posterior cruciate ligament ganglion cyst

Posterior cruciate ligament (PCL) ganglion cysts are intra-articular ganglion cysts and represent one type of many cyst-like lesions around the knee.

Terminology

Posterior cruciate ligament (PCL) ganglion cysts are also referred to as PCL cysts or PCL ganglia .

Epidemiology

The estimated prevalence of all (anterior and posterior) cruciate ligament cysts ranges from 0.2% to 1.9%. They seem to occur more commonly in the anterior cruciate ligament and males seem more commonly affected .

Clinical presentation

Similar to anterior cruciate ligament ganglion cysts the most common symptom in patients with posterior cruciate ligament ganglion cysts seems to be knee pain, limited range of motion especially terminal flexion, snapping, clicking or locking .

Pathology

Posterior cruciate ligament ganglion cysts as other ganglion cysts are usually well-defined, smooth-walled, multiloculated cystic masses filled with clear, mucoid material and are surrounded by dense connective tissue without synovium .

Etiology

As with anterior cruciate ligament ganglion cysts, the pathogenesis is controversial and few theories exist :

  • a sequel of mucoid degeneration
  • cyst formation as a consequence of trauma or tissue irritation
  • release of hyaluronic acid by mesenchymal stem cells and consecutive cyst formation
  • synovial herniation
  • congenital translocation of synovial cells
Location

Most posterior cruciate ligament ganglion cysts are located along and adjacent to the posterior cruciate ligament. The origin of the main cystic component is located posteriorly in most cases .

Radiographic features

MRI

MRI is the best modality for the visualization and evaluation of cruciate ligament cysts . The typical appearance is that of a well-defined multilocular cystic mass within or adjacent to the posterior cruciate ligament .

  • T1: will depend on protein content, but mostly hypointense
  • T2: hyperintense
  • PDFS/T2FS: hyperintense

Treatment and prognosis

Management options depend vastly on clinical symptoms and include conservative measures, image-guided percutaneous aspiration as well as arthroscopic excision, the latter being the preferred technique for symptomatic cysts due to good outcomes .

Differential diagnosis

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