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Skeletal Radiology

, Volume 33, Issue 4, pp 187–209 | Cite as

The MRI appearance of cystic lesions around the knee

  • Catherine L. McCarthy
  • Eugene G. McNally
Review Article

Abstract

This review presents a comprehensive illustrated overview of the wide variety of cystic lesions around the knee. The aetiology, clinical presentation, MRI appearances and differential diagnosis are discussed. Bursae include those related to the patella as well as pes anserine, tibial collateral ligament, semimembranosus–tibial collateral ligament, iliotibial and fibular collateral ligament–biceps femoris. The anatomical extension, imaging features and clinical significance of meniscal cysts are illustrated. Review of ganglia includes intra-articular, extra-articular, intraosseous and periosteal ganglia, highlighting imaging findings and differential diagnoses. The relationship between proximal tibiofibular joint cysts and intraneural peroneal nerve ganglia is discussed. Intraosseous cystic lesions, including insertional and degenerative cysts, as well as lesions mimicking cysts of the knee are described and illustrated. Knowledge of the location, characteristic appearance and distinguishing features of cystic masses around the knee as well as potential imaging pitfalls such as normal anatomical recesses and atypical cyst contents on MR imaging aids in allowing a specific diagnosis to be made. This will prevent unnecessary additional investigations and determine whether intra-articular surgery or conservative management is appropriate.

Keywords

Knee Cysts Bursa Ganglia Magnetic resonance imaging 

References

  1. 1.
    Steiner E, Steinbach LS, Schnarkowski P, Tirman PFJ, Genant HK. Ganglia and cysts around joints. Radiol Clin North Am 1996; 34:400–410.Google Scholar
  2. 2.
    Fielding JR, Franklin PD, Kustan J. Popliteal cysts: a reassessment using magnetic resonance imaging. Skeletal Radiol 1991; 20:433–435.PubMedGoogle Scholar
  3. 3.
    Miller TT, Staron RB, Koenigsberg T, Levin TL, Feldman F. MR imaging of Baker cysts: association with internal derangement, effusion and degenerative arthropathy. Radiology 1996; 201:247–250.PubMedGoogle Scholar
  4. 4.
    Ward EE, Jacobson JA, Fessel DP, Hayes CW, Van Holsbeeck M. Sonographic detection of Baker’s cysts: comparison with MR imaging. AJR Am J Roentgenol 2001; 176:373–380.PubMedGoogle Scholar
  5. 5.
    Torreggiani WC, Al-Ismail K, Munk PL, et al. The imaging spectrum of Baker’s (popliteal) cysts. Clin Radiol 2002; 57:681–691.CrossRefPubMedGoogle Scholar
  6. 6.
    Handy JR. Popliteal cysts in adults: a review. Semin Arthritis Rheum 2001; 31:108–118.CrossRefPubMedGoogle Scholar
  7. 7.
    De Maeseneer M, Debaere C, Desprechins B, Osteaux M. Popliteal cysts in children: prevalence, appearance and associated findings at MR imaging. Pediatr Radiol 1999; 29:605–609.CrossRefPubMedGoogle Scholar
  8. 8.
    Hermann G, Yeh HC, Lehr-Janus C, Berson BL. Diagnosis of popliteal cyst: double contrast arthrography and sonography. AJR Am J Roentgenol 1981; 137:369–372.PubMedGoogle Scholar
  9. 9.
    Janzen DL, Peterfy CG, Forbes JR, Tirman PFJ, Genant HK. Cystic lesions around the knee joint: MR imaging findings. AJR Am J Roentgenol 1994;163:155–161.PubMedGoogle Scholar
  10. 10.
    Goldberg RP, Genant HK. Calcified bodies in popliteal cysts: a characteristic radiographic appearance. AJR Am J Roentgenol 1978; 131:857–859.PubMedGoogle Scholar
  11. 11.
    Forbes JR, Helms CA, Janzen DL. Acute pes anserine bursitis: MR imaging. Radiology 1995; 194:525–527.PubMedGoogle Scholar
  12. 12.
    Zeiss J, Coombs R, Booth R, Saddemi S. Chronic bursitis presenting as a mass in the pes anserine bursa: MR diagnosis. J Comput Assist Tomogr 1993; 17:137–140.PubMedGoogle Scholar
  13. 13.
    Present DA, Bertoni F, Enneking WF. Case report 348: pigmented villonodular synovitis arising from bursa of the pes anserinus muscle, with secondary involvement of the tibia. Skeletal Radiol 1986; 15:236–240.PubMedGoogle Scholar
  14. 14.
    De Maeseneer M, Shahabpour M, Van Roy F, et al. MR imaging of the medial collateral ligament bursa: findings in patients and anatomic data derived from cadavers. AJR Am J Roentgenol 2001; 177:911–917.PubMedGoogle Scholar
  15. 15.
    De Maeseneer M, Shahabpour M, Vanderdood K, Machiels F, De Ridder F, Osteaux M. MR imaging of meniscal cysts: evaluation of location and extension using a three layer approach. Eur J Radiol 2001; 39:117–124.CrossRefPubMedGoogle Scholar
  16. 16.
    Lee JK, Yao L. Tibial collateral ligament bursa: MR imaging. Radiology 1991; 178:855–857.PubMedGoogle Scholar
  17. 17.
    Rothstein CP, Laorr A, Helms CA, Tirman PFG. Semimembranosus–tibial collateral ligament bursitis: MR imaging findings. AJR Am J Roentgenol 1996; 166:875–877.PubMedGoogle Scholar
  18. 18.
    LaPrade RF. The anatomy of the deep infrapatellar bursa of the knee. Am J Sports Med 1998; 26:129–132.PubMedGoogle Scholar
  19. 19.
    Rosenberg ZS, Kawelblum M, Cheung YY, Beltran J, Lehman WB, Grant AD. Osgood Schlatter lesion: fracture or tendonitis? Scintographic, CT and MR imaging features. Radiology 1992; 185:853–858.PubMedGoogle Scholar
  20. 20.
    LaPrade RF, Hamilton CD. The fibular collateral ligament–biceps femoris bursa. An anatomic study. Am J Sports Med 1997; 25:439–443.PubMedGoogle Scholar
  21. 21.
    Tyson LL, Daughters TC, Ryu RKN, Crues JV. MRI appearance of meniscal cysts. Skeletal Radiol 1995; 24:421–424.PubMedGoogle Scholar
  22. 22.
    Lektrakul N, Skaf A, Yeh LR, et al. Pericruciate meniscal cysts arising from tears of the posterior horn of the medial meniscus: MR imaging features that simulate posterior cruciate ganglion cysts. AJR Am J Roentgenol 1999; 172:1575–1579.PubMedGoogle Scholar
  23. 23.
    Burk DL, Dalinka MK, Kanal E, et al. Meniscal and ganglion cysts of the knee: MR evaluation. AJR Am J Roentgenol 1988; 150: 331–336.Google Scholar
  24. 24.
    Campbell SE, Sanders TG, Morrison WB. MR imaging of meniscal cysts: incidence, location and clinical significance. AJR Am J Roentgenol 2001; 177:409–413.PubMedGoogle Scholar
  25. 25.
    Smillie IS. Surgical pathology of the menisci. In: Injuries of the knee joint, 4th edn. London: E and S Livingstone, 1970:39–69.Google Scholar
  26. 26.
    Tasker AD, Ostlere SJ. Relative incidence and morphology of lateral and medial meniscal cysts detected by magnetic resonance imaging. Clin Radiol 1995; 50:778–781.PubMedGoogle Scholar
  27. 27.
    Feldman F, Johnston A. Intraosseous ganglion. AJR Am J Roentgenol 1973; 1182:328–342.Google Scholar
  28. 28.
    Bui-Mansfield LT, Youngberg RA. Intraarticular ganglia of the knee: prevalence, presentation, etiology, and management. AJR Am J Roentgenol 1997; 168:123–127.Google Scholar
  29. 29.
    Recht MP, Applegate G, Kaplan P, et al. The MR appearance of cruciate ganglion cysts: a report of 16 cases. Skeletal Radiol 1994; 23:597–600.PubMedGoogle Scholar
  30. 30.
    Kang CN, Kim DW, Kim DJ, Kim SJ. Intra-articular ganglion cysts of the knee. Arthroscopy J Arthrosc Rel Surg 1999; 15:373–378.Google Scholar
  31. 31.
    Malghem J, Vande Berg BC, Lebon C, Lecouvet FE, Maldague BE. Ganglion cysts of the knee: articular communication revealed by delayed radiography and CT after arthrography. AJR Am J Roentgenol 1998; 170:1579–1583.Google Scholar
  32. 32.
    Kim MG, Kim BH, Choi JA, et al. Intraarticular ganglion cysts of the knee: clinical and MR imaging features. Eur Radiol 2001; 11:834–840.CrossRefPubMedGoogle Scholar
  33. 33.
    Vahlensieck M, Linneborn G, Schild H, Schmidt HM. Hoffa’s recess: incidence, morphology and differential diagnosis of the globular shaped cleft in the infrapatellar fat pad of the knee on MRI and cadaver dissections. Eur Radiol 2002; 12: 90–93.CrossRefPubMedGoogle Scholar
  34. 34.
    McCarthy EF, Matz S, Steiner GC, Dorfman HD. Periosteal ganglion: a cause of cortical bone erosion. Skeletal Radiol 1983; 10:243–246.PubMedGoogle Scholar
  35. 35.
    Abdelwahab IF, Kenan S, Hermann G, Klein MJ, Lewis MM. Periosteal ganglia: CT and MR imaging features. AJR Am J Roentgenol 1993; 188:245–248.Google Scholar
  36. 36.
    Jerome D, McKendry R. Synovial cyst of the proximal tibiofibular joint. J Rheum 2000; 27:1096–1098.PubMedGoogle Scholar
  37. 37.
    Damron TA, Rock MG. Unusual manifestations of proximal tibiofibular joint synovial cysts. Orthopaedics 1997; 20:225–230.Google Scholar
  38. 38.
    McLaren DB, Buckwalter KA, Vahey TN. The prevalence and significance of cyst-like changes at the cruciate ligament attachments in the knee. Skeletal Radiol 1992; 21:365–369.PubMedGoogle Scholar
  39. 39.
    Ostlere SJ, Seeger LL, Eckardt JJ. Subchondral cysts of the tibia secondary to osteoarthritis of the knee. Skeletal Radiol 1990; 19:287–289.PubMedGoogle Scholar
  40. 40.
    Butler MG, Fuchigami KD, Chako A. MRI of posterior knee masses. Skeletal Radiol 1996; 25:309–317.CrossRefPubMedGoogle Scholar

Copyright information

© ISS 2004

Authors and Affiliations

  1. 1.Department of RadiologyNuffield Orthopaedic CentreHeadington, OxfordUK

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