TO THE EDITOR:
The article "Anomalous Insertion of the Medial Meniscus of the Knee. A Case Report" (77-A: 1894—1896, Dec. 1995), by Shea et al., describes a ligamentous connection between the anterior horn of the medial meniscus and the intercondylar notch of the femur. The authors stated that an earlier report1 of this anomaly had been published but had been lacking in detail.
It may be of interest that a detailed description of this anomaly and a list of previous reports was published in 1992 in Clinical Anatomy2. It was suggested in that article2 that such an anomaly was present in approximately 2 per cent of knees and that it be referred to as the antero-medial menisco-femoral ligament. It was histologically confirmed to be ligamentous and to insert into the medial aspect of the lateral femoral condyle and was distinct from the better known menisco-femoral ligaments running from the posterior horn of the lateral meniscus in front of and behind the posterior cruciate ligament to the medial femoral condyle.
Damian McCormack, F.R.C.S.(Orth), Cappagh Orthopaedic Hospital, Dublin, Ireland
Dr. Shea, Dr. Westin, and Mr. West reply:
Although the insertion of the medial meniscus that we described was located in a different region of the femur, the anomaly that we illustrated is otherwise comparable with that reported by Mr. McCormack2. We did not identify this reference during our search of the literature while preparing our article. According to the 1995-1996 edition of Ulrich's International Periodicals Directory, which provides journal-referencing information for text-based, CD-ROM, and electronic on-line scientific databases, Clinical Anatomy is not indexed by any major scientific database. The National Library of Medicine began referencing Clinical Anatomy in 1995. If this reference had been available to us when we wrote our article, we would have cited it. We appreciate Mr. McCormack's desire to inform us of his previous publication.
It is interesting to note that the clinical history of each patient who had this anomaly was similar, as was the response to the partial meniscectomy. The proportion of the meniscus excised from our patient was much smaller than that in Mr. McCormack's study2.
Mr. McCormack suggests that this anomaly may be present in as many as 2 per cent of knees2. On the basis of our own experience, we believe that this condition is very rare and that its prevalence is much lower than 2 per cent.
Kevin G. Shea, M.D.; John West: Department of Orthopaedic Surgery, University of Utah School of Medicine, 50 North Medical Drive, Salt Lake City, Utah 84132
Craig Westin, M.D.: 9844 South 1300 East, Suite 100, Sandy, Utah 84094