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Вступ. Колінний суглоб оточують різноманітні кістоподібні утворення (КПУ) — бурси, які у нормі клінічно не проявляються. Усі синовіальні порожнини, до яких, зокрема, належать колінний суглоб та бурси, які оточують колінний суглоб, містять синовіальну рідину. Синовіальна рідина є ультрафільтратом плазми крові і складається із білків та інтерстиціальної рідини. У літературі описані бурси, що оточують колінний суглоб, висвітлена ультразвукова класифікація кіст Бейкера залежно від стадії перебігу, яка запропонована І.М. Даниловою [10], та класифікація кістозного переродження меніска, але відсутня інформація щодо патофізіологічних та гістохімічних змін, які відбуваються у КПУ ділянки колінного суглоба, а також відсутня патофізіологічна модель КПУ ділянки колінного суглоба, яка б відображала природу даного захворювання з точки зору фізико-біохімічних процесів. Матеріали та методи. У травматологічному відділенні клініки ­ушкоджень Військово-медичного клінічного центру Північного регіону з початку 2016 року під спостереженням знаходилось 15 пацієнтів із клінічної картиною кістоподібного утворення ділянки колінного суглоба, що підтверджено інструментальними методами обстеженнями: ультразвуковим дослідженням (УЗД), магнітно-резонансною томографією (МРТ) та спіральною комп’ютерною артрографією (СКТА) колінного суглоба. Із них литково-напівперетинчастий бурсит спостерігався у 9 пацієнтів, кісти менісків — у 5 пацієнтів, бурсит переднього відділу колінного суглоба — в 1 пацієнта. Серед пацієнтів 11 чоловіків та 4 жінки. Середній вік пацієнтів становив 43,5 року. Об’єктом дослідження були кістоподібні утворення ділянки колінного суглоба. Усім хворим із КПУ проводили комплексне інструментальне обстеження, яке включало УЗД, СКТА, МРТ, вимірювання внутрішньосуглобового та внутрішньокістозного тисків за допомогою контактного манометра фірми Stryker та надалі — діагностично-лікувальної артроскопії. На основі отриманих даних УЗД проводився розподіл хворих на 4 групи, що базується на процентному відношенню внутрішньопросвітних нашарувань (включень) до загального просвіту КПУ, що дало можливість сформувати нову класифікацію КПУ ділянки колінного суглоба для вибору того чи іншого методу лікування. Результати та обговорення. Для формування та прогресування КПУ має значення підвищений тиск, який становить у середньому 29 мм рт.ст. у положенні згинання та до 58,4 мм рт.ст. у положенні розгинання. Виходячи із попередніх даних, на нашу думку, критичним показником тиску, при якому може настати розрив кісти Бейкера, є тиск більше 60 мм рт.ст. Зазвичай таке ускладнення виникає при тривалому існуванні кісти, коли тривала адсорбція білкових молекул на стінці кісти призводить до адсорбційного зниження міцності та зниження поверхневого натягу — ефект Ребіндера. Висновки. Враховуючи дані біохімічних процесів, УЗД та ендоскопії кіст Бейкера на різних стадіях, ми дослідили, що сама стінка кісти не потовщується, а відбувається пристінкове нашарування білкових молекул із формуванням глобул, які і формують так звану псевдостінку. У подальшому ці нашарування починають формувати перетинки між протилежними стінки, ущільнюватись, що призводить до камерності КПУ. На пізніх стадіях дані нашарування переважають над просвітом КПУ. Запропонована нами класифікація заснована на визначенні процентного відношення внутрішньопросвітних нашарувань до загального просвіту КПУ у двох зрізах та відображає основні морфологічні зміни, що дає можливість визначити оптимальний метод лікування даного кістоподібного утворення та широкого практичного використання у травматології та ортопедії.

Objective: Several symptoms are common to knee osteoarthritis and Baker’s cyst. To what extent each condition contributes to the patient’s discomfort is still a matter of debate. The aim of the present study was twofold: first, to compare the burden of symptoms in patients with isolated knee osteoarthritis and patients with knee osteoarthritis associated with Baker’s cyst; second, to assess the outcomes after conservative treatments. Subject and Methods: Patients suffering from monolateral idiopathic knee osteoarthritis were enrolled. Demographic, anthropometric and clinical data (KOOS scale) were collected. Ultrasound evaluation was performed according to standard protocols. On the basis of the clinical presentation different therapeutic options were used (fluid withdrawal, hyaluronic acid and/or steroids injections). Results: One-hundred and thirty patients were included in the study (97 with isolated knee osteoarthritis, 33 with knee osteoarthritis and Baker’s cyst). In basal conditions, lower scores in KOOS sub-scales were observed in patients with knee osteoarthritis associated with Baker’s cyst and in patients with effusion compared with patients without effusion. At 3 months after therapy significant higher scores were observed in both groups. At 6 months the scores were unchanged in the patients without Baker’s cyst, but worsened in those with Baker’s cyst. Conclusions: The study shows that Baker’s cysts associated with knee osteoarthritis contribute to the burden of symptoms. The conservative treatment of both conditions allows significant improvements, but in the medium term (6 months) the efficacy of the therapy declines in patients with knee osteoarthritis associated with Baker’s cyst.

Zusammenfasung Ziel Die Studie untersucht den Einfluss einer Radiosynoviorthese des Kniegelenks auf das Bakerzystenvolumen im Zeitverlauf. Methode Patienten mit Radiosynoviorthese des Kniegelenks bei gleichzeitiger Bakerzyste wurden retrospektiv ausgewählt und zu einer sonografischen Kontrolle gebeten. Voraussetzung war das Vorliegen einer prätherapeutischen Sonografie mit Darstellung der Bakerzyste in Längs- und Querschnitt zur Volumenbestimmung. Ausschlusskriterium war eine zwischenzeitliche Therapiemaßnahme mit Einfluss auf das Bakerzystenvolumen. Es wurden Gruppen mit zeitlichem Abstand zur Radiosynoviorthese mit einer Zeitspanne von 3 Monaten gebildet (2 bis 4 Monate, 5 bis 7 Monate usw.). Bei zu geringer Patientenzahl innerhalb einer Gruppe wurde diese mit der folgenden Gruppe zusammengefasst. Prä- und posttherapeutisches Bakerzystenvolumen wurden verglichen. Bei 4 auswertbaren Gruppen wurde das Signifikanzniveau mittels Bonferoni-Korrektur auf p = 0,0125 festgelegt. Ergebnisse 102 Radiosynoviorthesen bei 84 Patienten im Alter zwischen 23 und 86 Jahren waren auswertbar. Diese konnten Gruppen mit einem Abstand zur Radiosynoviorthese von 2 bis 4 Monaten, 5 bis 7 Monaten, 8 bis 16 Monaten sowie 20 und mehr Monaten zugeordnet werden. In Gruppe 1 nahm das Volumen um 53 % ab (p Schlussfolgerung Die Studie zeigt einen positiven Effekt einer Radiosynoviorthese auf eine bestehende Bakerzyste, auch über einen längeren Zeitraum. Es erscheint daher sinnvoll, die Radiosynoviorthese als Bestandteil einer multimodalen Therapie zu etablieren, beispielsweise vor einer operativen Intervention.

Basaran, Murat Alper/0000-0001-9887-5531 WOS: 000551478900021 PubMed: 31771037 BACKGROUND: Pain is a significant cause of disability in knee osteoarthritis. Conventional radiography is widely used in the assessment of knee osteoarthritis, however radiographic findings do not correlate well with pain. Ultrasonography can be used to evaluate the soft tissue structures of the knee that can be related to pain. OBJECTIVE: To evaluate pain-related soft tissue structures of the knee with ultrasonography. METHODS: This cross-sectional study included a total of 198 knees from 99 patients with knee osteoarthritis. Knee pain and functional status were evaluated by performing visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). On the ultrasound, cartilaginous thickness, knee effusion and presence of Baker's cyst were assessed and the correlation to pain was investigated. RESULTS: Baker's cyst was significantly more frequent in symptomatic knees (13.9%) compared to asymptomatic knees (2.5%). Patients with Baker's cyst had a significantly more limited degree of knee flexion, significantly higher resting VAS pain scores and worse WOMAC scores compared to patients without Baker's cyst. In log-linear analysis, presence of Baker's cyst increased the risk of pain by 2.94 times. CONCLUSION: Ultrasound as a modality that is easily accessible, inexpensive and without radiation exposure is helpful to demonstrate factors related to pain in knee osteoarthritis by allowing assessment of soft tissue structures.

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.

Context: Deep vein thrombosis (DVT) is a well-known complication of spinal cord injury (SCI). Low-molecular-weight heparin (LMWH) may be used in SCI patients who develop DVT, but can lead to subcutaneous bleeding. If subcutaneous bleeding occurs, then lymphedema, cellulitis, muscle or tendon tearing, or baker’s cyst rupture should be considered in the differential diagnosis. Findings: Herein, we present a 61-year-old female patient who was hospitalized for rehabilitation due to paraplegia, and used LMWH due to DVT development. The patient suddenly developed pain, swelling, and discoloration of the left lower extremity. Although subcutaneous hemorrhage was considered initially, ultrasound and MRI revealed a ruptured Baker’s cyst. In addition to supportive therapy, ultrasound-guided aspiration was performed. Conclusion/Clinical Relevance: In this report, we present a case of clinically severe Baker’s cyst rupture, which occurred in the lower extremity of a SCI patient using LMWH due to DVT in the same extremity. To our knowledge, no similar cases have been reported.

Background Baker's cysts are usually located in the posteromedial side of the knee and seldom cause neuropathy. Case We describe the rare case of a 57-year-old woman with a popliteal cyst who presented with limping gait and pain in her lower leg. She was electronically diagnosed with common peroneal neuropathy and transferred to our pain clinic. On ultrasound examination, about 2.0 × 1.2 cm sized popliteal cyst was found to extend to the fibular head, compressing the common peroneal nerve. Therefore, ultrasound-guided aspiration of the cyst and a common peroneal nerve block were performed. Immediately after the procedure, the pain, dysesthesia, and limping gait were relieved. Although her pain and dysesthesia were relieved, she underwent the surgery because of limping gait. Conclusions In this case, we found the Baker's cyst, the cause of the common peroneal neuropathy, and treated it immediately by just simple ultrasound examination and aspiration.

The authors present a case of a Baker's cyst in the right leg of an 86-year-old woman, whose presentation was more typical for a deep venous thrombosis. Both conditions have inflammation and acute calf pain. The clinical manifestations, imaging findings, and treatment of this common emergency department presentation are discussed.

Introduction: Nowadays, Magnetic resonance imaging (MRI) has a high ability to distinguish between soft tissues because of high spatial resolution. Image processing is extensively used to extract clinical data from imaging modalities. In the medical image processing field, the knee’s cyst (especially baker) segmentation is one of the novel research areas.Material and Method: There are different methods for image segmentation. In this paper, the mathematical operation of the watershed algorithm is utilized by MATLAB software based on marker-controlled watershed segmentation for the detection of baker’s cyst in the knee’s joint MRI sagittal and axial T2-weighted images.Results: The performance of this algorithm was investigated, and the results showed that in a short time baker’s cyst can be clearly extracted from original images in axial and sagittal planes.Conclusion: The marker-controlled watershed segmentation was able to detect baker’s cyst reliable and can save time and current cost, especially in the absence of specialists it can help us for the easier diagnosis of MR images.

Aims We report the natural course of Baker’s cysts following total knee arthroplasty (TKA) at short- and mid-term follow-up. Methods In this prospective case series, 105 TKA patients were included. All patients who received surgery had a diagnosis of primary osteoarthritis and had preoperatively presented with a Baker’s cyst. Sonography and MRI were performed to evaluate the existence and the gross size of the cyst before TKA, and sonography was repeated at a mean follow-up time of 1.0 years (0.8 to 1.3; short-term) and 4.9 years (4.0 to 5.6; mid-term) after TKA. Symptoms potentially attributable to the Baker’s cyst were recorded at each assessment. Results At the one-year follow-up analysis, 102 patients were available. Of those, 91 patients were available for the 4.9-year assessment (with an 86.7% follow-up rate (91/105)). At the short- and mid-term follow-up, a Baker’s cyst was still present in 87 (85.3%) and 30 (33.0%) patients, respectively. Of those patients who retained a Baker’s cyst at the short-term follow-up, 31 patients (35.6%) had popliteal symptoms. Of those patients who continued to have a Baker’s cyst at the mid-term follow-up, 17 patients (56.7%) were still symptomatic. The mean preoperative cyst size was 14.5 cm2 (13.1 to 15.8). At the short- and mid-term follow-up, the mean cyst size was 9.7 cm2 (8.3 to 11.0) and 10.4 cm2 (9.8 to 11.4), respectively. A significant association was found between the size of the cyst at peroperatively and the probability of resolution, with lesions smaller than the median having an 83.7% (36/43) probability of resolution, and larger lesions having a 52.1% (25/48) probability of resolution (p < 0.001). At the mid-term follow-up, no association between cyst size and popliteal symptoms was found. Conclusion At a mean follow-up of 4.9 years (4.0 to 5.6) after TKA, the majority (67.0%, 61/91) of the Baker’s cysts that were present preoperatively had disappeared. The probability of cyst resolution was dependent on the size of the Baker’s cyst at baseline, with an 83.7% (36/43) probability of resolution for smaller cysts and 52.1% (25/48) probability for larger cysts. Cite this article: Bone Joint J. 2020;102-B(1):132–136

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 experience in applying a new method of treating patients with Baker’s cyst is described. The method is based on laser-induced thermotherapy using a special dual-port introducer. It has been shown that the use of the developed surgical instruments makes it possible to reduce the time and cost of the procedure and to increase its safety. It also allows the period of rehabilitation to be reduced in comparison with the conventional surgical methods of treatment. Based on the results of the application of the new method and equipment, practical recommendations have been formulated that make it possible to individualize the treatment of patients with Baker’s cyst.

—A thermophysical model of heat transfer from a liquid heated by radiation into biological tissues with a cyst of an individual picture of temperature fields, which takes the parameters of laser radiation, as well as the individual thermodynamic and morphometric characteristics of the object of exposure and its syntopy, into account, is proposed. The model is designed for algorithmization of performance of laser-induced indirect thermotherapy of cavity tumors. A comparison was made between the theoretical prediction of the dynamics of temperature changes in the wall of a Baker’s cyst and the experimental data obtained using a thin needle thermocouple placed through a needle in the center of a cyst filled with liquid, whose dimensions had been previously determined by magnetic resonance imaging. It was shown that at the heat transfer coefficient of 3000 W/(m2 K) the proposed model described the heating of the cyst contents due to heat transfer from its inner wall accurately.

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.

Introduction: Implant wear and loosening with eluding metal/polythene debris are commonly implicated in the occurrence of Baker’s cysts in post-operative total knee replacement (TKR) patients, who present with post-operative pain and swelling, mimicking deep venous thrombosis. However, we present two symptomatic cases presenting with ruptured Baker’s cysts post-TKRs, with no evidence of implant loosening or wear. Cases Report: The 1st patient was a 55-year-old male, who underwent TKR for Grade 4 bilateral knee osteoarthritis and presented with acute onset of pain and swelling over the left popliteal fossa, which progressed to involve the calf. Radiographs showed no sign of infection or loosening, and venous color Doppler and magnetic resonance imaging (MRI) showed a hy-poechoic collection in the intermuscular plane at the upper part of popliteal fossa. Histological examination of the aspirated fluid showed mixed features of cystic fluid and a resolving hematoma. There was complete resolution of the 4 months with rest and graduated physiotherapy. The 2nd patient was a 51-year-old female who developed the cystic swelling 2 years after the surgery, and the ultrasound showed hypoechoic echoes in a Baker’s cyst-like collection. Cytological findings were suggestive of hemorrhagic nature of the aspirate, without any evi-dence of polyethylene debris, and the cultures were sterile. She became asymptomatic over 4 weeks with conservative management; the swelling resolved after 3 months. Conclusion: Majority of the cases in literature show implant loosening as cause of popliteal cysts after TKRs, however present cases highlight alternative mechanisms, and there are good chances of self-resolution of cysts with conservative treatment in such cases. Keywords: Knee replacement, Baker’s cyst, deep vein thrombosis, ruptured popliteal cyst.

Baker's cyst accompanying knee osteoarthritis represents a common cause of knee pain presenting to the emergency department. In this case report, a 56‐year‐old male presented with atraumatic left knee pain and swelling. Radiographically, he had tricompartmental osteoarthritis and was found to have a baker's cyst on duplex ultrasound. Using point‐of‐care ultrasound, the cyst was aspirated and corticosteroids were injected. The patient tolerated the procedure well and was discharged with a compression wrap and orthopedic follow‐up. Baker's cyst aspiration with corticosteroid injection represents a safe alternative treatment option for patients. In some cases, this treatment may be definitive. Orthopedists currently use this procedure to reduce pain and improve function for patients with chronic knee ailments related to baker's cysts. As demonstrated in this case report, implementing this bedside procedure in the emergency department with orthopedic follow‐up expands non‐surgical, non‐narcotic treatment options for patients with chronic knee pain secondary to Baker's cysts with osteoarthritis.

A one-way valve lesion plays an important role in the formation of Baker’s cysts and serves as an important landmark for accessing these cysts during arthroscopic surgery. This study aimed to investigate the incidence of one-way valve lesions and their effect on clinical outcomes in patients who underwent arthroscopic cystectomy for Baker’s cysts. Patients who underwent arthroscopic cystectomy for Baker’s cysts between June 2005 and November 2017 were retrospectively reviewed. Patient demographic characteristics, radiologic/arthroscopic findings (presence of one-way valve lesions, concurrent chondral and meniscal lesions, and cyst wall thickness), and clinical outcomes (clinical recurrence rate, Lysholm score, and complications) at the 2-year follow-up were evaluated. Subgroup analysis was performed to compare clinical outcomes between patients with and without one-way valve lesions. Thirty patients (mean age, 57.4 ± 9.4 years) were included in this study. One-way valve lesions were surgically documented in 11 patients (36.7%). Ten patients (33.3%) had chondral lesions with an International Cartilage Repair Society grade ≥ 3, and 23 patients (76.7%) had concurrent chondral and meniscal lesions. At the 2-year follow-up, none of the patients had experienced clinical recurrence; the mean Lysholm score was 76.3 ± 17.5 (48–100). Three patients reported persistent pain, while two reported numbness or paresthesia. Subgroup analysis showed no significant differences in clinical recurrence rates, Lysholm scores, and complication rates between the groups. The incidence of one-way valve lesions during arthroscopic cystectomy for Baker’s cysts was lower than that previously reported. Arthroscopic cystectomy showed good clinical results in patients with and without these lesions.

Popliteal cyst is a common condition of popliteal region and usually coexists with intra-articular pathologies. Typically it is an extension of the natural gastrocnemius-semimembranosus bursa caused by one-way joint fluid leakage to the bursa through existing valvular mechanism. If symptomatic, the popliteal cyst should be treated surgically. The most effective treatment involves correction of intra-articular pathologies, elimination of the valvular mechanism, and excision of cystic walls. In this chapter we present an arthroscopic technique of typical popliteal cyst treatment addressing each step of pathophysiological pathway of cyst formation.

Introduction A Baker’s Cyst is usually an incidental finding in adults being investigated for a joint arthropathy and its rupture preceding the diagnosis of Juvenile Idiopathic Arthritis (JIA) is rare in children. Here we describe a case of a 4 year old girl who presented to the Emergency Department with non-traumatic right calf pain and swelling. Case Summary A 4 year old girl presented to Emergency Department (A&E) with a 3 week history of right calf swelling after her usual, non-traumatic dancing. The swelling had worsened over 48 hours. On examination, her weight was 20 kg, just above the 75th centile with a BMI of 17.9. She was unable to fully extend her right leg or weight bear due to her calf swelling. Her right calf measured 28.6 cm compared to the left calf of 26.4 cm. She had been apyrexial with no erythema of the joint. There was no demonstrable joint effusion and no issues with joints above and below. There was no family history of clotting disorder or joint arthropathy. Ultrasound Scan showed a fluid collection in her right gastrocnemius. MRI confirmed a ruptured Baker’s Cyst with inflammatory arthropathy alongside an extensive synovial proliferation throughout the knee joint with large joint effusions and associated soft tissue oedema tracking superiorly and inferiorly along the medial head of gastrocnemius and anteriorly along the tibia. Her was ESR of 26 mm, CRP Clinical Implication This case highlights the atypical presentation of JIA and the clinical manifestations are highly variable in the presence of a ruptured Baker’s Cyst. Although, Baker’s cysts rare in children. Majority of them are managed conservatively with no other associated comorbidity. To our knowledge, this is the first case of JIA presenting with calf swelling in a toddler Conclusion We suggest clinicians consider a possible joint inflammatory arthropathy in children presenting with a ruptured Baker’s Cyst as early diagnosis and treatment could reduce morbidity associated with this inflammatory arthropathy.

Aim: To describe the successful treatment of a Baker’s cyst in the setting of post-traumatic osteoarthritis using ultrasound-guided injection of platelet-rich plasma. Setting: Outpatient sports clinic. Patient: 29-year old male basketball player. Case description: The patient presented with 2-months history of right knee pain, 17 months after undergoing right knee anterior cruciate ligament reconstruction surgery. Exam revealed medial joint line and medial collateral ligament tenderness with posterior knee swelling. After aspiration, a corticosteroid injection was administered with temporary symptom relief. Diagnostic ultrasound examination confirmed the Baker’s cyst. The patient then underwent two serial leukocyte-rich platelet-rich plasma injections into his right knee. Results: The patient reported complete resolution of pain and cyst size. Conclusion: Leukocyte-rich platelet-rich plasma may be considered as a treatment option for patients with Baker’s cysts in the setting of post-traumatic osteoarthritis.

Calf pain or swelling is a common presentation to the emergency department. The differential diagnoses are wide. Deep vein thrombosis (DVT) is often the first diagnosis to be excluded given its potentially fatal complications. Musculoskeletal causes of calf pain or swelling such as Baker's cyst, muscle or tendon tear, soft tissue infection, and inflammation are not uncommon and can often be confidently diagnosed with ultrasonography (US). Familiarity with these conditions and the sonographic findings would be useful in making timely and correct diagnosis.

When evaluating a patient with acute onset unilateral leg pain and concurrent inflammatory bowel disease (IBD), keeping a broad differential diagnosis will allow for prompt diagnosis and management. The patient described in this case report is a 32-year-old male with inflammatory ileocolonic Crohn’s disease (CD) status after ileocecectomy with perianal involvement and known Type 1 arthropathy. He presented with a three-day history of unilateral leg swelling and tenderness. Initial evaluation focused on possible thrombosis given the development of erythema and systemic symptoms. Final diagnosis was ruptured Baker’s (popliteal) cyst. This pathology is not well described in existing literature, but should be considered in IBD patients given their chronic inflammatory state and common associated intra-articular pathology.

The results of calorimetric studies of a histological preparation of a surgically excised Baker’s cyst are presented. The measurements were performed on a DSC 204 F1 Phoenix differential scanning calorimeter (Netzsch, Germany). The measurement error of the temperature dependences of the specific heat capacity of the samples analyzed did not exceed 2%. The denaturation temperature, which corresponded to the peak of the thermal signal, was 68.1°C for Baker’s cyst tissues and the denaturation enthalpy was 4.352 J/g. No thermal effects were observed on the thermograms when the samples were re-scanned; this is indicative of irreversible changes related to complete denaturation of collagen in the samples.

Osteoarthritis of the knee is a common disease, often associated with a Baker’s cyst. Besides osteoarthritis, also other joint pathologies of the knee can be causative for a Baker’s cyst. Radiotherapy is known to be an effective treatment for osteoarthritis, with an anti-inflammatory effect. As the excessive production of synovia usually is associated with intraarticular inflammation, our hypothesis was that radiotherapy might positively influence the synovial production and reduce the volume of a Baker’s cyst. We performed a prospective trial, including 20 knees receiving radiotherapy for knee arthritis. Besides documentation of NRS (numeric rating scale), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score and Knee Society Score, the volume of the Baker’s cyst was calculated for a short- (6 to 12 weeks) and long-term (9 to 12 months) follow-up. Ultrasonic volumetry was performed using an ultrasound device with a high-resolution multifrequency linear probe (6–9 MHz). Low-dose radiotherapy improved NRS, WOMAC score and Knee Society Score significantly. The mean volume of Baker’s cyst decreased from 22.3 ml to 10.7 respectively 3.1 ml during follow-up. A decrease in volume of more than 25% compared to the baseline could be achieved for 75% of the patients in the short-term and 79% of the patients in the long-term follow up. Radiotherapy of knee osteoarthritis is an effective treatment that decreases the volume of a Baker’s cyst. Most patients respond to the treatment. Whether radiotherapy is an effective treatment for Baker’s cyst without associated osteoarthritis has to be further examined.

The aim of the study was to reveal the features of the morphological structure and ultrasonic signs of Baker's cyst in patients of different ages. Material and methods. The study is based on a sonographic study of 213 patients (mean age 57.2±9.9 years) and 10 children aged 6 to 10 years with a detected Baker cyst. The size of the cyst was studied, its position, relationship with surrounding tissues was examined on sonographic equipment. In addition, parameters were measured, including the thickness of the synovium, the presence of septa and echo-inclusions, the degree of echogenicity of the contents of the cyst. All patients underwent open extirpation of the cyst followed by its morphological analysis. All manipulations were carried out after signing the informed consent of the patient or his legal representatives according to the recommendations "About legal, legislative and ethical norms and requirements in the performance of scientific morphological studies". Preparation of the histological material obtained after the removal of Baker's cyst was carried out according to standard procedures, followed by staining with hemothoxylin-eosin and Van Guzon. The obtained preparations were examined under a light microscope with the possibility of displaying an image on a computer monitor Results. In all adults with an identified Baker cyst, gonarthrosis of varying severity was detected, in contrast to children who had no such joint pathology. Morphological differences in the transformation of the tissues of education in different age groups were also significant. The difference was noted in the form of unexpressed dystrophy of the synovial membrane and the absence of necrotic and degenerative changes in the wall of the cyst in children. Conclusions. This work demonstrated several significant ultrasound and morphological differences in the popliteal cyst in children and adults.

Calf muscle tears are relatively common. They can be identified well as incidental findings using duplex sonography when performing a lower extremity venous Doppler exam. A case is presented of a 43-year-old male patient who underwent a sonogram to diagnose deep vein thrombosis. The exam results demonstrated patent and compressible common femoral, femoral, popliteal, and calf veins without evidence of deep vein thrombosis. As the sonographer was documenting the popliteal fossa, a complex fluid-filled structure within the left gastrocnemius muscle was identified. The diagnosis was reported as a gastrocnemius muscle tear. This case demonstrates a fairly common incidental finding, gastrocnemius muscle tear, when performing a venous Doppler exam.

Baker’s cyst is a closed collection of fluid that forms in the posterior aspect of the knee. Usually, it appears as a non-painful inflammation in the popliteal fossa. In adults, its aetiology is secondary to problems that cause distension of the knee joint. It is often associated with rheumatoid arthritis and osteoarthritis. Occasionally, the cyst may become oversized and rupture with the consequent leakage of synovial fluid into adjacent tissues, presenting a clinical course similar to acute thrombophlebitis. Infection of a popliteal cyst is an uncommon complication and is associated with septic arthritis. In this paper, we present the case of a patient, an intravenous drug user (IVDU), who developed a spontaneous infection of a Baker’s cyst secondary to Staphylococcus aureus, which was diagnosed in the emergency department (ED) using point-of-care-ultrasound (POCUS). Figure 1. Within the posterior aspect of the left calf on the medial aspect there is an extremely large cystic lesion measuring 18.7 cm in length and 4 cm in width with no adverse features. The cystic lesion is communicating with the semimembranosus/medial head gastrocnemius bursa more proximally in the knee where it demonstrates internal echoes and synovial thickening and a single septation.

Baker’s cysts are synovial cysts caused by the enlargement of the gastrocnemio-semimembranosus bursa, presenting as painless or tender masses of the popliteal fossa, secondary to trauma, degenerative or inflammatory conditions. We report the case of a 54-year-old female patient with enteropathic arthritis presenting to our clinic with a disease flare characterized by peripheral arthritis of her wrists, knees and ankles with concurrent appearance of a non-tender mass in her right medial mid leg, measuring approximately 45 mm, without pain, fever or other symptoms. Previous history was remarkable for indolent non-Hodgkin’s follicular lymphoma and Crohn’s disease. An ultrasound confirmed that the medial mid leg mass was a giant Baker’s cyst measuring 150 mm. Corticotherapy and immunosuppression was initiated, concomitantly with US-guided aspiration resulting in progressive clinical and analytical improvement. This case depicts an uncommon presentation of a Baker’s cyst, with dimensions that can be explained by the underlying inflammatory condition. Baker’s cysts should be taken into consideration in the differential diagnosis of leg masses that also include entities with poorer outcomes.

SummaryThe diagnosis of venous diseases and abnormalities has gained a new dimension with duplex ultrasound, which is now regarded as the gold standard for leg vein examination. The combination of B scan, doppler and colour-coding of the blood flow in duplex ultra-sound offers a simple, highly predictive, noninvasive diagnosis of venous disease. It provides important information not only on the haemodynamic function but also on the patient‘s anatomy, allowing a diagnostic look left, look right“. As a result, secondary findings frequently crop up during systematic duplex ultrasound examination of the superficial and deep leg veins. This Advanced Learning in Pictures presents the most common secondary findings in vein surgery consultations.

The aim of the current study was to investigate the efficacy of ultrasonography-guided aspiration treatment with concomitant steroid injection on relieving reflux blood flow in veins located next to symptomatic Baker’s cyst. All patients were examined by ultrasonography at administration and 1 month follow-up after intervention. Puncture and aspiration of the cyst, as well as injection of 1 ml dexamethasone were performed by the same radiologist. Compression on popliteal vein and vena saphena parva and the degrees of reflux before and after treatment were recorded. Twenty-six patients were included in the study. An overall reduction of the cyst’s size was observed in all patients of the study group. Reduction of the cyst size is more evident during the 1st week, which was observed by a slight enlargement during the 1st and the 3rd months controls. Ultrasonography-guided puncture, aspiration and steroid injection seems to yield promising outcomes in terms of relieving venous reflux flow around simple Baker’s cysts.

Background: Popliteal fossa cysts (PFCs aka Baker's cysts) are synovial cysts of the knee joint that can be symptomatic or asymptomatic and incidentally identified on ultrasound. Whether PFCs are associated with deep vein thrombosis (DVT) is unknown. Possible mechanisms for an association include direct compression of the popliteal vein, indirect compression on the popliteal vein with leg flexion, adjacent inflammation of the cyst, or relative immobility due to underlying joint disease itself. Methods: Lower extremity venous Duplex ultrasound radiology reports from the inception of electronic archiving through 11/14/2019 were evaluated across the Mayo Clinic Enterprise (Rochester MN, Jacksonville, FL, Scottsdale AZ, and Mayo Clinic Health System) in patients >18 years of age. Natural language processing (NLP) algorithms were created and validated to identify acute DVT (proximal or distal) and PFCs. A random sample of 1,752 ultrasound reports underwent manual review to calculate the sensitivity and specificity of the NLP algorithm. Cases (ultrasounds with acute DVT) were compared to controls (ultrasound without acute DVT) to examine the frequency of PFCs. IRB approval was obtained and patients lacking Minnesota research authorization were excluded. Results: A total of 332,016 lower extremity venous ultrasounds were performed in 223,035 patients; 156,846 unilateral and 175,170 bilateral lower extremities exams. The mean age at ultrasound was 63.3 (SD 16.5) and 54.7% were female. Ultrasound reports were available for analysis starting in 1992 with a significant increase in the number of ultrasounds performed over the study period across the enterprise (Figure 1). Overall, acute DVT was identified in 24,179 (7.3%) of ultrasounds, and PFCs were identified in 32,427 (9.8%) of ultrasounds. The sensitivity and specificity of the NLP algorithm in the full dataset to identify acute DVT was 86.0% and 97.2%, respectfully. The sensitivity and specificity of the NLP algorithm to identify PFCs was 97.8% and 99.5%, respectively. PFCs were present in 9.3% of ultrasounds with acute DVT and 9.8% of ultrasounds without acute DVT (p=0.007), OR 0.94 (95% CI 0.90-0.98). In a multivariate logistic regression model, after adjusting for age and sex, results remained significant (aOR 0.95, 95% CI 0.91-0.995). Comparing ultrasounds before and after 2010, there was a higher percentage of PFCs and acute DVT reported after 2010 (p Conclusions: PFCs are negatively associated with the presence of acute DVT on lower extremity venous Duplex ultrasound. This data does not support PFCs as a contributing or causative factor in the development of lower extremity DVT. Figure 1 Disclosures No relevant conflicts of interest to declare.

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.

Objective: The aim of the work was to demonstrate the effectiveness and safety of ultrasonographic guided aspiration performed with corticosteroid injection intra-lesional for ruptured Baker cysts (BCs). Methods: Single-center retrospective study that included 42 patients with knee joint disorder associated with ruptured BCs were treated by ultrasonographic guided aspiration of fluid from the cyst and different points from the calf then intra-lesional injection of corticosteroids once or twice, 1 week apart. Follow up were done weekly until complete resolution of symptoms. Visual analog scale (VAS) and Rauschning-Lindgren and Lysholm Knee Scoring Scales (RLC) were used for assessment. Results: Clinical parameters (VAS and RLC) improved significantly in all patients at both post injection evaluation visits (1 week and 12 weeks). Ultrasonographic features improved significantly with complete disappearance of free fluid in the calf in 35 (83.3%) cases 1 week after the injection, and in 41 (97.6%) after 12 weeks. As regards BCs only 4 (9.5%) cases showed complete disappearance after 1 week and there was recurrent BCs in 38 (90.5%) cases which required reaspiration. While after 12 weeks, BCs were completely disappeared in 23 (54.8%) cases, most of the relapsed BCs were complex BCs. No side effects were reported in all cases. Conclusion: Ultrasonographic guided aspiration followed by injection of corticosteroids intra-lesional is an efficient and safe method for managing ruptured BCs.

Knee injections are common procedures to treat pain when conservative treatment fails. Ultrasound-guided musculoskeletal injections are shown to improve accuracy and clinical outcomes. This objective of this chapter is to describe how to perform a few selected ultrasound-guided pain procedures at the knee: intra-articular, Baker’s cyst, pes anserinus bursa and tendon, iliotibial band bursa, and patellar tendon.

Purpose The aim of the study was to compare the clinical, radiographic, and ultrasound findings between simple and complicated Baker's cysts. Methods Forty-seven knees with Baker's cysts in 45 patients with knee pain were identified from a chart review. Baker's cysts were classified as simple or complicated according to ultrasound findings. Clinical data, including duration of knee pain, visual analog scale score, Kellgren-Lawrence grade, ultrasound findings, including the size and sonomorphology of the BC, severity of osteophytosis, thickness of joint effusion, meniscal tear, and synovial proliferation of the two types of BC, were compared. Results There were 22 knees with a simple cyst and 25 knees with a complicated cyst. The thickness of the suprapatellar effusion in complicated Baker's cysts (5.7 ± 3.0 mm) was significantly greater than that in simple Baker's cysts (3.8 ± 3.2 mm), and the presence of synovial proliferation in the suprapatellar recess was significantly higher in complicated Baker's cysts (22 knees, 88.0%) than in the simple Baker's cysts (12 knees, 54.5%). However, there were no significant differences in demographic, radiographic, and other ultrasound parameters between the two types of BC. Conclusions Synovial proliferation with larger effusion in the suprapatellar recess was more associated with complicated BC than simple BC.

Background Baker’s cyst is the most common mass in the popliteal fossa and results from fluid distension of the gastrocnemio-semimembranosus bursa. The most common complication of Baker’s cyst is the rupture or dissection of fluid into the adjacent proximal gastrocnemius muscle belly, which results in a pseudothrombophlebitis syndrome mimicking symptoms of DVT. Treatment of ruptured Baker cysts ranged from conservative management to surgical resection. Ultrasonographic guided aspiration and corticosteroids injection may be an effective and easy method of management of these cases. Up to the best of our knowledge, this is the first study to detect the efficacy and safety of ultrasonographic guided aspiration and injections of ruptured Baker cysts. Objectives To evaluate the efficacy and safety of ultrasonographic guided aspiration and local corticosteroids of ruptured Baker cysts based on follow-up clinical and sonographic results. Methods A retrospective study was conducted on 42 patients (12 males and 30 females, mean age 36 +/- 10 SD years) affected by a ruptured Baker cysts associated to knee joint disorders in the period between January 2013 to January 2019.The diagnosis was done by clinical presentation of acute calf pain, swelling, tenderness at the calf muscles and ultrasonographic evidences of ruptured backer cysts in the form of free fluid collection in the calf connected to a well defined cyst at the back of knee. All cases were treated by ultrasonographic guided aspiration and intra_lesional injection of corticosteroids once or twice one week a part. Follow up were done on a weekly basis until complete resolution of symptoms then 3 months later. Visual analogue scale (VAS) for calf pain and Rauschning-Lindgren and Lysholm Knee Scoring Scales were used to assess pre/post-injection knee functions. Results The primary diagnoses to patients presented with ruptured Baker cyst in this study were as follow: 18 (42.8%) cases with rheumatoid arthritis, 15 (37.5%) cases with osteoarthritis and 9 (21.4%) cases with psoriatic arthritis. Clinical parameters (VAS for calf pain and Rauschning-Lindgren score) improved significantly in all patients at both post injection evaluation visits. Rauschning-Lindgren score was significantly lower after US guided injections (mean, 0; range, 0-1) than at baseline (mean, 2; range, 1–2); p VAS for calf pain also significantly lower after US guided injections (mean,0.5; range, 0-1) than at baseline (mean, 9.5; range, 0-10); p Ultrasonographic features improved significantly with complete disappearance of free fluid at the calf in 35 (83.3%) cases one week after the injection. As regards Baker cyst only 5 (11%) cases showed complete disappearance of the backer cyst and in the majority of cases 37 (88%) there were persistent Baker cysts. No side effects were reported in all cases. VAS; visual analogue scale Conclusion Ultrasonographic guided aspiration and intra_lesional corticosteroids injection is an effective and safe method in management of ruptured Baker cysts. References [1] Nigerian Journal of Orthopaedics and Trauma June 2009: 8 (1): 31-32 Disclosure of Interests None declared

We report a 65-year-old man who presented with a necrotic fifth toe, incipient phlegmon and hypesthesia of the right foot, a swollen lower leg, and a palpable popliteal mass. An occlusion of the popliteal artery secondary to a Baker's cyst was found to have caused protracted ischemia and the abovementioned symptoms. Despite several endovascular and open-surgery procedures to restore perfusion of the limb, the patient eventually had to undergo above-knee amputation.It might be speculated whether earlier surgery would have preserved the patient's limb. Whereas the traditional procedure of open resection of the Baker's cyst has been associated with high recurrence rates, the condition can be treated effectively and safely today by means of arthroscopic surgery. We believe that arthroscopic interventions should at least be performed in the following instances: (1) in patients with recurrent symptoms of a Baker's cyst after previous treatment of the intra-articular pathology and previous aspiration of the cyst and (2) in patients with incipient sequelae that indicate relevant compression of neurovascular structures of the popliteal fossa (pseudothrombophlebitis, intermittent claudication, neuropathy).

Aims It is widely held that most Baker’s cysts resolve after treatment of the intra-articular knee pathology. The present study aimed to evaluate the fate of Baker’s cysts and their associated symptoms after total knee arthroplasty (TKA). Patients and Methods In this prospective cohort study, 102 patients with (105 were included, however three were lost to follow-up) an MRI-verified Baker’s cyst, primary osteoarthritis and scheduled for TKA were included. Ultrasound was performed to evaluate the existence and the gross size of the cyst before and at one year after TKA. Additionally, associated symptoms of Baker's cyst were recorded pre- and post-operatively. Results After one year, a Baker’s cyst was still present in 87 patients (85%). There was a significant reduction in associated symptoms arising from the Baker’s cyst before (71%) to after surgery (31%). No patients developed a new Baker’s cyst associated symptoms. However, of the 72 patients who had reported Baker’s cyst associated symptoms pre-operatively, 32 patients (44%) still complained of such symptoms one year after surgery. Conclusion Baker’s cysts had resolved in only a small number of patients (15%) one year after TKA and symptoms from the cysts persisted in 31%. Cite this article: Bone Joint J 2016;98-B:1185–8.

Baker's cyst is usually degenerative in origin, infective etiology is rare, and tubercular origin is exceptional; only 5 such cases have been reported in English literature till date. We present a case of a young female who presented with clinico-radiological features suggestive of Baker's cyst with associated posterior horn medial meniscal tear. Arthroscopic evaluation revealed suspicious synovial hypertrophy along with meniscal tear and Baker's cyst. Arthroscopic management of Baker's cyst and meniscal pathology was done along with radical synovectomy. Histopathological examination revealed epitheloid granulomas and Langhans giant cells pointing toward a tubercular etiology. Standard ATT protocol with rehabilitation was followed. The patient was asymptomatic at 1 year with complete resolution of symptoms and full range of motion. This case highlights the need to maintain high index of suspicion in cases hailing from endemic region with unusual intra-operative findings; also, it underlines the importance of routine histo-pathological examination.

In this paper, a classification procedure for Baker's cysts was proposed. The procedure contained two subprocedures: the image preprocessing (dual thresholding, labeling, feature extraction) and the classification (Random Forests, cross validation). In total, five features were required to classify the cysts. These geometric features represented the location, the area and the convexity of the cyst. The procedure was proven effective on a set 436 varied MRI images. The set contained 68 images with cysts ready for aspiration and was oversampled with the SMOTE approach. The proposed method operates on 2D MRI images. This reduces the time of diagnosis and, with the ever increasing demand for MRI scanners, is justified economically. The method can be employed in systems for autonomous and semi-autonomous Baker's cyst aspiration or as a standalone package for MRI images annotation. Furthermore, it can be also extended to other fluid-based medical conditions in the knee.

Adipose-derived therapies have increased in popularity for treatment of painful orthopaedic conditions, such as osteoarthritis. We report the passage of fat into a Baker’s cyst after injection of micro-fragmented adipose tissue in a patient with bilateral knee arthritis. Following fat grafting, the patient required drainage of fatty fluid from within the Baker’s cyst on multiple occasions. Approximately 3 months postprocedure, she began to notice an improvement in her knee pain with no further recurrence of pain or swelling from her Baker’s cyst.

In this work, the calibration of the temperature readings obtained with the help of infrared fibers was performed. Based on the data obtained, a model of a fiber pyrometer is proposed.

Objective: To determine whether (diagnostic and interventional) ultrasound imaging can be used to provide visual feedback affecting treatment outcome (pain and disability). Design: Controlled clinical trial. Subjects: A total of 52 patients with (ultrasonographically confirmed) symptomatic Baker’s cysts were enrolled. Methods: The cysts were drained under ultrasound guidance and, if necessary, corticosteroid injections were given on the follow-up visit. In group I (n = 26) the patients did not observe the procedures on the ultrasound (US) screen. In group II (n = 26) the US images/videos were shown and explained to the patients. The patients were included in one of the groups consecutively, unless they refused the protocol of that group. Treatment outcome was assessed via US measurements, aspirate volumes, visual analogue scale (VAS) (knee pain, procedure discomfort), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Rauschning-Lindgren Classification (RLC), Kellgren–Lawrence grading scale, Hospital Anxiety and Depression Scale, and paracetamol intake. Results: The 2 groups were similar regarding US measurements, aspirate volume and paracetamol use (p-values > 0.05). In both groups all VAS (p < 0.001) and WOMAC (p < 0.05) scores decreased after treatment. Although initial VAS and WOMAC scores were similar between the groups, all VAS/WOMAC scores, except VAS-2, WOMAC-2 pain, and WOMAC-3 stiffness, were significantly lower in group II (all p < 0.05). Initial RLC scores were similar between the groups; however, group II had significantly lower scores at visits 2 and 3. Conclusion: In patients with Baker’s cysts (diagnostic/interventional) US imaging can be used as a simple means of visual biofeedback, favourably affecting the treatment outcome (pain and disability).