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Management and outcomes of proximal tibiofibular joint ganglion cysts: A systematic review

  • Lachlan S. Huntington
    Correspondence
    Corresponding author at: Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC 3011, Australia.
    Affiliations
    Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC 3011, Australia
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  • Adrian Talia
    Affiliations
    Department of Orthopaedics, Latrobe Regional Hospital, 10 Village Avenue, Traralgon West, VIC 3844, Australia
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  • Brian M. Devitt
    Affiliations
    OrthoSport Victoria Research Unit, OrthoSport Victoria, Epworth HealthCare, Melbourne, VIC 3121, Australia
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  • Lachlan Batty
    Affiliations
    Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC 3011, Australia

    OrthoSport Victoria Research Unit, OrthoSport Victoria, Epworth HealthCare, Melbourne, VIC 3121, Australia
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      Abstract

      Background

      Proximal tibiofibular joint (PTFJ) ganglion cysts are rare; however, their optimal management remains unclear. This study aimed to systematically review the surgical treatment options with a focus on recurrence rates and complications.

      Methods

      A systematic review of the literature was performed, searching three electronic databases, according to the PRISMA guidelines. The presentation, treatment, and outcomes of PTFJ ganglion cysts of minimum 1-year follow-up was collected. Study quality was assessed using the Modified Downs and Blacks checklist. Surgical interventions were considered ordinally from simple to more extensive as follows; cyst aspiration, cyst excision, cyst excision with an intervention to the PTFJ, either a hemi-resection or arthrodesis.

      Results

      Twenty-two studies comprising 100 patients (101 knees) met inclusion criteria. Among all patients, pain was present in 59.7%, a lateral fullness in 71.6% and symptoms of the common peroneal nerve in 57.4%. The overall rate of recurrence after primary treatment was 28.9%. Recurrence rates for aspiration, cyst excision, PTFJ hemi-resection and PTFJ arthrodesis were 81.8%, 27.4%, 8.3% and 0%, respectively. Revision excision for recurrence failed in all cases. Outcomes beyond recurrence were poorly reported.

      Conclusion

      Addressing the PTFJ at the time of cyst excision reduces recurrence rates, however, the morbidity from PTFJ hemi-resection and arthrodesis are poorly reported. Whilst primary excision offers resolution in most cases (73%), revision cyst excision in isolation for the treatment of recurrent cysts is an inadequate treatment option. Cyst aspiration is ineffective. Data pertaining to patient reported outcomes for all treatment types are lacking.

      Keywords

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