Medial synovial fold cyst in the hip leading to pectineofoveal impingement

Abstract

Pectineofoveal impingement is a relatively rare condition, which can cause hip or groin pain along with mechanical symptoms of clicking in the young adult. We present the case of a 13-year-old girl who was referred to us with left hip pain, which had been affecting her for over six months along with mechanical symptoms of clicking. Following appropriate clinical examination and investigations the patient underwent arthroscopic surgery of her hip. At arthroscopy, a cyst was identified on the medial synovial fold, which was abutting against the zona orbicularis leading to pectineofoveal impingement. The cyst was decompressed and the synovial fold excised arthroscopically. Following arthroscopic intervention, the patient did extremely well and remains asymptomatic at the last follow-up (7 months following the procedure). The case highlights the importance of the medial synovial fold pathology as an important cause for pain and mechanical symptoms in the young adult hip.

The Blue Bulge Sign. Arthroscopic Tips to Identify and Decompress an Atypical Hip Paralabral Cyst

“…Although paralabral cysts are thought to communicate with the joint space via an associated labral tear, how often a paralabral cyst is filled with intra-articular contrast material has not been documented in peer-reviewed literature. In the only other case report of an inferomedial hip cyst described in the literature, a well-defined cyst on the medial synovial fold abutted the zona orbicularis, leading to pectineofoveal impingement and hip symptoms [5]. The cyst in that report was also located anteriorly and inferomedially, but the size of the paralabral cyst in our patient was significantly greater than that previously reported.…”

History of the hip joint pectineofoveal fold

“…The existence of this synovial fold has been confirmed by many anatomical publications (Bartoníček, 1990;Fu et al, 1997;Gojda & Bartoníček, 2012;Noriyasu et al, 1993). Orthopedic surgeons and radiologists have also revealed the existence of Amantini's fold via magnetic resonance imaging (Blankenbaker et al, 2009), arthrography (Bencardino et al, 2011), and arthroscopy (Nakano & Khanduja, 2016).…”

One case of wrist cyst rupture with nerve and blood vessel compression

“…If there is a pedicle connected with the articular cavity, after the removal of the cyst, the joint capsule needs to be repaired, ligated, repaired and connected with the joint capsule to prevent postoperative recurrence [8] . In recent years, with the extensive development of arthroscopic surgery, more and more scholars have adopted arthroscopic surgery to remove cysts and relieve compression symptoms, which has achieved good results and low recurrence rate [9] , [10] , [11] .…”