Proximal Tibiofibular Joint Ganglion Cysts

Abstract

Objective Proximal tibiofibular joint proximal tibiofibular joint cysts are rare entities that can cause disability. Excision remains the traditional surgical treatment. Cyst recurrence has been a problem. This study reviews one of the largest series of patients with proximal tibiofibular joint cysts and evaluates the role of a new surgical option, proximal tibiofibular joint fusion. Methods Thirteen patients were admitted to the institution between 1987 and 1999. Diagnoses were confirmed by magnetic resonance imaging and histological examination. A database was compiled after medical record review. Patients completed a phone survey describing activity levels, symptom severity, recurrence history, and additional surgery. Average postoperative follow-up and average time to date of survey were 1.7 and 6.3 years, respectively. Results Patient complaints included lateral knee “fullness” (75%) and peroneal nerve dysesthesias (54%). Twelve patients opted for surgery: cyst excision (8) and cyst excision with proximal tibiofibular joint fusion (4). A recurrence rate of 13% (1 of 8) following primary excision was observed. A 100% (3 of 3) repeat recurrence rate was noted in second resections. Four patients underwent proximal tibiofibular joint fusion: 2 with a recurrence history and 2 for primary treatment. At follow-up, all fusion patients were without cyst recurrence or activity limitations. Procedure morbidity was minimal. Conclusions Proximal tibiofibular joint cysts can recur after simple excision. Repeat resection after a recurrence is often not effective. Proximal tibiofibular joint arthrodesis appears to be a more effective surgical option after a recurrence.