Ganglion cysts of the proximal tibiofibular joint review of literature with three case reports

Proximal tibiofibular ganglion is a rare disorder. It may settle down in the subcutaneous tissue or may develop along the peroneal muscles and nerve. Common clinical findings are various sizes of mass, pain and hypoesthesis due to compression neuropathy. We report three cases of proximal tibiofibular ganglion and review the literature about the diagnostic tools, recurrence rates and treatment modalities.     

Synovial cysts of proximal tibiofibular joint causing peroneal nerve palsy: report of three cases and review of the literature

Introduction Synovial cyst of the proximal tibiofibular joint is a very rare condition, for which there is no consensus regarding treatment. Case presentation We present three patients who had synovial cysts of proximal tibiofibular joint that caused peroneal nerve palsy. We discuss the special features of synovial cysts and review the literature. Conclusion We consider the best treatment of synovial cysts originating from proximal tibiofibular joint and causing peroneal nerve palsy to be total surgical removal as soon as possible after the diagnosis is made. It should be kept in mind that despite surgical treatment the neurological symptoms may not recover.     

Synovial chondromatosis and instability of the proximal tibiofibular joint.

A patient with synovial chondromatosis involving both posterior compartments of the right knee and proximal tibiofibular joint had continued pain and weakness after partial synovectomy. The "Helfet Test" for proximal tibiofibular joint instability was positive; the fibular head was prominent and tender. Following excision of the proximal fibula, the patient was symptom free. This case demonstrates that it is essential to evaluate all joints involved with a disease process prior to surgical intervention.     

Dislocation of the proximal tibiofibular joint

We introduce a new method for fixation of a rare, isolated, proximal tibiofibular dislocation. One third of the biceps femoris muscle tendon was used for fixation of the dislocated proximal fibular head. The fixation was achieved by using a soft threaded interference ACL screw. Received: 6 November 1997     

Instability of the proximal tibiofibular joint

Injury to the proximal tibiofibular joint is typically seen in athletes whose sports require violent twisting motions of the flexed knee. Instability of this joint may be in the anterolateral, posteromedial, or superior directions. With acute injury, patients usually complain of pain and a prominence in the lateral aspect of the knee. A closed reduction should be attempted in patients with acute dislocation. If this is unsuccessful, open reduction and stabilization of the joint with repair of the injured capsule and ligaments can be done. Patients with chronic dislocation or subluxation report lateral knee pain and instability with popping and catching, which may be confused with lateral meniscal injury. Symptoms of subluxation may be treated nonsurgically with physical therapies such as activity modification, supportive straps, and knee strengthening. For patients with chronic pain or instability, surgical options include arthrodesis, fibular head resection, and proximal tibiofibular joint capsule reconstruction.     

Prevalence of ganglion cysts originating from the proximal tibiofibular joint: A magnetic resonance imaging study

Purpose: To determine the prevalence of proximal tibiofibular ganglion cysts in patients undergoing outpatient magnetic resonance imaging (MRI) of the knee. Type of Study: Observational cross-sectional study. Methods: From November 2000 to June 2001, every MRI of the knee performed at an outpatient imaging center was reviewed by a single examiner for the presence of a proximal tibiofibular ganglion cyst. In addition to the reason for ordering the MRI, demographic information on all patients was gathered. Results: A total of 654 knee MRI scans were performed at the outpatient imaging center during the study period. This study population consisted of 310 men and 344 women, with an average age of 43.4 years (range, 11 to 88 years). There were 308 left and 346 right knees imaged. The most common clinical diagnosis in these 654 patients was meniscal tear (42.8%). A total of 5 patients had a proximal tibiofibular ganglion cyst detected on MRI, yielding a prevalence of 0.76% (95% confidence interval [CI] = 0.1% to 1.4%). These cysts ranged in size from 1.0 to 2.8 cm in maximum diameter. Three were found in men and 2 in women. The mean age of these patients was 47.6 years (range, 42 to 54 years). The most common preimaging diagnosis in these patients was a medial meniscal tear (in 3 of 5). Conclusions: This study is the first to provide data on the prevalence of proximal tibiofibular ganglion cysts in a population of patients with knee pain significant enough to warrant MRI. Over half of the patients found to have proximal tibiofibular ganglion cysts had no symptoms or signs attributable to them.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 2 (February), 2003: pp 150–153     

The abnormal proximal tibiofibular joint

Abnormalities of the proximal tibiofibular joint are infrequently encountered. Mostly instability occurs as a result of trauma. Four types of instability are distinguished: subluxation, anterolateral, posteromedial and superior dislocation. Four radiological methods designed to visualize abnormalities of the proximal tibiofibular joint are discussed. Special notice is given to the clinical relevance of a new method. Instability was demonstrated in 19 patients; 16 of these were treated by an operation. History, data obtained by physical examination and ways of treatment are discussed.     

Traumatic instability of the proximal tibiofibular joint

Proximal tibiofibular instability, seems to be an infrequently diagnosed abnormality, which occurs in isolation or in combination with fractures of the leg and ankle. Four types of instability are distinguished: subluxation, anterolateral dislocation, posteromedial dislocation and superior dislocation.The method of treatment depends on the type of dislocation and on the presence or absence of dysfunction of the peroneal nerve.The methods of treatment are described. Ten patients treated for this instability are presented. The use of radiographs to define the lesion is discussed. Radiographs, taken at follow-up, showed degenerative changes in the proximal tibiofibular joint in 8 of the 10 patients.     

Synovial cyst of the proximal tibiofibular joint with peroneal nerve compression after total knee arthroplasty.

Synovial or ganglion cysts of the proximal tibiofibular joint are less common than synovial cysts of the knee joint but may present in a similar manner and may be difficult to diagnose clinically. Although synovial cysts arising from the knee joint after prosthetic arthroplasty have already been described, we report a case in which a lateral knee mass compressing the peroneal nerve was found to be a synovial cyst arising from the tibiofibular joint.     

Isolated dislocation of the proximal tibiofibular joint

We have reported the case of an anterolateral dislocation of the proximal tibiofibular joint in a soccer player, apparently the second case in the literature. As in that reported by O'Rourke and McManus, this patient was attempting to gain his balance and this may indeed be an important contributing factor. Ogden's classification is now well accepted and has been reviewed along with a discussion of the mechanisms of injury. The diagnosis can generally be made by clinical examination and confirmed by roentgenographs. Treatment usually consists of closed reduction with 3 weeks of casting. In complicated cases, however, resection of the fibular head may be required.     

Dislocation of the proximal tibiofibular joint in association with a tibial shaft fracture: two case reports and a literature review

Dislocation of the proximal tibiofibular joint (PTFJ) in association with a displaced tibial shaft fracture and an intact fibula is an exceedingly rare injury. We present 2 cases of tibia fractures associated with an intact fibula and a PTFJ dislocation. The first case involves a man who sustained a closed spiral fracture of the distal tibial shaft, with an intact fibula, an anterolaterally dislocated PTFJ, and a partial tear of the lateral collateral ligament. The tibia was percutaneously plated, and the PTFJ was reduced and then stabilized with temporary screw fixation. The second case involves a woman who sustained a closed fracture of the tibia in association with a PTFJ dislocation. The tibia was fixed with an intramedullary nail, and the PTFJ was similarly reduced and fixed with a temporary screw. We also provide a brief literature review focusing on classification of PTFJ dislocations, mechanism of injury, associated injuries, and treatment options.     

The proximal tibiofibular joint: an anatomic study

In the first stage of the current study, 14 fresh specimens from above-the-knee amputations were examined by magnetic resonance imaging arthrography. In the second part of the study, these amputation specimens and 38 embalmed knees from cadavers were dissected. The types of the joint and insertion of the biceps femoris tendon and the other structures were observed. Of 14 fresh specimens from above-the-knee amputations examined by magnetic resonance imaging arthrography, nine had a clear communication between the proximal tibiofibular joint and the knee. It was difficult to distinguish the anterior tibiofibular ligament in 30 specimens as a separate band because it was fused intimately with the biceps femoris tendon. Of these specimens, 24 had an oblique type of joint. Because of this communication, the proximal tibiofibular joint might be construed as the fourth compartment of the knee to explain subtle knee problems.     

Dislocation of the proximal tibiofibular joint in association with a tibial shaft fracture: two case reports and a literature review.

Dislocation of the proximal tibiofibular joint (PTFJ) in association with a displaced tibial shaft fracture and an intact fibula is an exceedingly rare injury. We present 2 cases of tibia fractures associated with an intact fibula and a PTFJ dislocation. The first case involves a man who sustained a closed spiral fracture of the distal tibial shaft, with an intact fibula, an anterolaterally dislocated PTFJ, and a partial tear of the lateral collateral ligament. The tibia was percutaneously plated, and the PTFJ was reduced and then stabilized with temporary screw fixation. The second case involves a woman who sustained a closed fracture of the tibia in association with a PTFJ dislocation. The tibia was fixed with an intramedullary nail, and the PTFJ was similarly reduced and fixed with a temporary screw. We also provide a brief literature review focusing on classification of PTFJ dislocations, mechanism of injury, associated injuries, and treatment options.     

Permanent anterior dislocation of the proximal tibiofibular joint

We report two patients with permanent dislocation of the proximal tibiofibular joint and no history of trauma. Both needed operation, one for persistent pain and the other for common peroneal nerve involvement, and both had a good result.     

Synovial cysts of the hip joint: a single-center experience

Background

Synovial cyst of the hip joint is a rare clinical condition in need of evidence-based guidelines for its diagnosis and management. Normally, synovial cyst of the hip joint requires no treatment, but when it intrudes into surrounding structures, various clinical symptoms appear. Because of its rarity, a symptomatic synovial cyst is often confounded with a tumor as a space-occupying lesion or with other diseases, depending on its various clinical presentations. Therefore, guidelines for the precise diagnosis and appropriate management for synovial cyst of the hip joint are required.

Methods

We retrospectively studied 7 cases of symptomatic synovial cyst of the hip joint, some of which showed lower limb edema due to mass effect. We compared physical exam findings on presentation, imaging findings, and size and location of the cyst.

Results

All cases were managed successfully with surgical excision. We found that, instead of the size of the cyst, the location of the cyst was an important contributor to venous compression. The recurrence rate was 0%, and some patients have significantly long follow-up of 2?years, 4?years, 6?years and 10?years, respectively.

Conclusions

For symptomatic synovial cyst of the hip joint, surgical excision can successfully resolve the symptoms without recurrence. This retrospective study discusses the clinical presentations, diagnostic approaches, and surgical treatment of symptomatic synovial cyst of the hip joint, hence shedding more light on the clinical management of this condition.