(Fig 2-D.08) ACL graft Mucoid degeneration and ganglia

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1. Cystic Degeneration of the Graft

• Cystic degeneration, also known as ganglion cyst formation within the graft, is recognized as a late complication of ACL reconstruction.
• These cystic fluid collections can extend proximally through the tibial tunnel into the joint space or distally into the soft tissues anterior to the tibial tubercle (AJR 2010).

2. Ganglion Cyst Formation

• Locations: Ganglion cysts may form within the graft or the tibial tunnel.
• Symptoms: While not associated with graft failure, cysts can be symptomatic due to mass effect, sometimes necessitating debridement or aspiration.
• Complications: Tunnel cysts may lead to pain, graft laxity, and joint instability, with tunnel widening observed.
• Common Associations: Ganglion cysts are more frequently observed with hamstring tendon (HT) grafts and endobutton fixation devices (Skeletal Radiology 2022).

3. Ganglion Cysts vs. Graft Rupture

Distinguishing Features

• Integrity: Ganglion cysts can be differentiated from graft rupture as the graft's fibers remain intact but are displaced by the ganglion cyst.
• Fluid Accumulation: Fluid may gather within the tunnels, particularly within doubled semitendinosus and gracilis tendon grafts, mainly in the first two years post-operation (AJR 2010).

AJR 2010; 194:476–484

Skeletal Radiology (2022) 51:1347–1364

 

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