Endoscopic treatment for intratendinous ganglion of the flexor hallucis longus tendon

Shimozono, Yoshiharu; Takao, Masato; Miyamoto, Wataru; Yasui, Youichi; Kawano, Hirotaka

doi:10.1016/j.jos.2016.05.010

Cited by 6 publications

(10 citation statements)

References 18 publications

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“…In the previous literature, the development of a synovial cyst of the FHL tendon sheath was thought to be preceded by mucoid degeneration of the tendon's collagen fibers and cellular hyperplasia associated with active mucin secretion. 11) In our study, ganglion cysts around the hallux were connected to synovial cysts in the FHL tendon sheath originating from the IP or MTP joint. We believe this clinical finding suggests that ganglion cysts around the hallux do not originate by degeneration or hyperplasia but by fluid from surrounding joints.…”

Section: Discussionmentioning

confidence: 47%

“…Intraoperatively, there were large effusions within the tendon sheath of the FHL in all patients. 11) In all cases, the ganglion cysts around the hallux were connected to the synovial cyst in the FHL tendon sheath. Because we had made this assumption, we squeezed the ganglion cyst of the hallux, which enhanced the complete evacuation of fluid from the ganglion cysts into the synovial sheath of FHL.…”

Section: Resultsmentioning

confidence: 86%

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Origin of Satellite Ganglion Cysts with Effusion in the Flexor Hallucis Longus Tendon Sheath around the Hallux

et al. 2018

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BackgroundTo describe the clinical and magnetic resonance imaging findings of ganglion cysts with effusion in the flexor hallucis longus tendon sheath around the hallux to evaluate their origin.MethodsPatients with recurrent or painful ganglion cysts around the hallux with effusion in the flexor hallucis longus tendon sheath who underwent surgical treatment at St. Vincent's Hospital from February 2007 to August 2016 were investigated. Surgical indication was a painful or recurrent mass caused by the cystic lesions. Those without effusion of the flexor hallucis longus tendon sheath were excluded. We assessed the clinical and magnetic resonance imaging findings.ResultsMagnetic resonance imaging findings in all patients showed several ganglion cysts around the hallux and large fluid accumulations within the flexor hallucis longus tendon sheath. Regarding the location, six ganglion cysts were on the dorsomedial aspect, one on the plantar medial aspect, seven on the plantar lateral aspect, and one in the toe pulp. Ten patients showed joint effusions in both the metatarsophalangeal and interphalangeal joints, two in the metatarsophalangeal joints, and three in the interphalangeal joints. There were communication stalks with a tail shape or abutment between ganglion cysts with surrounding joint effusions. Intraoperatively, connections between ganglion cysts, the synovial cyst of the flexor hallucis longus tendon sheath, and surrounding joints were seen.ConclusionsSynovial fluid accumulation in the metatarsophalangeal or interphalangeal joint supplies the synovial cyst of the flexor hallucis longus tendon sheath and subsequently ganglion cysts in the hallux. In clinical practice, the surgeon should carefully check surrounding joints with tendon sheaths to prevent recurrence of the ganglion cysts around the hallux.

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Section: Discussionmentioning

confidence: 47%

Section: Resultsmentioning

confidence: 86%

Origin of Satellite Ganglion Cysts with Effusion in the Flexor Hallucis Longus Tendon Sheath around the Hallux

et al. 2018

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“…Spontaneous tendon rupture is reportedly a high-risk factor[ 4 , 9 , 16 ]. Surgical treatment is considered only in patients with these symptoms[ 11 , 15 ]. Surgical treatments for intratendinous ganglions may involve only excision of the ganglion or en blo c resection.…”

Section: Discussionmentioning

confidence: 99%

“…Aspiration is a straightforward method; however, it has a high recurrence rate of approximately 50%-70%, which makes it less preferred as a treatment option[ 12 , 14 ]. Surgical treatment should be considered for patients with persistent pain, nerve compression, tendon dysfunction, or recurrence after more conservative treatments[ 11 , 15 ]. Surgical methods include excision of the ganglion and en bloc resection, with or without an additional procedure[ 8 - 10 ].…”

Section: Introductionmentioning

confidence: 99%

Recurrence of intratendinous ganglion due to incomplete excision of satellite lesion in the extensor digitorum brevis tendon: A case report

Park¹,

Seok²,

Yan³

et al. 2022

World J Clin Cases

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BACKGROUND Intratendious ganglions are rare lesions, especially on the foot and ankle. Although several studies have presented the intratendinous ganglion of the foot and ankle, there are only few reported cases, and no cases of recurrence or secondary surgery have been reported. CASE SUMMARY We present the case of a 32-year-old man with an intratendinous ganglion of the second extensor digitorum brevis (EDB) tendon that recurred after ganglion excision. Magnetic resonance imaging (MRI) performed before the first surgery was reviewed to analyze the causes of the recurrence. We confirmed that there was a lack of satellite detection. After recurrence, MRI revealed an extra-tendinous lesion, tenosynovitis, and intratendinous ganglion of the second EDB tendon. Since the second EDB tendon can compensate for the extrinsic muscle, en bloc resection was performed alone. In addition, meticulous excision and synovectomy were performed for extra-tendinous lesions and tenosynovitis, respectively. The patient returned to daily life without any functional problems or recurrence. CONCLUSION If removal of the affected tendon is not fatal, en bloc resection should first be considered to prevent incomplete excision and intraoperative leakage. When planning surgical excision, it is necessary to evaluate the presence of satellite lesions along the course of the affected tendon.

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“…The development of a ganglion cyst connected to a tendon sheath is thought to be proceeded by mucoid degeneration of the tendon’s collagen fibers and cellular hyperplasia associated with active mucin secretion. 14 Lee et al 8 suggested that HGC may be secondary to joint injury or repetitive trauma. The hallux is under pressure during weightbearing, and fluid leakage through the stalk (containing the tracts) of the cyst may act as a 1-way valve.…”

Section: Discussionmentioning

confidence: 99%

Operative Treatment for Ganglion Cyst of Flexor Hallucis Longus Sheath

et al. 2020

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Background: Intractable hallucal ganglion cysts (HGCs) are often a symptomatic and recurrent condition. Its connection with the ankle joint is not well understood. Our aim was to evaluate the relationship between tenosynovitis of the flexor hallucis longus (FHL) tendon at the level of the ankle with formation of an HGC. In addition, we sought to analyze the outcomes of cyst excision combined with ankle capsulorrhaphy. Methods: Nineteen patients with HGC who underwent surgical intervention were included between June 2016 and June 2019. Eight had known recurrences. Ankle arthrography and cyst excision were performed on all patients. Clinical evaluations included the American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and evaluation of postoperative complications. The mean follow-up period was 16.5 ± 8.6 months. Results: Thirteen of the 19 HGCs (68.4%) had a connection with the FHL tendon sheath. Combined with ankle capsulorrhaphy, there was no recurrence after cyst excision. The VAS score decreased from 2.1 ± 1.5 to 0.4 ± 0.8, and AOFAS score significantly improved from 84.3 ± 8.7 to 97.4 ± 5.2 at final follow-up ( P < .001). Conclusions: Most of these patients had a connection between the HGC and ankle joint. Ankle arthrography appeared to be useful for diagnosis, and cyst excision combined with ankle capsulorrhaphy was an effective treatment without cyst recurrence. Level of Evidence: Level IV, case series.

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Endoscopic treatment for intratendinous ganglion of the flexor hallucis longus tendon

Cited by 6 publications

References 18 publications

Origin of Satellite Ganglion Cysts with Effusion in the Flexor Hallucis Longus Tendon Sheath around the Hallux

Origin of Satellite Ganglion Cysts with Effusion in the Flexor Hallucis Longus Tendon Sheath around the Hallux

Recurrence of intratendinous ganglion due to incomplete excision of satellite lesion in the extensor digitorum brevis tendon: A case report

Operative Treatment for Ganglion Cyst of Flexor Hallucis Longus Sheath

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