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Lamour RJ, Patel NN, Harris GB, England JS, Lesniak BP, Kaplan LD, Jose J. Comparing MRI and arthroscopic appearances of common knee pathologies: A pictorial review. J Clin Imaging Sci 2024; 14:15. [PMID: 38841313 PMCID: PMC11152552 DOI: 10.25259/jcis_98_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/23/2024] [Indexed: 06/07/2024] Open
Abstract
Knee pathology, including anterior cruciate ligament (ACL) tears, meniscal tears, articular cartilage lesions, and intra-articular masses or cysts are common clinical entities treated by orthopedic surgeons with arthroscopic surgery. Preoperatively, magnetic resonance imaging (MRI) is now standard in confirming knee pathology, particularly detecting pathology less evident with history and physical examination alone. The radiologist's MRI interpretation becomes essential in evaluating intra-articular knee structures. Typically, the radiologist that interprets the MRI does not have the opportunity to view the same pathology arthroscopically. Thus, the purpose of this article is to illustratively reconcile what the orthopedic surgeon sees arthroscopically with what the radiologist sees on magnetic resonance imaging when viewing the same pathology. Correlating virtual and actual images can help better understand pathology, resulting in more accurate MRI interpretations. In this article, we present and review a series of MR and correlating arthroscopic images of ACL tears, meniscal tears, chondral lesions, and intra-articular masses and cysts. Short teaching points are included to highlight the importance of radiological signs and pathological MRI appearance with significant clinical and arthroscopic findings.
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Affiliation(s)
- Richard J. Lamour
- Department of Orthopaedic Surgery, Division of Sports Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Nikhil N. Patel
- Department of Orthopaedic Surgery, Division of Sports Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Griffin B. Harris
- Department of Orthopaedic Surgery, Division of Sports Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Jonathan S. England
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Bryson P. Lesniak
- Department of Orthopaedic Surgery, Division of Sports Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Lee D. Kaplan
- Department of Orthopaedic Surgery, Division of Sports Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Jean Jose
- Department of Orthopaedic Surgery, Division of Sports Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
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Bouzid YB, Dinia M, Bassir RA, Boufettal M, Mekkaoui J, Kharmaz M, Lamrani MO, Berrada MS. Anterior cruciate ligament cysts: About a rare condition. Radiol Case Rep 2023; 18:3309-3316. [PMID: 37497465 PMCID: PMC10365983 DOI: 10.1016/j.radcr.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 07/28/2023] Open
Abstract
The purpose of this study was to provide information on cysts of the anterior cruciate ligament (ACL) of the knee. This included an anatomical and radio-anatomical reminder of the cruciate ligaments of the knee, along with details of the epidemiology, etiopathogenesis, anatomical risk factors, clinical presentation, differential diagnosis, and treatment of ACL cysts. A retrospective analysis was conducted, involving the review of 7 radioclinical records from the medical imaging department of Ibn Sina University Hospital in Rabat, covering a period of 3 years (2018-2020), during which 7 cases of ACL cysts were diagnosed. The results revealed that ACL cysts are a rare condition, frequently detected incidentally during the assessment of meniscal lesions. Symptoms commonly include knee pain and limited mobility, and MRI is considered the diagnostic modality of for distinguishing between simple fluid-filled cysts and infiltrative cysts, as well as for ruling out other differential diagnoses. Treatment options include radio-guided infiltration puncture and arthroscopic resection.
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Tie K, Wang H, Zhao X, Tan Y, Qin J, Chen L. Clinical manifestation and arthroscopic treatment of symptomatic posterior cruciate ligament cyst. J Orthop Surg Res 2018; 13:84. [PMID: 29653540 PMCID: PMC5899343 DOI: 10.1186/s13018-018-0798-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 04/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Ganglion cyst of cruciate ligaments is a rare lesion; the prevalence is 0.3–0.8%. The purpose of this study was to present clinical features of symptomatic posterior cruciate ligament (PCL) cyst, introduce the arthroscopic excision technique, and evaluate the clinical outcome. Methods A series of 11 patients with symptomatic PCL cyst from November 2012 to December 2014 were involved in this retrospective study. Detailed medical history collecting and physical examination were conducted. Magnetic resonance imaging (MRI) scan was used to confirm the diagnosis. Arthroscopic resection was performed, and the sample of the cyst was taken for pathologic examination. The follow-up averaged 30.7 months. International Knee Documentation Committee (IKDC) score, the range of motion (ROM), and MRI evaluations were obtained pre- and postoperatively to assess the surgical outcome. SPSS software was used for statistics analysis. Results Eight males and 3 females with 6 left knees and 5 right knees were enrolled, the mean age was 34.4 years, and the duration of symptom was 19.0 months. All cases had a definite history of knee trauma or injury. The most common symptom was knee pain at flexion or in flexion-associated activities. MRI revealed the location and size of the cyst in each case. Pathologic examination showed the cyst wall was composed of dense fibroconnective tissue and widespread thick bundles of collagen, which is similar to the structure of ganglion cyst. At the final follow-up, MRI evaluation showed no cyst recurrence. The preoperative ROM and IKDC score were 2.3° to 108.6° and 40.5 ± 11.3, respectively, compared with the postoperative ROM and IKDC score which were 0° to 134.1° and 85.5 ± 4.8 (p < 0.05) separately. Conclusions We conclude that the etiology of symptomatic PCL cyst is most likely associated with trauma, pain on flexion is a typical manifestation of symptomatic PCL cyst, MRI evaluation is an ideal examination for the diagnosis, and arthroscopic resection of symptomatic PCL cysts has a good outcome with no recurrence. Electronic supplementary material The online version of this article (10.1186/s13018-018-0798-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kai Tie
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, 169# Donghu Rd, Wuchang District, Wuhan City, Hubei Provence, People's Republic of China
| | - Hua Wang
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, 169# Donghu Rd, Wuchang District, Wuhan City, Hubei Provence, People's Republic of China
| | - Xinyu Zhao
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, 169# Donghu Rd, Wuchang District, Wuhan City, Hubei Provence, People's Republic of China
| | - Yang Tan
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, 169# Donghu Rd, Wuchang District, Wuhan City, Hubei Provence, People's Republic of China
| | - Jun Qin
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, 169# Donghu Rd, Wuchang District, Wuhan City, Hubei Provence, People's Republic of China
| | - Liaobin Chen
- Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, 169# Donghu Rd, Wuchang District, Wuhan City, Hubei Provence, People's Republic of China.
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Anterior cruciate ligament reconstruction tunnel size: causes of tunnel enlargement and implications for single versus two-stage revision reconstruction. Skeletal Radiol 2017; 46:161-169. [PMID: 27885380 DOI: 10.1007/s00256-016-2535-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 11/07/2016] [Accepted: 11/14/2016] [Indexed: 02/02/2023]
Abstract
Anterior cruciate ligament (ACL) reconstructions have increased over the past 25 years. The increased incidence of ACL reconstructions has translated into a larger number of graft failures and revision ACL procedures. It is important to understand the causes of graft failure when evaluating for a revision ACL reconstruction and to appreciate changes in tunnel anatomy over time prior to planning revision surgery. In this manuscript, tunnel size for ACL reconstruction and implications for single-stage versus two-stage revision ACL reconstruction will be discussed, as well as causes of tunnel enlargement, including mechanical and biological factors.
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Tram-track appearance of the posterior cruciate ligament (PCL): correlations with mucoid degeneration, ligamentous stability, and differentiation from PCL tears. AJR Am J Roentgenol 2013; 201:394-9. [PMID: 23883220 DOI: 10.2214/ajr.11.7400] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to describe the MRI findings in the posterior cruciate ligament (PCL) analogous to mucoid degeneration in the anterior cruciate ligament (ACL); to correlate MRI findings in the PCL with ligamentous stability; to differentiate the PCL tram-track appearance from the appearance of PCL tears; and to emphasize the coexistence of PCL and ACL mucoid degeneration, cruciate ganglia, and meniscal cysts. CONCLUSION The tram-track PCL appearance commonly coexists with ACL mucoid degeneration; ganglia; and, less frequently, meniscal cysts. Both PCL tears and MRI findings suggestive of PCL mucoid degeneration show ligament thickening and increased PCL signal intensity. Tram-track PCLs are usually asymptomatic and typically have no ligamentous instability.
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Dacombe PJ, Robinson J. Falling up the stairs: the equivalent of 'bashing it with a bible' for an ACL ganglion cyst of the knee. BMJ Case Rep 2012; 2012:bcr.01.2012.5591. [PMID: 22605799 DOI: 10.1136/bcr.01.2012.5591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intra-articular anterior cruciate ligament (ACL) cysts are rare, the pathogenesis remains unknown, with trauma often implicated. Often asymptomatic, incidental MRI findings, 11% produce symptoms such as pain, locking or instability. Treatment of intra-articular ganglia differs from the traditional 'bash it with a bible' mantra for ganglia elsewhere with surgical debridement generally indicated for symptomatic cases. This case report describes a 43-year-old male car mechanic who presented with a symptomatic ACL cyst diagnosed on MRI. While waiting for surgery the patient fell up his stairs at home, causing forced hyperflexion of his knee. After an initial sharp pain, within 24 h the patient experienced complete resolution of symptoms. Postfall MRI showed no evidence of the initial lesion, leading to our conclusion that for this patient, a fall up the stairs was the equivalent of 'bashing it with a bible' for an ACL ganglion cyst of the knee.
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Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Knee Surg Sports Traumatol Arthrosc 2011; 19:1326-33. [PMID: 21331652 DOI: 10.1007/s00167-011-1433-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 02/01/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Anterior cruciate ligament (ACL) mucoid degeneration is a rare encounter in clinical practice, different, but often confused with ACL mucoid cysts. Its pathophysiology remains unclear. However, recent publications have suggested that it might be underdiagnosed or misdiagnosed, and that the adverse effects of treatment by ACL resection might be underestimated. The object of this work was to summarize this scattered knowledge to improve patient management. METHODS The authors carried out an exhaustive and comprehensive review of up-to-date literature. An extensive search of the MEDLINE database was carried out using MESH terms (ganglion cyst, anterior cruciate ligament) and generic search terms (mucoid degeneration, hypertrophy). RESULTS Anterior cruciate ligament mucoid degeneration is determined by interstitial glycosaminoglycan deposits amidst the collagen bundles causing ACL hypertrophy, knee pain, and limited range of motion. It is thought to arise from a primary synovial lesion and is associated with arthritic change or subsequent to acute or repeated trauma. Diagnosis is made on MRI scans and confirmed on histopathological samples. Current treatment involving ACL arthroscopic resection is efficient on pain and range of motion but is not a benign procedure and causes knee laxity. CONCLUSIONS Anterior cruciate ligament mucoid degeneration needs to be more broadly known and properly diagnosed so that progress can be made in its management. Further research will be necessary to confirm the current trends in the literature, which suggest being less aggressive with ACL arthroscopic resection when dealing with mucoid degeneration and making more use of conservative measures such as notchplasty. LEVEL OF EVIDENCE Systematic review, Level IV.
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Affiliation(s)
- Francois Lintz
- Andre Mignot Hospital of Versailles, Le Chesnay, France.
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Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Arthroscopy 2008; 24:642-9. [PMID: 18514107 DOI: 10.1016/j.arthro.2008.02.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 01/25/2008] [Accepted: 02/05/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to examine the clinical features and diagnosis of patients with mucoid hypertrophy of the anterior cruciate ligament (ACL) and to assess the results of arthroscopic treatment. METHODS Between May 1999 and August 2005, 156 knees in 132 patients were diagnosed with mucoid hypertrophy of the ACL and underwent arthroscopic treatment. Of these, 106 knees in 91 patients (86 women and 5 men), with a mean age of 61 years (range, 42 to 80 years), were followed up for at least 2 years. All 106 knees had central knee pain on terminal extension without preceding trauma, and 83 (78.3%) had extension deficit. Magnetic resonance imaging showed thickened, ill-defined ACLs with increased intraligamentous signals. Arthroscopy showed osteoarthritic changes of varying degrees in all, with 84 (79.2%) having intercondylar notch narrowing and 102 (96.2%) having additional degenerative pathologies. The posterolateral portion of the ACL appeared hypertrophied, which impinged on the lateral wall and roof of the notch. Arthroscopic debridement of hypertrophied ACLs was performed with or without notchplasty, according to the severity of impingement. RESULTS Good to excellent pain relief on terminal extension was obtained in 92 of 106 knees (86.8%), including complete pain relief in 57 (53.8%). The extension deficit was normalized in 68 of 83 affected knees (81.9%). Lachman and anterior drawer tests showed a firm endpoint in all, and 85.8% showed good to excellent subjective satisfaction. CONCLUSIONS Mucoid hypertrophy of the ACL should be suspected in elderly women presenting pain on terminal extension without preceding trauma, especially when associated with extension deficit. The magnetic resonance imaging findings are specific for preoperative diagnoses. Partial ACL debridement with notchplasty provides safe and effective symptom relief. Extension pain improved significantly in 92 of 106 knees (86.8%), and extension deficit was normalized in 68 of 83 knees (81.9%).
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Affiliation(s)
- Tae-Ho Kim
- Department of Orthopaedic Surgery, Cheong-Ju St. Mary's Hospital, College of Medicine, Catholic University, Cheong-Ju, South Korea
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Abstract
PURPOSE Intra-articular ganglia of the knee are rare and usually incidental findings of little clinical significance. Nevertheless some are large, symptomatic, and require treatment. We report on 3 patients with an intra-articular knee ganglion and an extrasynovial extension that was contained within the joint capsule. This seems to be a rare condition; a review of the English-language literature revealed no reports of similar cases. TYPE OF STUDY Case series. METHODS Three patients, 1 man and 2 women aged 27 to 40 years, presented with an almost identical history of anterior knee pain that had been treated conservatively for a long time as chondromalacia patellae. The symptoms, which were ill-defined, appeared to be deteriorating until a localized swelling appeared on the lateral side of the patella tendon in each case. On examination, a lateral meniscal cyst associated with an underlying meniscal tear was suspected. However, magnetic resonance imaging revealed a ganglion arising from the substance of the anterior cruciate ligament (case 1) and from the area of the tibial insertion of the anterior cruciate ligament (cases 2 and 3). All 3 ganglia extended anteriorly and then laterally over and in front of the lateral meniscus. The ganglia were approached through an anterior midline incision and lateral parapatellar arthrotomy, which allowed direct and easy access for complete excision. Histologic examination confirmed the diagnosis of a ganglion in all 3 cases. RESULTS The postoperative course was uneventful in all patients with no signs of recurrence at 1 year (case 1), 2 years (case 2), and 3 years (case 3). CONCLUSIONS Although the described condition seems very rare, we believe that it should be included in the differential diagnosis of cystic lesions about the knee joint. LEVEL OF EVIDENCE Level IV, case series, no, or historical control group.
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Affiliation(s)
- Georgios I Drosos
- Second Orthopaedic Department, Athens Naval Hospital, Athens, Greece.
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Abstract
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.
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Affiliation(s)
- Erin N Parish
- The Australian Institute of Musculo-Skeletal Research, Sydney, Australia
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Ozalay M, Tandoğan RN, Akpinar S, Cesur N, Hersekli MA, Ozkoç G, Uysal M. Arthroscopic treatment of solitary benign intra-articular lesions of the knee that cause mechanical symptoms. Arthroscopy 2005; 21:12-8. [PMID: 15650661 DOI: 10.1016/j.arthro.2004.08.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Most cases of knee locking and giving-way are caused by meniscal tears, loose bodies, or chondral lesions. Intra-articular benign tumors or tumor-like lesions can present with symptoms that resemble acute mechanical derangement. From a database of 2,200 arthroscopic interventions, 19 cases of intra-articular masses that presented with catching and locking symptoms in the knee were retrospectively analyzed. TYPE OF STUDY Case series. METHODS Our review revealed 33 patients with benign intra-articular masses in the knee joint. Nineteen of these individuals had sought medical attention for mechanical symptoms of catching or locking. The other 14 patients had a variety of symptoms including pain, swelling, and limitation of knee motion, but did not have mechanical symptoms. Age, sex, history of trauma, knee pain and effusion, medical illnesses, physical examination, arthroscopic findings, and pathologic findings were noted. RESULTS The average age of the 6 male and 13 female patients was 37.5 years (range, 18 to 58 years). Preoperative magnetic resonance imaging confirmed the diagnosis in 7 cases and 12 cases were diagnosed during knee arthroscopy. The mean follow-up time after surgery was 52.5 months (range, 6 to 120 months). Pathologic examination of the lesions revealed 15 cases of localized pigmented villonodular synovitis (79%), 1 lipoma arborescens (5%), 1 pseudocyst (5%), and 2 nonspecific synovial masses (11%). None of the lesions showed malignant transformation. CONCLUSIONS Solitary benign intra-articular lesions should be considered a rare cause of mechanical knee symptoms. Localized pigmented villonodular synovitis originating from the extensor mechanism or fat pad is the most common solitary intra-articular mass lesion in the knee and usually arises in the patellofemoral compartment. Recurrence has not occurred in our series, which includes 14 of 19 patients with greater than 24 months follow-up. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Metin Ozalay
- Baskent University Faculty of Medicine, Department of Orthopaedics and Traumatology, Adana Medical Center, Adana, Turkey.
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Lin KC, Teng HP, Chen CH, Hsu CJ. Intra-articular Ganglion Cyst from Medial Collateral Ligament of the Knee Joint: A Case Report and Review of the Literature. Kaohsiung J Med Sci 2004. [DOI: 10.1016/s1607-551x(09)70171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Sekiya JK, Elkousy HA, Fu FH. Recurrent pretibial ganglion cyst formation over 5 years after anterior cruciate ligament reconstruction. Arthroscopy 2004; 20:317-21. [PMID: 15007323 DOI: 10.1016/j.arthro.2003.11.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although ganglion cysts of the anterior cruciate ligament have been described in the literature, they are a relatively rare phenomenon. Cyst formation after anterior cruciate ligament reconstruction is even less frequent, with only a few reported cases. The proposed etiology of these cysts has been attributed to a number of causes, including the use of bioabsorbable screws, Gore-Tex (W. L. Gore and Associates, Flagstaff, AZ) grafts, extra-articular fluid extravasation secondary to direct tibial tunnel communication, allografts with or without ethylene oxide sterilization, and the use of nonabsorbable suture. We report an unusual case of a recurrent pretibial ganglion cyst that initially formed more than 5 years after an anterior cruciate ligament reconstruction and recurred 2 years after resection of the mass. We believe the initial surgical resection was unsuccessful probably because the foreign body irritant was not identified. Only after resection of the entire stalk of the cyst and removal of all of the inciting suture material that was found near the entrance of the tibial tunnel were we able to definitively eradicate the ganglion cyst.
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Affiliation(s)
- Jon K Sekiya
- Bone and Joint/Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA.
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Kakutani K, Yoshiya S, Matsui N, Yamamoto T, Kurosaka M. An intraligamentous ganglion cyst of the anterior cruciate ligament after a traumatic event. Arthroscopy 2003; 19:1019-22. [PMID: 14608325 DOI: 10.1016/j.arthro.2003.09.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
An unusual case of intraligamentous ganglion cyst of the anterior cruciate ligament after a traumatic event in a 12-year-old boy is presented. Magnetic resonance imaging was helpful in delineating the lesion. An arthroscopic aspiration of the cyst material resulted in resolution of symptoms to preserve satisfactory knee function. The patient remains asymptomatic 25 months after surgery.
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Affiliation(s)
- Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Abstract
Previous investigators have reported incidental findings and symptomatic cases of cystic ganglia on the anterior cruciate ligament (ACL) that were mucinous degeneration or herniation of the synovial tissue through a defect. However, we report 2 cases of grossly solid ganglia of the ACL those mimicked lateral meniscal tears. A literature search found no previous report of them. We discuss the possibility of their pathogenesis and treatment.
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Affiliation(s)
- Ko-Hsiu Lu
- Department of Orthopedic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
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Choi NH, Kim SJ. A ganglion of the anterior cruciate ligament causing erosion of the lateral femoral condyle: a case report. J Bone Joint Surg Am 2002; 84:2274-6. [PMID: 12473720 DOI: 10.2106/00004623-200212000-00023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Nam-Hong Choi
- Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Korea.
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Pedrinelli A, Castellana FB, Bragança de Vasconcellos Fontes R, Coelho RF, Alvaro de Menezes LA. Anterior cruciate ligament ganglion: case report. SAO PAULO MED J 2002; 120:195-7. [PMID: 12563429 DOI: 10.1590/s1516-31802002000600009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXT A ganglion is a cystic formation close to joints or tendinous sheaths, frequently found in the wrist, foot or knee. Intra-articular ganglia of the knee are rare, and most of them are located in the anterior cruciate ligament. The clinical picture for these ganglia comprises pain and movement restrictions in the knee, causing significant impairment to the patient. Symptoms are non-specific, and anterior cruciate ligament ganglia are usually diagnosed through magnetic resonance imaging or arthroscopy. Not all ganglia diagnosed through magnetic resonance imaging need to undergo surgical treatment: only those that cause clinical signs and symptoms do. Surgical results are considered good or excellent in the vast majority of cases. CASE REPORT A 29-year-old male presented with pain in the left knee during a marathon race. Physical examination revealed limitation in the maximum range of knee extension and pain in the posterior aspect of the left knee. Radiographs of the left knee were normal, but magnetic resonance imaging revealed a multi-lobed cystic structure adjacent to the anterior cruciate ligament, which resembled a ganglion cyst. The mass was removed through arthroscopy, and pathological examination revealed a synovial cyst. Patient recovery was excellent, and he resumed his usual training routine five months later.
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Affiliation(s)
- André Pedrinelli
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, Brazil.
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Abstract
Only solitary ganglion cysts within the knee have been reported. Multiple ganglion cysts within the same knee have not been reported. The author describes a patient with 2 ganglion cysts, one in the anterior cruciate ligament and one in the lateral meniscus of the same knee. Surgery was performed because of recurrent pain and functional disability.
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Affiliation(s)
- Ching-Jen Wang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Kaohsiung, Niao-Sung Hsiang, Kaohsiung, Taiwan
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Brager MA, Traina SM, Parker AW. Pretibial cyst following anterior cruciate ligament reconstruction using hamstring autografts. Orthopedics 2002; 25:79-82. [PMID: 11811248 DOI: 10.3928/0147-7447-20020101-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Ellen MI, Gilhool JJ, Rogers DP. Nonoperative treatment of an interosseous ganglion cyst. Am J Phys Med Rehabil 2001; 80:536-9. [PMID: 11421523 DOI: 10.1097/00002060-200107000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ganglion cysts of the knee are being reported more frequently secondary to an increased rate of magnetic resonance imaging studies. Although knee pain is the impetus for imaging, ganglion cysts are often incidental findings. Nonoperative treatment is a successful therapeutic option. We report a patient with variable pain presentations over the course of her treatment. The pattern of complaints pointed to different primary etiologies about the knee, but all were common to an interosseous ganglion cyst. A stepwise assessment and expansion of the differential diagnosis allowed for appropriate utilization of modalities and limited morbidity with nonoperative therapy.
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Affiliation(s)
- M I Ellen
- Department of Rehabilitation Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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Hammer DS, Dienst M, Kohn DM. Arthroscopic treatment of tumor-like lesions of the knee joint: Localized pigmented villonodular synovitis and ganglion cyst of the anterior cruciate ligament. Arthroscopy 2001; 17:320-323. [PMID: 11239356 DOI: 10.1053/jars.2001.22368] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We present the arthroscopic treatment of a case of localized pigmented villonodular synovitis that led to increasing restriction of knee flexion and the case of a ganglion cyst within the anterior cruciate ligament causing unspecific pain. Both pathologies could be resected arthroscopically with complete relief of symptoms and no recurrence. In cases with unspecific clinical signs and intra-articular masses shown on magnetic resonance imaging, arthroscopy is the next therapeutic step. Localized tumor-like lesions can often be excised without recurrence in the same session.
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22
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Abstract
Ganglion cysts originating from the cruciate ligaments have been reported rarely. A 38-year-old woman developed symptoms of knee pain with 10 degrees loss of knee extension. Preoperative magnetic resonance imaging showed a well-demarcated cystic mass surrounding the posterior cruciate ligament so clearly that further examination was not recommended. Because examination under anesthesia confirmed full extension of the knee, we presumed that pain produced by compression caused the diminished extension, and that mechanical block was not the reason. During arthroscopic examination, a mass was impinged between the anterior cruciate ligament and the intercondylar notch when extension of the knee was attempted. The mass was resected and immediate improvement was noted. The patient had experienced the same episode in the contralateral knee and removal of a ganglion cyst on the cruciate ligament 10 years ago. At the latest follow-up she was completely symptom free in both knees without any sign of recurrence.
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Affiliation(s)
- M Noda
- Department of Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan
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23
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Yu WD, Shapiro MS. Cysts and other masses about the knee: identifying and treating common and rare lesions. PHYSICIAN SPORTSMED 1999; 27:59-68. [PMID: 20086733 DOI: 10.3810/psm.1999.07.920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Masses about the knee are most commonly benign cysts. The diagnosis can often be made with a history and physical exam, but radiographs and MRI are sometimes required, and histologic evaluation is occasionally necessary. Popliteal (Baker's) cysts are often indicative of arthritis; treatment for the underlying pathology may reduce swelling and permit resorption. Meniscal cysts indicate an underlying tear; treatment is resection and cyst excision. Symptomatic ganglion cysts generally require surgical excision. Treatment for bursitis is conservative. The less-common synovial chondromatosis, pigmented villonodular synovitis, synovial sarcoma, and lesions of the proximal tibiofibular joint generally require referral and surgery.
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Affiliation(s)
- W D Yu
- Department of Orthopedic Surgery, University of California School of Medicine, Los Angeles, CA, 90095-6902, USA
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24
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Abstract
A ganglion is a cystic mass with myxoid matrix that occasionally occurs within muscles, tendons, and menisci. A ganglion cyst within the knee is very rare, with few reports to be found. We are reporting eight cases of a ganglion within the knee joint. Our cases include two ganglia in the infrapatellar fat pad which have not been previously reported. Ganglion cysts do not have specific symptoms. We hypothesize that symptoms of a ganglion cyst may correlate with the size and the location within the knee joint. The diagnosis of ganglia within the knee was established by magnetic resonance imaging study and confirmed by pathological testing. All the patients were treated successfully using the arthroscopic technique.
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Affiliation(s)
- C N Kang
- Department of Orthopaedics, College of Medicine, Ewha Womans University and Ewha Medical Research Center, Seoul, Korea
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25
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Antonacci VP, Foster T, Fenlon H, Harper K, Eustace S. Technical report: CT-guided aspiration of anterior cruciate ligament ganglion cysts. Clin Radiol 1998; 53:771-3. [PMID: 9817098 DOI: 10.1016/s0009-9260(98)80323-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We describe computed tomography (CT)-guided percutaneous anterior cruciate ligament (ACL) ganglion cyst aspiration in three patients. In so doing, we review clinical technique, patient outcomes and discuss advantages of radiologically guided intervention relative to traditional surgical incision and drainage.
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Affiliation(s)
- V P Antonacci
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, MA 02118, USA
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26
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Höcker K, Jagenbrein G, Schwarz N, Ritschl P. Painful functional impairment of the knee joint caused by an ACL-based ganglion cyst. Injury 1996; 27:516-8. [PMID: 8977843 DOI: 10.1016/0020-1383(96)00051-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- K Höcker
- AUVA Hospital of Traumatology, Meidling, Vienna, Austria
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27
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Campagnolo DI, Davis BA, Blacksin MF. Computed tomography--guided aspiration of a ganglion cyst of the anterior cruciate ligament: a case report. Arch Phys Med Rehabil 1996; 77:732-3. [PMID: 8670006 DOI: 10.1016/s0003-9993(96)90019-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This report describes the case of a ganglion cyst of the anterior cruciate ligament in a 26-year-old man who had long-standing intermittent knee pain with locking. The cyst was successfully aspirated under computed tomography guidance, with complete resolution of symptoms. A literature review is presented along with diagnostic and treatment approaches for this uncommon finding.
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Affiliation(s)
- D I Campagnolo
- Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark 07103-2406, USA
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28
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Abstract
Many previous investigators have reported the findings of ganglion cysts on the surface of the anterior cruciate ligament. The cysts reported in the literature were either symptomatic or only of incidental findings. So far, however, there has not yet been a report of a ganglion cyst within the substance of the anterior cruciate ligament. This is the first report of a ganglion cyst within the substance of the anterior cruciate ligament, which caused intermittent swelling and pain in the right knee of a 13-year-old girl without any history of trauma. The cyst was treated successfully with an arthroscopic debridement and arthroscopically guided needle aspiration.
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Affiliation(s)
- C N Kang
- Department of Orthopaedic Surgery, Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Korea
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