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Zhang S, Aiyer A, Sun C, Wang Z, Lin D, Qu F, Wei F, Wang X, Zhang F, Li S, Chen Y, Zhang J, Lintz F, Zhang M. Operative Treatment for Ganglion Cyst of Flexor Hallucis Longus Sheath. Foot Ankle Int 2020; 41:978-983. [PMID: 32486852 DOI: 10.1177/1071100720925426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Intractable hallucal ganglion cysts (HGCs) are often a symptomatic and recurrent condition. Its connection with the ankle joint is not well understood. Our aim was to evaluate the relationship between tenosynovitis of the flexor hallucis longus (FHL) tendon at the level of the ankle with formation of an HGC. In addition, we sought to analyze the outcomes of cyst excision combined with ankle capsulorrhaphy. METHODS Nineteen patients with HGC who underwent surgical intervention were included between June 2016 and June 2019. Eight had known recurrences. Ankle arthrography and cyst excision were performed on all patients. Clinical evaluations included the American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and evaluation of postoperative complications. The mean follow-up period was 16.5 ± 8.6 months. RESULTS Thirteen of the 19 HGCs (68.4%) had a connection with the FHL tendon sheath. Combined with ankle capsulorrhaphy, there was no recurrence after cyst excision. The VAS score decreased from 2.1 ± 1.5 to 0.4 ± 0.8, and AOFAS score significantly improved from 84.3 ± 8.7 to 97.4 ± 5.2 at final follow-up (P < .001). CONCLUSIONS Most of these patients had a connection between the HGC and ankle joint. Ankle arthrography appeared to be useful for diagnosis, and cyst excision combined with ankle capsulorrhaphy was an effective treatment without cyst recurrence. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Shu Zhang
- Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Amiethab Aiyer
- Department of Orthopaedics, University of Miami/Miller School of Medicine, Foot Ankle Service, Miami, FL, USA
| | - Chao Sun
- Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhi Wang
- Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dasheng Lin
- Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Feng Qu
- Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Fangyuan Wei
- Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - XianJun Wang
- Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Fengqi Zhang
- Department of Foot, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Shuyuan Li
- Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yaping Chen
- Department of Rehabilitation Medicine, Beijing Tongren Hospital, Capital Medical University,Beijing,China
| | - Jianzhong Zhang
- Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - François Lintz
- Clinique de l'Union, Ankle and Foot Surgery Center, Boulevard de Ratalens, Saint-Jean, France
| | - Mingzhu Zhang
- Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Qu W, Liu T, Chen W, Sun Z, Dong S, Chen M. Effect of extensive tenosynovectomy on diffuse flexor hallucis longus tenosynovitis combined with effusion. J Orthop Surg (Hong Kong) 2020; 27:2309499019863355. [PMID: 31366279 DOI: 10.1177/2309499019863355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The objective of this study was to examine the clinical and magnetic resonance imaging (MRI) outcomes of extensive tenosynovectomy on patients with diffuse flexor hallucis longus tenosynovitis combined with effusion (DFHLT-E). METHODS Consecutive patients undergoing extensive tenosynovectomy for DFHLT-E in the same foot and ankle center from January 2013 to December 2016 were selected; a total of 14 patients were included in the final analysis. Patients with a minimum 1-year follow-up were evaluated with physical examination, MRI, American Orthopaedic Foot and Ankle Society (AOFAS) clinical midfoot scale, and visual analog scale (VAS) pain scores. RESULTS The 14 patients were followed up for an average of 15.0 ± 2.3 months (12-18 months). There were no recurrences in all clinical examinations at the final follow-up. The AOFAS score was improved from 61.57 ± 10.70 before surgery to 90.28 ± 9.41 at the final follow-up. The difference was statistically significant (p = 0.001). The VAS score was improved from 4.00 ± 0.82 before surgery to 0.43 ± 0.53 at the final follow-up (p < 0.001). MRI examination revealed two patients with small residual and limited effusion with no clinical symptoms. Superficial pin infection was observed in one patient, and two patients had transient neurostimulation. CONCLUSIONS Extensive tenosynovectomy is an effective alternative for the treatment of DFHLT-E with less complications or recurrence.
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Affiliation(s)
- Wenqing Qu
- 1 Department of Foot and Ankle Surgery, Yantaishan Hospital, Yantai, China
| | - Tong Liu
- 1 Department of Foot and Ankle Surgery, Yantaishan Hospital, Yantai, China
| | - Wentao Chen
- 2 Department of Orthopedics, Friendship Hospital, Beijing, China
| | - Zhenzhong Sun
- 3 Department of Radiology, Yantaishan Hospital, Yantai, China
| | - Shengjie Dong
- 4 Department of Joint Surgery, Yantaishan Hospital, Yantai, China
| | - Mingxia Chen
- 5 Department of Pathology, Yantaishan Hospital, Yantai, China
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Wang C, Geng X, Wang X, Ma X, Zhang C, Huang J. Arthrodesis for Treatment of Intra-Articular Synovial Cysts of the Hallux Interphalangeal Joint. J Foot Ankle Surg 2019; 57:1221-1224. [PMID: 30093219 DOI: 10.1053/j.jfas.2018.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Indexed: 02/03/2023]
Abstract
Synovial cysts are benign tissue masses that develop near joints and tendons as a result of fluid leakage. They can be difficult to eradicate, and adjacent tendon and joint surfaces can complicate their treatment. We retrospectively analyzed the data from 4 consecutive patients who had undergone hallux interphalangeal fusion from January 2009 to December 2010. Of the 4 patients, 3 were male and 1 was female, with a mean age of 55 ± 22 (range 26 to 79) years. These 4 patients had developed painful interphalangeal arthritis with radiographic cystic changes of 1 to 4 years' duration. All patients were treated at a single facility, with surgical fixation of the joint performed by insertion of a single 4.3-mm headless lag screw across the interphalangeal joint. A final postoperative follow-up examination was performed at 22 ± 7 (range 14 to 30) months postoperatively. The mean American Orthopaedic Foot and Ankle Society hallux functional scores increased significantly from 70.8 ± 6.1 preoperatively to 90.5 ± 5.2 postoperatively (p < .01). No complications were observed, and complete interphalangeal joint fusion was observed at a mean of 9.2 ± 1.2 weeks. In conclusion, these preliminary data suggest that arthrodesis is an alternative effective treatment of symptomatic synovial cyst formation localized to the hallux interphalangeal joint.
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Affiliation(s)
- Chen Wang
- Orthopedist, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiang Geng
- Orthopedist, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Xu Wang
- Professor, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
| | - Xin Ma
- Professor, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Chao Zhang
- Orthopedist, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiazhang Huang
- Orthopedist, Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
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Lee JW, Joo MW, Sung JK, Ahn JH, Kang YK. Origin of Satellite Ganglion Cysts with Effusion in the Flexor Hallucis Longus Tendon Sheath around the Hallux. Clin Orthop Surg 2018; 10:94-98. [PMID: 29564053 PMCID: PMC5851861 DOI: 10.4055/cios.2018.10.1.94] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/01/2017] [Indexed: 11/23/2022] Open
Abstract
Background To describe the clinical and magnetic resonance imaging findings of ganglion cysts with effusion in the flexor hallucis longus tendon sheath around the hallux to evaluate their origin. Methods Patients with recurrent or painful ganglion cysts around the hallux with effusion in the flexor hallucis longus tendon sheath who underwent surgical treatment at St. Vincent's Hospital from February 2007 to August 2016 were investigated. Surgical indication was a painful or recurrent mass caused by the cystic lesions. Those without effusion of the flexor hallucis longus tendon sheath were excluded. We assessed the clinical and magnetic resonance imaging findings. Results Magnetic resonance imaging findings in all patients showed several ganglion cysts around the hallux and large fluid accumulations within the flexor hallucis longus tendon sheath. Regarding the location, six ganglion cysts were on the dorsomedial aspect, one on the plantar medial aspect, seven on the plantar lateral aspect, and one in the toe pulp. Ten patients showed joint effusions in both the metatarsophalangeal and interphalangeal joints, two in the metatarsophalangeal joints, and three in the interphalangeal joints. There were communication stalks with a tail shape or abutment between ganglion cysts with surrounding joint effusions. Intraoperatively, connections between ganglion cysts, the synovial cyst of the flexor hallucis longus tendon sheath, and surrounding joints were seen. Conclusions Synovial fluid accumulation in the metatarsophalangeal or interphalangeal joint supplies the synovial cyst of the flexor hallucis longus tendon sheath and subsequently ganglion cysts in the hallux. In clinical practice, the surgeon should carefully check surrounding joints with tendon sheaths to prevent recurrence of the ganglion cysts around the hallux.
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Affiliation(s)
- Jung Woo Lee
- Division of Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Wook Joo
- Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Kyeong Sung
- Department of Diagnostic Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Hoon Ahn
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Koo Kang
- Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Intraneural ganglion: review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2009. [DOI: 10.1007/s00590-009-0479-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
The case of a ganglion that had developed around the first metatarsophalangeal (MTP) joint and in which several other therapeutic approaches were unsuccessful was treated using an arthroscopic assisted procedure. During MTP arthroscopy, we found that the pedicle of the tumor was attached to the interior of the joint, and the lesion was successfully extirpated. Communication with the cyst was found on the medial side of the lateral sesamoid bone, which coincided with the rounded portion of the first MTP joint at the sole, where stress is exerted repeatedly while walking. Thus, the intracystic fluid could not return to the intra-articular space. Instead the cyst gradually extended to the extra-articular tissue, where it was relatively loosely connected. Researchers suspect that a ganglion originally develops through repeated mechanical stress; the lesion is constantly under pressure because of the weight bearing on it. Because of a higher pressure within the MTP joint, the communicating opening acts as a valve.
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Affiliation(s)
- Shinji Nishikawa
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Hiosaki City, Aomori, Japan.
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