Abstract
Background: Synovial cysts of the hip are commonly found in patients with intra- or extraarticular pathologies of the joint. Symptoms are mostly unspecific. To date there are no guidelines for a gold standard of treatment. Aim of this article is to show up how lesions of the ligamentum teres (LT) might possibly lead to a specific formation of synovial cysts of the hip joint and how this can be treated arthroscopically. Methods: This case series included 3 patients with ganglia of the hip. All patients had impingement symptoms, combined with untypical location of pain. All patients qualified for joint preserving surgery and underwent hip arthroscopy with pre- and postoperative MRI imaging. The mean follow-up time was 22 months. Results: MRI imaging showed extensive ganglia, presumably originating from the pelvic root of LT, extending to the obturator lodge. In 2 of 3 cases MRI showed lesions of the LT. Hip arthroscopy revealed damage of the LT in all cases, caused by chronic instability of the joint. The postoperative MRI showed a complete regression of the ganglia in all patients after offset correction. After follow-up, 2 of 3 patients were mostly symptom free. One patient was still suffering from a chronic weakness of the gluteus medius muscle. Conclusion: Whenever unspecific radiating pain of surrounding areas of the hip is encountered and cannot be explained by common pathologies of the hip, possible compression of nerves by ganglion cysts should be excluded. This should be done by MRI arthrography. A partial rupture of the LT can occur during FAI with consecutive formation of ganglia in the obturator canal, compressing the obturator nerve. Primarily the articular pathology needs to be repaired. In our cases, this was feasible by hip arthroscopy, as a minimally invasive and safe technique.
Highlights
Synovial cysts are commonly found in the shoulder or the knee joint
Aim of this article is to show up how lesions of the ligamentum teres (LT) might possibly lead to a specific formation of synovial cysts of the hip joint and how this can be treated arthroscopically
This was observed if the obturator nerve was compressed by the ganglia. (The radiating pain to the genitals might be explained by compression of the external pudendal artery and vein.) All patients described worsening of the symptoms during physical exertion, resting pain was common, especially after long sitting
Summary
Synovial cysts are commonly found in the shoulder or the knee joint. The exact cause is still unknown, the most common thesis is an excessive production of synovial fluid due to an intraarticular pathology [1] [2]. The bursa lies between the iliofemoral and the pubofemoral ligament, where the joint capsule has its thinnest portion [4] This might explain why anterosuperior cysts of the hip joint are more common than posterior cysts. The LT seems to have mechanoreceptors which help to counter micro instability by activating muscular stabilizers of the hip joint [11] Chronic instability, such as dysplasia or femoroacetabular impingement (FAI) with hypomochlion effect, can lead to recurrent overstretching of the LT and concomitant lesions [12]. Compression of peripheral nerves As synovial cysts are mostly located anteriorly of the hip joint, symptoms are mostly caused by compression of the femoral nerve. Joint related cysts, compressing the obturator nerve, are to date only described in 8 cases [15]-[22]. Compression of arteries is associated with intermittent claudicatio and coolness of the foot, whereas compression of veins where described in 40 cases, resulting in swelling of the leg [2]
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