title: Surgical treatment of recurrent proximal tibio-fibular joint ganglion cysts.
abstract: BACKGROUND
  Complex symptomatic ganglion cysts arising from the proximal tibio-fibular joint (PTJ) are not an uncommon presentation in specialist knee clinics and can be managed by aspiration or excision. There is, however, a high rate of recurrence and often there is progressive involvement of the common peroneal nerve (CPN) and its branches, and permanent nerve damage may result.
  
  
  METHODS
  This study is a review of the outcome of recalcitrant and recurrent cyst disease with CPN involvement treated by proximal fibulectomy. Nine patients with clinical and radiological diagnosis of a ganglion cyst involving the proximal tibio-fibular joint were treated by proximal fibulectomy. Average age was 47.2years (19 to 75). Patients were followed up clinically and radiologically. Medical notes were reviewed to assess clinical/pathological characteristics, surgical outcome, recurrence rate and the symptoms of instability and nerve function.
  
  
  RESULTS
  None of the patients were lost to follow-up. After an average follow-up of 83months (15 to 150), none of the patients had clinical or radiological evidence of recurrence. All patients were pain-free and had a complete resolution of nerve symptoms and no evidence of CPN injury. None of the patients complained of localised pain or knee instability and there were no wound healing problems.
  
  
  CONCLUSIONS
  MRI now confirms TFJ-ganglion cysts to be more common than previously recognised. Where there is refractory disease with progressive nerve symptoms and evidence of nerve sheath involvement, joint excision by proximal fibulectomy gives a satisfactory functional result in controlling disease and preventing further nerve damage.
  
  
  METHODS
  IV.
authors: Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, United Kingdom.
authors: Aashish
authors: A
authors: Gulati
authors: Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, United Kingdom; Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Marburg, Germany.
authors: Philipp
authors: P
authors: Lechler
authors: Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, United Kingdom.
authors: Robert
authors: R
authors: Steffen
authors: Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, United Kingdom.
authors: Tom
authors: T
authors: Cosker
authors: Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, United Kingdom.
authors: Nick
authors: N
authors: Athanasou
authors: Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, United Kingdom.
authors: Duncan
authors: D
authors: Whitwell
authors: Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, United Kingdom. Electronic address: maxgibbons@doctors.org.uk.
authors: Christopher L M H
authors: CL
authors: Gibbons
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005360:Fibula / Q000601:surgery; D045888:Ganglion Cysts / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D010027:Osteotomy; D020427:Peroneal Neuropathies / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Ganglion cyst; Knee; Proximal fibulectomy; Proximal tibio-fibular joint; Recurrence