Arthroscopic Excision of Posterior Cruciate Ligament Cysts Using a Double Posteromedial Approach

Summary

We present a surgical approach to treat posterior cruciate ligament cysts by an arthroscopic double posteromedial approach.

Abstract

Cruciate ligament cysts of the knee are a rare condition. Posterior cruciate ligament cysts of the knee are less common than anterior cruciate ligament cysts. In patients with asymptomatic isolated cruciate ligament cysts of the knee, conservative treatment is recommended. Symptomatic cruciate ligament cysts of the knee are mostly manifested as knee hyperflexion pain, straightening pain, knee discomfort after standing for a long time or walking for a long time, etc., which seriously affects the quality of life, surgical treatment can be performed. The surgical treatments can be divided into ultrasound-guided cyst puncture and fluid extraction procedure and arthroscopic cystectomy. Cysts are mostly lobulated with a multi-layer cyst wall, cyst fluid extraction does not remove the cyst wall completely but simply extracts cyst fluid, leading to a high recurrence rate. Arthroscopic surgery can completely remove the cyst wall with little trauma, a low recurrence rate, and fast postoperative recovery, so arthroscopic resection is the most common and preferred method of treatment. Since posterior cruciate ligament cysts mostly occur posterior to the ligament, we remove the cyst wall by adding a double posteromedial approach to the knee joint, and the cyst wall is removed under direct vision, which is simple to operate, the cyst wall is completely cleared, the trauma is small, the postoperative recovery is fast, and there is no recurrence. Here, 8 posterior cruciate ligament cysts were removed with complete postoperative symptom relief, no surgical complications, and no recurrence at 1-year follow-up.

Introduction

Joint cysts are cystic lesions, and the cyst fluid is a transparent jelly-like fluid that can be found in the ligament, meniscus, synovial membrane, and other parts of the knee joint^1,2. High mechanical stress can easily lead to cyst formation, which is why cysts are most common in the knee joint^3,4, and Baker's cysts are the most common type of cysts⁵. Cruciate ligament cysts of the knee are rare, occurring incidentally in 0.2% to 1.3% of cases scanned using knee magnetic resonance imaging (MRI) and in 0.6% of patients test....

Protocol

The protocol follows the guidelines of the Ethics Committee of the Third Hospital of Hebei Medical University. Informed consent was obtained from the patients for including them and the data generated as a part of this study. Patients enrolled in this study were between the ages of 18-60. A total of eight patients were included in the study, five females and three males.

1. Preoperative preparation

1. Use the following inclusion and exclusion criteria for enrolling pa.......

Discussion

Posterior cruciate ligament cyst is a rare disease. Knee ligament cysts are usually discovered during MRI or knee arthroscopy exams. The causes of knee ligament cyst formation are varied, including post-traumatic formation, synovial tissue hernia formation during embryogenesis, and mesenchymal stem cell proliferation and formation. Recently, trauma and tissue stimulation have been recognized by most experts^2,7,14.

Materials

Name	Company	Catalog Number	Comments
Arthroscopic sheath	smith&nephew	72200829	6mm
Arthroscopy	smith&nephew	72202087	30 mm x 4 mm
Beam guide	smith&nephew	72204925	5 mm x 3.6 m
Beam guide-arthroscopy end connector	smith&nephew	2143
Beam guide-panel connector	smith&nephew	2147
Blood-repellent belt	selani	tpe15100	15 cm x 1 m
Blunt puncture cone	smith&nephew	4356	4 mm
Camera	smith&nephew	72200561	NTSC/PAL
Coupler	smith&nephew	72200315
DYONICS POWER II	smith&nephew	72200873	100-24VAC, 50/60Hz
DYONICS POWERMAX ELITE	smith&nephew	72200616
Endoscopic camera system	smith&nephew	72201919	560P NTSC/PAL
HD monitor	smith&nephew	LB500031	27 inch
Hook probe	smith&nephew	3312
Incisor plus platinum shaver	smith&nephew	72202531	4.5 mm
Lumbar needle  AN-E/S	tuoren	AN-E/S	1.6 mm x 80 mm
Micropunch,teardrop,left	smith&nephew	7207602
Micropunch,teardrop,right	smith&nephew	7207601
Micropunch,teardrop,straight	smith&nephew	7207600
Pitbull Jr. Grasper	smith&nephew	14845