Operative Treatment for Ganglion Cyst of Flexor Hallucis Longus Sheath

Abstract

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.

Excision with Temporary Interphalangeal Joint Pin Fixation for Toe Ganglion Cysts

“…In general, recurrence is reported in 33% to 63% of ganglion cysts treated nonsurgically. 7) Between 60% and 95% of ganglion cysts recur after aspiration, while up to 50% recur even after excision. 8 9 10) Optimal surgical outcomes are associated with complete surgical resection, but complete resection does preclude recurrence.…”

“…Surgical treatment, considering the ganglion cyst and connections with the underlying pathology of adjacent joints and tendons, is challenging. 5 7) Additionally, complete excision of small ganglion cysts of the toe attached to the overlying thin skin is difficult. Even with complete resection, management through a comprehensive approach to all connections with the ganglion cyst, tendon sheath, and the joint is required.…”

“…Exclusion criteria were patients treated with observation alone because of mild symptoms and patients who had comorbidities, such as diabetes, rheumatoid arthritis, and gout. 7) Twelve of the 16 patients underwent repeated manual rupture, aspiration, or excision but were not cured. Despite the risk of discharge-induced infection after repeated spontaneous cystic rupture, no patients had an infection at the time of their respective operations.…”

Ganglion Cysts in the Hallux: A Report of Two Cases

“…Using ankle arthrography, Zhang et al demonstrated communication between the ankle or FHL tendon sheath and the cyst in 13 of 19 patients [ 4 ]. They reported no recurrence after the removal of the ganglion cysts and ankle capsulorrhaphy, although the tendon sheath was not directly visualized.…”

“…The basic treatment is conservative, including observation, compression, aspiration of cyst fluid, corticosteroid injection, and sclerotherapy, but the recurrence rate is as high as 33% to 63% [ 3 ]. Surgical resection must be chosen when they resist conservative treatment, but the recurrence rate after resection of all foot ganglia is still high, ranging from 5% to 30% [ 4 ]. In this report, we present two cases of persistent hallux ganglion cysts.…”