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

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          Abstract

          Background

          To 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.

          Methods

          Patients 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.

          Results

          Magnetic 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.

          Conclusions

          Synovial 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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          Most cited references 21

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          The dorsal ganglion of the wrist: its pathogenesis, gross and microscopic anatomy, and surgical treatment.

          During a period of 25 years, 500 dorsal ganglions of the wrist were treated surgically. Three hundred and forty-six were followed for a minimum of 9 months; there were three recurrences. Dissection of the cysts under magnification of six to 25 times and serial microscopic studies showed evidence of a one way, valvelike system between the scapholunate joint and the ganglion. Stress, as a cause of ganglions, is suggested. Operative treatment involved excising all attachments to the scapholunate ligament.
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            Soft-tissue tumors and tumor-like lesions of the foot. An analysis of eighty-three cases.

            The cases of eighty-three patients who had a soft-tissue tumor or tumor-like lesion in the foot or ankle were retrospectively analyzed to determine the relative frequency of the lesions and which factors, if any, could be used to identify them preoperatively. Seventy-two (87 per cent) of the lesions were benign, with ganglion cysts and plantar fibromatoses being the most common, and eleven (13 per cent) were malignant tumors, five (45 per cent) of which were synovial sarcomas. The age of the patient and the location of the lesion were the two most important factors that characterized the malignant tumors. For eight patients (12 per cent), radiographs were helpful in identifying the nature of the lesion. The sex of the patient, a history of trauma, the duration of the symptoms, the size of the lesion, and the presence of pain or of neurological symptoms were not useful in discriminating a benign lesion from a malignant tumor.
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              Ganglion cysts of the lower extremity: an analysis of 54 cases and review of the literature.

              This article reviews 54 consecutive patients with lower extremity ganglion cysts that were surgically removed and histologically confirmed at the Hospital for Special Surgery from 1981 to 1993. Lower extremity ganglia were more common among women. Patients' ages ranged from 13 to 80 years, with the fifth and sixth decades being the most common. Size of the cysts ranged from 3 cm to 10 cm (average: 2.9 cm). Thirty-six (67%) patients had ganglion cysts of the foot and ankle, and 18 (33%) patients had ganglion cysts of the knee area. Four (7%) patients had intraosseous ganglia located in the proximal tibia, patella, and the first metatarsal head. Follow-up data of 40 (74%) patients at an average of 5.9 years (range: 1 to 12.5 years) were obtained. Satisfaction was reported by 83% of patients. Recurrence was seen in 10% of patients, and a report of no or mild pain was given by 86% of the group. Patients who underwent revision ganglion excision had inferior results. Only 25% reported satisfaction and 50% reported no or mild pain. Patients who underwent curettage of an intraosseous ganglion appeared to have superior results. All patients reported satisfaction and no or mild pain. The performance of a concomitant surgical procedure, the anatomic region of the ganglion, or type of postoperative immobilization did not appear to affect the outcome.
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                Author and article information

                Journal
                Clin Orthop Surg
                Clin Orthop Surg
                CIOS
                Clinics in Orthopedic Surgery
                The Korean Orthopaedic Association
                2005-291X
                2005-4408
                March 2018
                27 February 2018
                : 10
                : 1
                : 94-98
                Affiliations
                Division of Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
                [* ]Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
                []Department of Diagnostic Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
                []Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
                Author notes
                Correspondence to: Yong-Koo Kang, MD. Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea. Tel: +82-31-249-7186, Fax: +82-31-254-7186, ykang77@ 123456daum.net
                Article
                10.4055/cios.2018.10.1.94
                5851861
                Copyright © 2018 by The Korean Orthopaedic Association

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Original Article

                Surgery

                hallux, ganglion cysts, recurrence

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