Advertisement

An evidence-based etiology study of synovial cyst of knee cruciate ligament: a real or pseudo-cyst

  • Jun Xiao
  • Yong Hu
  • Kai-Ying Tang
  • Tahsin Tarik Torsha
  • Yu Xu
  • Zhi-Han Li
  • Xiang-Zhao Li
  • Zhan-jun Shi
Original Paper
  • 10 Downloads

Abstract

Purpose

Synovial cyst of knee cruciate ligament (SCKCL) is a rare condition but can cause severe knee pain. The understanding of its etiology is relatively poor. This current study aimed to elucidate the pathogenesis of SCKCL based on a series of histo- and cytopathological examination.

Methods

Ten SCKCL patients who underwent arthroscopy were enrolled, among five patients claimed past knee injury. Hematoxylin & eosin staining was conducted to the cyst wall tissue sections and Papanicolaou staining to the cyst fluid smear. Prussian blue staining was employed to both the wall section and fluid smear. Immumohistochemical staining for mesothelial cells (MC), epithelial cells (CK), vascular endothelial cells (CD31), monocytes (CD68), and hematogenous stem cells (CD117) were taken to elucidate the possible involvement of various cell types in the development of SCKCL.

Results

No erythrocyte was discovered in the fluid; however, Prussian blue stained hemosiderin particles were found in the cyst wall and fluid, suggesting past hemorrhage in all patients. Abundant lymphocytes and plasmocytes were observed in the cyst wall and fluid. In addition, the cyst lining was infiltrated with abundant CD68(+) monocytes while only few MC(+) mesothelial cells were sporadically observed in four samples. The cyst submucosa was also diffused with abundant CD68(+) monocytes and proliferated capillaries stained with CD31. CD117-positve hematogenous stem cells were sporadically observed in eight specimens.

Conclusion

Our findings provided evidence that SCKCL is not a mature synovial cyst but rather an inflammatory pseudo-cyst. It may have resulted from past minor hemorrhage and intra-ligament chronic inflammation.

Keywords

Immumohistochemical staining Knee cruciate ligament Synovial cyst 

Notes

Acknowledgements

The authors would thank Dr. Yan-Qing Ding and Dr. Yong-Jian Deng from the pathological department for their generous help and advice on the pathological results.

Funding

This study was funded by NNSFC (National Natural Science Foundation of China (CN)) (grant number 81101389).

Compliance with ethical standards

The study was carried out upon the approval of the Ethics Committee of Nanfang hospital. For this type of study, formal consent is not required.

Conflict of interest

Jun Xiao receives a grant (81101389) from NNSFC (National Natural Science Foundation of China (CN)) to support the current research. For the rest of the co-authors, they declared that they have no conflict of interest.

References

  1. 1.
    Jawish R, Nemer CH (2009) Ganglion cyst of the anterior cruciate ligament in children. J Pediatr Orthop B 18(5):234–237CrossRefPubMedGoogle Scholar
  2. 2.
    Kim R-S, Kim K-T, Lee J-Y, Lee K-Y (2003) Ganglion cysts of the posterior cruciate ligament. Arthroscopy 19(6):e36–e40CrossRefGoogle Scholar
  3. 3.
    Mao Y, Dong Q, Wang Y (2012) Ganglion cysts of the cruciate ligaments: a series of 31 cases and review of the literature. BMC Musculoskelet Disord 13:137.  https://doi.org/10.1186/1471-2474-13-137 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Shetty GM, Nha KW, Patil SP, Chae DJ, Kang KH, Yoon JR, Choo SK, Yi JW, Kim JH, Baek JR (2008) Ganglion cysts of the posterior cruciate ligament. Knee 15(4):325–329.  https://doi.org/10.1016/j.knee.2008.02.010 CrossRefPubMedGoogle Scholar
  5. 5.
    Krudwig WK, Schulte KK, Heinemann C (2004) Intra-articular ganglion cysts of the knee joint: a report of 85 cases and review of the literature. Knee Surg Sports Traumatol Arthrosc 12(2):123–129.  https://doi.org/10.1007/s00167-003-0372-9 CrossRefPubMedGoogle Scholar
  6. 6.
    Rosenberg AE (2010) Bones, joints, and soft-tissue tumors. Pathol Basis Dis:1237–1240Google Scholar
  7. 7.
    Rolf C, Watson TP (2006) Case report: intra-tendinous ganglion of the anterior cruciate ligament in a young footballer. J Orthop Surg Res 1:11.  https://doi.org/10.1186/1749-799x-1-11 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Durante JA (2009) Ganglion cyst on the posterior cruciate ligament: a case report. J Can Chiropr Assoc 53(4):334–338PubMedPubMedCentralGoogle Scholar
  9. 9.
    Hameed SA, Sujir P, Naik MA, Rao SK (2012) Ganglion cyst of the posterior cruciate ligament in a child. Singap Med J 53(4):e80Google Scholar
  10. 10.
    Liu SH, Kabo JM, Osti L (1995) Biomechanics of two types of bone-tendon-bone graft for ACL reconstruction. J Bone Joint Surg Br 77(2):232CrossRefPubMedGoogle Scholar
  11. 11.
    Kang CN, Lee SB, Kim SW (1995) Symptomatic ganglion cyst within the substance of the anterior cruciate ligament. Arthroscopy 11(5):612–615CrossRefPubMedGoogle Scholar
  12. 12.
    Feldmann DD, Fanelli GC (2001) Development of a synovial cyst following anterior cruciate ligament reconstruction. Arthroscopy 17(2):200–202CrossRefPubMedGoogle Scholar
  13. 13.
    Joo YB, Kim YM (2012) Symptomatic posterior cruciate ganglion cyst causing impingement between posterior root of the medial meniscus and anterior to the posterior cruciate ligament. Knee Surg Relat Res 24(1):52–55.  https://doi.org/10.5792/ksrr.2012.24.1.52 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Tsai TY, Yang YS, Tseng FJ, Lin KY, Liu CW, Shen HC, Lee CH, Lin LC, Pan RY (2012) Arthroscopic excision of ganglion cysts of the posterior cruciate ligaments using posterior trans-septal portal. Arthroscopy 28(1):95–99CrossRefPubMedGoogle Scholar
  15. 15.
    Garcia-Alvarez F, Garcia-Pequerul JM, Avila JL, Sainz JM, Castiella T (2000) Ganglion cysts associated with cruciate ligaments of the knee: a possible cause of recurrent knee pain. Acta Orthop Belg 66(5):490–494PubMedGoogle Scholar
  16. 16.
    Sumen Y, Ochi M, Deie M, Adachi N, Ikuta Y (1999) Ganglion cysts of the cruciate ligaments detected by MRI. Int Orthop 23(1):58–60CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Sloane J, Gulati V, Penna S, Pastides P, Baghla DP (2010) Large intra-articular anterior cruciate ligament ganglion cyst, presenting with inability to flex the knee. Case Rep Med 2010:705919.  https://doi.org/10.1155/2010/705919 CrossRefPubMedGoogle Scholar
  18. 18.
    Kataoka H, Kobayashi TK, Amano S, Yamada E, Ishida M, Kushima R, Okabe H (2012) Body cavity fluid can induce epithelial and mesothelial differentiation from CD34 positive peripheral blood stem cells in vitro. Cytopathology 23(4):237–241CrossRefPubMedGoogle Scholar
  19. 19.
    Bui-Mansfield LT, Youngberg RA (1997) Intraarticular ganglia of the knee: prevalence, presentation, etiology, and management. AJR Am J Roentgenol 168(1):123–127.  https://doi.org/10.2214/ajr.168.1.8976934 CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Nanfang HospitalSouthern Medical UniversityGuangzhouPeople’s Republic of China
  2. 2.Department of Orthopaedic SurgeryThe second affiliated hospital of ChongQing Medical UniversityChongqingChina
  3. 3.Department of Pathology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina

Personalised recommendations