Abstract
A 20-year-old male medical student and keen rugby player presented with a 12-month history of progressively worsening right knee pain and stiffness with no history of trauma. Clinical examination revealed effusion and posterior knee pain exacerbated by end range movement and an extension lag of 15 degrees. Physiotherapy to improve the range of motion proved unsuccessful. Magnetic resonance imaging showed that the ACL was grossly thickened and displaced by material reported as mucoid in nature. There were also areas of focally high signal in relation to its tibial attachment and intra osseous small cysts. Arthroscopic examination revealed a ganglion related to the tibial attachment of the ACL and gross thickening and discoloration of the ACL. Biopsies were taken showing foci of mucoid degeneration in the ACL. A large intra-ACL mass of brownish coloured tissue was excised arthroscopically. Already at 2 weeks follow up the patient had greatly improved range of movement and was pain free. However, upon returning to rugby, joint instability was noticed and a tear of the ACL was confirmed.This rare clinical condition can be diagnosed with MRI and arthroscopic debridement effectively relieves symptoms. This case report illustrates that augmentation or reconstruction may end up being the definitive treatment for athletes. It may also offer some support to the argument that mucoid degeneration and ganglion cyst formation share a similar pathogenesis to intra-osseous cyst formation.
Highlights
A ganglion is a cystic lesion containing mucin-rich fluid associated with a joint or tendon sheath [1]
Bergin et al reported on the co-existence of mucoid degeneration and ganglia of the anterior cruciate ligament (ACL)
In this report we describe a case of intra ACL mucoid degeneration and ganglion cyst combined with intraosseous cysts in a 20-year-old medical student and keen rugby player who had to stop playing because of gradually increasing dysfunction of his knee
Summary
A ganglion is a cystic lesion containing mucin-rich fluid associated with a joint or tendon sheath [1]. Ganglia of the anterior cruciate ligament (ACL) are uncommon. The prevalence of ganglia associated with the ACL is reported to be 0.12–0.44% on MRI [2,3]. The prevalence of mucoid degeneration of the ACL has been reported to be 0.43% [5].
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