Abstract
Purpose
Cysts of the proximal tibiofibular articulation are rare and their optimal treatment remains unclear. The objective of this study was to evaluate the results and complications of the treatment of synovial ganglion cysts of the proximal tibiofibular articulation by simple excision or by excision and fusion of the proximal tibiofibular joint with a limited fibula excision.
Methods
Between January 2005 and December 2016, seven male patients with an average age of 46 years were treated for a ganglion cyst of the proximal tibiofibular articulation. Nine procedures were performed in total. Four patients underwent primary cyst excision, two underwent revision cyst excision and three underwent revision cyst excision with arthrodesis of the proximal tibiofibular joint and partial excision of the fibula (two patients underwent two procedures).
Results
Average follow-up was 79 months. The recurrence rate was 25% for simple cyst excision, 100% for revision cyst excision and 0% for cyst excision with arthrodesis. Average kitaoka score was 98 for simple cyst excision and 100 for cyst excision with arthrodesis (P = 0.34); resting visual analogue scores (VAS) were zero in both groups. With activity VAS was 0 for simple cyst excision and 1.6 in the arthrodesis group (P = 0.33). Two of the three arthrodesis patients went on to successful fusion. The third patient has an asymptomatic pseudarthrosis.
Conclusion
Simple primary cyst excision has a high failure rate at 25%. Revision cyst excision without fusion failed in all cases. We therefore recommend arthrodesis with limited fibula excision.
Similar content being viewed by others
References
Lennander KG (1891) Ett stort ganglion pa underbenet. Lak Forh 27419
Vatansever A, Bal E, Okcu G (2006) Ganglion cysts of the proximal tibiofibular joint review of literature with three case reports. Arch Orthop Trauma Surg 126:637–640. doi:10.1007/s00402-005-0084-3
Gayet LE, Morand F, Goujon JM et al (1996) Compression of the peroneal nerve by a synovial cyst in a 7-year-old child. Rev Chir Orthopédique Réparatrice Appar Mot 82:762–766
Gibbon AJ, Wardell SR, Scott RD (1999) Synovial cyst of the proximal tibiofibular joint with peroneal nerve compression after total knee arthroplasty. J Arthroplast 14:766–768
Ilahi OA, Younas SA, Labbe MR, Edson SB (2003) Prevalence of ganglion cysts originating from the proximal tibiofibular joint: a magnetic resonance imaging study. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 19:150–153. doi:10.1053/jars.2003.50007
Ward WG, Eckardt JJ (1994) Ganglion cyst of the proximal tibiofibular joint causing anterior compartment syndrome. A case report and anatomical study. J Bone Joint Surg Am 76:1561–1564
Artico M, Cervoni L, Carloia S et al (1997) Synovial cysts: clinical and neuroradiological aspects. Acta Neurochir 139:176–181
Damron TA, Rock MG (1997) Unusual manifestations of proximal tibiofibular joint synovial cysts. Orthopedics 20:225–230
Barrie HJ, Barrington TW, Colwill JC, Simmons EH (1980) Ganglion migrans of the proximal tibiofibular joint causing lesions in the subcutaneous tissue, muscle, bone, or peroneal nerve: report of three cases and review of the literature. Clin Orthop:211–215
Miskovsky S, Kaeding C, Weis L (2004) Proximal tibiofibular joint ganglion cysts: excision, recurrence, and joint arthrodesis. Am J Sports Med 32:1022–1028
Kapoor V, Theruvil B, Britton JM (2004) Excision arthroplasty of superior tibiofibular joint for recurrent proximal tibiofibular cyst. A report of two cases. Jt Bone Spine Rev Rhum 71:427–429. doi:10.1016/j.jbspin.2003.07.011
Omer GE Jr. (1981) Methods of assessment of injury and recovery of peripheral nerves. Surg Clin N Am 61(2):303–319
Kitaoka HB, Patzer GL (1997) Analysis of clinical grading scales for the foot and ankle. Foot Ankle Int 18:443–446
von Elm E, Altman DG, Egger M et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet Lond Engl 370:1453–1457. doi:10.1016/S0140-6736(07)61602-X
Hersekli MA, Akpinar S, Demirors H et al (2004) Synovial cysts of proximal tibiofibular joint causing peroneal nerve palsy: report of three cases and review of the literature. Arch Orthop Trauma Surg 124:711–714. doi:10.1007/s00402-004-0717-y
Lerais JM, Baudrillard JC, Durot JF et al (1986) Kystes synoviaux de topographie inhabituelle. Deux observations et revue de la littérature. J Radiol 67:201–207
Nucci F, Artico M, Santoro A et al (1990) Intraneural synovial cyst of the peroneal nerve: report of two cases and review of the literature. Neurosurgery 26:339–344
Glimet T. (1989) Pathologie de l’articulation péronéotibiale supérieure. In: Actualités rhumatologiques: Expansion Scientifique française. Paris, pp 75–81
Schwimmer M, Edelstein G, Heiken JP, Gilula LA (1985) Synovial cysts of the knee: CT evaluation. Radiology 154:175–177. doi:10.1148/radiology.154.1.3964937
McEvedy BV (1955) Cystic ganglia; their pathology, natural history and treatment. Med Illus 9:425–428
McEvedy BV (1954) The simple ganglion: a review of modes of treatment and an explanation of the frequent failures of surgery. Lancet Lond Engl 266:135–136
Pagnoux C, Lhotellier L, Marek JJ et al (2002) Synovial cysts of the proximal tibiofibular joint: three case reports. Jt Bone Spine Rev Rhum 69:331–333
Dubuisson AS, Stevenaert A (1996) Recurrent ganglion cyst of the peroneal nerve: radiological and operative observations. Case report. J Neurosurg 84:280–283. doi:10.3171/jns.1996.84.2.0280
Sun JCL, Wallace C, Zochodne DW (1995) Tibial mononeuropathy from a lower limb synovial cyst. Can J Neurol Sci 22(4):312–315
Leon J, Marano G (1987) MRI of peroneal nerve entrapment due to a ganglion cyst. Magn Reson Imaging 5:307–309
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Each author declares that they have no conflict of interest.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Electronic supplementary material
ESM 1
(DOCX 4 kb)
Rights and permissions
About this article
Cite this article
Lateur, G., Pailhé, R., Refaie, R. et al. Ganglion cysts of the proximal tibiofibular articulation: the role of arthrodesis and combined partial fibula excision. International Orthopaedics (SICOT) 42, 1233–1239 (2018). https://doi.org/10.1007/s00264-017-3542-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-017-3542-y