Intra-Articular Ganglia of the Knee Joint Associated With the Anterior Cruciate Ligament: A Report of 4 Cases in 3 Patients

Published:November 29, 2006DOI:


      Intra-articular ganglia are rare and mostly incidental findings on magnetic resonance imaging (MRI) and arthroscopy. We present 4 cases of intra-articular ganglion cysts associated with the anterior cruciate ligament (ACL) in 3 patients. The most commonly occurring symptoms were pain aggravated after stressing activities and limited knee range of motion. In 1 patient, ganglion cysts appeared in both knees with a time difference of 1 year. An MRI revealed typical signs of ganglion cysts in the substance of the ACL. Arthroscopy was performed for further evaluation and treatment. Histologic examination of the tissue removed revealed the presence of features consistent with ganglion cysts. Therefore, in the case of chronic knee discomfort with nonspecific clinical signs and symptoms and without a clear cause, an intra-articular ganglion cyst should be considered as causing pathology. An MRI is the most sensitive and specific method for diagnosis. However, the relatively slow progression of symptoms may delay the patient’s decision to seek medical attention. Delayed diagnosis makes arthroscopic total resection of the ganglion technically demanding or not possible at all, and extensive debridement of the ACL may be required.

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        • Garcia-Alvarez F.
        • Garcia-Pequerul J.M.
        • Avila J.L.
        • Sainz J.M.
        • Castiella T.
        Ganglion cysts associated with cruciate ligaments of the knee: A possible cause of recurrent pain.
        Acta Orthop Belg. 2000; 66: 490-494
        • Nokes S.R.
        • Koonce T.W.
        • Montanez J.
        Ganglion cysts of the cruciate ligaments of the knee: Recognition on MR images and CT-guided aspiration.
        AJR Am J Roentgenol. 1994; 162 (letter): 1503
        • Deutsch A.
        • Veltri D.M.
        • Altchek D.W.
        • Potter H.G.
        • Warren R.F.
        • Wickiewicz T.L.
        Symptomatic intraarticular ganglia of the cruciate ligaments of the knee.
        Arthroscopy. 1994; 10: 219-223
        • Do-Dai D.D.
        • Youngberg R.A.
        • Lanchbury F.D.
        Intraligamentous ganglion cysts of the anterior cruciate ligament: MR findings with clinical and arthroscopic correlations.
        J Comput Assist Tomogr. 1996; 20: 80-84
        • Kang C.N.
        • Kim D.W.
        • Kim D.J.
        • Kim S.J.
        Intra-articular ganglion cysts of the knee.
        Arthroscopy. 1999; 15: 373-378
        • Sumen Y.
        • Ochi M.
        • Deie M.
        • Adachi N.
        • Ikuta Y.
        Ganglion cysts of the cruciate ligaments detected by MRI.
        Int Orthop. 1999; 23: 58-60
        • Huang G.S.
        • Lee C.H.
        • Chan W.P.
        • et al.
        Ganglion cysts of the cruciate ligaments.
        Acta Radiol. 2002; 43: 419-424
        • Krudwig W.K.
        • Schulte K.-K.
        • Heinemann C.
        Intra-articular ganglion cysts of the knee joint: A report of 85 cases and review of the literature.
        Knee Surg Sports Traumatol Arthrosc. 2004; 12: 123-129
        • Kim G.M.
        • Kim B.H.
        • Choi J.-A.
        • et al.
        Intra-articular ganglion cysts of the knee: Clinical and MR imaging features.
        Eur Radiol. 2001; 11: 834-840
        • Noda M.
        • Kurosaka M.
        • Maeno K.
        • Mizuno K.
        Ganglion cysts of the bilateral cruciate ligaments.
        Arthroscopy. 1999; 15: 867-870
        • Caan P.
        Cyst formation (ganglion) in the anterior cruciate ligament of the knee.
        Dtsch Z Chir. 1924; 186: 403-408
        • Bellelli A.
        • De Luca F.
        • Maresca G.
        • Nardis P.
        Synovial cyst of the cruciate ligament.
        Radiol Med (Torino). 1996; 92 (in Italian): 346-350
        • Maffuli N.
        • Binfield P.M.
        • King J.B.
        Isolated ganglia of the anterior cruciate ligament.
        Med Sci Sports Exerc. 1993; 25: 550-553
        • Recht M.P.
        • Applegate G.
        • Kaplan P.
        • et al.
        The MR appearance of cruciate ganglion cysts: A report of 16 cases.
        Skeletal Radiol. 1994; 23: 597-600
        • Roeser W.M.
        • Tsai E.
        Ganglion cysts of the anterior cruciate ligament.
        Arthroscopy. 1994; 10: 574-575
        • Liu S.H.
        • Kabo J.M.
        • Osti L.
        Biomechanics of two types of bone-tendon-bone graft for ACL reconstruction.
        J Bone Joint Surg Br. 1995; 77: 232-235
        • Brown M.F.
        • Dandy D.J.
        Intra-articular ganglia in the knee.
        Arthroscopy. 1990; 6: 322-323
        • Hocker K.
        • Jagenbrein G.
        • Schwarz N.
        • Ritschl P.
        Painful functional impairment of the knee joint caused by an ACL-based ganglion cyst.
        Injury. 1996; 27: 516-518
        • Johnson W.L.
        • Corzatt R.D.
        Ganglion cyst of the anterior cruciate ligament.
        Am J Sports Med. 1993; 21: 893-894
        • Steiner E.
        • Steinbach L.S.
        • Schnarkowski P.
        • Tirman P.F.
        • Genant H.K.
        Ganglion and cysts around joints.
        Radiol Clin North Am. 1996; 34: 395-425
        • Motsis E.
        • Vasiliadis H.S.
        • Xenakis T.A.
        Intraarticular synovial lipoma of the knee located in the intercondylar notch, between ACL and PCL: A case report and review of the literature.
        Knee Surg Sports Traumatol Arthrosc. 2005; 13: 683-688
        • Muddu B.N.
        • Morris F.A.
        • Fahmy N.R.
        The treatment of ganglia.
        J Bone Joint Surg Br. 1990; 72: 147
        • Tyrrell P.N.M.
        • Cassar-Pullicino V.N.
        • McCall I.W.
        Intra-articular ganglion cysts of the cruciate ligaments.
        Eur Radiol. 2000; 10: 1233-1238
        • Lektrakul N.
        • Skaf A.
        • Yeh L.
        • et al.
        Pericruciate meniscal cysts arising from tears of the posterior horn of the medial meniscus: MR imaging features that simulate posterior cruciate ganglion cysts.
        AJR Am J Roentgenol. 1999; 172: 1575-1579
        • Kumar A.
        • Bickerstaff D.R.
        • Grimwood J.S.
        • Suvarna S.K.
        Mucoid cystic degeneration of the cruciate ligament.
        J Bone Joint Surg Br. 1999; 81: 304-305
        • Kang C.N.
        • Lee S.B.
        • Kim S.W.
        Symptomatic ganglion cysts within the substance of the anterior cruciate ligament.
        Arthroscopy. 1995; 11: 612-615