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Degenerative subtalar joints complicated by medial plantar intraneural cysts

Laumonerie, Pierre and Lapègue, Franck and Reina, Nicolas and Tibbo, Meagan E. and Rongières, Michel and Faruch, Marie and Mansat, Pierre Degenerative subtalar joints complicated by medial plantar intraneural cysts. (2018) The Bone & Joint Journal, 100-B (2). 183-189. ISSN 2049-4394

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Official URL: https://doi.org/10.1302/0301-620X.100B2.BJJ-2017-0990.R1

Abstract

AIMS: The pathogenesis of intraneural ganglion cysts is controversial. Recent reports in the literature described medial plantar intraneural ganglion cysts (mIGC) with articular branches to subtalar joints. The aim of the current study was to provide further support for the principles underlying the articular theory, and to explain the successes and failures of treatment of mICGs. PATIENTS AND METHODS: Between 2006 and 2017, five patients with five mICGs were retrospectively reviewed. There were five men with a mean age of 50.2 years (33 to 68) and a mean follow-up of 3.8 years (0.8 to 6). Case history, physical examination, imaging, and intraoperative findings were reviewed. The outcomes of interest were ultrasound and/or MRI features of mICG, as well as the clinical outcomes. RESULTS: The five intraneural cysts followed the principles of the unifying articular theory. Connection to the posterior subtalar joint (pSTJ) was identified or suspected in four patients. Re-evaluation of preoperative MRI demonstrated a degenerative pSTJ and denervation changes in the abductor hallucis in all patients. Cyst excision with resection of the articular branch (four), cyst incision and drainage (one), and percutaneous aspiration/steroid injection (two) were performed. Removing the connection to the pSTJ prevented recurrence of mIGC, whereas medial plantar nerves remained cystic and symptomatic when resection of the communicating articular branch was not performed. CONCLUSION: Our findings support a standardized treatment algorithm for mIGC in the presence of degenerative disease at the pSTJ. By understanding the pathoanatomic mechanism for every cyst, we can improve treatment that must address the articular branch to avoid the recurrence of intraneural ganglion cysts, as well as the degenerative pSTJ to avoid extraneural cyst formation or recurrence.

Item Type:Article
Audience (journal):International peer-reviewed journal
Uncontrolled Keywords:
Institution:Other partners > Centre Hospitalier Universitaire de Toulouse - CHU Toulouse (FRANCE)
Other partners > Mayo Clinic (USA)
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Deposited By: Pascal SWIDER
Deposited On:25 Mar 2019 12:29

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