Disclosures: Catherine A. Mills, MD, BA: No financial relationships or conflicts of interest

Case Diagnosis: Intratendinous ganglion cyst of the patellar tendon

Case Description or Program Description: A 26-year-old elite rower with history of Osgood-Schlatter of the left knee presented with left anteromedial knee pain. She recently competed at the international level, gone hiking, and been dancing. She noted anterior knee/thigh pain with descending while hiking and while dancing. The pain eventually began affecting her gait. Examination revealed normal alignment, a prominent left tibial tuberosity, intact strength, restricted active extension of the left knee due to pain, trigger points in the left quadriceps, and a positive Clarke’s test on the left. There was no joint instability on exam. Plain films revealed thickening of the patellar tendon without bony abnormalities. MRI to evaluate the integrity of the patellar tendon revealed a large fluid collection within the patellar tendon consistent with intratendinous ganglion cyst.

Setting: Sports Medicine Clinic

Assessment/Results: She opted for conservative management with physical therapy. Given her level of competition she wished to avoid invasive treatments. She had notable improvement of her symptoms and began a return to sport program in just three weeks.

Discussion (relevance): Intratendinous ganglion cysts are rare. They are thought to arise from mucoid degeneration of the tendon tissue resulting from chronic, repetitive stress and injury of the tendon. Another possible etiology is communication between the cyst and the joint. This patient’s high level of competition and the repetitive nature of rowing likely contributed to her development of this condition. Surgical management is often recommended as tearing of the surrounding tendon substance is frequently present, leading to impaired tendon integrity, as well as an increased risk for tendon rupture. Another possible option for treatment includes aspiration of the cyst and intra-articular steroid injection.

Conclusions: This case shows that conservative management of an intratendinous ganglion cyst is a feasible option with careful monitoring for recurrent or worsening symptoms.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-unusual-diagnosis-of-knee-pain-in-an-elite-rower-a-case-report/