Arthroscopic-assisted, joint preserving surgical treatment of a cuff tear arthropathy-related acromioclavicular joint cyst with associated geyser sign: a case report

While acromioclavicular (AC) joint cysts are rare, their pathogenesis is well described. Usually occurring as a painless severe swelling above the AC joint.7Kontakis G.M. Tosounidis T.H. Karantanas A. Isolated synovial cyst of acromio clavicular associated with degeneration and an intact rotator cuff.Acta Orthop Belg. 2007; 73: 515-520PubMed Google Scholar,9Montet X. Zamorani-Bianchi M.P. Mehdizade Martinoli C. Bianchi S. Intramuscular ganglion arising from joint.Clin Imaging. 2004; 28: 109-112https://doi.org/10.1016/S0899-7071(03)00104-9Abstract Full Text PDF PubMed Scopus (19) Scholar,12Ockert B. Mutschler W. Biberthaler P. Braunstein V. Die Akromioklavikulargelenkzyste: Eine Kasuistik und Zusammenfassung der Literatur.Orthopade. 2009; 38: 974-980https://doi.org/10.1007/s00132-009-1468-9Crossref (3) Scholar,15Segmüller H.E. Saies A.D. Hayes M.G. Ganglion joint.J Shoulder Elbow Surg. 1997; 6: 410-412Abstract (13) Scholar,17Tshering Vogel D.W. Steinbach L.S. Hertel R. Bernhard J. Stauffer E. Anderson S.E. Acromioclavicular cyst: nine cases pseudotumor shoulder.Skeletal Radiol. 2005; 34: 260-265https://doi.org/10.1007/s00256-004-0883-6Crossref (49) Scholar Hiller et al first described two etiologies cysts.6Hiller AD, Miller JD, Zeller JL. formation. Clin Anat 2010;23:145-152. https://doi.org/10.1002/ca.20918.Google The isolated type I limited to not cuff tear. increased fluid production leads formation that may become prominent in subcutaneous soft tissue.3De Maio F. Di Marcantonio De Luna Caterini Tresoldi I. Farsetti Synovial without tear: case series patients.Int J Surg Case Rep. 2020; 75: 390-393https://doi.org/10.1016/j.ijscr.2020.09.084Crossref Scholar,6Hiller Type II mostly seen due tear arthropathy (CTA) since superior migration humeral head causes abrasion inferior joint.2Craig EV. geyser sign torn cuff: clinical significance pathomechanics. Relat Res 1984;191:213-5.Google Scholar,3De Scholar,8Maziak N. Plachel Scheibel M. Moroder patient cuff-tear arthropathy: rare cause shoulder discomfort.BMJ 2018; 2018bcr-2018-226188https://doi.org/10.1136/bcr-2018-226188Crossref (6) Scholar,14Purohit Keny Raja Marathe Massive acromio-clavicular arthritis normal functional shoulder-A report.J Trauma. 2019; 10: 522-525https://doi.org/10.1016/j.jcot.2019.03.001Abstract (8) It thought these form through capsule either by valve mechanism or chronically pressure glenohumeral production.2Craig accumulates uniloculated multiloculated cystic mass joint.1Cooper H.J. Milillo Klein D.A. DiFelice G.S. MRI sign: setting chronic tear.Am (Belle Mead NJ). 2011; 40: E118-E121PubMed Craig leaking contrast subacromial bursa into erupting “geyser.”2Craig Several treatment procedures have been recommended for cysts: observation, aspiration, tear, débridement including excision acromioplasty, replacement, arthrodesis reverse arthroplasty, hemiarthroplasty.1Cooper Scholar,16Skedros J.G. Knight A.N. ganglionic treated allograft patch region.J 2012; 21: e1-e5https://doi.org/10.1016/j.jse.2011.07.033Abstract (14) Yet many therapies attributed high rates recurrence.12Ockert optimal strategy remains be defined. This report describes arthroscopic-assisted, preserving surgical large cyst. At final follow-up 2.5 years, no recurrence was observed, outcome showed satisfactory results, despite pre-existing advanced CTA. A 79-year-old male good general health presented our department progressive on his left noticed six months earlier (Fig. 1). did suffer any previous trauma pain. However, he complain about limitations social well-being dissatisfaction cosmetic appearance Clinical examination revealed top unremarkable skin appearance. had active range motion 150° forward flexion, 120° abduction, 30° external rotation. Radiographic magnetic resonance imaging depicted omarthritis CTA (grade 4b according Hamada classification) complete supraspinatus, infraspinatus, subscapularis, long biceps tendon5Hamada K. Yamanaka Uchiyama Y. Mikasa T. radiographic classification massive arthritis.Clin Res. 469: 2452-2460https://doi.org/10.1007/s11999-011-1896-9Crossref (175) 2). acromion significant acetabularization erosion accumulation 3). comprised segregated parts total size 3 × 6 8 cm. Due lack pain well-preserved mobility, authors decided against endoprosthetic care upon informed consent patient. Arthroscopic-assisted resection lateral clavicle considered best option. provided written publication this images.Figure 2Preoperative anteroposterior (A) axial (B) view radiographs showing classification).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Preoperative fluid. AC, acromioclavicular.View (PPT) Arthroscopic surgery performed beach chair position under anesthesia via standard posterior, anterosuperior, anterolateral viewing portals. débrided, 7 mm resected. Sufficient access drain anterior located available prepared 4). main part could addressed arthroscopic-assisted technique required transition open procedure. Via saber-cut approach, dissected surrounding tissue opened. residual jelly-like removed, remaining walls were sutured maintain stability reduce risk recurrence. incision arthroscopic portals closed fashion. attended examinations at weeks, four post-surgery years. hematoma resolved spontaneously within weeks 5). follow-up, there remained asymptomatic. Active passive ranges deteriorate four-month postoperative period. function decline 90° flexion/abduction 50° rotation 2.5-year which we natural course intervention 6). signs tenderness palpation rated satisfactory. He also completely satisfied improved experiencing restrictions everyday life. similar contralateral side 7). deterioration 8).Figure 6Stable (compared preoperative function) flexion (A D), abduction (B), (C), internal (E) achieved follow-up.View 7Assessment results equal affected sides (B)View 8Anteroposterior stable situation CTA, arthropathy.View Cysts events resulting full-thickness tears degenerative transformation Scholar,10Mullett H. Benson Levy O. cyst.Arthroscopy. 23: 446.e1-446.e4https://doi.org/10.1016/j.arthro.2005.12.037Abstract (20) Scholar, 11Nowak D.D. Covey A.S. Grant R.T. Bigliani L.U. cyst.J 18: e12-e14https://doi.org/10.1016/j.jse.2008.11.009Abstract (16) 12Ockert reliable diagnostic workup essential treating physician initially needs consider wide variety potential pathomechanisms infection, hematomas, benign malignant bone tumors, rheumatic diseases, connective conditions, gout, avascular necrosis, neuroarthropathy.3De Affected patients often focus stressful uncertainty possible tumor esthetics well-being.14Purohit Therefore, tool choice offers specificity sensitivity depicting particular pathology.1Cooper Scholar,7Kontakis options removal primarily involve aspiration techniques. usually frequent recurrence.1Cooper Scholar,13Postacchini F, Perugia D, Gumina three cases. 1993;294:111-3.Google underlying pathology addressed, infection draining fistula after repeated attempts.1Cooper Scholar,11Nowak Tshering reported who subsequently because recurrence.17Tshering more recent another underwent several failed attempts aspiration; free up surgery.9Montet Failure has frequently cyst, such degenerated unsolved.1Cooper Clear identification order differentiate types choose most effective preventing In irreparable cuff, combination distal clavicle.1Cooper By enlarging space, pinch effect can removed.1Cooper Although continues exist, shows therefore advised.1Cooper line findings. Despite notice excision. Additional stabilization closure deltotrapezial fascia covering using graft literature outcomes.1Cooper To achieve sufficient coverage supplementary prevent recurrence, opted suture additional reinforcement contrast, replacement greater systemic stress, blood loss, complications.16Skedros 1993 Groh al4Groh G.I. Badwey T.M. Rockwood C.A. Treatment hemiarthroplasty.J Bone Joint Am. 1993; 1790-1794Crossref (34) spontaneous healing years implantation hemiprosthesis multiple former recurrences Nowadays, less invasive preferable when considering treatment.10Mullett We point, Adequate conditions subsequent still ensured procedure, if necessary, future. phenomenon ideal algorithm yet determined. débridement, clavicle, excision, suturing excellent instability follow-up. pain-free full satisfaction function, some persistent outlined enables impairing future care. enhancement support available. Resection areas seems determine rate strongly recommended.