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Vascular Specialist International Jun 2021Adventitial cystic disease (ACD) of the veins is a rare vascular disease. Most cases of venous ACD are located adjacent to the joint area, such as the common femoral,...
Adventitial cystic disease (ACD) of the veins is a rare vascular disease. Most cases of venous ACD are located adjacent to the joint area, such as the common femoral, external iliac, and popliteal veins. To the best of our knowledge, 67 cases of venous ACD have been reported, and ACD of the superficial femoral vein (SFV) has never been reported. Herein, we report the case of a 57-year-old male who presented with swelling and discomfort in the left leg. Computed tomography venography revealed multiple cystic lesions in the left distal SFV. The patient underwent cyst excision, which relieved the compression in the vein, although mild stenosis prevailed in the SFV. After a week, thrombosis developed in the popliteal vein. The thrombosis resolved after three months of anticoagulant therapy, and the patient showed no recurrence of ACD during three years of follow-up.
PubMed: 34168097
DOI: 10.5758/vsi.210034 -
Folia Morphologica 2022Primary synovial chondromatosis (PSC) is a rare idiopathic pathology characterised by the formation of osseocartilaginous nodules within synovial joints, tendons, or...
BACKGROUND
Primary synovial chondromatosis (PSC) is a rare idiopathic pathology characterised by the formation of osseocartilaginous nodules within synovial joints, tendons, or bursae. The mineralisation pattern of PSC nodules is poorly understood and has yet to be investigated using elemental analysis. Mapping this pattern could elucidate the progression of the disease.
MATERIALS AND METHODS
Primary synovial chondromatosis nodules discovered during dissection of a formalin fixed donor were analysed. Scanning electron microscopy paired with energy dispersive X-ray spectroscopy (SEM-EDS) was used to quantify calcium and phosphorus levels to distinguish mineralised components from cartilage, indicated by increased carbon and oxygen concentrations.
RESULTS
Nine nodules with average dimensions 1.76 cm × 1.25 cm were identified in the semimembranosus bursa. SEM-EDS demonstrated increased calcium phosphate levels in nodular cores, while outer margins contained primarily carbon and oxygen. Quantification of these elements revealed nodular peripheries to contain 68.0% carbon, 30.2% oxygen, 0.8% calcium, and 1.0% phosphate, while cores were comprised of 38.1% carbon, 42.1% oxygen, 14.1% calcium, and 5.7% phosphate.
CONCLUSIONS
Nodules were found to have mineralised cores embedded within a cartilaginous matrix. This pattern suggests disease progression is facilitated by endochondral ossification, opening the potential for new therapeutic techniques.
Topics: Calcium; Carbon; Chondromatosis, Synovial; Humans; Oxygen; Phosphates
PubMed: 34060645
DOI: 10.5603/FM.a2021.0054 -
Medical Ultrasonography May 2021
Topics: Humans; Knee Joint; Meniscus; Popliteal Cyst; Ultrasonography
PubMed: 34015073
DOI: 10.11152/mu-3193 -
Orthopaedic Surgery Jun 2021To compare the clinical efficacy and safety of arthroscopic internal drainage for the treatment of unicameral popliteal cysts with or without cyst wall resection. (Comparative Study)
Comparative Study
Arthroscopic Internal Drainage with Cyst Wall Resection and Arthroscopic Internal Drainage with Cyst Wall Preservation to Treat Unicameral Popliteal Cysts: A Retrospective Case-Control Study.
OBJECTIVE
To compare the clinical efficacy and safety of arthroscopic internal drainage for the treatment of unicameral popliteal cysts with or without cyst wall resection.
METHODS
This was a retrospective case-control study of 73 patients diagnosed with unicameral popliteal cysts from January 2012 to January 2019 who received arthroscopic treatment. The study included 38 cases with cyst wall resection (CWR group) and 35 cases with cyst wall preservation (CWP group). The CWR group consisted of 14 men and 24 women with an average age of 51.8 years, while the CWP group consisted of 13 men and 22 women with an average age of 52.0 years. All patients were examined for intra-articular lesions and communicating ports by magnetic resonance imaging (MRI) prior to surgery, and recurrence of cysts was evaluated at the last follow-up examination. Rauschning and Lindgren grade (R-L grade) and Lysholm score were used to evaluate clinical outcomes. In addition, operation time and complications were recorded.
RESULTS
The average length of follow-up was 24.2 months (range, 16 to 32 months). There were no considerable differences in age, gender, cyst size, Lysholm score, R-L grade and concomitant intra-articular cases between the CWR group and CWP group prior to surgery (P > 0.05). The last follow-up MRI scans showed that in the CWR group, the cyst disappeared in 25 cases and shrunk in 13 cases. In the CWP group, the cyst disappeared in 22 cases, shrunk in 12 cases and persisted in one case. There was no obvious difference in recurrence rate between the two groups (0% vs 2.9%, P = 0.899). At the last follow-up, there were no differences in the R-L grade (P = 0.630) and Lysholm score (88.3 ± 5.6 points vs 90.1 ± 3.8 points, P = 0.071) between the two groups. Compared with the CWP group, operation time was significantly prolonged in the CWR group (38.3 ± 3.1 min vs 58.3 ± 4.4 min, P < 0.05). In the CWR group, three cases occurred fluid infiltration under the gastrocnemius muscle, which improved after pressure bandaging and cold compress. In another three cases, hematoma was found. The incidence of complications in the CWR group was markedly higher than that in the CWP group (15.8% vs 0%, P < 0.05). During the follow-up period, none of the patients developed serious complications such as neurovascular injury, deep venous thrombosis, or infection.
CONCLUSION
For unicameral popliteal cysts, arthroscopic internal drainage combined with resection of the cyst wall did not further improve the clinical outcomes or reduce the recurrence rate, while prolonging the operation time and increasing the possibility of complications.
Topics: Adult; Arthroscopy; Case-Control Studies; Drainage; Female; Humans; Male; Middle Aged; Popliteal Cyst; Plastic Surgery Procedures; Retrospective Studies; Surveys and Questionnaires
PubMed: 33942543
DOI: 10.1111/os.12917 -
Anesthesia and Pain Medicine Apr 2020Baker's cysts are usually located in the posteromedial side of the knee and seldom cause neuropathy.
BACKGROUND
Baker's cysts are usually located in the posteromedial side of the knee and seldom cause neuropathy.
CASE
We describe the rare case of a 57-year-old woman with a popliteal cyst who presented with limping gait and pain in her lower leg. She was electronically diagnosed with common peroneal neuropathy and transferred to our pain clinic. On ultrasound examination, about 2.0 × 1.2 cm sized popliteal cyst was found to extend to the fibular head, compressing the common peroneal nerve. Therefore, ultrasound-guided aspiration of the cyst and a common peroneal nerve block were performed. Immediately after the procedure, the pain, dysesthesia, and limping gait were relieved. Although her pain and dysesthesia were relieved, she underwent the surgery because of limping gait.
CONCLUSIONS
In this case, we found the Baker's cyst, the cause of the common peroneal neuropathy, and treated it immediately by just simple ultrasound examination and aspiration.
PubMed: 33329814
DOI: 10.17085/apm.2020.15.2.199 -
Journal of Experimental Orthopaedics Nov 2020Several studies have shown an excellent success rate of communication enlargement surgery for popliteal cysts (Baker's cysts). Ultrasound-guided surgery can improve the... (Review)
Review
PURPOSE
Several studies have shown an excellent success rate of communication enlargement surgery for popliteal cysts (Baker's cysts). Ultrasound-guided surgery can improve the accuracy of this procedure and may lead to better outcomes. This study describes a simple ultrasound-guided arthroscopic technique to manage popliteal cysts and reduce postoperative pain.
METHODS
After routine arthroscopic observation with a standard 2-portal approach, the arthroscope is redirected toward the posteromedial compartment from the anterolateral portal through the intercondylar notch. A posteromedial portal is then placed at this view. Subsequently, a contrast dye (indigo carmine) is injected into the popliteal cyst percutaneously using ultrasonography. This procedure makes it easier to find a capsular fold or valvular opening. The valvular opening between the semimembranosus and medial gastrocnemius is enlarged with a shaver and radiofrequency ablation. Cystectomy is not performed in any case. Finally, the irrigation fluid is suctioned, and the reduced cyst is visualized by ultrasound. Additionally, a periarticular multimodal drug injection is administered into the septum and inner wall of the cyst under ultrasound guidance.
CONCLUSIONS
Ultrasound-guided arthroscopic surgery for popliteal cysts can ensure reproducibility and be effective for postoperative pain relief. Thus, this combined procedure may be an optimal treatment option.
PubMed: 33251554
DOI: 10.1186/s40634-020-00314-x -
Stem Cells International 2020Mesenchymal stem cells (MSCs) are multipotent progenitor cells in adult tissues. The aim of this study is to isolate and identify synovial fluid-derived mesenchymal...
Mesenchymal stem cells (MSCs) are multipotent progenitor cells in adult tissues. The aim of this study is to isolate and identify synovial fluid-derived mesenchymal stromal cells (SF-MSCs) from the popliteal cyst fluid of pediatric patients. SF-MSCs were collected from the popliteal cyst fluid of pediatric patients during cystectomy surgery. After cyst fluid extraction and adherent culturing, in vitro morphology, growth curve, and cell cycle were observed. The expression of stem cell surface markers was analyzed by flow cytometry, and expression of cell marker protein was detected by immunofluorescence. SF-MSCs were cultured in osteogenic, adipogenic, and chondrogenic differentiation medium. The differentiation potential of SF-MSCs was analyzed by alkaline phosphatase (Alizarin Red), Oil Red O, and Alcian blue. Antibody detection of human angiogenesis-related proteins was performed compared with bone marrow mesenchymal stem cells (BM-MSCs). The results show that SF-MSCs from the popliteal cyst fluid of pediatric patients showed a shuttle appearance and logarithmic growth. Flow cytometry analysis revealed that SF-MSCs were negative for hematopoietic lineage markers (CD34, CD45) and positive for MSC markers (CD44, CD73, CD90, and CD105). Interstitial cell marker (vimentin) and myofibroblast-like cell marker alpha-smooth muscle actin (-SMA) were positive. These cells could differentiate into osteogenic, adipogenic, and chondrogenic lineages, respectively. Several types of human angiogenesis-related proteins were detected in the cell secretory fluid. These results show that we successfully obtained SF-MSCs from the popliteal cyst fluid of pediatric patients, which have the potential to be a valuable source of MSCs.
PubMed: 33014069
DOI: 10.1155/2020/7416493 -
Medicine Sep 2020Peroneal neuropathy is the most common type of peripheral neuropathy in the lower extremities. The peroneal nerve is usually compressed at the lateral aspect of the...
RATIONALE
Peroneal neuropathy is the most common type of peripheral neuropathy in the lower extremities. The peroneal nerve is usually compressed at the lateral aspect of the fibular head. Compression by ganglion cysts are one of the numerous underlying etiologies for peroneal nerve neuropathy and are most frequently located around the fibular neck and proximal tibiofibular joint. To the best of our knowledge, this is the first report of an extraneural ganglion cyst located at the level of the distal thigh that resulted in compressive peroneal neuropathy.
PATIENT CONCERNS
We report a case of a 56-year-old man with sudden onset of left foot drop and gait disturbance caused by an extraneural ganglion cyst located in the popliteal fossa.
DIAGNOSIS
Electrodiagnosis (EDX) suggested a peroneal nerve lesion. Subsequently, diagnostic ultrasonography (USG) revealed a cystic mass located within the left side of the supracondylar area of femur. Further magnetic resonance imaging confirmed that the mass was located at the proximal of popliteal fossa.
INTERVENTIONS
Surgical excision was performed using a direct posterior approach. The cystic mass was compressing the common peroneal nerve, and was carefully and completely removed ensuring that all nerve branches were protected.
OUTCOMES
A histopathologic evaluation confirmed the diagnosis of a ganglion cyst. There were no postoperative complications. Two months after the surgery, follow-up USG revealed no evidence of cyst recurrence or residual lesions. Six months after the surgery, the ankle dorsiflexor motor power improved and he experienced less pain and hypoesthesia.
LESSONS
Physicians should bear in mind that the peroneal neuropathy can occur because of the ganglion cyst in the distal thigh. The thorough evaluation of EDX and USG is crucial for the early diagnosis and surgical intervention, although there is no abnormal finding around the fibular neck.
Topics: Bone Cysts; Femur; Ganglion Cysts; Humans; Male; Middle Aged; Peroneal Neuropathies
PubMed: 32925762
DOI: 10.1097/MD.0000000000022123 -
Annals of the Royal College of Surgeons... Nov 2020Retroperitoneal abscesses can be gastrointestinal, urological or vascular in origin, and can spread via the retrofascial compartment through the psoas muscle to the...
Retroperitoneal abscesses can be gastrointestinal, urological or vascular in origin, and can spread via the retrofascial compartment through the psoas muscle to the lower limb. We describe the case of a 73-year-old woman with right knee pain for three weeks, a cellulitic right thigh and cholestatic liver function tests. A purulent sinus developed in the popliteal fossa and computed tomography of the abdomen revealed a right-sided retroperitoneal collection with gas, extending to the right pelvis and inguinal region. The popliteal fossa sinus and retroperitoneal collection were identified as a single pathology through computed tomography, magnetic resonance imaging and culture of identical organisms. At laparotomy, perforated duodenal ulcer disease was identified as the cause of the retroperitoneal abscess. Clinicians should seek to exclude retroperitoneal sources of infection in cases of lower leg infection, including perforated duodenal ulcer, caecal adenocarcinoma and appendicitis.
Topics: Abdominal Abscess; Aged; Duodenal Ulcer; Female; Humans; Popliteal Cyst; Retroperitoneal Space; Tomography, X-Ray Computed
PubMed: 32734780
DOI: 10.1308/rcsann.2020.0137 -
Journal of the Belgian Society of... Jul 2020This clinical case shows the importance of also examining the arteries when investigating suspected deep venous thrombosis.
This clinical case shows the importance of also examining the arteries when investigating suspected deep venous thrombosis.
PubMed: 32676549
DOI: 10.5334/jbsr.2109