PRETIBIAL CYST FORMATION AFTER ANTERIOR CRUCIATE LIGAMENT SURGERY WITH SOFT-TISSUE AUTOGRAFTS

Four cases of subcutaneous pretibial ganglion, with direct communicati on to the tibial tunnel after autologous reconstruction of the anterio r cruciate ligament (ACL) with hamstrings or iliotibial band, are repo rted. Tibial graft fixation was with a staple in three cases, and with a screw and soft tissue washer in one. The average time to ganglion d evelopment was 44 months, and all occurred more than 2 years after ACL surgery. At the time of cyst development. no patient had subjective o r objective knee instability. No patient had evidence of tibial tunnel enlargement. All ganglion communicated with the tibial tunnel. This c ommunication was shown with magnetic resonance imaging in two cases, w hich showed the origin at the joint. Three patients elected to have th e ganglion removed; in each of these there was a direct communication with the tibial tunnel. Additionally, hardware was removed in all case s, and local autologous bone grafting of the tibial tunnel aperture wa s done in two. Minimum follow-up after surgical excision was 2 years, without evidence of recurrence.