Ganglion cysts of the anterior cruciate ligament: a series of 15 cases

PURPOSE

To increase awareness of the presence of ganglion cysts of the anterior cruciate ligament and to consider this diagnosis in any knee that has lost range of motion (ROM) in the absence of osteoarthritis.

TYPE OF STUDY

Case series.

METHODS

We present a series of 15 cases recorded over a period of 5 years illustrating the clinical presentation and additional pathology seen at arthroscopy. International Knee Documentation Committee scores were calculated at the recent follow-up to establish outcome of the surgery.

RESULTS

The cysts occurred predominantly in men with the most common presenting complaint being decreased ROM and pain. Overall, results were excellent with no recurrence of symptoms at a mean 36-month follow-up, but outcome does appear to be associated with other pathology present. ROM was improved with arthroscopic excision of the cyst in all cases that were impaired.

CONCLUSIONS

Although rare, ganglion cysts related to the cruciate ligaments of the knee should be considered in the differential diagnosis of a painful knee especially when associated with a decreased ROM and no evidence of osteoarthritis on radiographs. Other pathology can often be present, which may affect the overall outcome, but arthroscopic debridement of the ganglion cyst should be considered the treatment of choice in order to reliably restore active ROM.

LEVEL OF EVIDENCE

Level IV, Case Series.

Ganglion of the groin in a child: an unusual cause of soft-tissue swelling of the groin

A case of groin ganglion with asymptomatic compression of the femoral vein is described. A 2-year-old girl was referred because of a symptomless groin mass. A mass was palpable in the right femoral triangle. Computed tomography and ultrasonography revealed a cystic lesion compressing the femoral vein ventrally. Prompt surgical removal of the cystic lesion was done without complications. Histopathological examination showed a benign structure similar to that of a ganglion.

Ulnar neuropathy at Guyon's canal: electrophysiological and surgical findings

Published correlations between electrophysiological and surgical findings are relatively rare in cases of ulnar nerve compression at the wrist, compared to the more common compression of the ulnar nerve at the elbow. We describe a patient who presented with clinical and electrodiagnostic findings of a pure motor ulnar neuropathy involving the territory of the deep branch. Surgical exploration revealed that a ganglion cyst caused compression of the deep ulnar motor branch at Guyon's canal. This case illustrates the usefulness of electrodiagnostic studies in the localization of nerve entrapment prior to surgery.

Unusual location of a posttraumatic ganglion and rupture of the peroneus brevis tendon: a case report

The typical location of a peroneus brevis tendon tear has been described at the posterior margin of the fibula due to an entrapment mechanism or repetitive anterior subluxation of the tendon. A case of a posttraumatic intratendinous ganglion of the peroneus brevis tendon in the distal third of the peroneus brevis is reported. The ganglion developed from a longitudinal tear in the tendon substance after an inversion ankle sprain. This case is reported because of the unusual location. The clinical course and surgical treatment is also discussed.

[A case of lumbar ganglion cyst causing radiculopathy]

Ganglion cysts represent a rare pathology mostly encountered in the lumbar region of the spinal column. Magnetic resonance imaging revealed a ganglion cyst at the L4-5 level in a 46-year-old woman who had a complaint of long-standing pain in her right leg. The cyst was completely excised following total laminectomy at L4. After surgery, her symptoms and neurological signs completely disappeared.

Cyst of the Ligamentum Flavum-Case Report-

An 86-year-old man presented with intermittent claudication caused by a cyst of the ligamentum flavum. Lumbar magnetic resonance imaging demonstrated an extradural cystic mass at the L5-S1 intervertebral space and canal stenosis at the L4-5 space. L-5 laminectomy and flavectomy at the L4-5 and L5-S1 spaces were performed, and the cystic mass was excised. The histological features were consistent with cyst of the ligamentum flavum. The histological diagnosis was ganglion cyst of the ligamentum flavum. After surgery, claudication completely disappeared and the patient made a good recovery.

Intra-articular cysts and ganglia of the knee: a report of nine patients

Completely intra-articular cysts and ganglia of the knee are rare. They have been found in various locations such as on the anterior or posterior cruciate ligaments, in the infrapatellar fat pad, on the posterior wall of the posteromedial compartment and (very rarely) in connection to the menisci. We analyzed nine patients with intra-articular cysts or ganglia found in a series of 2,400 consecutive arthroscopies. In four patients, the cyst or ganglion was found attached to the anterior part of the ACL, in two patients it was located between the ACL and the PCL, and in the remaining three cases it was found in connection with the meniscus. In three out of the nine patients there was either no or very minor additional pathology found in the knee besides the cyst or the ganglion. We believe that intra-articular cysts and ganglia of the knee can be symptomatic, and excellent or good results after cyst removal can be expected especially when there is little additional pathology.

Compression of the lower branch of the suprascapular nerve by a cyst: description of a case and review of the literature

Ganglion cysts responsible for compression syndrome of the lower branch of the suprascapular nerve are described, but they are rare. The authors describe a well-documented case that was treated in a traditional manner by exeresis conducted through posterior access. Pain was relieved immediately, while force in external rotation and electromyographic findings improved as early as two months after surgery. One year after surgery the patient does not complain of the recurrence of symptoms. The literature is analyzed and therapeutic options available are discussed.

Tarsal tunnel syndrome caused by ganglion

We report a case of delayed diagnosis of tarsal tunnel syndrome caused by a ganglion arising from the talo-calcaneal joint. Unusually the symptoms were mainly due to the lateral planter nerve compression with a positive Tinel's sign. A surgical decompression was successful in relieving the dysaesthesia in spite of a 7 years history.

Deep peroneal nerve paresis in a runner caused by ganglion at capitulum peronei. Case report and review of the literature

Although lateral popliteal sciatic nerve damage is not one of the commonest diseases in the general population, it is quite frequent among athletes. Several physiopathologic mechanisms have been thought to bring about this damage in athletes. Soft tissue ganglions with neurological involvement of the lateral popliteal sciatic nerve or its terminal rami are in differential diagnosis with several lesions of this area, as direct or indirect trauma, subcutaneous rupture of anterior tibialis muscle and long peroneal muscle, disc hernia, intraspinal tumor, anterior tarsal tunnel syndrome, cysts, neurofibroma, baker's cyst, vascular claudication, stenosing or inflammatory pathology of 2(nd) motoneuron, antimicrobial agents for urinary tract infection (nitrofurnantoin). The authors report the case of a 34-year-old amateur athlete with a recent paralysis of the hallux extensor, paresis of the toe extensor and hyposthenia of the tibialis anterior. The patient had been suffering from episodes of lumbalgia for a long time. He was sent to us because neurological damage due to disc herniation was suspected. Electromyography, sonography, and CT showed peripheral compression of the deep peroneal nerve caused by a mucous cyst at the capitulum peronei, a ''rare'' condition. The patient underwent surgery to excise the cyst, which led to the rapid resolution of the nerve deficit shown by clinical and electromyographical tests. A meticulous anamnesis and accurate objective examination, followed by specific tests (radiographs, sonography, and possibly CT scan) generally enable a correct diagnosis to be made. If diagnosis and therapy are carried out correctly, and without delay, symptoms quickly resolve and the nerve deficit progressively regresses.

Symptomatic intra-articular ganglion cyst of the knee

We are reporting a case of a patient with a symptomatic intra-articular ganglion of the knee arising from infrapatellar fat pad. Plain radiograph and Magnetic Resonance (MR) images were correlated with arthroscopic examination and histological findings. The cyst was removed and post operatively patient regained full extension.

A recurrent foot ganglion managed with extensor digitorum brevis muscle flap coverage

The case of a 42-year-old woman with a persistent ganglion cyst of the dorsolateral aspect of the foot is presented. After multiple aspirations and 4 attempts at excision, the lesion degenerated into a painful, persistently draining wound with communication to the calcaneocuboid joint. The case was treated with dissection of the lesion to the joint, excision, and coverage of the defect with an extensor digitorum brevis muscle flap. The rationale for this surgical approach and the literature regarding recurrent ganglia are discussed.

Giant ganglion formation in the quadriceps femoris tendon following total knee replacement

A case of giant ganglion cyst arising from the quadriceps femoris tendon, following total knee replacement is presented in this case report. The ganglion cyst was successfully excised. The formation of a ganglion cyst following total knee replacement has not been reported.

Subcutaneous emphysema of the hand caused by the suction drain -- a case report

Subcutaneous emphysema of the hand can be related to non-infectious causes and most commonly high-pressure injection injuries. Surgical emphysema of the hand is rare. We report a case of surgical emphysema of the dorsum of the hand following the excision of a dorsal wrist ganglion when the inserted suction drain did not work properly, accompanied by the inadvertent compression of the patient's body. Conservative management was adequate; oedema and emphysema subsided in several days.

A ganglion cyst that developed from the infrapatellar fat pad of the knee

A ganglion cyst may be seen in all joints with varying frequency depending on location, but it is rare in the knee joint. A 30-year-old man presented with a mass in the anterolateral aspect of his left knee. Magnetic resonance imaging revealed an intra-articular tumor arising from the infrapatellar fat pad of the knee. This multilobular tumor showed low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Complete open resection was performed after arthroscopic examination. Histologic examination of the specimen confirmed the diagnosis of ganglion cyst. At the 1-year follow-up examination, the patient's left knee was completely asymptomatic with full range of motion and no recurrence. Ganglion cyst should be considered in the differential diagnosis of intra-articular masses.

Ganglion cysts and other tumor related conditions of the hand and wrist

Most regard ganglion, giant cell tumor of tendon sheath and epidermal inclusion cysts as tumor-like conditions as opposed to true neoplasms. Ganglion cysts are the most common lesion of the hand and wrist, accounting for 50% to 70% of all masses identified. The majority of ganglion cysts can be treated nonoperatively but when surgery is performed a low recurrence rate can be anticipated. Giant cell tumor of the tendon sheath hand epidermoid cysts are also common hand lesions that require surgical excision in most instances. Of the three, giant cell tumor of tendon sheath have the most notable recurrence rates. This article reviews the clinical presentations of these lesions as well as their proposed pathophysiology.

Intra-articular ganglion cyst of the knee

Ganglion cysts of the knee are extremely uncommon. They usually cause non-specific symptoms and do not produce classical signs. Advances in imaging techniques as well as widespread use of arthroscopy have made detection of these cysts easier, and most can be treated arthroscopically. Ganglion cysts arising within the infrapatellar fat pad are even more uncommon. We report a case of a young lady with a giant intra-articular ganglion within the infrapatellar fat pad that was treated by open excision.

Large lateral meniscal ganglion cyst extending into the intercondylar fossa of the knee

We report the case of a 31-year-old, otherwise healthy man with a large intra-articular meniscal ganglion cyst (27.7 x 13.5 mm) originating from the dorsal horn of the lateral meniscus. Clinically, the patient presented with knee pain in a squatting position. Magnetic resonance imaging revealed a large intra-articular cyst in the posterior compartment. At arthroscopic surgery, the ganglion cyst was found in the intercondylar space posteriorly to the posterior cruciate ligament. After removal of the ganglion cyst, a horizontal tear in the dorsal horn of the lateral meniscus was revealed and treated by partial meniscectomy. To our knowledge, a meniscal ganglion cyst originating from the lateral meniscus and extending into the joint is an extremely rare event, with only two previous reported cases. We review the current literature on the pathogenesis, distribution, and treatment of meniscal ganglion cysts.

Proximal tibiofibular joint ganglion cysts: excision, recurrence, and joint arthrodesis

OBJECTIVE

Proximal tibiofibular joint proximal tibiofibular joint cysts are rare entities that can cause disability. Excision remains the traditional surgical treatment. Cyst recurrence has been a problem. This study reviews one of the largest series of patients with proximal tibiofibular joint cysts and evaluates the role of a new surgical option, proximal tibiofibular joint fusion.

METHODS

Thirteen patients were admitted to the institution between 1987 and 1999. Diagnoses were confirmed by magnetic resonance imaging and histological examination. A database was compiled after medical record review. Patients completed a phone survey describing activity levels, symptom severity, recurrence history, and additional surgery. Average postoperative follow-up and average time to date of survey were 1.7 and 6.3 years, respectively.

RESULTS

Patient complaints included lateral knee "fullness" (75%) and peroneal nerve dysesthesias (54%). Twelve patients opted for surgery: cyst excision (8) and cyst excision with proximal tibiofibular joint fusion (4). A recurrence rate of 13% (1 of 8) following primary excision was observed. A 100% (3 of 3) repeat recurrence rate was noted in second resections. Four patients underwent proximal tibiofibular joint fusion: 2 with a recurrence history and 2 for primary treatment. At follow-up, all fusion patients were without cyst recurrence or activity limitations. Procedure morbidity was minimal.

CONCLUSIONS

Proximal tibiofibular joint cysts can recur after simple excision. Repeat resection after a recurrence is often not effective. Proximal tibiofibular joint arthrodesis appears to be a more effective surgical option after a recurrence.

Radial tunnel syndrome caused by ganglion cyst: treatment by arthroscopic cyst decompression

Compressive neuropathies of the radial nerve at the elbow can lead to one of 2 clinical entities. Posterior interosseous syndrome is primarily a motor deficiency of the posterior interosseous nerve, and radial tunnel syndrome presents as pain along the radial tunnel and extensor muscle mass. The radial nerve can be compressed at a number of sites around the elbow. In addition, numerous mass lesions reported in the literature can cause compressive neuropathy of the radial nerve at the elbow. Standard surgical management for persistent radial tunnel syndrome that is refractory to nonsurgical treatment is open decompression of the radial nerve. Cysts occurring in other joints are commonly treated arthroscopically. Supraglenoid cysts of the shoulder, meniscal cysts in the knee, and dorsal wrist ganglia are routinely treated with arthroscopic decompression or excision with management of the underlying etiology of the cyst. We present a case of radial tunnel syndrome caused by a ganglion cyst of the proximal radioulnar joint that was treated using arthroscopic excision of the cyst and decompression of the radial nerve.