Arthroscopic Excision of a Deep Infrapatellar Cyst
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PROVIDER: S-EPMC11369953 | biostudies-literature | 2024 May
REPOSITORIES: biostudies-literature
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Project description:Popliteal cysts are known to be associated with intra-articular pathology, which must be addressed to prevent cyst recurrence. Indications for popliteal cyst excision include cases in which the popliteal cyst does not respond to conservative treatment or arthroscopic intervention or cases in which an underlying cause cannot be found. Several techniques have been described to excise these cysts. Traditionally, open techniques have been associated with cyst recurrence. More recently, arthroscopic cystectomy has been described. However, the risk of recurrence persists because arthroscopy may not afford complete surgical excision. This technical note presents an open posterior technique for popliteal cyst excision that allows for better visualization and complete removal of the cyst while minimizing the risk of neurovascular complications and soft-tissue damage. It is a safe, effective, and straightforward method to achieve symptomatic relief for refractory popliteal cysts.
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Project description:Posterior cruciate ligament (PCL) cysts are rare. Although they are usually asymptomatic and benign, in a few cases they may cause knee discomfort and restricted movements. Nonsurgical treatment is the initial approach, with medication and corticosteroid injections. However, there may be treatment failures, with some cysts needing to be excised surgically. Arthroscopic excision of PCL cysts located in the posterior compartment of the knee can be technically challenging. We describe the arthroscopic excision of a PCL cyst using a trans-septal portal, which is an easy and safe method for accessing and completely removing the lesion under direct vision.
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Project description:ObjectivesArthroscopic excision of dorsal wrist ganglion (DWG) cysts has recently become an alternative to open surgery, with the advantage of lower recurrence. However, in recurrent cases, whether re-excision using an arthroscopic approach would achieve favorable outcomes has not been determined. This study aimed to evaluate the clinical outcomes of function evaluation and recurrence rate after arthroscopic excision of recurrent DWG cysts.MethodsA total of 11 consecutive patients with clinically diagnosed recurrent DWG cysts were retrospectively reviewed between November 2017 and March 2020. Extensive re-excision of the ganglion cyst and its surrounding pathological capsule was performed using an arthroscopic approach. Magnetic resonance imaging (MRI) was routinely performed before surgery to identify the location and limits of the cyst. All patients were followed up for a minimum of 2 years. A second recurrence was recorded if a mass reappeared at the same site with a positive transillumination test. Pain during activity was evaluated using the visual analog scale (VAS). The active range of motion (ROM) of the wrist was measured using a goniometer, and the hand grip strength was measured using a digital dynamometer. Comparative analysis between the pre- and postoperative indexes was performed using Student's t-test.ResultsAfter a mean follow-up period of 29.3 months (range, 24-34 months), no second recurrence of the cyst was recorded. The VAS score improved from 1.4 to 0.3 (t = 3.833, p = 0.003), and residual pain was reported by three patients (VAS score = 1 for each). Active wrist flexion increased from 73.6° to 78.2° (t = 2.887, p = 0.016). No significant changes were found in active wrist extension or hand grip strength (p > 0.05). No major complications occurred during the study.ConclusionArthroscopic excision of a recurrent DWG cyst yielded satisfactory results with no second recurrence, significant pain relief, and good wrist function at a minimum of 2-year follow-up. Clear identification of the location and limits of the ganglion based on preoperative MRI could be helpful to achieve complete excision and therefore prevent a second recurrence.
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Project description:The infrapatellar fat pad (IFP), also known as Hoffa's fat pad, may be a common site of pain in the knee because of its susceptibility to injury and its vast innervation and vascular supply. Patients who have trauma to the IFP may undergo a process of hemorrhage, inflammation, and fibrosis that may become painful. Patients with Hoffa's disease in whom conservative treatment with medications, physical therapy, and injections has failed may receive significant pain relief and benefit from undergoing arthroscopic subtotal removal of the IFP. We describe a safe and effective way to perform this procedure allowing excellent visualization through the use of a superolateral viewing portal.
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Project description:A bipartite patella usually presents as an incidental finding on radiographs because most cases are asymptomatic. However, some patients may present with pain and functional limitations. Conservative treatment is sufficient to resolve symptoms in most cases; however, a small minority of patients may require surgical management. Recent studies have reported excellent results with an arthroscopic approach. This Technical Note details our procedure for treating a symptomatic bipartite patella that has not resolved with conservative care.
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Project description:PurposeTo describe a novel surgical technique using trypan blue assistance for iris cyst excision.MethodsWith viscoelastic in the anterior chamber, the cyst contents are aspirated with a 27G needle. Trypan blue is then injected into the residual cyst cavity to stain its walls. Forceps and anterior vitrectomy are utilized to ensure complete removal of the cyst wall with a safe margin of surrounding iris tissue.ResultsThe trypan blue-assisted technique facilitates cyst visualization, enabling precise and complete cyst removal.ConclusionsTrypan blue-assisted excision provides an effective approach for iris stromal cyst removal, minimizing recurrence risk and enhancing surgical precision.
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Project description:Osteoarthritis changes at the sternoclavicular joint (SCJ) have been shown to be present on computed tomography in more than 90% of people over the age of 60 years. Although usually asymptomatic, when symptoms do occur, they can be very debilitating. Most patients respond favorably to conservative treatment, but there is a small cohort of patients who continue to be symptomatic despite adequate conservative treatment. Surgical management with an open SCJ excision has been shown to give satisfactory results. However, probably due to concerns with regard to damage to the mediastinal structures, instability, and scarring, there is a high threshold for surgery. Arthroscopic SCJ excision has been shown to achieve similar results to an open procedure while avoiding some of the risks. In this Technical Note, we describe the indications, imaging, and the technique of an arthroscopic excision of the SCJ.
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Project description: Not available
| S-EPMC7145223 | biostudies-literature
Project description:The surgical technique for the management of a symptomatic os acromiale remains unclear. Several operative techniques have been described including open excision, open reduction-internal fixation (ORIF), arthroscopic acromioplasty or subacromial decompression, and arthroscopic excision. There are 4 types of os acromiale, with the meso-acromion being the most common and difficult to treat. The excision of a pre-acromion arthroscopically or in an open manner usually produces satisfactory results. However, the open excision of a meso-acromion can lead to persistent pain and deltoid weakness and atrophy. The management of a meso-acromial fragment with ORIF can also result in persistent pain and deltoid weakness and atrophy with nonunion of the fragments. The purpose of this article is to describe an alternative surgical technique to open excision or ORIF when presented with a symptomatic meso-acromiale.
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Project description:Ganglions are common soft tissue masses of the hand. High recurrence rates are associated with nonsurgical treatment; thus, excision is often indicated. Arthroscopic excision and open excision have similar recurrence rates; however, the latter is associated with prolonged healing time and increased scarring. Recently, dry wrist arthroscopic techniques have been used. This technique allows easier confirmation of complete ganglion removal, easier conversion to open surgery, earlier return of motion, and stitch-less closure when compared with traditional "wet" arthroscopic excision.
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