Ganglions can be symptomatic!
Ganglion Knee Cysts Adjacent to the Anterior Cruciate Ligament (ACL) 12/30/2011 11:43PM Reply | Return to Index | Report Post
I am a frequent poster to letsRun.com and I just thought I'd share my story here in case or someone has this injury and happens to Google or do a LetsRun.com search for ganglion cysts adjacent to the Anterior Cruciate Ligament (the ACL).

The story in short: I've had trouble bending my knee on my runs for the past 10 months. I am a pretty serious runner - I was running about 80mpw before this problem and went to about 15 doctors in USA - some orthos and some physiatrists - and had 3 MRIs on it - because of this. One of the first times it became problematic was when I tried to go for a 13 miler with the last 4miles at half marathon pace and I had to cut the workout short as I struggled to flex the knee back. I jogged my way home limping slightly. I saw doctors but they didn't know what was wrong. The first doctor I saw (a local yocal ortho) just told me it was tendinopathy and that I needed to back off. I continued to run on and off through it. Months later, the knee was so bad that on an easy 10miler I ended up unable to bend my knee more than about 20 degrees without excruciating pain and having to just walk home 4-5 miles into the run. Since I was already miles from my house this really sucked. I wasn't getting through to the doctors that this kind of thing just doesn't happen to a serious distance runner without some kind of explanation. Despite 3 MRIs (each of which showed a ganglion cyst of the ACL), out of the 15 doctors I saw, only 2 of them (one of them suggested to me by someone on LetsRun.com and the other a top50 in the USA knee surgeon) came to a conclusion that the ganglion was the problem.

It was especially frustrating because when I visited most doctors, the main thing that would happen to me is that I would explain to them that I have an inability to flex the knee on distance runs and I'd be on the examiner's table, and the doctor would then do a standard tests checking my ligaments (such as Lachman test), not find anything, basically tell me things are fine with my knee, and send me on my way.

One doctor immediately pointed out the problem is the cyst. When I went to any 2nd get opinions on this though, this was often what I was told:
Doctors: "Those are almost always asymptomatic."
Radiologists: "Yes we do make note of them in our reports, but they are incidental findings."

The cyst has increased in size over the past 10 months. 1st MRI it was 1cm, 2nd it was 1.6cm, 3rd it was significantly larger.

I found a couple cases in the med literature that show these can cause problems in some cases, but most of them are from outside the US.
http://www.kneeclinic.com.au/papers/documents/GanglionCystsoftheACL-paperfinal.pdf

http://radiology.casereports.net/index.php/rcr/article/viewarticle/309/623

The bottom line is this - do not assume that if you have a ganglion cyst on your MRI that it is asymptomatic. This may be the case but not always. Doctors need to be aware that they can sometimes be symptomatic because (as I understand it) these things can change size and place during athletic activity/movement and press on things, causing pain and other problems.

Quote from http://smj.sma.org.sg/5011/5011me1.pdf
"Ganglion cysts of the cruciate ligaments are usually asymptomatic, and are often hard to diagnose clinically due to the lack of specific symptoms and signs. Symptomatic patients may present with pain aggravated with flexion or athletic activity, increased pain during posture change, locking, clicking or popping sensations, and a decreased range of motion.(1,8-13) "
Ganglions can be symptomatic!
RE: Ganglion Knee Cysts Adjacent to the Anterior Cruciate Ligament (ACL) 12/31/2011 1:24AM - in reply to Ganglions can be symptomatic! Reply | Return to Index | Report Post
Also, I'm pretty sick of filling out surveys asking me if my knee is locking, buckling, swelling, giving way, etc. as I never really noticed any of these, just increased pain deep inside the knee during and following athletic activities (running being the worst).
ametzy
RE: Ganglion Knee Cysts Adjacent to the Anterior Cruciate Ligament (ACL) 1/3/2012 9:42PM - in reply to Ganglions can be symptomatic! Reply | Return to Index | Report Post
Thank you for posting this. I just received my MRI results today and have a Ganglion Cysts on my ACL and I definitely have symptoms. My main symptom being difficulty in bending my knee all the way back and feeling excruciating pain at times, when I try to force it. My other symptoms are an aching feeling in the bottom of my leg at times and/or in my thigh. This has gotten worse recently, which is partly why I decided to get the MRI. I have suffered with the pain when bending for quite a few years, but it would come and go, but it has gotten worse since October of this year and has been a daily problem. I am a hiker and have noticed that my knee gets worse after a long hike. I believe this problem started for me when I trained and ran a marathon about 8 years ago, I started having problems with the same knee at that point and it has been problematic, on and off over the years.
What are you planning on doing for your cyst? Have you met with an Ortho?
Ganglions can be symptomatic!
RE: Ganglion Knee Cysts Adjacent to the Anterior Cruciate Ligament (ACL) 1/4/2012 3:28AM - in reply to ametzy Reply | Return to Index | Report Post
I'm having it scoped in a few weeks by a top 50 ranked knee Ortho. Dont go to a local ortho. You need to go to an open minded above average Ortho for this IMO because most Ortho and radiologists today (I've talked with them) automatically assume that they're asymptomatic (probably because it's what they read/learned in textbooks and is usually the case but not always). On my first MRI the radiologist put down some kind of minor quadriceps tendonopathy as the main cause of my pain and listed the ganglion like it happened to be there but was an incidental finding/asymptomatic. Minor quad Tendonopathy is nothing really - is not that painful and youd probably expect to see some anyway on any distance runners MRI. I talked to a radiologist at a local place who said "we see them [ganglions] all the time and we make note of them but they're often incidental findings." They can be symptomatic at times especially if You're doing a lot of activity and bending and it's near something and pressing on things. One paper in medical literature says that if during an arthroscopy the Ortho finds a ganglion they should take it out even if it is asymptomatic now because it will likely become symptomatic at some time later. Usually if they find them while inside they will take them out anyway as part of a scope. But they are not usually open to scoping to get rid of them unless the time course of the symptoms suggest that yours is symptomatic and Is worth going after. Ganglions are rare to begin (i think like .6% of knee MRIs) and the general belief is that most are asymptomatic. It makes it difficult because if symptomatic they can produce a variety of symptoms (usually flexion/extension of the knee and generalized deep knee pain without swelling) but there can also be clicking and locking, making it difficult to diagnose. One Ortho I met with (he was a semi famous one too and had done Acl recomstruction on a celebrity) wasn't convinced mine was symptomatic because I didn't report any instability in my knee that they expect from something that interferes with AcL function. One of my symptoms in addition to low grade pain all the time where the pain increases with running and difficulty bending was that if i stop in the middle of a light run to retie my shoe or stretch my calf or something and then start back up, i have difficulty starting my run back up without increased difficulty bending the knee, which i assume is fluid buildup, since these things change size and formation. Sometimes mine doesnt affect flexion or extension that much but more so rotating my bent leg a bit to the side just sitting on the couch, hitting the clutch driving, or going about daily activities. Mine is embedded in the ACL, giving it what they call the celery stalk appearance on an MRI.

For My last MRI my Ortho and the hospital staff let me go for a run to get it hurting and then immediately had me lie on the MRI machine. I'm not sure if my running that time made it appear any larger but mine was larger than its ever been. The radiologist in this report said it's a large ganglio "distorting the architecture of the ACL"

Bottom line is i believe it takes an open minded Ortho to watch the time course to figure out if it's causing problems in your case or not. I was frustrated when i would meet with an Ortho who meets with you for like 5mins each time and bills a couple hundred bucks, does a bunch of the standard tests on the patient table for common things like ligament strains or tears, and doesn't even really listen to the symptoms. You can't really blame them for this sometimes though because they know a lot about how to treat common things and common things are common. That's why every single questionnaire at the doctors office about knee pain asks things about swelling, locking, or giving way, and I never really had any of these. Instead I'd scribble with my pen in messy handwriting under the Other checkbox that Im a runner and i have trouble bending it during my runs and have generalized knee pain that lasts during and after the runs and then gets better, and of course many docs read this and don't know what it could be, but they can figure it out with some more time and energy to think a little outside the box.
Ganglions can be symptomatic!
RE: Ganglion Knee Cysts Adjacent to the Anterior Cruciate Ligament (ACL) 10/17/2012 5:19PM - in reply to Ganglions can be symptomatic! Reply | Return to Index | Report Post
Just to update I had arthroscopy in January 2012 to remove the large ganglion. But It didn't work because while it felt somewhat better I continued to have some pain ... an MRI 6 months later (June 2012) showed the ganglion was back only close to the PCL area this time (smaller than the previous one removed at least). I then found that there is pain not only with flexion this time but also with extreme extension

October 2012
Instead of having surgery again I got the thing aspirated this week (October 2012) and they were Able to take out a little over 2 cubic cm of a thick yellow jelly like substance. They also poked a lot of holes it in with the needle so hopefully it won't grow big again, and inserted some cortisone in there I believe. I'm now waiting to see what the effect of the needle aspiration is, but it's already feeling somewhat better.


I haven't raced since December 2010 where I ran a 3k on the indoor track

I'm hoping I'm now Getting closer to a permanent solution
Misty
RE: Ganglion Knee Cysts Adjacent to the Anterior Cruciate Ligament (ACL) 10/24/2012 11:38AM - in reply to Ganglions can be symptomatic! Reply | Return to Index | Report Post
I have been experiencing terrible pain on the outside of my left knee since July of 2012. I was 1st told that I had a bad case of IT Band Syndrome. After 2 rounds of physical therapy, I am still in pain. Ortho thought maybe I had a tear in my meniscus. My MRI showed no tear and a small ganglion cyst. He gave me a shot of cortisone to see if that will relieve some of my pain.

My knee buckled and was very stiff when I first injured it. I felt something "pop" while running. I am very frustrated with no answers.

I plan to seek a 2nd opinion. How is the knee now for you?
Mrs. M
RE: Ganglion Knee Cysts Adjacent to the Anterior Cruciate Ligament (ACL) 10/30/2012 8:46PM - in reply to Ganglions can be symptomatic! Reply | Return to Index | Report Post
I'm curious too about others G. cysts - found out today from my chiro that thing sticking out the side of my left knee since I first starting running when I was 27 is actually a ganglion cyst. It's never, ever bothered me but I've recently been having some knee catching issues AFTER my run or with light jogging in between intervals. I'm not sure if the cyst has anything to do with this or not.....
ACL Ganglion Cyst in Austin
RE: Ganglion Knee Cysts Adjacent to the Anterior Cruciate Ligament (ACL) 2/3/2013 9:59AM - in reply to Misty Reply | Return to Index | Report Post
Just had an MRI of right knee. Torn meniscus and small ganglion cyst on ACL ajacent to laterl femoral condyle. Dr wants to replace my knee! He would not even discuss the cyst. After research on my own I am convinced that the cyst is causing my pain. I can jog but not sprint. Can't lift my knee without real discomfort. Climbing stairs, getting in and out of car...lots of non-athletic activities hurt. Tried cycling yesterday and only able to handle 8 miles. I'm a 65 yr old female and active in masters track and field and this sucks. My favorite activity is hurdling. Where to go from here???
earth4514
RE: Ganglion Knee Cysts Adjacent to the Anterior Cruciate Ligament (ACL) 6/5/2013 12:16AM - in reply to Ganglions can be symptomatic! Reply | Return to Index | Report Post
I had a ganglion cyst in my left knee. Before I found out, I was having trouble bending my knee. I have had surgery twice before on my left knee so I had ortho appointments often. My othro recommended a MRI and the MRI showed a decent size cyst. He told me that my cyst most likely was causing my problems. The recommendation was to remove the cyst. Since then, I have had no problems with my left knee. My right knee however, has become problematic. I had a MRI on my right knee and it showed a smaller ganglion cyst. The othro doctor told me since it worked well for my left knee they plan to remove the one on my right knee. I am scheduled for surgery in two months. Hopefully I do not get another cyst after that.
Keith Stone
RE: Ganglion Knee Cysts Adjacent to the Anterior Cruciate Ligament (ACL) 6/5/2013 7:11AM - in reply to Ganglions can be symptomatic! Reply | Return to Index | Report Post
They definitely can change size and shape. Mine will vary from the size of half a golfball (it's current "normal" size) to what looks like a partially flattened tennis ball. Great for grossing people out when you're wearing shorts.

In any case that combined with a bone spur under the IT band and you have some really bad news. cyst swells, puts pressure on the IT band and also various nerves in the same region. Adds up to a really unhappy camper.

I've had it drained twice, but they have what looks like bloody gelatin in them and it's not a simple process. Placement makes removal tricky, but it's going to happen by default when I get a total knee replacement next month.

The long and short of it is cysts can and do change shape in response to triggers, and if there's anything nearby like a nerve or abnormality like a bone spur the result can be extremely unpleasant.
jwolford77
RE: Ganglion Knee Cysts Adjacent to the Anterior Cruciate Ligament (ACL) 6/10/2013 12:17PM - in reply to Ganglions can be symptomatic! Reply | Return to Index | Report Post
Hello first I wanted to say thank you for the information. I have had severe knee pain since Oct '12. My doctors have been treating me like crap ever since I reported my injury. I have been getting treated like a drug seeker because I keep telling them nothing helps with the pain. I had an MRI done and after getting the run around from my doctors, I got the MRI report. Come to find out I have 2 ganglion cysts one at each end of my ACL and a multitude of other problems. I can barely walk, stairs are a nightmare and sleeping at night is almost impossible. I have all the symptoms, clicking, popping, patella dislocation, pain that runs down my shin, and numbness and tingling in my foot, and so on. So far I have had one cortisone injection and it has not worked. I am tired of being in this much pain. But with your information I am now "armed" with information to take to my next appointment. Thank you again.
Katinka
RE: Ganglion Knee Cysts Adjacent to the Anterior Cruciate Ligament (ACL) 6/18/2013 8:25AM - in reply to Ganglions can be symptomatic! Reply | Return to Index | Report Post
I'd like to contribute a special variant of this kind of issue. Having had an ACL repair a few years ago, I am just about to have a second ganglion removed from the tibial tunnel (drilled as part of the original reconstruction). A previous cyst was successfully removed a couple of years ago. The cysts grow and shrink in size - at their largest they fill the length of the tunnel and then"pop out" at the end, showing as a swelling on the inside below the knee anywhere between the size of a large marble and half a tennis ball. When its really bad it is extremely painful to walk on, especially uphill. Running is then out of the question. My surgeon plans to fill the tunnel with bone chip this time to see whether that might prevent another recurrence of the cyst. Fingers crossed - I'd like to run again!
Allison
RE: Ganglion Knee Cysts Adjacent to the Anterior Cruciate Ligament (ACL) 10/15/2014 8:16AM - in reply to Ganglions can be symptomatic! Reply | Return to Index | Report Post
Finally I have found others with the same issue! So back in may I was averaging 100 miles a month.. Then June 1 I fell on my left knee during a 1/2 and finished anyway. I stopped running cause I had swelling and scraped my knee pretty bad. Well a couple months went by where just walking around the office I had problems fully extending my L leg and bring my leg to my chest. I could feel a sharp pain. It was intermittent. Although walking around all day on it, I could feel it aching at night so I would elevate it. That's just walking around the office. Then the next time I went for a 3mile walk and that night the pain came from the back of my knee shooting to my foot 8 out of 10 kind of pain I couldn't sleep so I went to see my GP. He set me up with PT and an MRI. The MRI found a 3cm ganglion cyst behind the back of my knee just above it. Of course not saying they normally remove those things that they are asymptomatic. I told them, this pain is keeping me from my serenity of running. I was supposed to run the Marine Corps Marathon and had to cancel. I was sent to Ortho who gave me a compression sleeve for my leg. They ordered another MRI of my femur to see if the cyst is sitting on an artery or a nerve. Everytime I leave the drs or pt my leg starts to ache. The pain I experience is only after it's been messed with or I over exert with exercise... To me that's an issue that they need to fix! Any suggestions?