Posterior cruciate ligament ganglion cyst

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Posterior cruciate ligament (PCL) ganglion cystsare 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~~'posterior cruciate ligament cysts' or ~~PCL ganglia~~ 'ganglia' ¹.

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 ^2-6.

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 ^2,3,6.

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 ^1,4,6.

Aetiology

As with anterior cruciate ligament ganglion cysts, the pathogenesis is controversial and few theories exist ^2-4:

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 ⁴.

Radiographic features

MRI

MRI is the best modality for the visualization and evaluation of cruciate ligament cysts ². The typical appearance is that of a well-defined multilocular cystic mass within or adjacent to the posterior cruciate ligament ¹.

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 ^2,4,6.

Differential diagnosis

mucoid degeneration of the posterior cruciate ligament
anterior cruciate ligament ganglion cyst
Hoffa’s fat pad ganglion cyst
posteromedial meniscal cyst with central extension
synovial cyst
synovial sarcoma

-<p><strong>Posterior cruciate ligament (PCL) ganglion cysts</strong> are <a href="/articles/intra-articular-ganglion-cyst">intra-articular ganglion cysts</a> and represent one type of many <a href="/articles/cyst-like-lesions-aroundthe-knee-1">cyst-like lesions around the knee</a>.</p><h4>Terminology</h4><p>Posterior cruciate ligament (PCL) ganglion cysts are also referred to as PCL cysts or PCL ganglia <sup>1</sup>.</p><h4>Epidemiology</h4><p>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 <sup>2-6</sup>. </p><h4>Clinical presentation</h4><p>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 <sup>2,3,6</sup>.</p><h4>Pathology</h4><p>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 <a href="/articles/synovium">synovium</a> <sup>1,4,6</sup>.</p><h5>Aetiology</h5><p>As with anterior cruciate ligament ganglion cysts, the pathogenesis is controversial and few theories exist <sup>2-4</sup>:</p><ul>
~~-<li>a sequel of mucoid degeneration</li>~~
+<p><strong>Posterior cruciate ligament (PCL) ganglion cysts </strong>are <a href="/articles/intra-articular-ganglion-cyst">intra-articular ganglion cysts</a> and represent one type of many <a href="/articles/cyst-like-lesions-aroundthe-knee-1">cyst-like lesions around the knee</a>.</p><h4>Terminology</h4><p>Posterior cruciate ligament ganglion cysts are also referred to as 'posterior cruciate ligament cysts' or 'ganglia' <sup>1</sup>.</p><h4>Epidemiology</h4><p>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 <sup>2-6</sup>. </p><h4>Clinical presentation</h4><p>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 <sup>2,3,6</sup>.</p><h4>Pathology</h4><p>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 <a href="/articles/synovium">synovium</a> <sup>1,4,6</sup>.</p><h5>Aetiology</h5><p>As with anterior cruciate ligament ganglion cysts, the pathogenesis is controversial and few theories exist <sup>2-4</sup>:</p><ul>
+<li>a sequel of <a title="Mucoid degeneration" href="/articles/mucoid-change">mucoid degeneration</a>
+</li>
~~-<li>mucoid degeneration of the posterior cruciate ligament</li>~~
+<li>
+<a title="Mucoid degeneration" href="/articles/mucoid-change">mucoid degeneration</a> of the posterior cruciate ligament</li>

References changed:

1. Perdikakis E & Skiadas V. MRI Characteristics of Cysts and “cyst-Like” Lesions in and Around the Knee: What the Radiologist Needs to Know. Insights Imaging. 2013;4(3):257-72. <a href="https://doi.org/10.1007/s13244-013-0240-1">doi:10.1007/s13244-013-0240-1</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23479129">Pubmed</a>
2. Stein D, Cantlon M, MacKay B, Hoelscher C. Cysts About the Knee: Evaluation and Management. J Am Acad Orthop Surg. 2013;21(8):469-79. <a href="https://doi.org/10.5435/jaaos-21-08-469">doi:10.5435/jaaos-21-08-469</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23908253">Pubmed</a>
3. Mao Y, Dong Q, Wang Y. Ganglion Cysts of the Cruciate Ligaments: A Series of 31 Cases and Review of the Literature. BMC Musculoskelet Disord. 2012;13(1):137. <a href="https://doi.org/10.1186/1471-2474-13-137">doi:10.1186/1471-2474-13-137</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22862803">Pubmed</a>
4. Durante J. Ganglion Cyst on the Posterior Cruciate Ligament: A Case Report. J Can Chiropr Assoc. 2009;53(4):334-8. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796952">PMC2796952</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/20037698">Pubmed</a>
5. Ahmed F, Ibrahim S, Soliman A, Khirat S. Ganglion Cyst of the Posterior Cruciate Ligament. Case Reports. 2010;2010(aug24 1):bcr0920092263. <a href="https://doi.org/10.1136/bcr.09.2009.2263">doi:10.1136/bcr.09.2009.2263</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22767478">Pubmed</a>
6. Nam D, Macaulay A, Cross M, Shindle M, Warren R. Posterior Cruciate Ligament Resection for Ganglion Cyst and Associated Ligament Degeneration. Am J Orthop (Belle Mead NJ). 2011;40(6):E110-4. - <a href="https://www.ncbi.nlm.nih.gov/pubmed/21869944">Pubmed</a>
7. Tie K, Wang H, Zhao X, Tan Y, Qin J, Chen L. Clinical Manifestation and Arthroscopic Treatment of Symptomatic Posterior Cruciate Ligament Cyst. J Orthop Surg Res. 2018;13(1):84. <a href="https://doi.org/10.1186/s13018-018-0798-x">doi:10.1186/s13018-018-0798-x</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29653540">Pubmed</a>
1. Perdikakis E & Skiadas V. MRI Characteristics of Cysts and "cyst-Like" Lesions in and Around the Knee: What the Radiologist Needs to Know. Insights Imaging. 2013;4(3):257-72. <a href="https://doi.org/10.1007/s13244-013-0240-1">doi:10.1007/s13244-013-0240-1</a>
2. Stein D, Cantlon M, Mackay B, Hoelscher C. Cysts About the Knee: Evaluation and Management. J Am Acad Orthop Surg. 2013;21(8):469-79. <a href="https://doi.org/10.5435/JAAOS-21-08-469">doi:10.5435/JAAOS-21-08-469</a>
3. Mao Y, Dong Q, Wang Y. Ganglion Cysts of the Cruciate Ligaments: A Series of 31 Cases and Review of the Literature. BMC Musculoskelet Disord. 2012;13(1):137. <a href="https://doi.org/10.1186/1471-2474-13-137">doi:10.1186/1471-2474-13-137</a>
4. Durante JA. Ganglion Cyst on the Posterior Cruciate Ligament: A Case Report. J Can Chiropr Assoc. 2009;53(4):334-8. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796952">PMC2796952</a>
5. Ahmed F, Ibrahim S, Soliman A, Khirat S. Ganglion Cyst of the Posterior Cruciate Ligament. BMJ Case Rep. 2010;2010(aug24 1):bcr0920092263-bcr0920092263. <a href="https://doi.org/10.1136/bcr.09.2009.2263">doi:10.1136/bcr.09.2009.2263</a>
6. Nam D, Macaulay A, Cross M, Shindle M, Warren R. Posterior Cruciate Ligament Resection for Ganglion Cyst and Associated Ligament Degeneration. Am J Orthop (Belle Mead NJ). 2011;40(6):E110-4. <a href="https://www.ncbi.nlm.nih.gov/pubmed/21869944">PMID 21869944</a>
7. Tie K, Wang H, Zhao X, Tan Y, Qin J, Chen L. Clinical Manifestation and Arthroscopic Treatment of Symptomatic Posterior Cruciate Ligament Cyst. J Orthop Surg Res. 2018;13(1):84. <a href="https://doi.org/10.1186/s13018-018-0798-x">doi:10.1186/s13018-018-0798-x</a>