Case report: intra-tendinous ganglion of the anterior cruciate ligament in a young footballer

A 20-year-old male medical student and keen rugby player presented with a 12-month history of progressively worsening right knee pain and stiffness with no history of trauma. Clinical examination revealed effusion and posterior knee pain exacerbated by end range movement and an extension lag of 15 degrees. Physiotherapy to improve the range of motion proved unsuccessful. Magnetic resonance imaging showed that the ACL was grossly thickened and displaced by material reported as mucoid in nature. There were also areas of focally high signal in relation to its tibial attachment and intra osseous small cysts. Arthroscopic examination revealed a ganglion related to the tibial attachment of the ACL and gross thickening and discoloration of the ACL. Biopsies were taken showing foci of mucoid degeneration in the ACL. A large intra-ACL mass of brownish coloured tissue was excised arthroscopically. Already at 2 weeks follow up the patient had greatly improved range of movement and was pain free. However, upon returning to rugby, joint instability was noticed and a tear of the ACL was confirmed. This rare clinical condition can be diagnosed with MRI and arthroscopic debridement effectively relieves symptoms. This case report illustrates that augmentation or reconstruction may end up being the definitive treatment for athletes. It may also offer some support to the argument that mucoid degeneration and ganglion cyst formation share a similar pathogenesis to intra-osseous cyst formation

Two patients with a complete proximal rupture of the hamstring

Two men visited our Emergency Room because of a water-ski-accident. At physical examination, there was hematoma at the upper leg with loss of strength at extension of the hip and flexion of the knee. Both patients had a palpable gap just distal of the ischial tuberosity. Further imaging by sonography and MR-scan showed a rupture of the proximal hamstring tendon. Treatment was operative refixation of the hamstring tendons at the ischial tuberosity. Aftertreatment consisted of brace for 4 weeks after operation. Both patients returned to their pre-operatively sports, though at a lower level. Surgical treatment of a complete proximal rupture of the hamstrings is recommended in case of sportive patients

Tarsal Navicular Stress Fracture: A Challenging Injury in Athletes

Background: Tarsal navicular stress fracture is a serious injury. Results from conservative treatment of early phase navicular stress fracture and surgical treatment of severe phase navicular stress fracture in athletes was evaluated.Methods: 34 athletes were diagnosed to have a tarsal navicular stress fracture. Seventeen patients were treated conservatively. Seventeen patients had surgical treatment. The follow-up time was >2 years and return to pre-injury level of sports was evaluated in all patients using four categories: excellent, good, moderate or poor.Results: The results from conservative treatment were excellent in all patients. Recovery from surgical treatment was excellent in 7 patients, good in 7, moderate in 2 and poor in 1 patient.Conclusions: Early diagnosis is very important for successful treatment of tarsal navicular stress fracture. The treating physician must keep in mind the symptoms and use an appropriate imaging method in the early phase of forefoot pain.</p