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AlGhamdi YS, Mahmoud BM, AlBlaui SM, Altaraman KK, Alhumam KE, AlSinan IA, AlHossan AM. A Ganglion Cyst in the Anterior Cruciate Ligament of a 13-Year-Old Boy. Cureus 2023; 15:e37692. [PMID: 37206534 PMCID: PMC10191157 DOI: 10.7759/cureus.37692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Intra-articular ganglion cysts of the knee are a rare occurrence in pediatric patients, particularly involving the anterior cruciate ligament (ACL). Only a handful of case reports have been documented in the medical literature, highlighting the rarity of this condition. Patients with intra-articular cysts often experience knee discomfort and mechanical symptoms like locking of the knee. We present the case of a 13-year-old boy who had a unilateral intra-articular ganglion cyst of the ACL in his left knee. To diagnose and treat the cyst, we conducted radiographs and MRIs, and arthroscopic drainage was performed, resulting in a successful cyst decompression. Our case report provides an overview of the pathogenesis, diagnostic methods, treatment options, and complications of treatment for intra-articular cysts of the ACL. It highlights the rarity of this condition in pediatric patients and underscores the importance of prompt diagnosis and appropriate management.
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Affiliation(s)
- Yousef S AlGhamdi
- Orthopedic Surgery, King Fahad Military Medical Complex, Dhahran, SAU
| | | | - Sultan M AlBlaui
- Orthopedic Surgery, King Fahad Military Medical Complex, Dhahran, SAU
| | | | | | - Ibrahim A AlSinan
- Orthopedic Surgery, Imam Abdulrahman Al Faisal Hospital, Dammam, SAU
| | - Abdullah M AlHossan
- College of Medicine, Alfaisal University, Riyadh, SAU
- Orthopedic Surgery, King Fahad Military Medical Complex, Dhahran, SAU
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2
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Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Role of ultrasound-guided decompression in management of mucoid degeneration of the anterior cruciate ligament. Skeletal Radiol 2021; 50:1837-1843. [PMID: 33683407 DOI: 10.1007/s00256-021-03750-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the effectiveness of ultrasound-guided decompression in managing symptomatic mucoid degeneration of the anterior cruciate ligament (ACL). MATERIALS AND METHODS Retrospective analysis of 55 patients who underwent ultrasound-guided ACL mucoid degeneration decompression between July 2013 and August 2019. Subjective satisfaction scores were gathered immediately post-procedure for all 55 patients; follow-up satisfaction scores (scale of 0-10, 10 being excellent) were gathered telephonically for 46 patients (83.6%) up to 63 months post-procedure. Follow-up duration of each patient was classified as short (1-6 months), intermediate (7-12 months), or long (more than 12 months) post-procedure. Forty-five patients (81.8%) MRI were retrospectively analyzed and classified into cystic (n = 13, 28.9%), mucoid (n = 11, 24.4%), or mucoid-cystic (21, 46.7%) types. Multivariate logistic regression was used to identify associations between follow-up satisfaction score, follow-up duration, patient age, and type of ACL degeneration. RESULTS All patients had immediate marked post-procedure improvement, with excellent (>7/10) satisfaction scores. Forty-six of 55 patients were telephonically followed up: 21 (45.6%) short-term interval, 18 (39.1%) intermediate term, and 7 (15.2%) long-term. Thirty (65.22%) patients had excellent and eight (17.4%) patients had average satisfaction scores at follow-up. Eight (17.4%) patients had poor post-procedure satisfaction scores within six months. There were no significant associations between immediate or follow-up satisfaction score and duration of follow-up, age of patient, or type of ACL degeneration. CONCLUSION Ultrasound-guided aspiration, fenestration, and injection are an effective, safe, minimally invasive and radiation-free technique for management of mucoid degeneration of ACL with excellent immediate- and long-term results.
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Affiliation(s)
- Ankita Ahuja
- Innovision Imaging, 210 Doctor House, 14 Pedder Road, Mumbai, Maharashtra, 400026, India.
| | - Chaitali Parekh
- Innovision Imaging, 210 Doctor House, 14 Pedder Road, Mumbai, Maharashtra, 400026, India
| | - Angela Salomon
- Queen's University School of Medicine, 15 Arch Street, Kingston, Ontario, K7L 3N6, Canada
| | - Malini Lawande
- Innovision Imaging, 210 Doctor House, 14 Pedder Road, Mumbai, Maharashtra, 400026, India.,Sir H N Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Aditya Daftary
- Innovision Imaging, 210 Doctor House, 14 Pedder Road, Mumbai, Maharashtra, 400026, India.,Sir H N Reliance Foundation Hospital and Research Centre, Mumbai, India
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Geannette C, Warren RF, Miller TT. Ultrasound-guided aspiration of anterior cruciate ligament mucinous cysts in the posterior intercondylar notch: Technique and short-term outcomes. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:194-198. [PMID: 32984955 DOI: 10.1002/jcu.22930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To describe our technique of aspirating symptomatic anterior cruciate ligament (ACL) mucinous cysts in the posterior intercondylar notch with ultrasound guidance, and to detail short-term patient outcomes. METHODS We identified 13 patients from February 2008 to May 2020 who underwent ultrasound-guided aspiration of symptomatic ACL mucinous cysts in the posterior intercondylar notch. Post-procedural imaging was reviewed to evaluate the degree of cyst decompression. Needle size was noted. Post-procedural symptomatology was also assessed. RESULTS No or minimal fluid was initially aspirated in 11/13 (84.6%) patients. For the two patients in which the cysts were aspirated completely with initial needle placement, with no need for lavage, a 13-gauge trocar was utilized. Of the remaining cysts, 10/11 were aspirated with an 18-gauge needle and one with a 20-gauge needle. Subsequent lavage was performed in 10 of the remaining 11 patients. After lavage, in eight there was a reduction of at least 50% volume by retrospective image interpretation; of 25% to 50% volume in one patient and of less than 25% volume in one patient. Five of the 13 patients reported immediate post-procedural symptomatic relief. In the other patients, immediate efficacy or post-procedural symptomatology was not documented. CONCLUSION Aspiration of symptomatic ACL mucinous cysts is a safe procedure and can provide symptomatic relief that may be temporary, but useful clinically. We recommend needles larger than 18 gauge for the best chance of successful aspiration.
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Affiliation(s)
- Christian Geannette
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Russell F Warren
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
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Vaishya R, Esin Issa A, Agarwal AK, Vijay V. Anterior Cruciate Ligament Ganglion Cyst and Mucoid Degeneration: A Review. Cureus 2017; 9:e1682. [PMID: 29152439 PMCID: PMC5679775 DOI: 10.7759/cureus.1682] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mucoid degeneration and ganglion cyst are two distinct non-traumatic lesions of the anterior cruciate ligament (ACL) that most commonly occur discretely but occasionally coexist. They are relatively uncommon, and their exact aetiopathogenesis is still not clear. ACL ganglion cyst occurs more frequently among relatively younger patients compared to mucoid degeneration. They could be asymptomatic and discovered incidentally while evaluating the knee for other pathologies. Symptomatic cases of the two conditions present with nonspecific chronic pain, painful limitation of terminal flexion and extension, and mechanical block (among other symptoms), similar to that of other internal derangement pathologies of the knee. Magnetic resonance imaging is the investigation of choice, and diagnostic criteria are defined. Arthroscopic management of these conditions efficiently provides an improvement in symptoms without instability. Computed tomography scan guided aspiration is also useful in selected cases of ACL ganglion cyst. ACL ganglion cyst and mucoid degeneration should be considered in the differential diagnosis of chronic knee pain and stiffness of unspecified etiology.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopedics, Indraprastha Apollo Hospital, New Delhi
| | | | | | - Vipul Vijay
- Department of Orthopedics, Indraprastha Apollo Hospital, New Delhi
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Sayampanathan AA, Koh THB, Lee KT. Anterior cruciate ligament ganglion causing flexion restriction: a case report and review of literature. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:219. [PMID: 27386493 DOI: 10.21037/atm.2016.05.46] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ganglion cysts originating from the anterior cruciate ligament (ACL) are uncommon. Often asymptomatic, they infrequently present with non-specific symptoms such as knee pain, stiffness, clicks, locking or restriction of knee extension. However, the patient we report presented with knee flexion restriction. A 37-year-old Chinese gentleman, with no history of knee trauma, presented with left knee pain. Left knee range of motion (ROM) was from 0 to 110 degrees. Magnetic resonance imaging (MRI) scan revealed a 1.5 cm × 3.3 cm × 1.7 cm cyst located in the intercondylar region arising from the ACL and extending predominantly posteriorly. Arthroscopy confirmed an intrasubstance ACL ganglion cyst, which was extending posteriorly. Complete excision of the cyst was performed. At 1-year follow-up, the patient regained knee flexion of 130 degrees. We describe one of the largest ACL ganglion cysts. Such cysts often extend anteriorly and impinge onto the roof of the intercondylar notch during knee extension, thus restricting extension. The restriction in knee motion in our patient was in flexion instead; this was because the cyst took an unusual course of extension predominantly in the posterior direction. Although rare, it must be included as a possible differential diagnosis when patients present with such knee symptoms.
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Affiliation(s)
- Andrew Arjun Sayampanathan
- 1 Department of Yong Loo Lin School of Medicine, National University of Singapore, Singapore ; 2 Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Thean Howe Bryan Koh
- 1 Department of Yong Loo Lin School of Medicine, National University of Singapore, Singapore ; 2 Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Keng Thiam Lee
- 1 Department of Yong Loo Lin School of Medicine, National University of Singapore, Singapore ; 2 Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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6
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Ultrasound-guided aspiration and steroid injection of a posterior cruciate ligament ganglion cyst: report of a case. J Ultrasound 2015; 18:283-6. [PMID: 26261469 DOI: 10.1007/s40477-014-0099-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 05/10/2014] [Indexed: 10/25/2022] Open
Abstract
Ganglion cysts are benign masses that originate from mucinous degeneration of the connective tissues and are quite rare when arising from the knee joint. Symptoms are often represented by pain, joint tenderness, effusion and occasional swelling with a palpable mass in the popliteal region of the knee. Percutaneous aspiration followed by a corticosteroid injection of a ganglion cyst has either a diagnostic or therapeutic meaning and its guidance through ultrasound allows the operator to make more accurate the procedure, ensuring the correct placement of the needle inside the lesion. We report our experience in the treatment of a voluminous ganglion cyst of the posterior cruciate ligament performed through the ultrasound guidance in a symptomatic young patient.
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Hackel JG, Khan U, Loveland DM, Smith J. Sonographically Guided Posterior Cruciate Ligament Injections: Technique and Validation. PM R 2015; 8:249-53. [PMID: 26247162 DOI: 10.1016/j.pmrj.2015.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/15/2015] [Accepted: 07/25/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe and validate a technique for sonographically guided posterior cruciate ligament (PCL) injections. DESIGN Prospective, cadaveric laboratory investigation. SETTING Procedural skills laboratory. SUBJECTS Eight unembalmed, cadaveric, mid-thigh-knee specimens (4 left knees and 4 right knees) obtained from 4 male and 4 female donors aged 57 to 64 years (mean 60.8 years) with body mass indices of 27.7 to 36.5 kg/m(2) (mean 32 kg/m(2)). METHODS A 5-2-MHz curvilinear probe and a 22-gauge, 78-mm stainless steel needle was used to inject 2 mL of diluted blue latex into the PCL of each specimen using an in-plane, caudad-to-cephalad approach. At a minimum of 24 hours postinjection, each specimen was dissected to assess the presence and distribution of latex within the PCL. MAIN OUTCOME Presence and distribution of latex within the PCL. RESULTS All 8 injections accurately delivered latex throughout the PCL, including the tibial and femoral footprints. In 2 of 8 specimens (25%), a small amount of latex was noted to extend beyond the PCL and into the joint space. No specimens exhibited evidence of needle injury of latex infiltration with respect to the popliteal neurovascular bundle, menisci, hyaline cartilage, or anterior cruciate ligament. CONCLUSIONS Sonographically guided intraligamentous PCL injections are technically feasible and can be performed with a high degree of accuracy. Sonographically guided PCL injections should be considered for research and clinical purposes to deliver therapeutic agents into the PCL postinjury or postreconstruction.
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Affiliation(s)
- Joshua G Hackel
- Andrews Orthopaedic and Sports Medicine Center, Gulf Breeze, FL(∗)
| | - Umar Khan
- Regenerative Orthopaedic and Sports Medicine Institute, Bowling Green, KY(†)
| | - Dustin M Loveland
- Andrews Orthopaedic and Sports Medicine Center, 1040 Gulf Breeze Pkwy, Gulf Breeze, FL 32561(‡).
| | - Jay Smith
- Department of Physical Medicine & Rehabilitation, Radiology, and Anatomy, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, MN(§)
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Demircay E, Ofluoglu D, Ozel O, Oztop P. Simultaneous bilateral ganglion cysts of the anterior cruciate ligaments. Singapore Med J 2015; 56:e59-61. [PMID: 25917477 DOI: 10.11622/smedj.2015062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Intra-articular ganglion cysts of the anterior cruciate ligament (ACL) are rare, and bilateral ganglion cysts are even rarer. These cysts may cause intermittent or chronic nonspecific knee discomfort. Although three cases of bilateral ganglion cysts have been reported in the literature, the knees were not simultaneously affected in those cases. Herein, we report the case of a 56-year-old woman who presented with simultaneous bilateral ganglion cysts of the ACL that were symptomatic. She was successfully treated with arthroscopic resection and debridement. We also present a brief review of the literature, highlighting the aetiology, diagnosis and management of ganglion cysts of the ACL. To the best of our knowledge, this is the first report of simultaneous bilateral intra-articular ganglion cysts of the ACL.
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Affiliation(s)
- Emre Demircay
- Department of Orthopedic Surgery, Baskent University School of Medicine, Oymaci Sok, No. 7, Altunizade, Uskudar, Istanbul 34662, Turkey.
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9
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Smith J, Hackel JG, Khan U, Pawlina W, Sellon JL. Sonographically Guided Anterior Cruciate Ligament Injection: Technique and Validation. PM R 2015; 7:736-745. [PMID: 25637471 DOI: 10.1016/j.pmrj.2015.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 01/20/2015] [Accepted: 01/22/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To describe and validate a practical technique for sonographically guided anterior cruciate ligament (ACL) injections. DESIGN Prospective, cadaveric laboratory investigation. SETTING Procedural skills laboratory in a tertiary medical center. SUBJECTS Ten unembalmed, cadaveric mid-thigh-knee-ankle foot specimens (5 left knees and 5 right knees; 5 male and 5 female) from 10 donors aged 76 to 93 years (mean 85.6 years) with body mass indices of 17.6 to 42.2 kg/m(2) (mean 28.8 kg/m(2)). METHODS A single, experienced operator used a 22-gauge, 63.5-mm stainless steel needle and a 12-3-MHz linear transducer to inject 1.5 mL of diluted colored latex into the ACLs of 10 unembalmed cadaveric specimens via an in-plane, caudad-to-cephalad approach, long axis to the ACL. At a minimum of 24 hours postinjection, specimens were dissected, and the presence and distribution of latex within the ACL assessed by a study co-investigator. MAIN OUTCOME Presence and distribution of latex within the ACL. RESULTS All 10 injections accurately delivered latex into the proximal (femoral), midsubstance, and distal (tibial) portions of the ACL. No specimens exhibited evidence of needle injury or latex infiltration with respect to the menisci, hyaline cartilage, or posterior cruciate ligament. CONCLUSIONS Sonographically guided intra-ligamentous ACL injections are technically feasible and can be performed with a high degree of accuracy. Sonographically guided ACL injections could be considered for research and clinical purposes to directly deliver injectable agents into the healing ACL postinjury or postreconstruction.
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Affiliation(s)
- Jay Smith
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, W14, Mayo Building, 200 1st St, SW, Rochester, MN 55905; and Departments of Radiology and Anatomy, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | | | - Umar Khan
- Regenerative Orthopedic and Sports Medicine Institute, Bowling Green, KY
| | - Wojciech Pawlina
- Department of Anatomy, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Jacob L Sellon
- Department of Physical Medicine & Rehabilitation, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, MN
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10
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Krill M, Peck E. Percutaneous Ultrasound-Guided Aspiration of an Anterior Cruciate Ligament Ganglion Cyst: Description of Technique and Case Presentation. PM R 2014; 6:1166-9. [DOI: 10.1016/j.pmrj.2014.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 07/16/2014] [Accepted: 07/20/2014] [Indexed: 10/25/2022]
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Report of ganglion cyst in the anterior cruciate ligament of a 6-year-old child. Knee 2013; 20:144-7. [PMID: 23154035 DOI: 10.1016/j.knee.2012.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 09/17/2012] [Accepted: 10/15/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Intra-articular ganglion cysts of the knee are extremely rare within the pediatric population. To our knowledge, only seven case reports have been published in the medical literature identifying pediatric patients with intra-articular cysts of the anterior cruciate ligament (ACL). Intra-articular cysts of the knee are a rare cause of knee discomfort and mechanical symptoms such as locking of the knee. To our knowledge, up until now the youngest patient reported in the medical literature with an intra-articular ganglion cyst of the ACL was a 7-year-old boy. CASE REPORT We describe a 6-year-old boy who presented with a unilateral intra-articular ganglion cyst of the ACL in the right knee. In addition to the diagnostic work-up of radiographs and MRI, the cyst was successfully treated with arthroscopic resection and debridement to decompress the cyst. CLINICAL RELEVANCE We provide a review of the proposed pathogenesis, diagnostic modalities, differential diagnosis, treatment options, and complications of treatment for intra-articular cysts of the ACL. LEVEL OF EVIDENCE Level V, case report.
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13
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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: 43] [Impact Index Per Article: 3.3] [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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14
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Willis-Owen CA, Konyves A, Martin DK. Bilateral ganglion cysts of the cruciate ligaments: a case report. J Orthop Surg (Hong Kong) 2010; 18:251-3. [PMID: 20808023 DOI: 10.1177/230949901001800224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Symptomatic ganglion cysts of the cruciate ligaments are rare, and bilateral cases are extremely rare, with only one reported case in the literature. We report a case of bilateral cruciate ligament ganglion cysts successfully treated with arthroscopic resection, and review the literature regarding aetiology, diagnosis and management.
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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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16
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Tachibana Y, Ninomiya T, Goto T, Yamazaki K, Ninomiya S. Intra-articular ganglia arising from the posterior joint capsule of the knee. Arthroscopy 2004; 20 Suppl 2:54-9. [PMID: 15243426 DOI: 10.1016/j.arthro.2004.04.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Magnetic resonance imaging (MRI) is an effective method to evaluate cystic lesions of the knee. Intra-articular ganglia of the knee joint was considered to be rare before the advent of MRI. However, because an MRI is often used to diagnose knee pathology, the reported prevalence of intra-articular ganglia has increased. We describe two cases of an intra-articular ganglion arising from the posterior joint capsule. Both cysts appeared to be arising from the posterior cruciate ligament by both MRI as well as arthroscopy through a lateral infrapatellar portal. However, arthroscopy through a posteromedial portal revealed the cysts to originate from the posterior joint capsule. It suggests that some of the ganglion arising from the posterior cruciate ligament reported in the literature might actually be from the posterior joint capsule. To prevent recurrence of a ganglion cyst, when preoperative MRI shows the mass to be located posterior to the cruciate ligaments, we recommend that the relationship of the ganglion cyst to the posterior joint capsule be evaluated at arthroscopy through the posteromedial or posterolateral portal.
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Affiliation(s)
- Yomei Tachibana
- Division of Sports Medicine, Saitama Medical School, Saitama, Japan.
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17
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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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18
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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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19
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Ellen MI, Jackson HB, DiBiase SJ. Uncommon causes of anterior knee pain: a case report of infrapatellar contracture syndrome. Am J Phys Med Rehabil 1999; 78:376-80. [PMID: 10418845 DOI: 10.1097/00002060-199907000-00018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The uncommon causes of anterior knee pain should always be considered in the differential diagnosis of a painful knee when treatment of common origins become ineffective. A case is presented in which the revised diagnosis of infrapatellar contracture syndrome was made after noting delayed progress in the rehabilitation of an active female patient with a presumed anterior horn medial meniscus tear and a contracted patellar tendon. The patient improved after the treatment program was augmented with closed manipulation under arthroscopy and infrapatellar injection of both corticosteroids and a local anesthetic. Infrapatellar contraction syndrome and other uncommon sources of anterior knee pain, including arthrofibrosis, Hoffa's syndrome, tibial collateral ligament bursitis, saphenous nerve palsy, isolated ganglions of the anterior cruciate ligament, slipped capital femoral epiphysis, and knee tumors, are subsequently discussed. Delayed functional advancement in a rehabilitation program requires full reassessment of the patient's diagnosis and treatment plan. Alternative diagnoses of knee pain are not always of common origins. Ample knowledge of uncommon causes of anterior knee pain is necessary to form a full differential diagnosis in patients with challenging presentations.
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Affiliation(s)
- M I Ellen
- Department of Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia 19104-4283, USA
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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: 27] [Impact Index Per Article: 1.0] [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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