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Background Pediatric patients rarely exhibit Baker’s cysts. This study was conducted on 15 cases (9 males, 6 females) presented with Baker (popliteal) cyst in the last 2 years (from September 2017 to September 2019). The mean age was 8.5 years. The aim of this study was to present our experience in management of these cases based on clinical and imaging criteria. Plain x-ray and knee ultrasonography were routinely done for all cases. If the size of the cyst was less than or equal to 3 cm by ultrasonography, with no or minimal pain, the patients were managed conservatively and were scheduled to followed up visits after 3 months, 6 months, and after 12 months for clinical assessment of symptoms and sonographic size of the cyst. Surgical excision of the Baker’s cyst was considered if the size of the cyst was more than 3 cm with persistent of pain. Results Seven cases had cysts less than 3 cm by ultrasonography and were managed conservatively. In five out of these seven cases, the cysts disappeared with no recurrence within the first year of follow-up. In two cases, the cysts increased in size with increase in pain. These two cases were subjected to surgical excision after 1 year of follow-up. The remaining eight cases had cysts more than 3 cm and were managed by surgical excision. Out of the ten cases which were managed by surgical excision, recurrence occurred in 3 cases within the first post-operative year (after 4 months, 7 months, and 8 months) consecutively. Conclusions The management of Baker’s cysts in children is debatable, with no definite protocol. In this current study, we conclude that surgical excision of large Baker’s cysts (more than 3 cm) with persistent symptoms is crucial providing meticulous dissection without rupture of the cyst and proper closure of the pedicle which connects the cyst with the knee joint, while conservative management and follow-up is effective in small Baker’s cysts (less than 3 cm) with no recurrence.

PurposeSeveral 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.MethodsAfter 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.ConclusionsUltrasound-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.

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.

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.

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.

A ruptured Baker’s cyst is a rare presentation and may mimic deep vein thrombosis (DVT) or acute thrombophlebitis. In rare cases, it may present with infection or compartment syndrome. We present our experience related to a case of a ruptured Baker’s cyst and its management. A 54-year-old female presented to us with knee pain, which was initially managed conservatively. After six weeks, she came to us with severe pain and swelling in her left calf and foot. It was an acute presentation and DVT was suspected initially. Ultrasound color Doppler showed no DVT and then MRI revealed it to be a ruptured Baker’s cyst. The patient was subsequently managed conservatively and her condition improved in 12 weeks of follow-up. A high index of suspicion and knowledge is required to diagnose a ruptured Baker’s cyst, and most of the patients respond well to conservative management.

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

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.

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.

Objectives: Baker's cysts are not uncommon in patients eligible for total knee arthroplasty (TKA). There is a paucity of medium-term studies that assess the natural course of Baker's cyst following TKA. In this study, we report the one and five year outcome of patients to elucidate the state[for full text, please go to the a.m. URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019)

Baker's cyst is a distention or enlargement of the gastrocnemius-semimembranosus bursa toward the popliteal fossa which is usually associated with intra-articular pathologies. Rupture or dissection of the Baker's cyst results in extravasation of the cyst content into the calf within intermuscular space under the fascia. This clinical entity, also called pseudothrombophlebitis, is a self-limited condition that usually resolves with supportive treatment. However, in patients using anticoagulants, excessive hemorrhage may cause compartment syndrome in case of cyst rupture. Early diagnosis of compartment syndrome is the most important step in preventing permanent disability. Therefore, compartment syndrome should be kept in mind and ruled out in a patient with pseudothrombophlebitis syndrome under anticoagulation therapy.

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.

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.

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 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.

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.

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.

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.

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

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.

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.

Baker's cysts or popliteal cysts are common cystic lesions surrounding the knee joint. These are prevalent among the adult population but rare in children. These are asymptomatic in majority of cases, and are identified incidentally by the parent or physician. We report a case of 15-year boy who presented to the emergency room with symptoms of calf pain and swelling for two weeks. He was in good health previously, and had no underlying knee pathology. Prior to presenting in emergency department (ED), he was suspected as deep vein thrombosis (DVT), and referred for evaluation and management. During his evaluation for DVT, the diagnosis of ruptured Baker's cyst was made on ultrasound. This was further confirmed with magnetic resonance imaging (MRI) of knee joint. He responded to conservative management and was discharged home after reassurance.

Aims and Objectives: Baker’s cysts are common in knees with degenerative changes. Common opinion is that most them vanish after treatment of the intraarticular knee disorder. The present study aimed to evaluate the fate of Baker’s cyst and its associated symptoms after TKA. Materials and Methods: In this prospective study, 105 patients with a MRI verified Baker’s cyst, primary OA and an appointment for TKA were included. Three patients were lost to follow-up (two died and one septic TKA removal). Mean age was 70.1 ± 7 years. Ultrasound was performed to evaluate the existing and the gross size of the cyst was performed before and one year (mean 12.3 ± 1.1 months) after TKA. Additionally, Baker’s cyst associated symptoms were recorded Results: After one year, Baker’s cysts were still detected in 85.3% of the patients (n = 87). There was a significant reduction in Baker’s cyst associated symptoms from before (70.6%) to after surgery (31.4%; p < 0.0001). No patients developed new Baker’s cyst associated symptoms. However, out of the 72 patients that reported preoperatively about Baker’s cyst associated symptoms, one year after surgery 44.4% (n = 32) of the patients still complained about Baker’s cyst associated symptoms. The size of Baker’s cysts decreased significantly from pre- (mean 1447 mm2) to postoperative (969 mm2) ultrasound assessment (p < 0.0001). Conclusion: Baker’s cysts vanished only in a small amount of patients (15%) one year after TKA. Nevertheless in this in general considered successful surgery, in close to half of the patients (44.4%) with preoperative Baker’s cyst associated symptoms, these symptoms did not vanish until one year after TKA. Thus, it might be worthwhile to evaluate its treatment options and include them in future treatment plans.

Deep venous thrombosis (DVT) is an extremely common disorder, estimated to occur in approximately 2 million Americans per year. Ultrasonography of an extremity to check for the presence of a DVT is a commonly requested examination. A lower extremity venous ultrasound consists of imaging the common femoral vein (CFV) beginning at its confluence with the greater saphenous vein in the inguinal region and continuing to the superficial femoral vein until the distal thigh. Examination of the popliteal vein (PV) is performed by slight flexion of the knee and external rotation of the hip. Lack of vein compressibility is the main indicator of a thrombus. The use of bedside sonography in patients with a painful swollen extremity is helpful in diagnosing a deep venous thrombosis. The most important component of this exam is the determination of the compressibility of the veins.

Baker's cyst is a distension of the gastrocnemius-semimembranosus bursa of the knee, which communicates with the posterior portion of the joint capsule. Baker's cyst is commonly located in the inferomedial or superficial layers of the knee joint and rarely extends laterally or proximally. Complications of Baker's cysts are dissection, rupture, pseudothrombophlebitis, leg ischemia, nerve entrapment, and compartment syndrome. However, hematomas in the Baker's cyst have not been reported in Korea. We report a rare case of hematoma in the Baker's cyst with subfascial extension into the calf. The hematoma was demonstrated by magnetic resonance imaging and removed by mass excision.

Baker’s cyst is known to be associated with intra articular pathologies such as meniscus tears, chondral lesions, synovitis, synovial plica and cruciate ligament injuries. Complex Baker’s cyst excision alone is known to have high chance of recurrence. Combined treatment strategies that addresses intra-articular pathologies with excision of the cyst and closure of the valve, are thought to reduce chances of recurrence of such cysts. We present a case of massive complex Baker’s cyst treated with arthroscopic partial medial meniscectomy, synovectomy, open cystectomy and closure of the valve.

Background Baker's cysts are related to increased intra-articular pressure. The causes may be inflammatory, degenerative or traumatic disorders. Owing to the increased intra-articular pressure a cyst protrudes between the semimembranosus and the medial gastrocnemius tendons. The traditional treatment for a Baker's cyst is open resection. As an alternative, an arthroscopic procedure can be performed, which is demonstrated by the video on surgical technique that accompanies this short report. Surgical technique From the anterolateral portal the arthroscope is advanced through the intercondylar notch (below the posterior cruciate ligament) to the posteromedial recess. Under visual control, a posteromedial portal is created followed by identification of the capsular fold separating the cyst from the joint cavity. This fold (valvular mechanism) is resected with a shaver from the posteromedial portal until a large enough connection exists between the joint and the cyst (cyst decompression). After the decompression, the arthroscope is inserted from the posteromedial portal directly into the cyst cavity. Subsequently, the inner wall of the cyst is removed with the shaver via an additional far posterior cystic portal. It is obligatory to treat the associated intra-articular pathological condition. In our video a medial meniscal lesion is treated with partial meniscectomy.

Objective To compare physical examination and ultrasonographic (US) examination for detecting Baker's cyst (BC) in asymptomatic popliteal fossa. Methods Popliteal fossa was examined in a total of 220 knees in 110 patients with knee pain/osteoarthritis (OA) and non-OA individuals. Clinical examination was performed by two independent physicians and US examination was performed by a third blinded physician. Results Examiner A found 25 BC, examiner B found 30 BC in 220 knees examined (κ = 0.35; 95% CI; 0.14–0.56) and inter-observer reliability was moderate. When US examination taken as the reference, receiver operating characteristic analysis revealed an area under the curve of 0.58 (95% CI; 0.51–0.65) for examiner A and 0.57 (95% CI; 0.50–0.64) for examiner B, showing a weak agreement between physical examination and US assessment. Conclusion This study demonstrates that many patients may have BCs without any symptoms at the popliteal fossa and clinical examination of the popliteal fossa could not accurately detect BC. US examination of the popliteal fossa should be performed to detect BCs and this may recover the diagnosis.

Limb pain and swelling is one of the ‘top 20’ presentations in acute medicine. Patients present mainly with lower limb signs and symptoms, but upper limb presentations also occur and should be investigated and managed in a similar way. The causes can be divided into those producing bilateral changes, including fluid overload from cardiac or renal failure, low serum albumin or dependency oedema resulting from immobility, and those with primarily unilateral signs and symptoms that include disorders of the arterial, venous and lymphatic systems. An acutely painful limb, which can result from trauma, acute ischaemia or infection, is an emergency requiring urgent assessment and treatment, including surgical care. Other common presentations of limb pain and swelling include cellulitis, Baker's cyst and haematoma, and musculoskeletal pain caused by osteoarthritis or crystal and septic arthritis. Ambulatory (outpatient) management of stable patients with deep vein thrombosis or cellulitis is now the rule in most acute medical units with the use of low-molecular-weight heparin and novel oral anticoagulants increasing.