TITLE:
Intra- and Periarticular Ganglia (Synovial Cysts) of the Hip with Compression of the Obturator Nerve, Concomitant with Lesions of the Ligamentum Teres—A Report of 3 Cases
AUTHORS:
Florian Haug, Richard Herzog
KEYWORDS:
Ganglion of the Hip, Lesion of Ligamentum teres, Hip Arthroscopy
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.11 No.5,
May
31,
2021
ABSTRACT: Background: Synovial cysts of the hip are
commonly found in patients with intra- or extraarticular pathologies of the
joint. Symptoms are mostly unspecific. To date there are no guidelines for a
gold standard of treatment. Aim of this article is to show up how lesions of
the ligamentum teres (LT) might possibly lead to a specific formation of
synovial cysts of the hip joint and how this can be treated arthroscopically. Methods: This case series included 3
patients with ganglia of the hip. All patients had impingement symptoms,
combined with untypical location of pain. All patients qualified for joint preserving
surgery and underwent hip arthroscopy with pre- and postoperative MRI imaging.
The mean follow-up time was 22 months. Results: MRI imaging showed extensive
ganglia, presumably originating from the pelvic root of LT, extending to the
obturator lodge. In 2 of 3 cases MRI showed lesions of the LT. Hip arthroscopy
revealed damage of the LT in all cases, caused by chronic instability of the
joint. The postoperative MRI showed a complete regression of the ganglia in all
patients after offset correction. After follow-up, 2 of 3 patients were mostly
symptom free. One patient was still suffering from a chronic weakness of the
gluteus medius muscle. Conclusion: Whenever unspecific radiating pain of
surrounding areas of the hip is encountered and cannot be explained by common
pathologies of the hip, possible compression of nerves by ganglion cysts should
be excluded. This should be done by MRI arthrography. A partial rupture of the
LT can occur during FAI with consecutive formation of ganglia in the obturator
canal, compressing the obturator nerve. Primarily the articular pathology needs
to be repaired. In our cases, this was feasible by hip arthroscopy, as a
minimally invasive and safe technique.