Arthroscopic treatment of massive acromioclavicular joint ganglion cysts with color-aided visualization: a case series of 4 patients

BACKGROUND: Acromioclavicular joint ganglion cysts are rare lesions that mainly arise from the degeneration of the acromioclavicular joint in elderly patients. Although surgical management may be required because of their high recurrence rate after aspiration, few reports have described arthroscopic surgical procedures to treat acromioclavicular ganglion cysts. We report the surgical results of arthroscopic ganglionectomy with color-aided visualization for massive acromioclavicular ganglion joint cysts. METHODS: This retrospective case series examined patients identified with massive ganglion cysts that were localized above the acromioclavicular joint. All patients underwent an arthroscopic removal of subacromial synovium and subsequent injection of indigo carmine into the ganglion. The distal end of the clavicle was excised arthroscopically from the inferior surface, and the ganglion stalk was confirmed using indigo carmine for enhanced visualization and magnification. A ganglion portal was created, and the ganglion cyst was resected with the aid of the dye. RESULTS: Four female patients, aged 78-90 years, were identified with a massive acromioclavicular joint ganglion cyst. Plain radiography showed joint degeneration in the acromioclavicular joint, and magnetic resonance imaging scans showed fluid-filled mass formation. Although all patients initially underwent multiple aspirations of the ganglion cyst, we opted for surgical intervention because of its persistent recurrence. Three patients exhibited concurrent rotator cuff tears, and one patient had a prior history of cuff repair with no retear. After arthroscopic ganglionectomy with color-aided visualization for massive acromioclavicular ganglion joint cysts, none of the patients have shown recurrences at 2 years postoperatively. CONCLUSION: Novel aspects of this case series include the use of indigo carmine to provide a better visualization and identification of the ganglion stalk under arthroscopy. Furthermore, a ganglion portal is useful for achieving complete resection of the indigo carmine–stained ganglion cyst. Color-aided visualization using indigo carmine and the construction of a ganglion portal were useful techniques for performing arthroscopic ganglionectomy in patients with a massive acromioclavicular joint ganglion cyst.