Arthroscopic ganglion cyst excision in the anterolateral aspect of the knee

Endoscopic Resection of Medial Extra-articular Cysts of the Knee

Although most of the parameniscal cysts are very small and asymptomatic, some of them can present with a painful mass or snapping knee. Because parameniscal cysts are almost always associated with horizontal meniscal tears, arthroscopic partial meniscectomy of the involved part of meniscus and intra-articular cyst drainage has become the most accepted procedure. However, arthroscopic cyst decompression through partial meniscectomy to the meniscocapsular junction to expose the communication between the cyst and the knee joint may sacrifice some of the healthy parts of the meniscus especially when meniscal tear is peripheral. Moreover, internal drainage may not be an adequate treatment for a cyst larger than 5 cm in size or a multiloculated cyst. The excision of the cyst is a more appropriate treatment option in these situations. The purpose of this Technical Note is to describe the details of endoscopic resection of medial extra-articular cysts of the knee. This technique is indicated in symptomatic medial extra-articular cysts of the knee with peripheral or no tear of the medial meniscus, especially if the cysts are large and multiloculated.

When should the external approach be resorted to in the arthroscopic treatment of perimeniscal cyst?

Introduction: Meniscal cysts very often cause meniscal tears and especially when it is peripheral, some of the healthy parts of meniscus might be needlessly sacrificed. In particular conditions, extraarticular approaches might save some menisci. In the present study, we evaluated the conditions which required using the extraarticular approach in addition to the arthroscopic procedure, to maximally preserve the meniscus.

Methods: Eight patients with perimeniscal cysts were evaluated retrospectively. One cyst was localized within the medial meniscus and seven in the lateral meniscus. The mean age was 36.13 (range; 19–63) years, mean follow-up time, 27.3 (range; 12–47) months. Patients were evaluated by using a Visual Analogue Score (VAS) to measure pain relief and “Lysholm score” to measure functional improvement. In all patients except one, in which the cystic cavity was connected with the joint at the periphery of the meniscus, the cyst was drained from the intraarticular opening. When the cyst was too large (three cases) and in one case where a large amount of meniscus was preserved for reasons mentioned above, additional extraarticular drainage was carried out.

Results: The mean preoperative and postoperative VAS were 6 (range; 2–8) and 1.55 (range; 0–3) (p = 0.00058) and Lysholm scores were 64.75 (range; 48–86) and 93.11 (range; 80–100) (p = 0.0014), respectively.

Discussion: In cysts, which have very limited or no connection with the joint on the most peripheral region of the meniscus and/or are larger than the meniscus height, extraarticular drainage of the cyst might produce unnecessary meniscal loss and function. In the extraarticular drainage, scrapping the walls of the cyst, while inspecting with an arthroscope, reduces recurrence of the cyst.

Large infrapatellar ganglionic cyst of the knee fat pad: a case report and review of the literature

Introduction

Large ganglionic cystic formations arising from the infrapatellar fat pad are quite uncommon and only a few are mentioned in the literature. An open excision in these cases is mandatory.

Case presentation

We report the case of a large infrapatellar fat pad ganglion in a 37-year-old Greek man with chronic knee discomfort. The ganglionic cyst originated from the infrapatellar fat pad and had no intrasynovial extension. The final diagnosis was determined with magnetic resonance imaging of the knee, and the lesion was treated with surgery.

Conclusions

These lesions are asymptomatic in most cases but often are misdiagnosed as meniscal or ligamentous lesions of the knee joint. Nowadays, the therapeutic trend for such lesions is arthroscopic excision, but when there is a large ganglion, as in this case report, the treatment should be an open and thorough resection. This report is intended mostly but not exclusively for clinical physicians and radiologists.

Large extrasynovial intracapsular ganglia of the knee: a report of 3 cases

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.

An unusual complication of knee arthroscopy: portal site synovial cyst

We describe a previously un-reported case of a large synovial cyst developing in the portal site 10 years post knee arthroscopy. The pathology, indications and method of treatment are discussed.

Differential diagnosis of tumours and tumour-like lesions of the infrapatellar (Hoffa?s) fat pad: pictorial review with an emphasis on MR imaging

A variety of intrinsic and extrinsic tumours and tumour-like conditions may affect the infrapatellar (Hoffa's) fat pad (IFP). MR imaging is the technique of choice in evaluating these conditions, but correlation with radiographs is important to identify those lesions producing mineralization. This pictorial review illustrates the spectrum of mass-like lesions that can affect the IFP, emphasizing the radiographic and MR findings that suggest a specific diagnosis.