Ganglion cyst on the posterior cruciate ligament: a case report

Objective:

To present the diagnostic and clinical features of a ganglion cyst located on the posterior cruciate ligament and create awareness amongst clinicians of this uncommon diagnosis.

Clinical Features:

A 24-year old woman complaining of intermittent left knee pain brought on by an increase in mileage during her training for a half-marathon. A diagnosis of mild chondromalacia patella and a ganglion cyst on the posterior cruciate ligament was made via diagnostic imaging.

Intervention and outcome:

Patient was followed up with imaging. The patient chose to withdraw a surgical consult due to patient preference. No conservative treatment was provided.

Conclusion:

Although chondromalacia patella is the more probable, a secondary diagnostic consideration in this patient could be a ganglion cyst. A ganglion cyst on the posterior cruciate ligament is an uncommon diagnosis and the clinical manifestations are variable and non-specific. It is important to be aware of its clinical features and to obtain appropriate methods of imaging to generate the diagnosis promptly.     

Ganglion cysts of the cruciate ligaments detected by MRI

 Eight patients with ganglion cysts arising from the cruciate ligaments of the knee joint underwent arthroscopic excision after the MR examination. The MR findings, clinical features and arthroscopic findings were evaluated comparatively.

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Résumé  Après un examen IRM, huit patients présentant des kystes se développant à partir des ligaments croisés du genou, ont subi une excision arthroscopique. Les résultats de l’examen IRM, de l’examen clinique et de l’examen arthroscopique ont été comparés.

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Accepted: 4 March 1998     

Ganglion cyst of the cruciate ligament with atlantoaxial subluxation

Background

Ganglion cysts of the cruciate ligament are rare and sometimes asymptomatic. The authors present three cases of ganglion cysts of the cruciate ligament with atlantoaxial subluxation, which has rarely been reported previously.

Methods

Generally, ganglion cysts of the cruciate ligament are reported as case reports. Several theories regarding the process of cyst formation and the development of treatment options have been described. However, trans-oral decompression with total removal of the cyst may be one of the options for treatment of this kind of disease.

Results

A retrospective review of three patients, two female and one male patient, with a mean age of 68 years was conducted. The operation performed was a trans-oral decompression with cyst removal for all patients. Clinical outcomes were evaluated after the operation. All patients underwent trans-oral decompression with total removal of the cyst, followed by posterior fusion and pathologic examination of the cyst, revealing myxoid stroma with an absence of synovial linings.

Conclusion

The ganglion cysts and synovial cysts of the cruciate ligament are two different diseases with different presentation, pathogenesis, pathophysiology, and pathologic findings.     

Arthroscopic posterior cruciate ligament repair

This article presents a classic case of posterior cruciate ligament disruption, as an isolated entity, with avulsion of the cruciate from the tibia origin. The treatment is an arthroscopic technique for reimplantation of the posterior cruciate ligament, using the Instrument Maker staple for fixation to facilitate proper reduction of the posterior cruciate, and presents a follow-up with excellent range of motion and stability of the knee.     

Arthroscopic posterior cruciate ligament repair

Purpose: We present our technique of arthroscopic repair for femoral avulsion soft-tissue tears of the posterior cruciate ligament (PCL) and its results. Type of Study:Case series, retrospective review. Methods: We performed 13 arthroscopic repairs of the PCL and reviewed them retrospectively. Follow-up was available for 11 (85%) patients. Nonabsorbable monofilament sutures were placed through the loose fibers of the ligament and tied over a bone bridge. Patients were evaluated using magnetic resonance imaging, comparative stress views, and according to the scoring systems of Lysholm and Gillquist and the International Knee Documentation Committee (IKDC). Results: Mean follow-up was 51.4 months. IKDC scores revealed 4 (36.4%) patients with normal knee function, and 7 (63.6%) with nearly normal function. Average Lysholm and Gillquist score was 95.4 (90 to 100). All athletes returned to the same or a higher level of competition. Conclusions: Arthroscopic repair of the PCL in patients with a femoral avulsion is effective in reducing postoperative instability and improving functional outcome.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 7 (September), 2002: pp 695–702     

Aplasia of the anterior cruciate ligament with a compensating posterior cruciate ligament.

Aplasia of the anterior cruciate ligament is a rare condition and is usually associated with other abnormalities of the lower extremities. We report aplasia of the anterior cruciate ligament with a compensating posterior cruciate ligament in a 15-year-old boy.     

Epidemiology of posterior cruciate ligament injuries

BACKGROUND: The epidemiology of posterior cruciate ligament (PCL) injuries has not been well clarified. Isolated and combined PCL injuries are a frequently missed diagnosis. A better understanding of typical injury mechanisms may help in more accurate diagnosis of these injuries. METHODS: In this study the epidemiology of PCL insufficiency in 494 patients was retrospectively analysed. Stress-radiography was used to quantify posterior tibial displacement. RESULTS: The mean age at the time of injury was 27.5+/-9.9 years. Traffic accidents (45%) and athletic injuries (40%) were the most common injury causes. Motorcycle accidents (28%) and soccer-related injuries (25%) accounted for the main specific injury causes. The most common injury mechanisms were dashboard injuries (35%) and falls on the flexed knee with the foot in plantar flexion (24%). The mean side-to-side difference of posterior tibial displacement on posterior stress-radiographs in 90 degrees of flexion was 13.4+/-4.7 mm. According to the posterior displacement values, 232 (47%) patients had isolated PCL ruptures, while 262 (53%) patients with a posterior displacement of >12 mm were classified as having a combined posterior instability. There were significantly more combined PCL lesions due to vehicular trauma as compared with athletic trauma ( p<0.0001). CONCLUSIONS: In many PCL lesions, initiation of an adequate treatment regimen is delayed despite typical injury mechanisms and symptoms. In the future, a better understanding of the epidemiology of PCL injuries should enable us to diagnose the injury more reliably through a detailed history and a thorough physical and radiographic examination in the acute setting.     

Value of posterior cruciate ligament index in the diagnosis of anterior cruciate ligament injuries

Assessment of the diagnostic value of the posterior cruciate ligament index (PCL index) for injuries of the anterior cruciate ligament (ACL) was done. Magnetic resonance imaging (MRI) and knee joint arthroscopy of 170 patients were evaluated. The shortest distance between the femoral and tibial attachment of PCL (x) and the distance from that line to the tip of the arc marked by the PCL (y) on the sagittal plane images were measured. The quotient of these two parameters (x/y) defined the PCL index. In 100 patients, for whom arthroscopy ruled out ACL injury, the mean PCL index was 5.01 +/– 0.76. In 30 patients in whom arthroscopy showed total ACL rupture, the mean PCL index was 2.88 +/– 0.74, and in 10 patients with ACL partial rupture, 3.09 +/– 0.23. The conclusion is that injury to the ACL changes the PCL index markedly. In diagnostically unreliable MR images, deterioration of the PCL index could help in the diagnosis of ACL injury. Received: 19 July 1996     

Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal

We describe an arthroscopic technique for the reconstruction of the posterior cruciate ligament (PCL), while preserving the remnant bundle of the original PCL and meniscofemoral ligament, using the posterior trans-septal portal. The posterior trans-septal portal provides an excellent visualization of the PCL tibial attachment and an easy access to the tibial tunnel without injuring any neurovascular structure. The remnant bundle of the original PCL and meniscofemoral ligament, which significantly contributes to the posterior stability of the knee joint, are preserved to be healed with a graft and subsequently form an integrated structure. We report a new arthroscopic technique for an effective reconstruction of the PCL, using the posterior trans-septal portal.     

Ganglion cyst of the anterior cruciate ligament: a case report

A ganglion is a cystic swelling that usually arises close to tendons or joints. Its occurrence inside a joint is rare, and its diagnosis is usually incidental during magnetic resonance imaging or arthroscopy. 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 or meniscus. Magnetic resonance imaging is the investigation of choice for diagnosis. Ganglia commonly arise from the anterior cruciate ligament, but can also arise from other structures such as the posterior cruciate ligament or meniscus. Ganglia are typically treated by arthroscopic excision and debridement. We report a case of ganglion cyst of the anterior cruciate ligament in a 16-year-old man.     

膝关节后交叉韧带起点撕脱骨折的治疗体会

2000年1月～2007年1月,我院手术治疗110例膝关节后交叉韧带胫骨起点的撕脱骨折患者,疗效满意。     

膝关节前交叉韧带囊肿的诊断与治疗

目的探讨膝关节前交叉韧带囊肿的诊断和治疗方法。方法回顾分析2000年12月-2007年8月收治的13例前交叉韧带囊肿患者临床资料。男7例,女6例;年龄32～55岁,平均46.3岁。左膝6例,右膝7例。有明确外伤史7例,慢性损伤史4例,无明显诱因2例。病程6～29个月,平均20个月。前抽屉试验阳性1例,轴移试验阳性1例,McMurray试验阳性3例。术前6例经MRI检查确诊。关节镜下检查6例囊肿位于胫骨止点附近,3例位于前交叉韧带与后交叉韧带间,4例靠近股骨止点。术中完整切除囊肿,取囊壁行病理检查。结果病理检查结果为胶原组织和结缔组织黏液样变性,诊断为前交叉韧带囊肿。术后患者切口均Ⅰ期愈合,无相关并发症发生。13例均获随访,随访时间2～5年,平均2年6个月。患膝关节疼痛、肿胀、交锁症状均消失,随访期间无复发。术后24个月前抽屉试验阳性1例,轴移试验阳性1例,McMurray试验阳性4例。术后3、6、12、24个月时关节活动度及Lysholm评分均较术前明显改善(P<0.01)。结论 对于单纯膝关节疼痛,尤其是伴膝关节活动受限但X线片检查无异常者,应考虑前交叉韧带囊肿;MRI检查具有重要意义;关节镜下完整切除囊肿可作为首选治疗方法。