Risk factors for residual popliteal cyst after arthroscopic decompression and cystectomy: Associated with degenerative cartilage lesions.

BACKGROUND: In previous studies, good results have been reported after arthroscopic treatment of popliteal cysts and concomitant intra-articular pathology. However, only a few studies have reported the associated factors with residual popliteal cysts. The aim of this study was to examine the clinical and radiographic outcomes and investigate the factors associated with the recurrence of popliteal cyst after arthroscopic cyst decompression and cyst wall resection. HYPOTHESIS: The authors hypothesized that residual popliteal cyst after arthroscopic decompression and cystectomy would be associated with degenerative cartilage lesions. PATIENTS AND METHODS: From December 2010 to December 2018, 54 patients with popliteal cysts were treated with arthroscopic decompression and cyst wall resection through an additional posteromedial cystic portal. Magnetic resonance imaging (MRI) or ultrasonography was used to observe whether the popliteal cyst had disappeared or decreased. The maximum diameter of the popliteal cyst was measured after surgery. The patients were classified into the disappeared and reduced groups according to the treatment outcome. Age, sex, symptom duration, preoperative degenerative changes based on the Kellgren-Lawrence (K-L) grade, cartilage lesions according to the International Cartilage Repair Society (ICRS) grades, synovitis, functional outcomes, and associated intra-articular lesions were compared between the two groups. The functional outcome was evaluated on the basis of the Rauschning and Lindgren knee score. The study included 22 men and 32 women, with mean age of 49.6 years (range, 5-82 years). According to the ICRS grade system, 28 (51.8%) patients had grade 0 to II, 26 (48.2%) patients had grade III to IV. RESULTS: Follow-up radiographic evaluation revealed that the cyst had completely disappeared in 20 patients (37%) and reduced in size in 34 (63%). The mean cyst size was decreased significantly from 5.7cm (range, 1.7-15cm) to 1.7cm (range, 0-6.4cm), and the Rauschning and Lindgren knee score showed improved clinical features in all the patients. Between the disappeared and reduced groups, the presence of degenerative cartilage lesions (p=0.022, odds ratio 8.702, 95% confidence interval: 1.368-55.362) showed statistically significant differences. DISCUSSION: Through the posteromedial cystic portal, cysts were completely removed in approximately 40% of patients, and the size was reduced in 60% of patients. Presence of degenerative cartilage lesion represents an associated risk factor for residual popliteal cyst. These findings could be helpful in ensuring explaining poor prognostic factors. LEVEL OF EVIDENCE: IIIb; retrospective cohort study.

Endoscopic/arthroscopic decompression of the suprascapular nerve at the spinoglenoid notch: indications and surgical technique.

Suprascapular nerve compression at the spinoglenoid notch can lead to posterior shoulder pain, muscle weakness, and longstanding muscle atrophy of the infraspinatus. Although rare, it is most commonly seen in overhead athletes and laborers who perform repetitive overhead activities. Early diagnosis requires a thorough history and physical examination including imaging, diagnostic injections, and electromyography to avoid a missed diagnosis. While a course of nonoperative treatment is most often prescribed, early surgical intervention may be prudent to avoid irreversible damage especially if a space occupying lesion is present. This article will describe the history, physical examination findings, diagnostic workup, and our surgical technique for arthroscopic decompression of the suprascapular nerve at the spinoglenoid notch through a simple posterior approach avoiding the subacromial space.

A Rare Cause of Compression of the Suprascapular Nerve: The Paraglenoid Cyst.

INTRODUCTION: The ductal syndromes of the shoulder combine all the compressive processes of the suprascapular nerve at the level of its passage in the spinoglenoid notch and this for several causes. The most common is a lesion of the labrum resulting in the formation of a cyst. These cysts are rare and often underestimated. Provoking a compression of the suprascapular nerve, they are likely to cause an atrophy of the external rotator muscles of the cuff. CASE REPORT: We present a rare case of a paraglenoid cyst resulting in a ductal syndrome by suprascapular nerve compression. A 56-year-old man consulted our department for chronic pain of the left shoulder with a decrease in muscle strength. On clinical examination, the patient had a deficit of external rotation with a clear amyotrophy of the infraspinatus fossa. We opted for arthroscopic surgical resection. At the last follow-up, the patient did not show any more pain, with a total recovery of muscle strength. CONCLUSION: The clinical signs of compressive processes of the suprascapular nerve are quite misleading, so establishing a correct diagnosis and surgical management is vital before irreversible muscularatrophy takes place.

SLAP repair with arthroscopic decompression of spinoglenoid cyst.

INTRODUCTION: A spinoglenoid cyst with suprascapular nerve disorders is highly associated with superior labrum anterior posterior (SLAP) lesion. Conservative or surgical treatment is applied to relieve pain and neurological symptoms. The purpose of this study was to evaluate clinical outcomes of patients treated by arthroscopic surgery for SLAP lesion with a spinoglenoid cyst. METHODS: The subjects of this study were six patients with SLAP lesion with a spinoglenoid cyst who underwent arthroscopic surgery. There was one female and five males with a mean age of 48.5 years. SLAP lesion was found in all the patients at arthroscopy. A small tear of the rotator cuff was found in the two patients. The SLAP lesion was repaired using suture anchors, and the rotator cuff tears were repaired by suture-bridge fixation. The spinoglenoid cyst was decompressed through the torn labrum in three patients, and through the released superior to posterior portion of the capsule in the other three patients. RESULTS: All patients showed excellent improvement in pain and muscle strength at the final follow-up examination. The mean Constant score was improved from 60.5 points preoperatively to 97.2 points postoperatively. The mean visual analog scale (VAS) score decreased from 4.5 on the day of the surgery to 2.5 within one week postoperatively. Postoperative MRI showed disappearance or reduction of the spinoglenoid cyst in four and two patients, respectively. There were no complications from the surgical intervention and in the postoperative period. DISCUSSION: The patients treated by decompression through the released capsule obtained pain relief at an early period after the surgery. Arthroscopic treatment for a spinoglenoid cyst can provide a satisfactory clinical outcome. Arthroscopic decompression of a spinoglenoid cyst through the released capsule is recommended for a safe and reliable procedure for patients with suprascapular nerve disorders.

Arthroscopic management of popliteal cysts.

BACKGROUND: Management of popliteal cyst is controversial. Owing to high failure rates in open procedures, recent trend is towards arthroscopic decompression and simultaneous management of intraarticular pathology. We retrospectively analysed clinical results of symptomatic popliteal cysts after arthroscopic management at 24 month followup. MATERIALS AND METHODS: Retrospective analysis of hospital database for patients presenting with pathology suggestive of a popliteal cyst from June 2007 to December 2012 was done. Twelve cases of popliteal cyst not responding to NSAIDS and with Rauschning and Lindgren Grade 2 or 3 who consented for surgical intervention were included in the study. All patients underwent arthroscopic decompression using a posteromedial portal along with management of intraarticular pathologies as encountered. Furthermore, the unidirectional valvular effect was corrected to a bidirectional one by widening the cyst joint interface. The results were assessed as per the Rauschning and Lindgren criteria. RESULTS: All patients were followed for a minimum of 24 months (range 24-36 months). It revealed that among the study group, six patients achieved Grade 0 status while five had a minimal limitation of range of motion accompanied by occasional pain (Grade 1). One patient had a failure of treatment with no change in the clinical grading. CONCLUSION: Arthroscopic approach gives easy access to decompression with the simultaneous management of articular pathologies.

Arthroscopic decompression of paralabral cyst around suprascapular notch causing suprascapular neuropathy.

A case of 22 year old male gymnast, who suffered from suprascapular neuropathy due to compression of suprascapular nerve by paralabral cysts around suprascapular notch, leading to marked atrophy of supraspinatus and infraspinatus muscles. After arthroscopic decompression of paralabral cysts, weakness and atrophy of the supraspinatus and infraspinatus muscles improved.

Current UK practices in the management of subacromial impingement.

BACKGROUND: Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. METHODS: BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. RESULTS: Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. CONCLUSIONS: Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections.

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.