Knee Ganglion Cyst Excision

Diagnosis

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With good physical examination, the ACL or PCL ligament laxity can be identified in patients with ganglion cyst. Usually the laxity will be mild. 

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X-ray. X-ray is performed and is useful to rule out any bone injuries, however, ligaments are not visible on the X-ray.

MRI Scan. MRI Scan is the gold standard investigation to identify the type and extent of the ACL and PCL ligament condition. The fluid filled cyst stretching the ACL or PCL stretching the fibers of the ligament can be identified. 

 

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Treatment

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Ganglion cysts of the knee remain so and can gradually expand, leading the symptoms of instability of the knee. Although strengthening the Quadriceps (thigh muscles) with eccentric exercises may help to minimise the signs of instability, the pain due to ganglion cyst often persists especially on doing squats and with cross legged sitting. 

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Platelet Rich Plasma (PRP) Injection

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PRP injection to ACL can help improve the stability in these patients. As the ACL or PCL is usually overstretched and not torn, PRP injection can actually help in improving the stability of the ligament. Post PRP injection, a period of 4 to 6 weeks is needed for the injection to work. However, pain may persist inspite of the improved stability of the joint. Under those circumstances, surgery is warranted. 

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Arthroscopic Ganglion cyst excision

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Arthroscopic (key hole) surgery is performed for this condition. The ganglion cyst is identified and the cyst wall is cleared with instruments. Post cyst removal, the ACL and PCL ligaments are assessed for stability. If they are overstretched then a PRP injection is also performed during the surgery. 

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Post ganglion cyst excision rehabilitation

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Post-surgery, you are allowed to walk on the same day evening. Walking without any support is possible in most patients, but some may need the support of a walker for upto a week. Physiotherapy in the form of exercises to activate quadriceps (thigh muscles) and range of movement exercises are started on the day 1. Full return to sporting activity is usually delayed upto 6 weeks particularly if the ligament laxity was identified during surgery. 

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