Acta Chir Orthop Traumatol Cech. 2008; 75(4):301-305 | DOI: 10.55095/achot2008/054

Double Synovial Cyst of the Proximal Tibiofibular Joint Confirmed by MRI as a Cause of the Peroneal Tunnel SyndromeCase report

H. I. PEĈINA1,*, I. BORIĈ1, T. C. PEĈINA2, T. SMOLJANOVIĈ3, M. PEĈINA3
1 Department of Radiology Clinical Hospital "Sestre Milosrdnice", Zagreb, Croatia
2 Department of Radiology Clinical Hospital Dubrava, Zagreb, Croatia
3 Department of Orthopaedic Surgery School of Medicine University of Zagreb, Croatia

The aim of this case report is to present an unusual double synovial cyst that arose from the proximal tibiofibular joint compressing the peroneal nerve in the peroneal tunnel and was unrecognized at the beginning. According to the review of literature back to 1891, only 62 cases of cysts originating from the proximal tibiofibular joint (PTFJ) have been described. We report a case of a 32 year old male patient who was admitted to the Department of Orthopaedic Surgery because of a classic peroneal tunnel syndrome of the left leg. On the lateral side of the proximal third of his left leg a tumefaction of 12 x 2.5 cm was visible. The sonography showed a characteristic image of the para-articular synovial cyst of the left knee. A surgical extirpation of the synovial cyst and decompression of the peroneal nerve in the peroneal tunnel were performed. PHD confirmed a classic synovial cyst. Postoperatively, the symptoms of the peroneal nerve compression disappeared. Three years after the first surgical intervention the patient was readmitted to the Department because of quite similar problems, only the neurological symptoms were less intensive than during the first admittance. This time the performed MR imaging showed a double synovial cyst originating from the proximal tibiofibular joint. The surgical treatment consisted of a total extirpation of both cysts including the narrow stalks of communication with the PTFJ. The joint was opened and a synovectomy was done using an electrocauter and a sharp curette. Regular check-ups were done every 6 months and twice during the control period of 4 years, as was the MR imaging control. MRI findings 4 years after the second surgical intervention were normal. Clinical findings after 7 years were normal and we are sure that the recidivation of the synovial cyst excluded. The MRI diagnostics was crucial for an adequate surgical treatment and the relief of the peroneal tunnel syndrome symptoms.

Keywords: proximal tibiofibular joint, synovial cyst, peroneal nerve compression, MRI diagnostics

Accepted: April 2, 2008; Published: August 1, 2008  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
PEĈINA HI, BORIĈ I, PEĈINA TC, SMOLJANOVIĈ T, PEĈINA M. Double Synovial Cyst of the Proximal Tibiofibular Joint Confirmed by MRI as a Cause of the Peroneal Tunnel Syndrome. Acta Chir Orthop Traumatol Cech. 2008;75(4):301-305. doi: 10.55095/achot2008/054. PubMed PMID: 18760088.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. ANDERSON, C., SOGARD, I.: Peroneal paresis caused by a ganglion. Compression of the deep peroneal nerve caused by a ganglion cyst. Ugeskr. Laeger., 152:1598, 1990.
    2. BARRIE, T. W., BARRINGTON, T. W., CARWILL, J. C., SIMMONS, E. H.: Ganglion migrans of the proximal tibio-fibular joint causing lesions in the subcutaneous tissue, muscle, bone or peroneal nerve. Report of three cases and review of the literature. Clin. Othop., 149:211-215, 1986. Go to original source...
    3. BIANCHI, S., ABDELWAHAB, I. F., KENAN, S., ZWASS, A., RICCI,G., PALOMBA, G.: Intramuscular ganglia arising from the superior tibiofibular joint. CT and MR evaluation. Skeletal Radiol., 24 : 253-256, 1995. Go to original source... Go to PubMed...
    4. BURK, D. L., DALINKA, M. K., KANAL, E., SCHIEBLER, M. L., COHEN, E. K., POROK, R. J., GEFTER, W. B., KRESSEL, H. Y.: Meniscal and ganglion cysts of the knee: MR evaluation. AJR,150:331-336, 1988. Go to original source... Go to PubMed...
    5. DAMRON, T. A., ROCK, M. G.: Unusual manifestations of proximal tibiofibular joint synovial cysts. Orthopedics, 20:225-230, 1997. Go to original source... Go to PubMed...
    6. De SCHRIJVER, F., SIMON, J. P., De SMET, L., FABRY, G.: Ganglia of the superior tibiofibular joint: report of three cases and review of the literature. Acta orthop., belg., 64:233-241, 1998. Go to PubMed...
    7. EVANS, J. D., NEUMAN, L., FROSTICK, S. P.: Compression neuropathy of the common peroneal nerve caused by a ganglion. Microsurgery, 15:193-195, 1994. Go to original source... Go to PubMed...
    8. GAYET, L. E., MORAND, F., GOUJON, J. M., PRIES, P., CLARAC, J. P.: Compression of the peroneal nerve by cyst in a seven-year-old child. Europ. J. Pediat. Surg., 8:61-63, 1998. Go to original source... Go to PubMed...
    9. GIBBON, A. J., WARDELL, S. R., SCOTT, R. D.: Synovial cyst of the proximal tibiofibular joint with peroneal nerve compression after total knee arthroplasty. J. Arthroplasty, 14:766-768, 1999. Go to original source... Go to PubMed...
    10. HERSEKLI, M. A., AKPINAR, S., DEMIRORS, H., OZKOC, G., OZALAY, M., CESUR, N., UYSAL, M., TANDOGAN, R. N.: Synovial cysts of proximal tibiofibular joint causing peroneal nerve palsy: report of three cases and review of the literature. Arch. Orthop. Traum. Surg., 124:711-714. 2004. Go to original source... Go to PubMed...
    11. JEROME, D., McKENDRY, R.: Synovial Cyst of the Proximal Tibiofibular Joint. J. Rheumatol., 27:1096-1098, 2000.
    12. KAPOOR, V., THERUVIL, B., BRITON, J. M.: Excision arthroplasty of superior tibiofibular joint for recurrent proximal tibiofibular cyst. A report of two cases. J. Bone Spine,71:427-429, 2004. Go to original source... Go to PubMed...
    13. KELM, J., AMES, M., WEISSENBACH, P., ENGEL, C.: A ganglion of the superior tibiofibular joint as a mucoid-cystic degeneration of unusual localization. A case report and review of the literature. Knee Surg. Sports Traumatol. Arthrosc., 6:62-66, 1998. Go to original source... Go to PubMed...
    14. LENNANDER, K. G.: Ett stort ganglion pa underbenet. Ups. Lak. Forb., 27:419, 1891-1892.
    15. McCARTHY, C. L., McNALLY, E. G.: The MRI appearance of cystic lesions around the knee. Skeletal Radiol., 33:187-209, 2004. Go to original source... Go to PubMed...
    16. MORTAZAVI, S. M., FARZAN, M., ASADOLLAHI S.: Proximal tibiofibular joint synovial cyst-one pathology with three different presentaions. Knee Surg. Sports Traumatol. Arthrosc., 14:875-879, 2006. Go to original source... Go to PubMed...
    17. MUCKART, R. D.: Compression of the common peroneal nerve by intramuscular ganglion from the superior tibio-fibular joint. J. Bone Jt Surg., 58:241-244, 1976. Go to original source... Go to PubMed...
    18. PAGNOUX, C, LHOTELLIER, L, MAREK, J. J, BALLARD, M., CHAZERAIN, P., ZIZA, J.: Synovial cysts of the proximal tibiofibular joint: three case reports. J. Bone Spine, 69:331-333, 2002. Go to original source... Go to PubMed...
    19. PEĈINA, M. M., KRMPOTIĈ-NEMANIĈ, J., MARKIEWITZ, A. D.: Tunnel Syndromes. Peripheral Nerve Compression Syndromes. Boca Raton, London, New York, Washington, D.C., CRC Press 2001.
    20. STACK, R. E., BIANCO, A. J, MACCARTY, C. S.: Compression of the common peroneal nerve by ganglion cysts. J. Bone Jt. Surg. Amer., 47-A:773-778, 1965. Go to original source...
    21. STENER, B.: Unusual ganglion cysts in the neighbourhood of the knee joint. Acta orthop. scand., 40:393-401, 1969. Go to original source... Go to PubMed...

    Return to the content