-
Case Reports in Orthopedics 2022Tenosynovial giant cell tumor (TGCT) is a rare neoplasm of the joint synovium that has a wide clinical spectrum including pain and stiffness in the affected joint, joint...
Tenosynovial giant cell tumor (TGCT) is a rare neoplasm of the joint synovium that has a wide clinical spectrum including pain and stiffness in the affected joint, joint swelling, periarticular erosions, and cartilage loss, which can severely impact quality of life. The mainstay treatment for TGCT has been surgery involving partial or total synovectomy using arthroscopic or open techniques. However, surgical resection alone is associated with high recurrence rates, particularly in diffuse-TGCT (D-TGCT) cases. The 3 cases presented here summarize a combination approach (surgery+pexidartinib [tyrosine kinase inhibitor]) in patients with previously unresectable or inoperable D-TGCT. A 29-year-old male was treated with pexidartinib prior to surgery, resulting in tumor reduction. A left total hip arthroplasty (THA) was then performed with a lack of recurrence in 12 months postoperative, and the patient currently on pexidartinib treatment. A 35-year-old female, nearly a decade following a left foot mass resection, was treated with pexidartinib following disease recurrence. A decrease in soft tissue lesions at the midfoot and decreased marrow enhancement at the first metatarsal head were seen within 4-5 months of pexidartinib treatment; the patient is currently on pexidartinib (400 mg/day) with improved symptom control. A 55-year-old male patient received pexidartinib pre- and postoperatively. A reduction in swelling and the size of the popliteal cyst was significant and maintained, with the synovial disease growing when pexidartinib was discontinued. Surgery and adjuvant therapy eliminated the disease as of the last follow-up visit (11 months postoperative). These cases provide a unique perspective based on tumor location, type/timing of treatment strategy, and patient outcomes. Optimal treatment strategies for this debilitating disease may entail utilizing a combination approach (surgery+systemic treatment) to reduce surgical morbidity and the risk of postoperative disease recurrence.
PubMed: 36510622
DOI: 10.1155/2022/7768764 -
Journal of Orthopaedic Surgery and... Dec 2022Baker's cyst is the most common cystic disease of the knee, and a fast and accurate diagnosis of Baker's cyst is essential for a better management. Ultrasound is a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Baker's cyst is the most common cystic disease of the knee, and a fast and accurate diagnosis of Baker's cyst is essential for a better management. Ultrasound is a rapid, portable, widely available, inexpensive and noninvasive imaging modality. However, the diagnostic accuracy of ultrasound on Baker's cyst still remains undetermined. We conducted the first meta-analysis to comprehensively assess the accuracy of ultrasound for the detection of Baker's cyst.
METHODS
PubMed, Embase and Web of Science were searched from inception to July 14, 2022, without language restrictions. Studies providing cross-tabulations of ultrasound versus pathology (gold standard) or MRI (standard imaging technique) for diagnosis of Baker's cyst were included. Indicators for the diagnostic accuracy of ultrasound, including sensitivity, specificity and area under the curve, were calculated using a bivariate model. Sensitivity analysis was conducted to evaluate the heterogeneity and robustness of the results.
RESULTS
A total of 13 studies with 1,011 subjects (mean age 32.2 years; men 53.5%) met the inclusion criteria. The pooled sensitivity, specificity and area under the curve of ultrasound for diagnosis of Baker's cyst, compared with pathology, were 0.97 (95% confidence intervals: 0.73-1.00), 1.00 (0.98-1.00) and 1.00 (0.99-1.00), respectively. The pooled estimates of ultrasound versus MRI were 0.94 (0.87-0.98) for sensitivity, 1.00 (0.83-1.00) for specificity and 0.97 (0.95-0.98) for area under the curve. Sensitivity analysis did not change the results materially.
CONCLUSION
Ultrasound shows excellent diagnostic accuracy for the assessment of Baker's cyst and provides similar diagnostic information (absent or present) compared to MRI. Because of its advantages of low cost, portability and accessibility, ultrasound is likely to be a choice of imaging technique for screening Baker's cyst in clinical and population settings as well as in follow-ups.
Topics: Male; Humans; Adult; Popliteal Cyst; Ultrasonography; Osteoarthritis, Knee; Knee Joint; Knee
PubMed: 36510299
DOI: 10.1186/s13018-022-03430-9 -
Frontiers in Cardiovascular Medicine 2022Intramuscular ganglion cyst (IMGC) is a very rare lesion with an unidentified pathogeny that originates within the muscle. We encountered a case of 49-year-old man who...
Intramuscular ganglion cyst (IMGC) is a very rare lesion with an unidentified pathogeny that originates within the muscle. We encountered a case of 49-year-old man who complained of intermittent claudication in the right lower limb for 2 months. An intramuscular ganglion cyst in the biceps femoris muscle was diagnosed and located by Computed tomography angiography (CTA) and magnetic resonance imaging (MRI), which compressed the popliteal artery and resulted in ischemia in the right lower limb. Six months after surgical resection, there was no recurrence of the cyst and the popliteal artery was patency. We describe this case with a review of the relevant literature.
PubMed: 36505376
DOI: 10.3389/fcvm.2022.1018694 -
Pakistan Journal of Medical Sciences 2022To evaluate the efficacy of arthroscopic internal drainage (AID) and cyst wall resection (CWR) in children with popliteal cysts.
OBJECTIVES
To evaluate the efficacy of arthroscopic internal drainage (AID) and cyst wall resection (CWR) in children with popliteal cysts.
METHODS
This study included 16 pediatric patients with popliteal cysts and received arthroscopy using the double posteromedial (PM) portal system during June 2020 and June 2021 at The General Hospital of Northern Theater Command. Among these pediatric patients, 14 were males and two were females, with the mean age of nine years (range: 7-12 years). The left knee was affected in 12 cases, while the right knee was involved in the rest four cases. All patients underwent MR imaging before the procedure to assess whether there was intra-articular trauma and whether the popliteal cyst communicated with the knee-joint cavity. The MRI results showed that each patient had a simple popliteal cyst that involved a single knee joint without intra-articular trauma, which was classified as Grade-1 (n=3), Grade-2 (n =10) or Grade-3 (n =3) according to the Rauschning and Lindgren grading of knee joint symptoms. Arthroscopy was performed through anterolateral (AL) and PM portals to the knee joint for AID plus CWR, and the surgical outcomes were evaluated based on the Rauschning and Lindgren criteria.
RESULTS
No major vascular or nerve injury occurred during the operation. Postoperative complications such as wound infection and lower-extremity deep venous thrombosis were not recorded in these patients. Complications involving the saphenous nerve or the great saphenous vein or pseudocyst formation were not observed during the follow-up period. All patients completed the follow-up ranging from 3-12 months and were identified to have grade-0 (n=15) and grade-1 (n=1) popliteal cysts based on the Rauschning and Lindgren criteria, indicating significant improvement compared with the preoperative levels (all p<0.05). Moreover, no recurrence was recorded after operation.
CONCLUSION
AID plus CWR is a minimally invasive and safe approach for pediatric patients with popliteal cysts to promote postoperative recovery and reduce the recurrence rate.
PubMed: 36415283
DOI: 10.12669/pjms.38.8.5354 -
Arthroscopy Techniques Oct 2022When treating a popliteal cyst in the knee joint, it is often necessary to simultaneously treat the intra-articular lesions so as to reduce the recurrence of the cyst...
When treating a popliteal cyst in the knee joint, it is often necessary to simultaneously treat the intra-articular lesions so as to reduce the recurrence of the cyst after the operation. Herein, we propose an arthroscopic resection technique for popliteal cyst, in which the position of the popliteal cyst is indirectly located by finding out the location of the semimembranosus tendon during the operation, thereby completing the arthroscopic resection of the popliteal cyst. This method does not involve the posteromedial compartment of the knee joint. Arthroscopic treatment can be performed on the combined intra-articular lesions through anteromedial and anterolateral approaches before or after popliteal cyst resection.
PubMed: 36311321
DOI: 10.1016/j.eats.2022.06.024 -
World Journal of Clinical Cases Jul 2022One of the causes of foot drop is compression of the common peroneal nerve caused by space-occupying lesions such as a synovial cyst or a ganglion cyst. Most previous...
BACKGROUND
One of the causes of foot drop is compression of the common peroneal nerve caused by space-occupying lesions such as a synovial cyst or a ganglion cyst. Most previous reports have involved compressive common peroneal neuropathy by intraneural ganglion cysts and synovial cysts. Compression of the peroneal nerve by extraneural ganglion cysts is rare. We report a rare case of compressive common peroneal neuropathy by an extraneural ganglion cyst.
CASE SUMMARY
A 46-year-old man was hospitalized after he reported a right foot drop for 1 mo. Manual muscle testing revealed scores of 1/5 on dorsiflexion of the right ankle. Hypoesthesia and paresthesia on the right lateral leg and foot dorsum were noted. He was diagnosed with a popliteal cyst by using electrophysiologic study and popliteal ultrasound (US). To facilitate common peroneal nerve (CPN) decompression, 2 cc of sticky gelatinous material was aspirated from the cyst under US guidance. Electrical stimulation and passive and assisted active ROM exercises of the right ankle and strengthening exercises for weak muscles using elastic band were prescribed based on the change of muscle power. A posterior leaf spring ankle-foot orthosis was prescribed to assist the weak dorsiflexion of the ankle. Follow-up US revealed that the cystic lesion was growing and magnetic resonance imaging demonstrated compression of the CPN by the cystic mass. The cyst was resected to prevent impending compression of the CPN.
CONCLUSION
Precise diagnosis and immediate treatment are important in cases of compressive common peroneal neuropathy caused by an extraneural cyst.
PubMed: 36158030
DOI: 10.12998/wjcc.v10.i21.7539 -
Cureus Aug 2022Popliteal cysts represent one of the commonest knee pathologies in the adult population. The vast majority of cases may be treated conservatively as symptoms tend to...
Popliteal cysts represent one of the commonest knee pathologies in the adult population. The vast majority of cases may be treated conservatively as symptoms tend to resolve spontaneously. However, few patients may experience persistent pain and nerve-related symptoms not responding to conservative management. We present a case of a 46-year-old patient who suffered from tibial nerve palsy due to a popliteal cyst that was treated successfully with combined open and arthroscopic procedure. It is important to understand that popliteal cysts rarely may lead to tibial nerve entrapment and in selected cases operative management may be indicated.
PubMed: 36120222
DOI: 10.7759/cureus.27984 -
Contrast Media & Molecular Imaging 2022Knee osteoarthritis (KOA) is the most common chronic bone joint disease. The WHO points out that KOA has become the fourth most disabling disease in the world, and the...
Knee osteoarthritis (KOA) is the most common chronic bone joint disease. The WHO points out that KOA has become the fourth most disabling disease in the world, and the main clinical treatment is prevention. At present, the clinical diagnosis of knee osteoarthritis with deformation is mainly made by X-ray and two-dimensional ultrasound, and the preventive treatment effect is not good. Shear wave elastography (SWE) has been widely used in clinical practice for its advantages of noninvasive, simple, rapid, and high accuracy in soft tissue hardness. This study investigates the feasibility of using SWE in the grading diagnosis of KOA and the detection of early skeletal muscle injury. 60 patients were enrolled with unilateral KOA who met the inclusion criteria. Routine scanning and SWE exploration were carried out and compared between the affected and healthy knee joints. The measurements included morphology, damage degree of cartilage, joint effusion, joint synovial thickness, the degree of meniscus convexity, and shear wave speed (SWS) in the tendon attachment area of the quadriceps femoris superior patella, and tendon thickness and SWS between and within groups. The affected was scored according to the ultrasonic characteristics. The correlation between them was analyzed to evaluate the feasibility of SWE in grading the diagnosis of KOA. 57 cases had knee cavity effusion (57/60, 95.0%), 58 cases had knee cartilage injury (58/60, 96.6%), and 35 cases had a lateral process of the medial meniscus (35/60, 53.3%); 30 cases had synovial hyperplasia (30/60, 50%), 21 cases had osteophyte formation (21/60, 35%), and no one had a popliteal cyst. There was no significant difference in tendon thickness between and within groups ( > 0.05), but a significant difference in SWS ( < 0.01); the SWS of the quadriceps femoris tendon is negatively correlated with ultrasound score ( = 0.955, < 0.01). There is a strong negative correlation between SWS and the degree of KOA. It can be used in the grading diagnosis of KOA to help find more early strain points.
Topics: Elasticity Imaging Techniques; Humans; Muscle, Skeletal; Osteoarthritis, Knee; Ultrasonography
PubMed: 36072618
DOI: 10.1155/2022/4229181 -
Malaysian Orthopaedic Journal Jul 2022Popliteal swelling is a common complaint seen in the practice of orthopaedics. Although imaging is useful to aid in the diagnosis of popliteal swelling pre-operatively,...
Popliteal swelling is a common complaint seen in the practice of orthopaedics. Although imaging is useful to aid in the diagnosis of popliteal swelling pre-operatively, definitive diagnosis is often obtained post-operatively through histopathological report of the swelling. Baker's cyst arises medially and hence usually spares the posterolaterally located neurovascular bundle until it becomes larger in size. A thrombosed aneurysm can mimic that of Baker's cyst on computed tomography (CT) imaging in view of its location and the absence of contrast within the lesion. Diagnosis of a popliteal swelling with neural or vascular compression is not as straightforward and surgeons should be well aware that intra-operative findings may differ from diagnosis made pre-operatively. Meticulous exploration is pertinent in identifying the origin of the swelling and structures related to it. MRI imaging of the swelling should be done pre-operatively whenever possible.
PubMed: 35992974
DOI: 10.5704/MOJ.2207.015 -
Comparison of arthroscopic internal drainage and open excision for the treatment of popliteal cysts.BMC Musculoskeletal Disorders Jul 2022The purpose of this study was to introduce the arthroscopic internal drainage with anterior-anteromedial approach for the treatment of popliteal cysts in children. To...
BACKGROUND
The purpose of this study was to introduce the arthroscopic internal drainage with anterior-anteromedial approach for the treatment of popliteal cysts in children. To compare its clinical efficacy with open surgery.
METHODS
This was a retrospective case-control study of 102 patients diagnosed with popliteal cysts from January 2018 to February 2020 who received surgery. The study included 27 cases with minimally invasive group (MI group) and 75 cases with open surgery group (OS group). The MI group included 21 males and 6 females, age 6.71 ± 2.16 years who received arthroscopic internal drainage of the cysts to adequately widen the valve opening between the cyst and the articular cavity, excised the fibrous diaphragm without complete excision of the cyst wall. The OS group included 57 males and 18 females, age 6.21 ± 1.67 years who received open excision. The clinical parameters regarding the preoperative characteristics and surgical results were compared. Ultrasound or MRI was used to identify the recurrence of the popliteal cysts. Rauschning-Lindgren grade was recorded to evaluate the clinical outcome.
RESULTS
All patients were followed up for at least 24 months. There were no significant differences between the two groups in age, gender, left and right sides, disease time, cyst size, length of hospitalization, preoperative Rauschning-Lindgren grade (p > 0.05). At the last follow-up, the preoperative and postoperative Rauschning-Lindgren grade was improved in both groups. Compared with the OS group, operation time was significantly shortened in the MI group (28.89 ± 4.51 min vs 52.96 ± 29.72 min, p < 0.05). The MI group was superior to the OS group in terms of blood loss and plaster fixation, with statistical significance (p < 0.05). There was obvious difference in recurrence rate between the two groups (0% vs 17.33%, p = 0.018). No postoperative complications occurred during the follow-up period.
CONCLUSIONS
Compared with open excision, the treatment of popliteal cyst in children by arthroscopic internal drainage to expand the articular cavity and eliminate the "one-way valve" mechanism between the cyst and the articular cavity exhibits better clinical outcomes and significantly reduces the recurrence rate, which is worthy of further clinical promotion.
Topics: Arthroscopy; Case-Control Studies; Child; Child, Preschool; Drainage; Female; Humans; Male; Popliteal Cyst; Retrospective Studies; Treatment Outcome
PubMed: 35907946
DOI: 10.1186/s12891-022-05658-2