Ganglion Cysts of the Proximal Tibiofibular Joint: Low Risk of Recurrence After Total Cyst Excision.

Autor:	Papanastassiou ID; I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias 'Agioi Anargyroi,' Athens, Greece.; I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, 'ATTIKON' University General Hospital, Athens, Greece.; K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, 'KAT' General Hospital, Athens, Greece., Tolis K; I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias 'Agioi Anargyroi,' Athens, Greece.; I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, 'ATTIKON' University General Hospital, Athens, Greece.; K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, 'KAT' General Hospital, Athens, Greece., Savvidou O; I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias 'Agioi Anargyroi,' Athens, Greece.; I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, 'ATTIKON' University General Hospital, Athens, Greece.; K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, 'KAT' General Hospital, Athens, Greece., Fandridis E; I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias 'Agioi Anargyroi,' Athens, Greece.; I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, 'ATTIKON' University General Hospital, Athens, Greece.; K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, 'KAT' General Hospital, Athens, Greece., Papagelopoulos P; I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias 'Agioi Anargyroi,' Athens, Greece.; I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, 'ATTIKON' University General Hospital, Athens, Greece.; K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, 'KAT' General Hospital, Athens, Greece., Spyridonos S; I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias 'Agioi Anargyroi,' Athens, Greece.; I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, 'ATTIKON' University General Hospital, Athens, Greece.; K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, 'KAT' General Hospital, Athens, Greece.
Jazyk:	angličtina
Zdroj:	Clinical orthopaedics and related research [Clin Orthop Relat Res] 2021 Mar 01; Vol. 479 (3), pp. 534-542.
DOI:	10.1097/CORR.0000000000001329
Abstrakt:	Background: Peroneal nerve neuropathy due to compression from tumors or tumor-like lesions such as ganglion cysts is rare. Few case series have been published and reported local recurrence rates are high, while secondary procedures are frequently employed. Questions/purposes: (1) What are the demographics of patients with ganglion cysts of the proximal tibiofibular joint, and what proportion of them present with intraneural cysts and peroneal nerve palsy? (2) What Musculoskeletal Tumor Society (MSTS) scores do patients with this condition achieve after decompression surgery with removal of the ganglion cyst, but no arthrodesis of the tibiofibular joint? (3) What proportion of patients experience local recurrence after surgery? Methods: Between 2009 to 2018, 30 patients (29 primary cases) were treated for chronic peroneal palsy or neuropathy due to ganglion cysts of the proximal tibiofibular joint at two tertiary orthopaedic medical centers with total resection of the cystic lesion. MRI with contrast and electromyography (EMG) were performed preoperatively in all patients. The minimum follow-up for this series was 1 year (median 48 months, range 13 to 120); 14% (4 of 29) were lost to follow-up before that time. The MSTS score was recorded preoperatively, at 6 weeks postoperatively, and at most-recent follow-up. Results: A total of 90% of the patients were male (26 of 29 patients) and the median age was 67 years (range 20 to 76). In all, 17% (5 of 29) were treated due to intraneural ganglia. Twenty-eight percent (8 of 29) presented with complete peroneal palsy (foot drop). The mean MSTS score improved from 67 ± 12% before surgery to 89 ± 12% at 6 weeks postoperative (p < 0.001) and to 92 ± 9% at final follow up (p = 0.003, comparison with 6 weeks postop). All patients improved their scores. A total of 8% (2 of 25 patients) experienced local recurrence after surgery. Conclusion: Ganglion cysts of the proximal tibiofibular joint occurred more often as extraneural lesions in older male patients in this small series. Total excision was associated with improved functional outcome and low risk of neurologic damage and local recurrence, and we did not use any more complex reconstructive procedures. Tendon transfers may be performed simultaneously in older patients to stabilize the ankle joint, while younger patients may recover after decompression alone, although larger randomized studies are needed to confirm our preliminary observations. Level of Evidence: Level IV, therapeutic study. Competing Interests: Each author certifies that neither he nor she, nor any member of his or her immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. (Copyright © 2020 by the Association of Bone and Joint Surgeons.)
Databáze:	MEDLINE
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