Ganglion cysts of the anterior cruciate ligament: a series of 15 cases.

PURPOSE: To increase awareness of the presence of ganglion cysts of the anterior cruciate ligament and to consider this diagnosis in any knee that has lost range of motion (ROM) in the absence of osteoarthritis. TYPE OF STUDY: Case series. METHODS: We present a series of 15 cases recorded over a period of 5 years illustrating the clinical presentation and additional pathology seen at arthroscopy. International Knee Documentation Committee scores were calculated at the recent follow-up to establish outcome of the surgery. RESULTS: The cysts occurred predominantly in men with the most common presenting complaint being decreased ROM and pain. Overall, results were excellent with no recurrence of symptoms at a mean 36-month follow-up, but outcome does appear to be associated with other pathology present. ROM was improved with arthroscopic excision of the cyst in all cases that were impaired. CONCLUSIONS: Although rare, ganglion cysts related to the cruciate ligaments of the knee should be considered in the differential diagnosis of a painful knee especially when associated with a decreased ROM and no evidence of osteoarthritis on radiographs. Other pathology can often be present, which may affect the overall outcome, but arthroscopic debridement of the ganglion cyst should be considered the treatment of choice in order to reliably restore active ROM. LEVEL OF EVIDENCE: Level IV, Case Series.

Surgical reconstruction of severe patellofemoral maltracking.

Dysfunction of the patellofemoral mechanism presents in many ways. Results from different realignment procedures show great variability in patient outcome. A surgical technique is presented that attempts to correct all the abnormalities of patellofemoral maltracking. The procedure consists of a lateral release, a vastus medialis (obliquus) tendon advancement, and a tibial tubercle transfer. Along with being moved medially, the tubercle also is moved distally to correct patella alta and elevated anteriorly to reduce patellofemoral joint reaction forces. One hundred seven knees in 84 patients were reviewed. Fifty-five percent of patients had frank dislocation. The remaining patients had anterior knee pain and had abnormal patella tracking on examination. The mean followup was 5.6 years. Seventy-nine percent of patients had a good to excellent functional outcome and 84% of patients stated they would have the operation again. Two patients with marked generalized ligamentous laxity had recurrent dislocation of the patella.