical Science 2025;42:38.
DOI: https://doi.org/10.12701/jyms.2025.42.38
Published online: June 17, 2025

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Türkiye

Corresponding author: Berkay Yalçınkaya, MD Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Zemin Kat, Fiziksel Tıp ve Rehabilitasyon AD, Sıhhiye, Ankara 06230, Türkiye Tel: +90-312-3094142 • Fax: +90-312-3105769 • E-mail: berkay0lka@gmail.com

• Received: May 9, 2025 • Revised: June 9, 2025 • Accepted: June 11, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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A 59-year-old female patient presented with bilateral knee pain predominantly affecting the right side, along with mild swelling that had persisted for approximately 2 years. The symptoms had worsened over the past month and were accompanied by nocturnal pain. The patient reported that the pain was exacerbated by walking and was slightly relieved by rest. The pain was unresponsive to analgesic medications and local cold or hot therapies. She denied experiencing limited mobility, paresthesia, weakness, erythema, or any other symptoms. The patient’s medical history was otherwise unremarkable. Physical examination revealed bilateral crepitation, grinding, and positive Clarke test results, with a positive McMurray test only on the right side. Plain radiography and magnetic resonance imaging (MRI) revealed a 6-mm intrameniscal ossicle (the last knee X-ray, performed 3 years ago, was negative for the same lesion) in the posterior horn of the medial meniscus, accompanied by degenerative changes in the medial tibiofemoral and patellofemoral cartilages as well as in the medial meniscus, along with substantial intra-articular effusion in the right knee joint (Figs. 1, 2). The patient was prescribed a physical therapy program that included range of motion and quadriceps muscle strengthening exercises. The range of motion exercises included knee flexion and extension. The quadriceps strengthening program consisted of wall slide (semi-squat) and terminal knee extension exercises (closed kinetic chain) using a towel. At the 6-month follow-up, the patient reported significant improvement in her symptoms. The patient remains under routine and uneventful follow-up.

A meniscal ossicle is defined as an ossified mass within the meniscal tissue containing mature lamellar and spongy bone surrounded by cartilage. Its occurrence is exceedingly rare, with an estimated prevalence of 0.15% [1]. These ossicles are typically solitary masses predominantly observed in young men. Although the precise etiology remains unclear, potential mechanisms include degenerative changes, congenital factors, and post-traumatic events [2]. Clinical manifestations range from intermittent knee pain, restricted mobility, and swelling to locking episodes. Although MRI remains the gold standard for confirmation, radiographic evaluation is useful in diagnosing meniscal ossicles [2]. On the other hand, ultrasonography is a valuable and effective first-line diagnostic imaging modality for evaluating superficial structures, such as the medial collateral ligament and medial meniscus, in the medial compartment of the knee joint [3]. It can detect various meniscal pathologies, including protrusion, extrusion, and tears, thereby aiding diagnosis and management [3]. The treatment options for meniscal ossicles include conservative management and surgical intervention. Conservative treatment is generally recommended for asymptomatic and mild cases, whereas surgical removal is indicated for those with severe symptoms or concurrent meniscal tears, as meniscal ossicles are often associated with chronic meniscal tears [2]. In our patient, because the symptoms significantly improved with conservative treatment, we opted for nonsurgical management. The clinical significance of meniscal ossicles lies in their potential to cause mild, intermittent knee pain and their resemblance to other intra-articular conditions, such as loose bodies, meniscal calcifications, avulsion fractures, or osteochondritis dissecans, which may complicate the diagnosis. Considering these aspects, we emphasize the importance of thorough differential diagnosis and tailored treatment strategies.

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Ethics statement

Informed consent was obtained from the patient.

Conflicts of interest

No potential conflict of interest relevant to this article was reported.

Funding

None.

Author contributions

Conceptualization: all authors; Formal analysis, Supervision: MK; Investigation: BY, AFÇ; Writing-original draft: BYa, AFÇ; Writing-review & editing: MK.

Fig. 1.

(A) Radiography showing the meniscal ossicle (arrowhead) located in the posterior part of the right knee joint. Magnetic resonance images of (B) zero echo time sequence (sagittal view), (C) multiple-echo recombined gradient echo (sagittal view), and (D) proton density sequence (sagittal view) demonstrating the same intrameniscal ossicle (arrowheads). MFC, medial femoral condyle; T, tibia.

Fig. 2.

(A) Coronal and (B) axial magnetic resonance images of the right knee joint illustrating the degenerative changes, erosion and thinning in the medial tibiofemoral and patellofemoral cartilages (arrows), degeneration in the medial meniscus (arrowhead), and intra-articular effusion (asterisks). MFC, medial femoral condyle; T, tibia; P, patella; F, femur.

References

1. Vangrinsven G, Vanhoenacker F. Meniscal ossicle mimicking a radial meniscal tear. J Belg Soc Radiol 2020;104:33.Article PubMed PMC
2. Qalib YO, Tang Y, Lu H. The meniscal ossicle associated with medial meniscus posterior root tear. BJR Case Rep 2022;8:20210243.Article PubMed PMC
3. Ricci V, Özçakar L, Galletti L, Domenico C, Galletti S. Ultrasound-guided treatment of extrusive medial meniscopathy: a 3-step protocol. J Ultrasound Med 2020;39:805–10.Article PubMed PDF

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Figure

Intrameniscal ossicle: an overlooked cause of knee pain

Fig. 1. (A) Radiography showing the meniscal ossicle (arrowhead) located in the posterior part of the right knee joint. Magnetic resonance images of (B) zero echo time sequence (sagittal view), (C) multiple-echo recombined gradient echo (sagittal view), and (D) proton density sequence (sagittal view) demonstrating the same intrameniscal ossicle (arrowheads). MFC, medial femoral condyle; T, tibia.

Fig. 2. (A) Coronal and (B) axial magnetic resonance images of the right knee joint illustrating the degenerative changes, erosion and thinning in the medial tibiofemoral and patellofemoral cartilages (arrows), degeneration in the medial meniscus (arrowhead), and intra-articular effusion (asterisks). MFC, medial femoral condyle; T, tibia; P, patella; F, femur.

Fig. 1.

Fig. 2.

Intrameniscal ossicle: an overlooked cause of knee pain