Intra-Articular Ganglia of the Knee Joint Associated With the Anterior Cruciate Ligament: A Report of 4 Cases in 3 Patients

Intra-articular ganglia are rare and mostly incidental findings on magnetic resonance imaging (MRI) and arthroscopy. We present 4 cases of intra-articular ganglion cysts associated with the anterior cruciate ligament (ACL) in 3 patients. The most commonly occurring symptoms were pain aggravated after stressing activities and limited knee range of motion. In 1 patient, ganglion cysts appeared in both knees with a time difference of 1 year. An MRI revealed typical signs of ganglion cysts in the substance of the ACL. Arthroscopy was performed for further evaluation and treatment. Histologic examination of the tissue removed revealed the presence of features consistent with ganglion cysts. Therefore, in the case of chronic knee discomfort with nonspecific clinical signs and symptoms and without a clear cause, an intra-articular ganglion cyst should be considered as causing pathology. An MRI is the most sensitive and specific method for diagnosis. However, the relatively slow progression of symptoms may delay the patient’s decision to seek medical attention. Delayed diagnosis makes arthroscopic total resection of the ganglion technically demanding or not possible at all, and extensive debridement of the ACL may be required.     

Intra-articular knee mass in a 51-year-old woman

A 51-year-old woman presented with moderate knee pain refractory to conservative measures. Radiographs revealed a well-defined, but irregularly-shaped ovoid soft tissue density at the posterior superior aspect of the infrapatellar fat pad of Hoffa. On magnetic resonance imaging, the mass was mildly heterogeneous and had intermediate signal in the proton density series and mixed signal intensity on the T2-weighted images. A low-signal rim could be seen around a portion of the lesion. Arthroscopic resection was performed and a vascular stalk was encountered. The differential diagnosis included: ganglion cyst, meniscal cyst, intra-articular lipoma, villous proliferation of the synovial membrane, Hoffa disease, and intracapsular chondroma. Histologic examination revealed a fibrous capsule partially surrounding a benign lipomatous neoplasm containing an abundance of thin- and thick-walled blood vessels with periadventitial myxoid stroma. To our knowledge, this is the first reported case of an intra-articular angiomyxolipoma in the literature. At 8-month follow-up, the patient was asymptomatic with no sign of recurrence. We postulate a low recurrence rate based on the insidious growth rate and benign histological appearance of such lesions. To our knowledge, no other intra-articular lipomatous lesion of the knee has been removed solely with arthroscopic techniques. Further follow-up information is needed to better understand the natural course of these lesions.     

Suprapatellar pouch ganglion cyst managed with arthroscopic excision: a case report

This report highlights the first known case of an intra-articular ganglion cyst of the suprapatellar pouch. The patient presented with insidious-onset medial knee pain, swelling, and progressive dysfunction. Initial imaging was negative for pathology. More extensive thigh imaging led to the diagnosis. The patient was treated successfully with arthroscopic excision and was symptom-free at final follow-up.     

Two-stage operation for treatment of a large dissecting popliteal cyst after failed total knee arthroplasty

A symptomatic popliteal cyst after total knee arthroplasty (TKA) is rare, occurring most frequently as a result of intra-articular knee pathology. We present a case of a large dissecting popliteal cyst 7 years after TKA with symptoms of severe calf pain and functional disability. The symptomatic cyst was excised completely in a first-stage operation, and the severely worn TKA was corrected by a second-stage surgical procedure. The patient in this report was pain free and had satisfactory range of knee motion 5 years after the index revision TKA, without recurrence of effusion or popliteal cyst formation.     

Intraneural ganglion cyst of the peroneal nerve in a four-year-old girl: a case report

Intraneural ganglion cysts of the peroneal nerve are rare, usually occurring in adult men with a typical presentation of knee or proximal leg pain preceding motor weakness and/or sensory disturbances in the peroneal nervous distribution. A history of knee trauma and a palpable mass of the lateral knee in the region of the peroneal nerve are common. We present the unusual case of an intraneural ganglion cyst of the peroneal nerve in a 4-year-old girl. Although extremely rare in the pediatric population, the condition should be considered in the differential diagnosis of children presenting with new-onset foot deformities, foot drop, or clinical examinations consistent with a peroneal nerve lesion. Surgical treatment consisting of ganglion decompression with exploration and ligation of the articular branch of the peroneal nerve may result in improved functional recovery in the pediatric population compared with the adult population. Greater access to magnetic resonance imaging may allow diagnosis of cases that were not previously identified.     

Arthroscopic evaluation of intra-articular haemangiomatous lesions: a technical note

We are describing an arthroscopy tip, which is helpful in suspected/diagnosed cases of intra-articular haemangioma of the knee. Intra-articular haemangiomas of the knee are a rare but known condition. Arthroscopy or MRI can be used for diagnosis. Arthroscopy was performed in a case of haemangioma diagnosed on MRI performed for anterior knee pain. Appearances of the haemangioma were entirely different when hydrostatic pressures inside the knee joint were different. The picture with bright strawberry coloured haemangioma was seen when lowered hydrostatic pressure in the knee allowed the haemangioma to fill up, defining its full extent. The appearance of the same haemangioma changed to a pale appearance when we allowed hydrostatic pressure to build up inside the knee. We recommend that when dealing with intra-articular haemangiomas of the knee, arthroscopy should be performed under low hydrostatic pressure for better and complete visualisation of the haemangioma, which will prevent incomplete treatment.     

Solitary intra-articular lipoma locking the knee in a young boy

Intra-articular lipomas have been described in adult patients: only in five of them was it responsible for acute pain and locking of the knee. We report here the unique case of an 8-year-old boy with a painful locked knee caused by a solitary intra-articular lipoma in the anteromedial compartment of the knee.     

Intra-articular hemangioma of the knee as a cause of knee pain

We report the case of a young patient with knee pain, limited range of motion, and swelling due to an intra-articular hemangioma. Clinically, the symptoms and findings were similar to those of a meniscal lesion. The diagnosis of an intra-articular tumor was made using magnetic resonance imaging. The tumor was excised, and the definitive diagnosis was made histologically. After tumor excision, the patient was pain free.     

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 treatment of tumor-like lesions of the knee joint: Localized pigmented villonodular synovitis and ganglion cyst of the anterior cruciate ligament

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.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 3 (March), 2001: pp 320–323     

An unusual case of vascular abnormality mimicking a lateral meniscal cyst

An unusual case of a vascular abnormality mimicking a lateral meniscal cyst is reported. The patient was a 31-year-old actie sportsman who presented with intermittent pain over the lateral aspect of the left knee joint line, occurring only during activities involving twisting motions such as playing soccer. He did not experience local tenderness or swelling, clicking, locking, or giving way. The magnetic resonance imaging, which was done after a diagnostic arthroscopy with normal intra-articular findings, showed a cyst formation of approximately 4-mm diameter adjacent to the lateral meniscus periphery, but no meniscal tissue degeneration. Exactly at the preoperatively marked site of most intensive pain sensation during twisting motions, surgical exposure showed a venous-aneurysm—like tumor, which was removed. The operation resulted in complete relief of symptoms and undisturbed sporting activities including soccer.     

The Removal of a Dislocated Femoral Interference Screw Through a Posteromedial Portal

The intra-articular migration of a femoral interference screw is a rare complication after anterior cruciate ligament (ACL) reconstruction in the knee. Only a few reports of cases have been published within the last few years and different approaches toward this complication have been described. We report the case of a 23-year-old female patient who was admitted with knee pain after undergoing an ACL reconstruction 4 years previously. After the clinical examination, a knee radiograph in 2 planes revealed a dislocated femoral interference screw lying in the popliteal fossa. During arthroscopy, the interference screw was retrieved through an additional posteromedial portal to avoid an arthrotomy. The causes for intra-articular screw migration are multiple and most cases were reported in the early postoperative period. The arthroscopic removal of a screw is recommended because of the lower morbidity.     

Cavernous hemangioma of Meckel's cave. Case report

A case of a cavernous hemangioma located within Meckel's cave and involving the gasserian ganglion is described in a patient presenting with facial pain and a trigeminal nerve deficit. Although these lesions have been reported to occur in the middle fossa, this is believed to be the first case of such a vascular malformation arising solely from within Meckel's cave.     

Infection of a total knee prosthesis revealed by an abscess of the posterior leg compartment. A case report

We report a case of infection of a non-cemented total knee prosthesis that led to abscess formation in the posterior compartment of the leg. This case illustrates the deleterious effect of screws used to fix the non-cemented articular surface of the tibia. Infection, like osteolysis due to polyethylene granuloma, can develop along the screw tract and reach the posterior compartment, especially when the screw protrudes through the posterior cortical of the tibia. Diffusion of an intra-articular event into the posterior compartment should be suspected in patients with a total knee prosthesis who experience calf pain.     

Synovial hemangioma in the knee of a 10-month-old boy

Synovial hemangioma is a benign vascular tumor. While mainly affecting the knee, it can also appear in other joints or tissues. The condition is very rare in children. A delay between debut and diagnosis due to its unspecific symptomatology is common. We report a case of a boy affected by an intra-articular synovial hemangioma of the knee with a debut at the early age of 10 months, the youngest reported in English literature.     

Intra-articular ropivacaine injection does not alleviate pain after day-case knee arthroscopy performed under spinal anaesthesia

BACKGROUND AND AIMS: To evaluate the effect of intra-articular ropivacaine injection on postoperative knee pain after day case arthroscopy. MATERIAL AND METHODS: We studied one hundred outpatients in a prospective, randomized, double-blind fashion to examine the postoperative analgesic effect of intra-articular ropivacaine or saline injected into the knee joint after day-case knee arthroscopy performed under spinal anaesthesia. Patients were interviewed postoperatively with a standardized questionnaire. The postoperative pain was measured using a 100-mm visual analogue scale (VAS). RESULTS: There were no statistically significant differences in the VAS scores of knee pain eight hours or more after the operation between the intra-articular ropivacaine and saline groups, and there was no significant difference in the need for postoperative pain killer. CONCLUSIONS: This study failed to demonstrate a decrease in postoperative VAS scores at eight hours and later postoperatively when 20 ml of ropivacaine 0.5% were injected intra-articularly after day-case knee arthroscopy performed under spinal anaesthesia. Furthermore, there was no significant difference in the need for postoperative pain medication between the study groups.     

Symptomatic ganglion cysts of cruciate ligaments of the knee: A series of nine cases

BackgroundGanglion cysts of cruciate ligaments of the knee are uncommon, especially because a proportion of them are asymptomatic. Moreover, symptomatic lesions have diverse presentation and are not easily detected in physical examinations. The purpose of this report was to define the relationship between clinical symptoms and the sites of ganglia of cruciate ligaments of the knee.Materials and methodsWe conducted a retrospective review of a series of nine patients treated at our institute for intra-articular ganglion cysts of cruciate ligaments of the knee. One patient presented with pain and an inability to fully extend the knee. The remaining eight patients presented with nonspecific pain or pain during knee flexion and/or extension. The diagnosis and definite location of ganglia of cruciate ligaments were confirmed by arthroscopy. All patients were treated by ganglionectomy using arthroscopic techniques.ResultsSubstantial cyst impingements were observed during knee motion using arthroscopy. At the last follow-up, all but one patient had achieved considerable symptomatic improvement after arthroscopic ganglionectomy.ConclusionWe suggest that depending on cyst location, a more applicable hypothesis for knee joint pain during motion is cyst impingement on the other cruciate ligament or the intercondylar notch.     

Ganglion cysts of the cruciate ligaments: a series of 31 cases and review of the literature

ABSTRACT: BACKGROUND: A case series for ganglion cyst of the cruciate ligament with MRI findings, clinical presentation, and management options along with review of literature is presented. METHODS: Of 8663 consecutive patients referred for knee MR imaging, 31 were diagnosed with ganglion cysts of the cruciate ligaments, including 21 men and 10 women of ages 12 to 73 years (mean: 37). A review of charts revealed that knee pain was the chief complaint in all cases. Arthroscopic debridement of ganglion cyst was performed in 11 patients. RESULTS: MRI proved to be a valuable tool in diagnosing and deciding management of these cases. All 11 patients who underwent arthroscopic treatment were symptom-free on a minimum follow-of one year. CONCLUSION: Cyst formation associated with cruciate ligament of the knee is an infrequent cause of knee pain. MR imaging was important in confirming the cyst lesions and provided useful information prior to arthroscopy. Arthroscopic debridement of ganglion cyst produced excellent outcome without recurrence. This study describes the pertinent MRI and intraoperative findings of ganglion cyst.     

Arthroscopic removal of intra-articular osteoid osteoma in the knee: case report and review of the literature

Osteoid osteoma is a relatively common benign bone tumor first described by Jaffe [1]. It most frequently arises in the long bones and exhibits a characteristic X-ray appearance, that is, a small radiolucent zone surrounded by reactive circumferential sclerosis (nidus) [2, 3]. Nocturnal pain, which can be alleviated by aspirin, is one of the characteristic clinical manifestations of this bone tumor [4]. Although it is relatively rare, osteoid osteoma can also arise in the intra-articular regions, and we found 14 such cases arising in the knee joint in the literature [5–18]. Patients with intra-articular osteoid osteoma often present with joint pain, intracapsular effusion, restricted motion, and muscle atrophy in the affected limb, which can be mistaken for more common entities, such as traumatic or degenerative pathologies of the joint. Furthermore, X-ray examination often fails to show the characteristic nidus that is typically seen in extra-articular osteoid osteoma and therefore can result in a delayed diagnosis. We herein present a case of intra-articular osteoid osteoma arising in the knee joint, which was successfully treated by arthroscopy, and review the reported cases of intra-articular osteoid osteoma arising in the knee.     

Intra-articular hemangioma of the knee

Intra-articular hemangioma of the knee is a rare cause of pain and spontaneous hemarthrosis, often seen as an internal derangement of the joint in children and young adults. The tumor is observed in two different forms: the synovial hemangioma or the arteriovenous malformation named also as hemangiohamartomas. They may cause hemorrhagic synovitis and arthropathy, probably as a result of recurrent episodes of intra-articular bleeding and mechanical irritation. Four cases of intra-articular hemangioma of the knee are presented in this study. Two of our cases were diagnosed as synovial hemangioma with the lesions localized inside the knee and the other 2 were intermediate type with the tumor extending to the muscle group and the skin. After magnetic resonance imaging and angiographic assessment, arthroscopic excision was performed in the localized type of the tumor. The other 2 cases received only diagnostic arthroscopy and biopsy followed by conservative treatment due to the extensive localization of the tumors and the serious chondral lesions. The decision of the treatment modality is very difficult in intra-articular hemangioma of the knee because, when combined with chondral degeneration, the incidence of local recurrence is high.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 3 (March), 2003: pp E17