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Proximal Tibiofibular Joint Ganglion Cyst: Surgical Treatment

March 15, 2015

Contributors: Mohammadreza Chehrassan, MD; Federico Pilla, MD; Raffaele Borghi, MD; Daniele Fabbri, MD; Fabrizio Perna; Constantino Errani, MD; Marcello De Fine, MD; Cesare Faldini, MD; Francesco Traina, MD, PhD; Francesco Traina, MD, PhD

INTRODUCTION: Proximal tibiofibular joint (PTFJ) ganglion cyst is a rare pathology, which may cause pain, sensory and/or motor deficit by direct compression on the common peroneal nerve (CPN). Pathogenesis of PTFJ ganglion cyst is still uncertain. The most accredited theory is the degenerative theory in which these cysts are considered as out pouching of joint capsule secondary to intra-articular pressure rise. Usually these cysts present as palpable and tender mass over the lateral aspect of the proximal fibula. Patients may complain of lateral joint tenderness, pain, and/or sensor or motor deficit. Imaging studies include plain x-ray and MRI that usually show uniloculated or multiloculated lesions that may be extended through periarticular tissues or in to the proxiamal fibular bone. The treatment is indicated only for symptomatic lesions and include excision of the cyst; however due to high rate of recurrence PTFJ arthrodesis can be advisable. The aim of this video is to show the surgical technique of PTFJ ganglion cyst excision and PTJF arthrodesis.

METHODS: Eight male patients were included in our study in which one of them is shown in this video. All the patients were symptomatic. The diagnosis was made in all cases based on the clinical and imaging findings. Briefly the surgical technique included lateral knee approach, exploration and isolation of CPN, excision of the ganglion cyst, and PTFJ arthrodesis. Patients were followed up in an outpatient clinic at four weeks, three months, and then annually; the routine examination included the assessment of lateral joint stability, knee function, range of motion, and peroneal nerve assessment. The postoperative follow up was at least 24 months. Complete relief of pain was achieved two months following the surgery in all cases. Histological examination con?rmed the diagnosis in all cases. In the routine outpatient visits, no patient was presented with any sign of recurrence, CPN suffering, or any other complication. All patients had return to their normal level of activity three months following the surgery.

CONCLUSION: We believe the cyst excision and the arthrodesis can be a good option in the treatment of PTFJ ganglion cyst; however due to the presence of CPN and postero-lateral compartment adjacent to this zone, it's necessary to know the anatomy and surgical approach of PTFJ to avoid any damage to this structures, which may lead to motor or sensory deficit or lateral knee instability respectively. This video may help young surgeons learn how to approach PTFJ and manage this rare pathology.

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