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Background Baker9s cyst (BC) is a distension of a bursa between the gastrocnemius and semimembranosus tendons that has an anatomical communication with the knee joint. direct puncture of the cyst for aspiration and corticosteroid administration are widespread practices and gives a signifcant pain relief and functional improvements. Objectives Objective is to evaluate the value of ultrasound guided intervention versus clinically guided aspiration of Bakers cyst on knee function in patients with knee OA Methods The study was carried out on 50 patients with the following inclusion criteria: knee osteoarthritis, grade III according to kellgren and Lawrence scale, knee function KOOS scale 50 or less in all scale components and symptomatic Bakers cyst diagnosed clinically and confirmed by ultrasound. Aspiration and corticosteroid triamcinolone 40mg injection of the Bakers cyst done for 25 patients under ultrasound guidance (group I) and in the other 25 patients aspirationand injection done clinically guided (group II). Knee functional status was assessed twice before and after aspiration in both groups using KOOS scale for Pain, other Symptoms, Activities of Daily Living (ADL), Sport and Recreation Function (Sport/Rec) and knee-related Quality of Life (QOL). Results Comparison of both groups as regards the KOOS scale parameters before aspiration shows no significant difference between both groups. KOOS scale parameters after aspiration was significantly improved in both groups but there was a significantly higher improvements in group one than group two, as t was 8.4 for Pain, 8.3 for Symptom,9.5for ADL, 16.8 for Sport/Rec, and 10.3 for QOL and p Conclusions Baker9s cyst aspiration and corticosteroid administration appears to be effective method for relieving pain and functional improvement in patients with knee OA, and ultrasound guidance appears to an effective tool to maximise the benefits of this intervention in comparison to clinical guidance. Disclosure of Interest None declared

Background Baker9s cysts have a significant functional impact in patients with knee osteoarthritis (KOA), which in turn made its detection an important issue. Despite the impact of these cysts, clinical diagnosis remains of low sensitivity which raises the possibility of subclinical cysts. Objectives Estimate the subclinical presence of popliteal cyst and its impact on functional limitation in patients with KOA. Methods Study was carried out on 444 patients with primary KOA, grade III according to kellgren and Lawrence scale with absence of any clinical signs suggesting the presence of Baker9s cyst. Knee functional status was assessed using KOOS scale for Pain, other Symptoms, Activities of Daily Living (ADL), Sport and Recreation Function (Sport/Rec) and knee-related Quality of Life (QOL). All patients were assessed by Ultrasound and power Doppler for detection of Baker9s cyst. Results US showed that 396 (89.2%) patients out of 444 had no Bakers cyst and they represent group one, on the other hand bakers cyst detected in 48 (10.8%) patients which represent group two. Comparison of both groups shows that KOOS scale parameters was significantly higher in group one than group two, as t was 9.4 for Pain, 8.2 for Symptom, 10.1 for ADL, 17.9 for Sport/Rec, and 11.3 for QOL and p On the other hand a significant negative correlation was found between the cyst size and the KOOS parameters where r was -0.794, -0.702, -0.653, -0.448, -0.607 for Pain, Symptom, ADL, Sport/Rec, and QOL respectively and p Conclusions According to our results Baker9s cysts appears to be frequently present subclinically and its subclinical presence was associated with highly significant functional limitation of the Knee joint. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.1144

Background A Baker9s cyst is an enlargement of the gastrocnemius-semimembranosus bursa in the knee that usually communicates with the joint. Ultrasonographical examination is important for differentiation of Baker9s cyst from other pathologies such as aneurysms of the popliteal artery, synovial sarcoma, and ganglia of the popliteal tendon. In addition, ultrasonography may provide guidance for safe injections. Treatment options are physical therapy, aspiration and korticosteroid injection, and surgery (1, 2). Objectives The purpose of this study was to compare the effectiveness of intraarticular and intracyst corticosteroid injections for the treatment of Baker9s cyst using ultrasonographic evaluation and guidance. Methods Fifty-five patients with a clinical suspicion of Baker9s cyst were evaluated with B-mode ultrasonography using a 7–13 MHz linear probe. Of these, 38 patients who were diagnosed with a Baker9s cyst, is secondary to osteoarthritis were randomized into 2 groups based on injection type. The maximum transverse and longitudinal cyst areas were measured by ultrasonography, and disability was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at the first examination and again 2 and 6 weeks later. Under ultrasonographic guidance during the first examination, the Baker9s cyst was aspirated directly, and 40 mg triamcinolonehexacetonide was administered via intraarticular injection (group 1) or intracyst injection (group 2). Results There was a significant reduction from baseline in the WOMAC scores and transverse and longitudinal cyst areas in both groups at week 2, while only the WOMAC scores were significantly lower in both groups at week 6 (all p 0.05). There was not observed any side effect. Conclusions Ultrasonography enables the diagnosis, follow-up, safe aspiration, and safe injection of Baker9s cysts. Corticosteroid administered via both intraarticular and intracyst injections are effective for reductions in cyst area, pain, and disability associated with Baker9s cysts; however, based on these results, intraarticular injections appear to be more effective especially in the long term. References Di Sante L, Paoloni M, Loppolo F et al. ULltrasound guided aspiration and corticosteroid injection of Baker9s cyst in knee osteoarthritis: a prospective observational study. Am J Phys Med Rehabil. 2010; 89: 970-5. Bandinelli F, Fedi R, Generini S et al. Longitudinal ultrasound and clinical follow-up of Baker9s cyst injection with steroids in knee osteoarthritis. Clin Rheumatol. 2012; 31: 727-31. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4138

We investigated the mechanism of Foucher's sign, the change in pressure in the Baker's cyst with extension and flexion of the knee, by echography, arthrography, and computed tomography. With extension the gastrocnemius and the semimembranosus muscles approximate each other and the joint capsule compressing the cyst against the deep fascia. Opposite effects in flexion allow the cyst to relax.