A giant ganglion cyst that developed in the infrapatellar fat and partly extended into the knee joint

Ganglion cyst of Hoffa's fat pad of knee-a rare cause of knee pain and swelling-a case report and literature review

Ganglion cysts around knee joint are uncommon and that from Hoffa's fat pad are even rarer. We present a case of 30 year old male patient with complaint of pain and swelling in left knee joint. Radiograph did not show any bony abnormality. MRI showed large tubulocystic lesion within Hoffa's fat pad which showed low signal intensity on T1-weighted images and high signal intensity on T2-STIR images. Open excision of the lesion was done. Histopathology of the specimen confirmed the diagnosis of the ganglion cyst. In follow-up, patient had asymptomatic left knee with full range of motion and did not show any sign of recurrence. Ganglion cysts from fat pad though very rare but should be considered in differential diagnosis to have an early diagnosis and management. Symptomatic ganglion cyst should be excised by open procedure or arthroscopically depending upon the size and extent of the lesion.

A Case of Infrapatellar Fat Pad Ganglion of the Knee

Introduction:

A ganglion cyst can induce symptoms around the knee and should be considered as an intra-articular mass in differential diagnosis.

Case Presentation:

A 22-year-old female presented with a persistent medial knee joint pain in her left knee for 2 years. There was soft tissue swelling on the anteromedial aspect of the infrapatellar region on her left knee. Lachman and McMurray tests were negative. MRI showed a multilobular cyst in the infrapatellar fat pad with T1 low intensity and T2 STIR high intensity. The cyst was not attached to either meniscus. ACL and PCL looked normal.

During surgery, the cyst was found to arise from the intra-patellar fat pad and was not attached to the menisci or synovium. The cyst was completely resected.

Histological findings showed a multilobular cyst with a glassy fibrous tissue wall and clear jelly-like consistency, confirming the diagnosis of a ganglion. The patient recovered asymptomatically and has been without recurrence 7 years postoperatively.

Conclusion:

Differential diagnoses of an infrapatellar swelling are a meniscal cyst, synovial cyst, or ganglion. Most cases of cysts around the knee generate from fluid collection through meniscal tears. A ganglion cyst is a synovium-lined structure and is common around the wrist joint, but rare in the knee joint. A ganglion cyst in the knee joint often arises from ACL or PCL, but rarely arises from the infrapatellar fat pad. A ganglion cyst is one of the differential diagnoses of parameniscal cysts around the knee. We recommended an open resection with arthroscopic examination.

Ganglion cyst arising from the infrapatellar fat pad in a child

A ganglion cyst is a cystic lesion containing myxoid matrix and lined by a pseudomembrane. A ganglion cyst arising from the infrapatellar fat pad is very rare, with only a few reports appearing in the literature, and the present case is the first report of this lesion in a child. A 10-year-old boy presented with right knee pain that showed no improvement despite resting from sports activity for 1 month. Magnetic resonance imaging revealed a multilobular mass between the infrapatellar fat pad and anterior cruciate ligament. Arthroscopic excision of the mass was performed. The mass was noted to arise from the infrapatellar fat pad and was filled with myxoid matrix. The histological diagnosis was a ganglion cyst. In active pediatric patients with pain or limited range of motion in the knee, physicians should consider the possibility of a ganglion cyst from the infrapatellar fat pad, despite its rarity.

Hoffa's fat pad tumours: what do we know about them?

PURPOSE

We report on a group of patients with tumours in the Hoffa's fat pad (HFP), their clinical presentation, histological type and treatment, including two synovial sarcomas with their clinical follow-up, which have not been described previously in the literature.

METHODS

We performed a retrospective review of our prospectively collected database of 25 cases of HFP tumours with at least six months follow-up.

RESULTS

The gender, age at presentation (over and under 16 years of age), clinical features, history of trauma, treatment chosen, and complications were recorded. The mean age of the patients was 32 years (three to 47). Six patients were under 16 years old. Pain was the most common symptom, present in 92% (n = 23/25). The final diagnoses included 23 (92%) benign tumours and two (8%) malignant tumours. The most common benign tumour was pigmented villonodular synovitis (PVNS) (48% n = 12). The two malignant tumours were synovial sarcomas and both presented in patients under 16 years old.

CONCLUSIONS

Hoffa's fat pad tumours are an uncommon and rarely diagnosed group of lesions that can be misinterpreted as any knee pathology. Although the majority of HFP tumours are benign, malignant tumours should be considered in the differential diagnosis for the paediatric population.

Tumor like swellings arising from Hoffa's fat pad: A report of three patients

We report three rare cases of tumor-like conditions arising from Hoffa's fat pad (HFP). Patients were having persistent knee pain, the cause of which was not diagnosed by the general physician, and then were referred to us for knee pain. Magnetic resonance imaging revealed the lesions to be arising from HFP (ganglion cysts and hemangioma), as was suggested by clinical findings. Anatomy, pathology, and radiological features of the Hoffa's disease are described here to increase awareness in orthopedic community of this rare but interesting disease which is often misdiagnosed as meniscal pathology. These cases illustrate that increased cognizance can facilitate timely intervention which will prevent morbidity of the patient.

MR findings of synovial disease in children and young adults: Part 2

Synovium is the thin membranous lining of a joint. It produces synovial fluid, which lubricates and nourishes the cartilage and bone in the joint capsule. Synovial diseases in children can be classified as normal structures as potential sources of pathology (synovial folds: plicae, infrapatellar fat pad clefts), noninfectious synovial proliferation (juvenile idiopathic arthritis, hemophilic arthropathy, lipoma arborescens, synovial osteochondromatosis, pigmented villonodular synovitis, reactive synovitis), infectious synovial proliferation (pyogenic arthritis, tuberculous arthritis), deposition disease (gouty arthropathy), vascular malformation, malignancy (metastasis) and intra-/periarticular cysts and cyst-like structures. Other intra-articular neoplasms, such as intra-articular synovial sarcoma, can mimic synovial disease in children.

Ganglion cyst of the posterior cruciate ligament

A ganglion is a fluid cyst with a myxoid matrix that arises close to the tendons and joints. Its occurrence inside a joint is rare. Among the various pathological conditions producing impairment of the knee function, ganglia of the cruciate ligaments are quite rare. It may be painful or asymptomatic. Some patients may have a trauma history. Ganglia may mimic intra-articular lesions like tears of the anterior cruciate ligament (ACL) or meniscus. Ganglia, though commonly arise from the ACL, can also arise from other structures such as the posterior cruciate ligament (PCL) or meniscus. Ganglia are typically treated by arthroscopic excision and debridement. We report a case of ganglion of the PCL in a 28-year-old man; the lesion was incidentally discovered during ACL reconstruction with double bundle (Rigid fix technique). The patient underwent arthroscopic excision of the ganglion. At the end of 1-year follow-up the patient was pain free; a full range of motion of his right knee was restored, and he returned to his preinjury sport activity.

Case report. An unusual cause of a patient presenting with an acutely locked knee: multiple benign fat pad cysts

Benign ganglion (synovial) cysts within the knee are uncommon and especially so when located in the infrapatellar fad pad. They cause many non-specific symptoms but usually present as a swelling. We report the case of a young gentleman with multiple benign synovial cysts within the fat pad causing a locked knee, which was treated with arthroscopically assisted open excision. We can find no previous reports of isolated multiple fat pad cysts causing acute locking of the knee.

Conservative treatment for a symptomatic solitary ganglion cyst of the anterior meniscus invading into the infrapatellar fat pad

Symptomatic meniscal cysts without accompanying meniscal tears are uncommon, especially those which are formed from the anterior meniscus and invading into the infrapatellar fat pad (IPFP). The current recommended treatment for such cysts is excision through open method or arthroscopy. To our knowledge, this is the first case study about a symptomatic solitary meniscal cyst invading the IPFP that was successfully treated with needle aspiration and steroid injection after arthroscopic treatment of the associated disorders. In this paper, similar cases are also reviewed to discuss the treatment and the link between meniscal cyst and meniscal tear.

The modified outside-in suture: vertical repair of the anterior horn of the meniscus after decompression of a large meniscal cyst

This article describes a modified suture technique designed for the vertical repair of the anterior horn of the meniscus after arthroscopic decompression of a large meniscal cyst. This procedure comprises of three steps: first, the meniscus was pierced vertically using a suture hook and a No. 0 PDS suture. Second, both ends of the No. 0 PDS on the femoral and tibial surfaces of the meniscus were pulled to the outside of the joint capsule using a spinal needle preloaded with suture material. Finally, a skin incision was made adjacent to the suture materials, and both ends were tied. We recommend this technique not only for the vertical repair of the anterior horn of the meniscus after decompression of large meniscal cyst, but also to repair a longitudinal tear of the meniscus.

An unusual meniscal ganglion cyst that triggered recurrent hemarthrosis of the knee

A 58-year-old woman suffered spontaneous recurrent hemarthrosis of the knee. In the clinical course, pigmented villonodular synovitis was mostly suspected, but in arthroscopic surgery the lateral meniscus appeared to be upturned and stuck into the lateral pouch with the meniscal ganglion cyst. It was suggested that meniscal tear with meniscal ganglion cyst was related with recurrent hemarthrosis. Generally, both the meniscal ganglion cysts and spontaneous recurrent hemarthrosis are highly rare conditions. In this case, we speculated that a negligible power could induce the meniscal tear with recurrent hemarthrosis in the particular situation in which the meniscal ganglion cyst existed. In other words, the meniscal ganglion cyst might basically and physically relate with hemorrhagic condition. Arthroscopically, the meniscal ganglion cyst was removed together with the anterior segment of the lateral meniscus. Recurrent hemarthrosis was treated successfully by resection of the meniscus.

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.