The Follow Up Results of Residual Spinoglenoid Ganglion Cyst after Arthroscopic Decompression and Superior Labral Repair: Cases Report

PURPOSE: There are many known treatment modalities for spinoglenoid ganglion cyst accompanied by suprascapular nerve palsy. However, to the author's knowledge, there is no report on the follow-up outcomes focused on remnant cysts. MATERIALS AND METHODS: Six (n=6) patients with spinoglenoid ganglion cyst accompanied by suprascapular nerve palsy, with a mean follow-up of 15 months (12-23months) following arthroscopic cyst decompression and superior labral repair, were enrolled. Residual cyst was investigated by ultrasonography and MRI. RESULTS: Immediate postoperative ultrasonography revealed complete remission of ganglion cyst in one patient and reduced ganglion cyst size in five patients. Three-month follow-up ultrasonography showed spontaneous complete remission of the residual cysts in all patients. No recurrence on MRI was seen at one-year follow-up. CONCLUSION: Residual spinoglenoid ganglion cyst remaining after arthroscopic decompression and superior labral repair tends to resolve spontaneously within 3 months of surgery.

Arthroscopic Treatment of Popliteal Cysts using the Trans-Septal Approach

PURPOSE: The purpose of this study is to evaluate the usefulness of the trans-septal approach for treating popliteal cyst, to determine the frequency and types of the associated pathologies and to assess the follow up ultrasound evaluation. MATERIALS AND METHODS: From February, 2002 to February, 2007, 44 patients with popliteal cyst were treated by arthroscopy only. Fourteen patients were male and 30 patients were female. Their average age was 50 years (range: 20~77 years). We used the trans-septal portal approach. We evaluated the satisfaction of the patients and the recurrence of the popliteal cyst by performing ultrasound exams at an average follow up of 36 months after surgery. At the final follow up, we evaluated the clinical results by the criteria of Rauschning and Lindgren. RESULTS: We found no communication between the knee joint and the popliteal cyst by CT or MRI in 4 cases (8%), but we found a communication by arthroscopy in all the cases. Thirty-four cases had intra-articular pathologies and 9 cases didn't. The total intra-articular pathologies included 17 articular cartilage defects or chondral lesion (38%) and 15 meniscus tears (34%). In 1 case, open excision was performed for the revision surgery because the patient had recurrence of the popliteal cyst, which caused compressive neuropathy of the common peroneal and tibial nerve. At the last follow up, the clinical outcome of surgery according to the criteria of Rauschning and Lindgren was grade 0 (28 cases), grade1 (12 cases), grade 2 (3 cases) and grade 3 (1 case). CONCLUSION: We can approach the orifice of a popliteal cyst directly with using the trans-septal portal and easily decompress the orifice of the cyst. We propose that the arthroscopic decompression using the trans-septal portal is an excellent treatment modality for popliteal cysts.

Arthroscopic Decompression and Shaving of Popliteal Cyst Using Posteromedial Portal: Technical Note

PURPOSE: To present the surgical procedure of arthroscopic decompression and shaving of popliteal cyst using posteromedial portal. OPERATIVE TECHNIQUE: After diagnostic knee arthroscopic examination, if there is associated intra-articular pathology with popliteal cyst, appropriate arthroscopic procedure has to be performed to adress the associated intra-articular pathology. It is the most important procedure to find the opening of connection between joint cavity and popliteal cyst at posteromedial compartment using anterolateral or posteromedial In some cases the capsular fold overlie the opening of connection, so thorough diagnostic examnation is mandatory. When the opening of connection is visualized, it is enlarged about 8 mm by the arthroscopic decompressive procedure of popliteal cyst using arthroscopic shaver which is approached via the posteromedial portal. After then arthroscope is positioned at posteromedial portal and advanced into popliteal cyst via enlarged opening to visualize the inside of popliteal cyst. While visualizing the inside of popliteal cyst, a 18 gauge spinal needle is introduced by outside-in technique from medial side of the skin overlying popliteal cyst. And then we make trans-cystic portal at the site of spinal needle by incising the skin with # 11 blade and arthroscopic shaver is introduced within popliteal cyst via trans-cystic portal, and arthroscopic cystectomy is performed to shave the inner wall of popliteal cyst with arthroscopic shaver. DISCUSSION: The arthroscopic procedure for popliteal cyst is an alternative of traditional surgical removal of popliteal cyst and it is expected to diagnose and to manage associated intra-articular pathology and to perform arthroscopic decompression and cystectomy effectively using posteromedial portal.

Arthroscopic Treatment of Meniscal Cysts

PURPOSE: To assess the efficacy of arthroscopic decompression of the meniscal cyst. MATERIAL AND METHOD: From January 1996 to December 1997, 8 patients with meniscal cyst were treated by arthroscopic cyst decompression as well as partial meniscectomy of torn menisci. The average follow-up was 18.8 months(range: 12~35 months). There were 6 men and 2 women and the average age was 38.1 years(range: 26 to 56 years). Six(75%) patients had no history of trauma associated with their symptoms. All the meniscal cysts were associated with horizontal tear of the menisci. The arthroscopic partial meniscectomy consisted of gentle trimming of leading edge of the superior leaf and excision out to peripheral rim of the inferior leaf, followed by intraarticular cyst decompression using probe, punch for-ceps or shaver with pressure over the cyst. Postoperative results were assessed according to the evaluation form of Glasgow et al. RESULT: The ratio of medial-to-lateral cyst formation was 1:1. Meniscal cysts were always associated with horizontal tears of the meniscus. The patterns of horizontal tear consisted of 2 horizontal/cleav-age(25%), 2 horizontal/flap(25%), and 4 horizontal/ degenerative complex tears(50%). The sites of meniscal tears were the posterior horn-midbody junction of the medial meniscus in 4, the anterior horn-midbody junction of the lateral meniscus in 3 and the midbody of the lateral meniscus in 1. We could get excellent or good results in all the patients with no recurrence of the cyst. CONCLUSIONS: The treatment of the meniscal cyst can be entirely arthroscopic(partial meniscectomy and intraarticular decompression of the cyst) with predictable success.