THE SURGICAL TREATMENT OF PROXIMAL TIBIO-FIBULAR GANGLIONS

Abstract

The aim of this study was to retrospectively assess the long term results of the surgical excision of a series of proximal tibio-fibula joint ganglions. They are uncommon tumours in this position (prevalence < 1%) and mimic more sinister pathology creating diagnostic difficulty. From the Queensland Orthopaedic Oncology Database, twelve patients were identified who had presented with proximal tibio-fibular joint cysts between 1991 and 2004 and proceeded to surgery. There were four males and eight females with an average age of 44 years (18–75). One patient had bilateral cysts but elected to only have one side resected. The side distribution was equal. All patients presented with a swelling and ten with pain. Two patients presented with a common peroneal nerve palsy. All patients obtained a marginal excision and histology confirmed a ganglion cyst. Patients were seen at clinic or contacted by phone to assess continued symptoms or recurrence. At mean long term follow up of 49 months (8–168), eight patients had had no recurrence. One patient postoperatively had a transient common peroneal nerve palsy. Of the four patients who had had a recurrence, one patient’s surgery is planned and another patient at 5 months post surgery is symptom free following further resection. The two remaining patients have required re-resection but have presented with further recurrence within 1 year. The common peroneal nerve palsies resolved between 6–12 weeks post surgery. A number of case reports record neurological involvement by direct epineurial involvement but this behaviour was not observed in our series. Review of the literature shows no larger series than ours. We conclude that cysts arising in this region commonly present with pain, swelling and neurology. Recurrence rate is high (33%) and further marginal resection is unlikely to lead to cure. More aggressive surgery such as joint excision or arthrodesis may then be necessary.