半月縫合術後に発生したガングリオンの1例

Development of a Ganglion after Meniscal Repair : Case Report

　抄録：鏡視下半月縫合術後に発生したガングリオンの1例を経験したので報告する．症例は25歳，女性で事務員である．1994年，スキーにて左膝を受傷し，他医で保存的加療を受けていた．1996年，前十字靱帯（ACL）損傷，内・外半月損傷および後外側靱帯損傷と診断され，当院にてACL再建術，外側半月部分切除および内側半月縫合術を受けた．術後経過は良好であったが，術後4年頃より左膝関節内側部に腫瘤を触知するようになり，2002年当院を受診した．MRIで内側半月に接する多房性の腫瘤を認め手術を行った．関節鏡視では内側半月の縫合部は治癒しておらず部分切除を行い，腫瘤の摘出も行った．半月縫合後のガングリオンの成因は，縫合糸を介した滑膜細胞の関節外への浸潤との報告があるが，本症例では組織学的に縫合糸周囲には滑膜細胞は認めず，むしろ半月の変性を基盤として発生したのではないかと推測された．

　A cace in which a ganglion developed after arthroscopic meniscal suture is reported. A 25-year-old woman injured her anterior cruciate ligament (ACL), medial meniscus, and lateral meniscus at 21 years of age. The ACL had been reconstructed with a bone-patella tendon-bone graft, and the medial meniscus had been sutured with 2-0 poly-filament nylon sutures. Four years after the meniscal repair, she developed a mass under the surgical scar, and an MRI scan of the knee showed a periarticular cyst. Arthroscopy revealed that the sutured meniscus had never healed. Both the mass and the unhealed meniscus were removed, and the nylon suture was found inside the cyst. Meniscal ganglion is not an uncommon condition, and degenration of a meniscus is sometimes associated with the development of an isolated meniscal ganglion. Meniscal cysts that form after meniscal repair have been reported to be caused by active fluid secretion after synovial cell invasion along the suture. However, histolongical examination showed no evidence of synovial cell development around the suture thread in our patient, and the meniscal ganglion may have developed as a result of degeneration of the meniscus itself.