Letter to Editor: The Ganglionic Cysts of the Proximal Tibiofibular Joints: Mystery Unfolded

The article titled “A Synovial Ganglion of the Knee: Two Cases in Athletes” by Dragoni et al., generates much interest [2]. The authors describe two interesting cases of the ganglion cyst of the proximal tibiofibular joint but the title appears to be confusing as it projects something pertaining only to the ganglion. The authors mention the proximal tibiofibular joint to be an uncommon site. A detailed look at earlier research studies depicts that 15 – 20 % of all ganglion cysts occur in the lower extremity, with 33 % involving the knee itself [4]. Past studies have outlined the absence of any symptoms associated with such cysts [3]. In fact, I feel it is not only the asymptomatic feature of the ganglion cyst, rather it is the difficulty which is encountered in diagnosing the same, which makes it both clinically and academically important.

Both cases described by the authors are interesting. The authors highlight different research works while describing the higher age to be associated with an increased incidence of ganglion cysts but a thorough look at the past studies depicts that it may be even detected in individuals aged between 21 – 54 years (average age of 34 years) [3]. To arrive at a conclusion that the ganglion cyst is rare in a younger age group based on the study involving two cases, is too premature. The authors say that there are no reports on the existence of ganglion cysts in athletic populations but a past study had already defined the presence of a ganglionic cyst in the posterior longitudinal ligament in athletes aged between 20 – 30 years [1].

Two interesting cases of ganglionic cysts were mentioned in a national tennis player and a gymnast but there was no mention of any duration of the association of each individual with their respective sport. Often, the duration of association with any sport may play an important role in the development of such cysts. A lesser period of association would have made the study more rare and interesting. It is an accepted fact that the development of ganglionic cyst is related to trauma, facet arthrosis, spondylolisthesis, degeneration of mucoid and increase in the level of hyalurodinase [5]. The authors mentioned that the second case did not have any history of trauma but there was no such information on trauma history for the first case.

The duration of the ganglion cyst may cause severe symptoms like foot drop. Often, it is necessary to conduct electromyographic studies for ascertaining the involvement of action of an individual muscle. Mere observation on the muscle weakness may not be helpful. If the common peroneal nerve is involved, all its branches may also be involved. Overall, the article is interesting and the authors and the editorial board deserve credit for an important publication.

Srijit Das

References

• 1 Christophis P, Asamoto S, Kuchelmeister K, Schachenmayr W. “Juxtafacet cysts”, a misleading name for cystic formations of mobile spine (CYFMOS).  Eur Spine J. 2007;  16 1499-1505
• 2 Dragoni S, Giombini A, Di Cesare A, Ripani M. A synovial ganglion of the knee: two cases in athletes.  Int J Sports Med. 2008;  29 692-695
• 3 Miskovsky S, Kaeding C, Weis L. Proximal tibiofibular joint ganglion cysts: excision, recurrence, and joint arthrodesis.  Am J Sports Med. 2004;  32 1022-1028
• 4 Rozbruch S R, Chang V, Bohne W H, Deland J T. Ganglion cysts of the lower extremity: an analysis of 54 cases and review of the literature.  Orthopedics. 1998;  21 141-148
• 5 Vasani S S, Demetriades A K, Joshi S M, Yeh J, Ellamushi H. Traumatic intraspinal extradural ganglion cyst in a teenager: case report and review of the literature.  Clin Neurol Neurosurg. 2007;  109 88-91