Anterior Cruciate Ligament Cyst

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Anterior Cruciate Ligament Cyst

Authors, Editors, Case Information Author: Marlee Franden, OMS-IV Affiliation: Rowan-Virtua School of Osteopathic Medicine Co Author(s): Altamash Raja, DO Senior Editor: Laura Mattson, DO Clinical Vignette: A 26-year-old female weightlifter with previous right tibial plateau fracture, sustained two years ago from dropping a barbell during a snatch attempt, presented with right knee pain and limited knee flexion. Pain was deep and worsened with squatting and lunging, limiting her return to sport. Type of Probe Used: 15-4 MHz Linear Transducer #1 - Video View Video Labeled attempted compression of the anechoic structure in short axis demonstrating its noncompressibility. #2 - Video View Video Unlabeled attempted compression of the anechoic structure in short axis. Unlabeled Long-Axis Right Knee Ultrasound Unlabeled right knee in long axis. Labeled Long-Axis Right Knee Ultrasound Labeled right knee in long axis demonstrating the two likely communicating anechoic structures deep to the infrapatellar fat pad. Unlabeled Long-Axis Right Knee Ultrasound with Doppler Unlabeled right knee in long axis with Doppler. Labeled Long-Axis Right Knee with Doppler Labeled right knee in long axis with Doppler demonstrating the anechoic structure without hyperemia. Unlabeled Short-Axis Right Knee Ultrasound Unlabeled right knee in short axis. Labeled Short Axis Right Knee Ultrasound Labeled right knee in short axis demonstrating the anechoic structure inferior to the infrapatellar fat pad. Interpretation Image Interpretation: An anechoic, well-circumscribed, well-demarcated mass was noted deep to the infrapatellar fat pad. This measured 2.02 cm x 1.08 cm x 1.72 cm. No color Doppler flow was noted and the structure remained noncompressible when pressure was applied. A separate, smaller, anechoic mass was noted deeper to this structure and likely communicated with it. Findings were consistent with a multiloculated cyst of intra-articular origin. MRI was subsequently performed with findings of chronic high grade partial ACL tear with mucoid degeneration of the ACL and multilobulated ganglion cyst originating from the anteriorly from the ACL at the intercondylar notch, correlating well with ultrasound findings. Teaching Pearl: Literature reports that knee intraarticular cysts are rare, with a prevalence of 1.3% on MRI. They may develop within the intra- or extra-synovial space, with the latter affecting the infrapatellar fat pad and cruciate ligaments. Anterior cruciate ligament (ACL) cysts may have purely cystic or infiltrative origin. While MRI is considered the gold standard in diagnosis, these cysts may also be visualized on ultrasound as anechoic, unilocular or multilocular structures. Trauma and repetitive mechanical stress may contribute to cyst development. Proposed mechanisms include mucoid degeneration of connective tissue and protrusion of synovial tissue and fluid through damaged ligament fibers. Clinically, these patients may present with pain, limited mobility, and stiffness within the affected knee. References: Bouzid YB, Dinia M, Bassir RA, et al. Anterior cruciate ligament cysts: About a rare condition. Radiol Case Rep. 2023;18(9):3309-3316. Published 2023 Jul 12. doi:10.1016/j.radcr.2023.06.028 Sloane, Jake, Gulati, Vivek, Penna, Sreeram, Pastides, Philip, Baghla, Davinder Paul Singh, Large Intra-Articular Anterior Cruciate Ligament Ganglion Cyst, Presenting with Inability to Flex the Knee, Case Reports in Medicine, 2010, 705919, 5 pages, 2010. https://doi.org/10.1155/2010/705919
NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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Authors, Editors, Case Information

#1 - Video

#2 - Video

Unlabeled Long-Axis Right Knee Ultrasound

Labeled Long-Axis Right Knee Ultrasound

Unlabeled Long-Axis Right Knee Ultrasound with Doppler

Labeled Long-Axis Right Knee with Doppler

Unlabeled Short-Axis Right Knee Ultrasound

Labeled Short Axis Right Knee Ultrasound

Interpretation

UPCOMING EVENTS

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