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脛骨側に発生した後十字靱帯(PCL)ガングリオンは前方鏡視では処置が困難である.今回,PCLガングリオン症例に対して後方trans-septalポータルを作成し,後内側と後外側の後方2ポータルにより腫瘤の確認と処置ができた1例を経験した.症例は48歳の男性で,主訴は膝窩部痛である.MRI所見ではPCL後方にT1強調画像で低輝度,T2強調画像で高輝度の囊包性の腫瘤があった.関節鏡視下手術でtrans-septalポータルによる後方鏡視でPCL後方の滑膜が黄色粘調性の内容物により膨隆しており,腫瘍壁を切除した.病理所見はガングリオンであった.術後のMR画像でガングリオンは消失した.
Ganglions arising from the tibial side of the posterior cruciate ligament (PCL) are difficult to excise through the conventional anterior portals. We excised a PCL ganglion by using two portals posterior through a trans-septal portal. The patient was a 48-year-old male who complained of pain in the back of his right knee. Magnetic resonance imaging (MRI) showed a cystic mass behind the PCL that was low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Arthroscopic examination of the posterior compartment through the trans-septal portal revealed expansion of the synovial surface of the PCL by yellowish mucinous fluid. The wall of the cyst was excised, and the pathological examination confirmed that the cystic lesion was compatible with a ganglion. Postoperative MRI revealed complete absence of the ganglion.
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