Answer to S. Das' Letter to the Editor: “The Ganglionic Cysts of the Proximal Tibiofibular Joints: Mystery Unfolded”

We are grateful for the interest our paper has generated and for the observations that have been made by Dr. Das.

His comments on the title can be shared; in fact the title of the original draft was: “A synovial ganglion of the proximal tibiofibular joint: reports of two cases in athletes”, which seems to be more comprehensible than the one which appeared in the journal. Unfortunately during the electronic sending of the paper to the Editor, the program imposed a progressive cutback in the number of words of the title in order to respect the form of a “Rapid Communication”, which made it very different from the reality of the paper.

We also agree on Dr. Das' comments on the age of individuals affected by ganglion cysts and on the presence of such abnormalities in the sport population; however the assertion reported in our text refers only to the ganglion cysts of the proximal tibiofibular joint; other localisations, as those detected by MRI on the knee PCL, are more common in young athletes, even with no clinical relevance.

The association between the duration of this pathology and for how long the sport has been practiced is another important matter; both our athletes were engaged in their sport activity since childhood, with higher levels of activity in the last 10 years for the first case and 6 years for the second case.

We did not have any history of trauma even in our first case, however the relationship between sport activity and ganglion cysts remains unclear.

The absence of objective relevant neurological signs in both cases motivated us not to conduct an EMG study, but we agree that for a more complete and comprehensive clinical procedure an EMG study should be recommended in these cases.

Stefano Dragoni