A Unique Technique for Precise Targeting in Treatment of Rare Bifocal Intraosseous Ganglion Cysts of the Talus: A Case Report and Review of the Literature

Abstract

BACKGROUND This article presents a rare case of 2 separate intraosseous ganglion cysts of the talus in a 51-year-old man, treated with a unique technique of precise lesion targeting to avoid extensive bone loss and minimize articular chondral injury of the talus. CASE REPORT Two separate intraosseous ganglion cysts of the talus were diagnosed in a 51-year-old man with chronic ankle pain. A single straight-line incision with an entry point through the talonavicular joint was created to spare the precarious blood supply of the talus network. The 2 distinct subchondral lesions were approached under fluoroscopic control for curettage and autologous bone grafting using the anterior cruciate ligament tibial guide in a pair-of-compasses fashion. In almost 5 years of follow-up the patient has been asymptomatic. Magnetic resonance imaging has revealed no signs of degenerative changes in the ankle or the talonavicular joint, and the intraosseous edema has almost disappeared. CONCLUSIONS To the best of our knowledge, this case is the first report of 2 distinct intraosseous ganglion cysts of the talus. We recommend the precise targeting technique used in our case for treating intraosseous talar lesions with intact articular cartilage.

Figure 1.

Anteroposterior (A) and lateral (B) radiographs of the left ankle revealing a radiolucent lesion (red arrow) in the lateral aspect of the talar dome.

Figure 2.

T2-weighted fat-saturated (A) coronal and (B) sagittal magnetic resonance images showing extensive bone marrow edema of the talus, subchondral lesions, and joint effusion.

Figure 3.

T1-weighted fat-saturated (A) coronal and (B) sagittal consecutive magnetic resonance images with gadolinium contrast 1 year postoperatively illustrating subchondral cystic lesions and extensive bone marrow edema of the talus and synovitis.

Figure 4.

Schematic illustration of our surgical approach. (A) Two entry portals in the medial and lateral side of the talus were created to avoid branches of the anterior tibial artery. (B) Usage of the anterior cruciate ligament tibial guide. (C) Thick gelatinous fluid was extruded from both cysts (blue arrow).

Figure 5.

Photomicrographs at magnification of (A) ×20 and (B) ×40 depicting the loose connective tissue with myxoid change and the presence of blood vessels and a small number of lymphocytes.

Figure 6.

T1-weighted (A) coronal and (B) sagittal magnetic resonance images 2.5 years after surgery show mild bone marrow edema of the talus and only 1 nondiscrete small subchondral lesion. (C) Final clinical follow-up was excellent.