Treatment Of A Cruciate Associated Cyst In A Collegiate Rower

Abstract

HISTORY: A 20 year old female collegiate rower presents to the training room with gradual onset of right knee pain and decreased range of motion. She is unable to identify specific time or mechanism of injury. Her pain is in the posterior knee and worsens with knee flexion and extension against resistance. She particularly notices this while on the ergometer and has had to completely halt her training regimen. She has no history of prior knee injury. PHYSICAL EXAMINATION: The right knee is without obvious deformity, erythema or effusion. There is tenderness to palpation of the popliteal space, there is no palpable lesion. Range of motion is limited at full flexion. She has pain with full flexion and extension against resistance. Lachman is intact though produces pain. Posterior drawer and valgus/varus testing are intact. The remainder of the knee exam is unremarkable. DIFFERENTIAL DIAGNOSIS: 1. ACL sprain. 2. Popliteal cyst 3. Meniscus injury TEST AND RESULTS: Point of care US: No effusion. No Baker's cyst. Xray right knee: No osseous abnormalities. MRI right knee: Cystic lesion centered at the junction of the posteromedial ACL and lateral meniscal root bundles FINAL/WORKING DIAGNOSIS: Ganglion cyst associated with the ACL/meniscus. TREATMENT AND OUTCOMES: The athlete worked closely with her ATs on a rehab protocol with no improvement in symptoms. Injection therapy with corticosteroid versus arthroscopic intervention were discussed. Ultimately, she was taken to the operating room for successful arthroscopic debridement of the cyst. She was able to return to rowing within weeks of surgery and did not miss any competition.