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Introduction: Popliteal cysts (PCs) are occasionally accompanied by knee osteoarthritis (OA) and varus malalignment. However, whether concomitant arthroscopic excision of PCs with medial open-wedge high tibial osteotomy (MOWHTO) improves the osteoarthritic environment remains unclear. Therefore, this study assessed serial changes in C-size, medial meniscus extrusion (MME), and cartilage status for up to 2 years following an MOWHTO. Methods: This study retrospectively used serial magnetic resonance imaging (MRI) evaluations to assess 26 consecutive patients who underwent MOWHTO. Of the 26 patients, six with preoperative PCs were included. Based on the arthroscopic findings at the time of the MOWHTO, concomitant meniscal and chondral lesions, and whether or not partial meniscectomy was performed, were evaluated. All patients underwent second-look arthroscopy with plate removal 2 years postoperatively. The PC size, MME, and cartilage sub-scores in the medial compartment of the whole-organ MRI score (WORMS) were assessed by serial MRI preoperatively and at 3, 6, 18, and 24 months postoperatively. The recurrence of PCs and clinical outcomes, including the Rauschning–Lindgren grade, were also evaluated when serial MRI was performed. Moreover, changes in cartilage status were assessed using two-stage arthroscopy. Results: All patients underwent concomitant partial meniscectomy for medial meniscal tears in the posterior horn. A significant decrease in the mean size of preoperative PCs (27.4 ± 22.3 mm) was noted from 3 months postoperatively (8.7 ± 7.6 mm, p = 0.018), and thereafter. The mean size of PCs further decreased with time until 2 years (1.5 ± 4.0 mm, p = 0.018) following an MOWHTO with partial meniscectomy. Moreover, significant improvements in the MME and WORMS values were noted from 3 to 24 months postoperatively. Meanwhile, no PC recurrence occurred during the follow-up period and the preoperative Rauschning–Lindgren grade improved significantly with time after MOWHTO (p = 0.026). Furthermore, the two-stage arthroscopic assessments showed significant improvements in ICRS grade in the medial femoral condyle (p = 0.038). Conclusions: After an MOWHTO with partial meniscectomy, PCs decreased with time up to 2 years postoperatively; no recurrence occurred during the follow-up period, although cyst excision was not concomitantly performed. Furthermore, the reduction in PCs corresponded with improvements in MME and chondral lesions in the knee joint following the MOWHTO.

The primary objective of this study was to assess the outcomes of arthroscopic management of popliteal cysts using the modified Gillquist maneuver for visualization. The original Gillquist maneuver was originally developed to gain access to the posterior knee compartment. However, there were drawbacks, including blind arthroscope insertion, which could potentially lead to unnecessary trauma to the knee and the risk of arthroscope damage. The modified Gillquist maneuver was introduced to overcome these limitations, offering the advantage of direct visualization during arthroscope insertion into the posterior compartment through either the anterolateral or anteromedial portals. This single-institution case series focused on a cohort of five patients aged over 60 diagnosed with unilateral popliteal cysts. These individuals underwent arthroscopic valvulectomy using the modified Gillquist maneuver. The results of the procedure were highly encouraging, providing symptomatic relief for all five patients. Significant improvements were observed in clinical metrics, including the Numeric Rating Scale (NRS), Rauschning and Lindgren Criteria, Lysholm Score, and Knee Range of Motion during a follow-up period of up to 24 months. These promising outcomes highlight the potential efficacy of the modified Gillquist maneuver as a viable surgical approach for managing popliteal cysts in the elderly population.

A 55-year-old women was diagnosed with Baker’s cyst and underwent open Baker’s cyst excision. She had developed acute pulmonary embolism in the post-operative period. Our case report is to emphasise the sub-clinical concomitant deep vein thrombosis with Baker’s cyst. Such a fatal complication has not been reported in literature and preventive measures of pre-operative venous Doppler and post-operative thrombo-prophylaxis can prevent them.

Bakers cyst (BC) is a common condition and can be caused by both inflammatory and non-inflammatory disorders. Small BCs are usually asymptomatic and accidentally revealed. Large BCs present with pain and discomfort in the posterior knee as well as certain limitations of mobility. Large BCs may rupture resulting the fluid efflux down into the calf, which in turn presents with acute pain and number of potential thrombotic and neural complications. On another note, BC rupture requires differentiation with some urgent conditions such as venosus or arterial thrombosis, soft tissue infections etc. In this article we present some aspects of the etiopathogenesis, clinical signs and course of the BC. We also discuss the problematic issues of assessment and diagnostic work-up in case of BC ruptures.

Introduction. The wide prevalence of varicose veins of the lower extremities and relapses of this disease causes a frequent combination of this pathology with other surgical and traumatological diseases. The expediency of using simultaneous operations is manifested in their obvious economic advantages.Objective. To substantiate the expediency and effectiveness of simultaneous laser thermal obliteration of recurrent veins of the lower extremities and Baker’s cyst.Materials and methods. 9 patients with recurrent varicose veins and Baker’s cyst were operated on. Of these, there were 7 (77.8%) women and 2 (22.2%) men, the average age was 52.8 ± 0.2 years. The average duration of the incidence of varicose veins was 14.1 ± 0.3 years, Baker’s cyst – 3.5 ± 0.1 years. As planned, patients underwent simultaneous laser endovenous coagulation of recurrent veins and intracavitary thermal obliteration of Baker’s cyst.Results. There were no complications, the duration of operations was 40.3 ± 0.4 minutes. The intensity of the pain syndrome in 6–8 hours after surgery was 4.1 ± 0.2 points. On the 10th day, no pain was observed in any patient. The duration of pain was 7.8 ± 0.4 days. Long-term results were studied 12–16 months after completion of treatment in 9 (100%) patients. Recurrent varicose veins were not detected. In 8 (88.9%) patients, complete obliteration of Baker’s cyst was established.Conclusions. Reliable obliteration of Baker’s cyst and recurrent varicose veins, 100% technical success, disappearance of clinical symptoms of this pathology, absence of relapses of both diseases in 8 (88.9%) patients after 12-16 months indicates high efficiency and indisputable prospects of such an approach to the treatment of this category of patients. However, the study is based on a small number of observations, so further accumulation of experience is required to generalize the results of the study.

Background: Renal insufficiency reduces the excretion of uric acid and inflammatory factors and exacerbates the structural deformities caused by gouty arthritis. Musculoskeletal ultrasonography (MSKUS) is often used to evaluate the severity and inflammatory progression of gout. Aim: We aimed to determine whether ultrasound help to identify structural damage in patients with chronic kidney disease (CKD) and gout. Methods: This was a retrospective review of the clinical manifestations and abnormalities observed with MSKUS in 280 patients with gouty arthritis between August 2004 and April 2017. MSKUS identified intra-articular features, including joint effusion, synovial proliferation, Baker's cysts, double contour sign, tophi, and extra-articular tenosynovitis. Serum and synovial fluid were collected and analyzed. Significant differences were identified using the Pearson correlation coefficient and independent t-test. Results: This retrospective cohort included 257 men (91.8%) and 23 women (8.2%) with a mean age of 54.6 years. CKD stage correlated positively with the presence of joint Baker's cyst (P = 0.004). Notably, serum estimated glomerular filtration rate correlated negatively with serum C-reactive protein level in patients with CKD (P < 0.001), and more severe CKD correlated with a higher prevalence of Baker's cyst in CKD patients (P = 0.0037). Conclusion: Insufficient control of hyperuricemia can lead to chronic gouty arthritis and subsequent structural deformities. Reciprocally, acute inflammation of joints is downregulated as chronic gouty arthritis develops. Patients with hyperuricemia and CKD should receive regular MSKUS examination to avoid the progression of structural damage in the joints.

IntroductionPopliteal cysts are secondary to degenerative changes in the knee joint. After total knee arthroplasty (TKA), 56.7% of patients with popliteal cysts at 4.9 years follow-up remained symptomatic in the popliteal area. However, the result of simultaneous arthroscopic cystectomy and unicompartmental knee arthroplasty (UKA) was uncertain.Case presentationA 57-year-old man was admitted to our hospital with severe pain and swelling in his left knee and the popliteal area. He was diagnosed with severe medial unicompartmental knee osteoarthritis (KOA) with a symptomatic popliteal cyst. Subsequently, arthroscopic cystectomy and unicompartmental knee arthroplasty (UKA) were performed simultaneously. A month after the operation, he returned to his normal life. There was no progression in the lateral compartment of the left knee and no recurrence of the popliteal cyst at the 1-year follow-up.ConclusionFor KOA patients with a popliteal cyst seeking UKA, simultaneous arthroscopic cystectomy and UKA are feasible with great success if managed appropriately.

Abstract Synovial chondromatosis is a rare benign condition characterized by chondral proliferation from synovium forming loose bodies which can occur extra‐articularly and intra‐articularly. Surgical removal remains the mainstay of treatment for synovial chondromatosis. Due to the risk of recurrence, every case must be followed up with an MRI.

Popliteal swelling is a common complaint seen in the practice of orthopaedics. Although imaging is useful to aid in the diagnosis of popliteal swelling pre-operatively, definitive diagnosis is often obtained post-operatively through histopathological report of the swelling. Baker’s cyst arises medially and hence usually spares the posterolaterally located neurovascular bundle until it becomes larger in size. A thrombosed aneurysm can mimic that of Baker’s cyst on computed tomography (CT) imaging in view of its location and the absence of contrast within the lesion. Diagnosis of a popliteal swelling with neural or vascular compression is not as straightforward and surgeons should be well aware that intra-operative findings may differ from diagnosis made pre- operatively. Meticulous exploration is pertinent in identifying the origin of the swelling and structures related to it. MRI imaging of the swelling should be done pre- operatively whenever possible.

Objectives: To identify the factors associated with Baker’s cyst rupture on MRI. Material and methods: From January 2021 to December 2022, a total of 441 knee MRI examinations in 441 patients (mean age: 47.7 ± 13.8 years) with Baker’s cyst were included in this study. Patients were classified into two groups: those with ruptured vs. unruptured Baker’s cysts. On knee radiograph, osteoarthritis grade was assessed based on Kellgren-Lawrence grade. On MRI, combined structure injuries, alignment type between semimembranosus tendon and medial head of gastrocnemius tendon, amount of joint effusion, presence of septation, maximal diameters of cyst, and cyst volume were evaluated. Receiver operating characteristic (ROC) analysis was performed to assess the predictive performances of imaging factors for cyst rupture. Results: There were 146 patients with Baker’s cyst rupture and 295 patients without rupture. Patients with cyst rupture showed significantly longer maximal transverse diameter (25.8 ± 6.8 mm vs. 21.6 ± 5.8 mm, p = 0.035) and larger volume (13.3 ± 6.2 cm3 vs. 9.9 ± 5.1 cm3, p = 0.012) than those without rupture. On ROC analysis, maximal transverse diameter of cyst ≥ 22.2 mm (sensitivity = 64.4%, specificity = 54.9%) and cyst volume ≥ 10.9 cm3 (sensitivity = 71.2%, specificity = 58.3%) were the cutoff values for predicting rupture of cyst, respectively. The cyst volume showed significantly higher area under the curve (AUC) than maximal transverse diameter (0.726 vs. 0.642, p = 0.002). Conclusion: Longer transverse diameter and larger volume of Baker’s cyst could be predictive imaging parameters for cyst rupture.

Abstract Background Primary cutaneous mucinosis are a heterogeneous group of diseases characterized by the deposition of glycosaminoglycans in the dermis and the follicles. These diseases are rare in children therefore their diagnosis and management are still challenging. Joint involvement has been reported in patients with secondary cutaneous mucinosis and, rarely, in primary mucinosis. We describe a case of Cutaneous Mucinosis of Infancy with joint involvement. Case presentation An healthy 5-year-old boy showed acute arthritis of the left knee and left elbow confirmed by ultrasound. Laboratory tests were within normal range. Symptoms disappeared after a course of nonsteroid anti-inflammatory drugs. One year later, the knee swelling reappeared; juvenile idiopathic arthritis was diagnosed and intra-articular steroid injection was performed. Due to persistence of arthritis of the knee he was admitted to our hospital. On physical examination variable skin-colored lesions were observed, which had been in existence for over 2 years. We performed a skin biopsy that showed an interstitial mucine deposition in the reticular dermis. Cutaneous Mucinosis of Infancy was diagnosed. Discussion and conclusions Cutaneous Mucinosis of Infancy is a persistent dermatosis with benign prognosis and no treatment is generally required. Our case report is particularly interesting because it is the first in which joint involvement has been reported in CMI, a disorder that has so far been described as limited to skin involvement. Further studies will be necessary in order to clarify the pathogenesis of joint involvement in primary mucinosis.

Abstract Background Lymphatic malformations are the second most common vascular malformations after venous malformations. These slow-flow lesions occur most often in the paediatric population and seldom in the extremities. We report a case of lymphangioma at the popliteal fossa in an adult who underwent complete surgical resection. Case presentation A 30-year-old male presented to the department of orthopaedics with a swelling in the right calf region. Clinically, it was suspected to be a Baker’s cyst. Ultrasound showed a multiloculated anechoic cystic lesion in the inferior aspect of popliteal fossa along the intermuscular plane with multiple internal septations. Infected Baker’s cyst was considered, and MRI was suggested for further evaluation. On MRI, the lesion measured 7.2 × 4.6 × 5.8 cm, appeared as a low signal on T1 and high signal on STIR and T2, with multiple internal septations and was situated in the inferior aspect of the right popliteal fossa along the intermuscular plane between the lateral head of gastrocnemius and soleus muscles. No obvious synovial extension. A post-contrast study showed minimal peripheral and septal enhancement. Neither internal enhancing solid components nor significant internal derangement of the knee was observed. Diagnosis of lymphangioma was considered based on the imaging features and ruling out the common differentials for cystic lesions around the knee. Wide local excision was performed. Histopathological evaluation showed multiple irregularly dilated lymphatic channels lined by flatted epithelium. The lymphatic channels were seen to be surrounded by thick fibro collagenous cyst wall with scattered congested blood vessels, skeletal muscle fibre and chronic inflammatory cells. Conclusion Lymphangioma must be included in the differential diagnosis of any cystic lesion if the lesion appears multiseptated and/or infiltrative. At the popliteal fossa, it presents as a multiseptated cyst with no synovial continuity or internal derangement of the knee.

Abstract Purpose Several studies have shown an excellent success rate of communication enlargement surgery for popliteal cysts (Baker’s cysts). Ultrasound-guided surgery can improve the accuracy of this procedure and may lead to better outcomes. This study describes a simple ultrasound-guided arthroscopic technique to manage popliteal cysts and reduce postoperative pain. Methods After routine arthroscopic observation with a standard 2-portal approach, the arthroscope is redirected toward the posteromedial compartment from the anterolateral portal through the intercondylar notch. A posteromedial portal is then placed at this view. Subsequently, a contrast dye (indigo carmine) is injected into the popliteal cyst percutaneously using ultrasonography. This procedure makes it easier to find a capsular fold or valvular opening. The valvular opening between the semimembranosus and medial gastrocnemius is enlarged with a shaver and radiofrequency ablation. Cystectomy is not performed in any case. Finally, the irrigation fluid is suctioned, and the reduced cyst is visualized by ultrasound. Additionally, a periarticular multimodal drug injection is administered into the septum and inner wall of the cyst under ultrasound guidance. Conclusions Ultrasound-guided arthroscopic surgery for popliteal cysts can ensure reproducibility and be effective for postoperative pain relief. Thus, this combined procedure may be an optimal treatment option.

Objective. To determine the magnetic resonance imaging (MRI) morphological features of Baker’s cysts and to assess their correlation with the age of patients.Material and methods. The investigation was based on the assessment of MRI readings in 37 patients with Baker’s cysts; of them there were 29 (78.4%) women and 8 (21.6%) men. The mean age of the examinees was 60.3 years (25 to 82 years).Results. The mean dimensions of the cysts were measured. Their length, width, and height were 34 ± 2.1 mm, 5 ± 1.2 mm (range 4–31 mm), and 58 ± 2.9 mm, respectively. Their mean thickness was 0.7 mm. Intracystic chondral bodies were detected in 3 (7.5%) cases. These parameters were shown to be unrelated to age. It was found that all cysts were multi-chamber and an average of 6.8 chambers was detected. There was a weak, inversely proportional, statistically significant relationship between the age of the patients and the number of chambers in the cyst. The younger participants of the investigation exhibited no meniscal damage in an overwhelming case (57.1%); whereas complete and incomplete meniscal tears much more often occurred in older patients with Baker’s cysts (from 29 (78.4%) to 34 (91.9%) people, respectively).Conclusion. Degenerative bone and cartilage tissue changes in the joint increase with age, regardless of the cyst sizes.

Interventional laser-induced thermal therapy (LITT) is an emerging technique to treat popliteal synovial cysts. The goal of LITT is coagulation and subsequent obliteration of inosculation and cystic cavity under local tumescent anesthesia. Ultrasound is an imaging method used for LITT. Analyzing the results of the use of laser obliteration of Baker's cyst, the authors concluded that obliteration of solely the cystic popliteal cavity can provide persistent recovery. As expected, in any invasive procedure, there are some procedure-related adverse events or complications.

Most popliteal vein aneurysms are asymptomatic and commonly detected during Duplex ultrasound examination for varicose veins. Some cases may be misdiagnosed as Baker's cyst or tibiofibular cysts. Surgical repair is recommended to avoid life-threatening complications including pulmonary embolism. Herein, we report the successful surgical repair of a primary popliteal vein saccular aneurysm misdiagnosed as Baker's cyst during the initial admission for pulmonary embolism. [Turk J Vasc Surg 2021; 30(2.000): 159-61]

Abstract Background In adults, Baker’s cyst development is attributable principally to secondary alterations after degenerative changes. The latter changes often accompany osteoarthritis, and we frequently encounter patients with Baker’s cysts seeking total knee arthroplasty (TKA). Baker’s cysts are not usually subject to extensive preoperative evaluation because the cysts often disappear naturally after surgery, unaccompanied by any adverse symptoms. Case presentation A 63-year-old woman presented with moderate pain in the left knee joint that had developed 1 year ago. Posterior knee pain was aggravated on maximum knee flexion. Three months previously, a popliteal mass had become palpable and the patient had undergone needle mass aspiration twice in a local orthopedic hospital, but the mass had recurred. We initially considered TKA for her severe degenerative osteoarthritis. However, we decided to perform only arthroscopic debridement and cyst excision because the patient was experienced severe pain only on maximal knee flexion, and did not want TKA. Pus gushed from the torn cyst during the operation. We diagnosed an infected Baker’s cyst. The patient was treated with a first-generation cephalosporin postoperatively. Conclusions A Baker’s cyst that was aspirated and still causes symptoms with altered blood tests needs to be evaluated accurately before TKA.

A popliteal cyst or Baker’s cyst is easily distinguished from other cystic or solid tumors on the magnetic resonance imaging sections. At the current level of medicine development, many options have been developed for medical and surgical treatments for popliteal cysts; however, there are still disputes on their validity and efficiency. In addition, there is no consensus on the etiology and pathogenesis of the disease. MRI is known to show similar intraarticular changes in asymptomatic patients and articular syndrome patients, which could suggest that intraarticular pathological changes played a secondary role in a number of cases of Baker’s cyst formation. Under these conditions, laser-induced thermotherapy is considered by the authors to be justified. Its main goal is to coagulate the wall of the tissue cyst, which subsequently leads to obliteration of its anastomosis and cavity. Ultrasound control is used to visualize and ensure the safety of manipulation. This paper describes a case of MRI for diagnosing a popliteal cyst and monitoring the efficiency of laser-induced thermotherapy.

The work is devoted to the study of the theoretical value of destructive influence on normal tissues of an organism by infrared radiation that goes beyond the treated pathological focus. This situation is possible if the direct laser radiation on the tissues is extremely long-acting. The solution to this problem can be the uniform distribution of heat inside the volume through indirect heating of the liquid, which contributes to minimal damage to the perifocal structures. A non-stationary thermophysical model of the process of heat propagation in biological tissues is presented, allowing to carry out studies of energy transfer from internal liquid contents of Baker's cyst heated by infrared laser radiation of a given specific power through a certain thickness of its wall to surrounding biological tissues. Calculation of the spacetime temperature distribution in the cyst wall and surrounding fat tissue is carried out by the finite-difference method. The time of effective exposure to temperature on the entire thickness of the cyst wall was estimated to be 55 ° C on its outer surface. The safety procedure ensures the exposure duration of this value is not more than 10 seconds. As a result of the calculations carried out, it is established that there are several operating modes of a surgical laser that meet all the safety requirements with a simultaneous effective procedure. Local one-sided hyperthermia of the synovial membrane and subsequent coagulation of the entire wall thickness due to heat transfer contributes to the elimination of the cavity neoplasm of the popliteal region. With a thickness of 3 mm, the heating mode is satisfactory, under which the exposure time lasts about 200 seconds, and the specific power of the laser radiation in the internal medium of the liquid contents of the Baker cyst is approximately 1.

Abstract Background Baker’s cyst is a benign lesion that results from degenerative or inflammatory diseases of the knee joint. When Baker’s cyst ruptures, it may simulate deep vein thrombosis known as Pseudothrombophlebitis syndrome with calf pain, swelling and redness. Pseudothrombophlebitis syndrome without thrombus in popliteal veins has distinct treatment choice than deep vein thrombus. Case presentation In this report, we presented a 47 year-old male rheumatoid arthritis patient with complaints of redness, pain and swelling on his right calf. Pseudothrombophlebitis syndrome was diagnosed due to ruptured Baker’s cyst. Conclusions We used musculoskeletal ultrasound for both differential diagnosis and treatment of pseudothrombophlebitis syndrome. Ultrasonography revealed massive fluid collection within muscle layers. 280 cc inflammatory fluid was aspirated simultaneously. We also emphasized the importance of ultrasonography in diagnosis and treatment of Pseudothrombophlebitis syndrome with this report.

A 42-year-old presented gradually a posterior pain of his left knee for one month with no trauma history. He consulted our orthopedic department. Clinical examination showed no abnormality. The radiograph was normal. Sonography of the calf revealed a baker´s cyst of the knee with no sign of compressions and so we elected for medical treatment and rest advised. Three months later, the pain got worse with irradiation to the leg along with a sensation of chest tightness, reasons for which, he was transferred to our emergency department. On admission, his blood pressure was 110/52 mmHg, pulse rate 110 beats/min, respiratory rate 23 breaths/min, SaO2 96% on room air without signs of respiratory distress. The local examination found a decrease in calf bloating of his left leg with Homan´s sign positive. The D-dimer result was positive. The blood gas sampling found hypoxia-hypocapnia. The Doppler ultrasound of the left lower limp revealed a deep venous thrombosis of the popliteal vein. In the view of the strong suspicion of pulmonary embolism, computed tomography angiography of the thorax revealed a distal bilateral pulmonary embolism and so the patient was put on anticoagulant treatment and oral´s analgesics. A few days later, we performed a magnetic resonance imaging of the knee that showed a poly-lobed baker´s cyst with compression of the pedicle (A,B) prompting the patient to undergo surgery. After anesthetic preparation, we performed the resection of the cyst (C) and the intra-operative aspect showed the thrombosis of the popliteal vein (D). At a follow up of 12 months, the patient did well with no pain no dyspnea and no recurrence of Baker cyst.

We present a case of popliteal venous aneurysm causing recurrent pulmonary embolism successfully treated by surgical resection.

We report a case of a chronic huge popliteal cyst, which dissected into the gastrocnemius without rupture and was complicated with acute primary infection mimicking calf abscess upon presentation. To the best of our knowledge, it is the largest popliteal cyst with intramuscular dissection reported in the literature. It is noteworthy that infected popliteal cyst is a rare differential diagnosis of calf abscess.

We have examined the soft-tissue state and bone structure of the joint in osteoarthritis of the knee joint. The analysis was performed in 120 male and female patients with primary osteoarthritis of the knee joint. Digital X-ray and ultrasonographic semiotics of diseased joint has been studied. According to finfings we established the correlation between degenerative changes in the subchondral and changes in the meniscus, capsule, ligamentous apparatus, etc.

This is an unusual case of pseudothrombophlebitis resulting from rupture of Baker's cyst in a patient with Reiter's syndrome. The patient presented with a swollen, painful left calf and persistent itching on the skin of the calf. Ultrasonography showed a ruptured popliteal cyst with minimal hemorrhage and fluid collection within the fascial compartments and gastrocnemius muscle. Color Doppler ultrasound showed a patent popliteal vein and artery and duplex Doppler scans revealed a normal flow pattern. In conclusion, the clinical picture of deep vein thrombosis and that of pseudothrombophlebitis are difficult to distinguish by clinical examination and necessitate detailed examination by imaging techniques. Persistent pruritus on calf skin resulting from irritation of inflammatory synovial fluid may be an important clinical feature.