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 history of 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 Unlabeled Long Axis View of the Right Patellar Tendon Unlabeled Long Axis View of the Right Patellar Tendon Labeled Long Axis View of the Right Patellar Tendon Labeled Long Axis View of the Right Patellar Tendon demonstrating the two likely communicating anechoic structures deep to the infrapatellar fat pad. Unlabeled Short Axis View of the Right Patellar Tendon Unlabeled Short Axis View of the Right Patellar Tendon Labeled Short Axis View of the Right Patellar Tendon Labeled Short Axis View of the Right Patellar Tendon demonstrating the anechoic structure deep to the infrapatellar fat pad. Unlabeled Long Axis View of the Right Patellar Tendon with Doppler Unlabeled Long Axis View of the Right Patellar Tendon with Doppler Labeled Long Axis View of the Right Patellar Tendon with Doppler Labeled Long Axis View of the Right Patellar Tendon with Doppler demonstrating the anechoic structure without hyperemia. #7 - Video View Video Unlabeled Short Axis cine of the Patellar Tendon with attempted compression of the anechoic structure. #8 - Video View Video Labeled Short Axis cine of the Patellar Tendon with attempted compression of the anechoic structure demonstrating its noncompressibility. 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: Intra-articular knee cysts are uncommon and may occur in, or around, the cruciate ligaments or infrapatellar fat pad. Ultrasound can identify a well-circumscribed, avascular cystic mass deep to the fat pad, but MRI is often needed to define the relationship to the ACL and surrounding intra-articular structures. ACL cysts may be simple or multilobulated and can cause pain, mechanical symptoms, or range-of-motion limitation. Recognizing a nonvascular cystic lesion should prompt appropriate MRI correlation rather than treatment as a superficial soft tissue mass. References: 1. Kim MG, Kim BH, Choi JA, et al. Intra-articular ganglion cysts of the knee: clinical and MR imaging features. Eur Radiol. 2001;11(5):834-840. doi:10.1007/s003300000713 2. Mao Y, Dong Q, Wang Y. Ganglion cysts of the cruciate ligaments: a series of 31 cases and review of the literature. BMC Musculoskelet Disord. 2012;13:137. doi:10.1186/1471-2474-13-137 3. Ramrattan LA, Masri G, Kaeley GS. Musculoskeletal ultrasound diagnosis of symptomatic Hoffa’s fat pad ganglion cyst successfully managed nonoperatively: a case report. Cureus. 2021;13(10):e18665. doi:10.7759/cureus.18665
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Right Patellar Tendon

Labeled Long Axis View of the Right Patellar Tendon

Unlabeled Short Axis View of the Right Patellar Tendon

Labeled Short Axis View of the Right Patellar Tendon

Unlabeled Long Axis View of the Right Patellar Tendon with Doppler

Labeled Long Axis View of the Right Patellar Tendon with Doppler

#7 - Video

#8 - Video

Interpretation

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