Intraarticular knee ganglion: a case report of an unusual cause of limping in a 4-year-old

Knee Flexum Revealing Anterior Cruciate Ligament Ganglion Cyst in an 11-Year-Old Child: A Case Report

CASE

We report the case of an 11-year-old child who presented with knee pain and moderate limp associated with knee flexum, without trauma history. Radiographic investigations including a magnetic resonance imaging showed a large cyst that seemed to have developed anteriorly from the anterior cruciate ligament, causing the loss of terminal extension, mimicking a cyclops syndrome-like of the knee. Knee arthroscopy with debridement of the cyst was performed, and the patient quickly recovered his range of motion. Histological analysis confirmed a synovial cyst in accordance with arthroscopic and radiological findings.

CONCLUSION

This case is interesting because of the rare occurrence of ganglion cysts in children.

Diagnosis and Treatment of a Symptomatic Posterior Cruciate Ganglion Cyst in a Child with Autism

Introduction

Intra-articular ganglion cysts of the knee joint are rare and mostly incidental findings in magnetic resonance imaging (MRI) or arthroscopy. Posterior cruciate ligament (PCL) ganglion cyst in a child is an extremely rare finding, and to the best of our knowledge, only one case has been described in the literature. We report a case of a large intra-articular ganglion cyst of the knee arising from the PCL in an autistic child.

Case Presentation

An 8-year-old Caucasian boy affected by autism presented with nontraumatic knee pain. His parents, observing child's gait, reported recurrent limp while walking, sometimes accompanied by knee locking. Clinical examination was hindered by the noncompliance of the patient and revealed painful limitation of terminal flexion and extension. MRI scans showed a large ganglion cyst located in the intercondylar notch. Arthroscopy confirmed an intrasubstance PCL ganglion cyst, extending both anteriorly and posteriorly. Complete excision of the cyst was performed, with full recovery of the child and no recurrence.

Conclusion

In pediatric patients with pain or limited knee range of motion, physicians should consider the possibility of a ganglion cyst arising from the PCL, despite its rarity. Arthroscopic excision is a safe and effective procedure that guarantees a complete recovery of the patient with the lowest rate of recurrence.

Ganglion cyst of the anterior cruciate ligament in children

The incidence of ganglion cysts of the anterior cruciate ligament (ACL) has increased significantly since the advent of MRI, but it remains exceptional in children. We report the case of a 7-year-old boy, with an exceptional imaging exam and histological finding of a ganglion cyst. The lesion was at first an MRI finding with a hypointensity signal on T2-weighted sequences of a normal ACL. An arthroscopy was performed that showed a cyst measuring 40 mm filling the intercondylar notch and involving the roof and the edges of the ACL. A cystography confirmed the position of the cyst, which was removed with specific management of the ACL. Histological examination confirmed the absence of mucoid degeneration, which is always observed in adult lesions. We believe that the ganglion cyst of the ACL in children differs in pathogenesis from common degenerative cyst in adults.

Intra-articular ganglion cysts of the cruciate ligaments: case report and review of the literature

BACKGROUND

A ganglion can arise as a cystic lesion from a tendon sheath or a joint capsule and contain a glassy, clear, and jelly-like fluid. They can occur within muscles, menisci, and tendons. Intra-articular ganglion cysts of the knee joint are rare. We report on three ganglion cysts of the cruciate ligaments: Two were intercruciate, and one was located around the posterior cruciate ligament.

METHODS

The clinical diagnosis was established using magnetic resonance imaging. All patients were treated successfully using arthroscopic debridement by basket punch and shaver. Subsequent histological examination confirmed the diagnosis.

RESULTS

All three patients were asymptomatic at the postoperative follow-up of 16-36 months.

CONCLUSION

A review of the literature reveals a controversial discussion about the clinical significance as well as the etiology of ganglion cysts arising from the cruciate ligaments. These case reports show that an intra-articular ganglion cyst of the cruciate ligaments is difficult to diagnose. A cyst does not necessarily have to be associated with specific clinical symptoms or a previous trauma. Preoperatively, MRI is essential when diagnosing ganglion cysts of the knee joint. An intra-articular ganglion cyst of the knee joint can be successfully treated by arthroscopy.

Arthroscopic ganglion cyst excision in the anterolateral aspect of the knee

We present a case of ganglion cyst of the knee treated arthroscopically. Ganglion cysts typically arise from the anterior or the posterior cruciate ligament. In this case of an anomalous location, a 3.5-cm mass arose directly from the anterolateral articular capsule, lying over the lateral meniscus, displacing Hoffa's fat pad and joining the pretibial bursa. We removed it arthroscopically using only medial portals to avoid cystic wall damage and fluid leakage from the lateral portal. Arthroscopic evaluation was performed starting from the inferomedial portal to assess the cyst location, and shifting to the mid patellar portal. From that portal, we were able resect the cyst, opening the wall and shaving and aspirating the myxoid fluid.