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Arthroscopy is commonly used to treat popliteal cysts, but the influence of the cyst wall on treatment outcomes remains controversial. The goal of this study was to compare clinical outcomes associated with arthroscopic cyst wall resection versus preservation in patients undergoing treatment for popliteal cysts. We searched the PubMed, Embase, Web of Science, and Cochrane Library databases to identify all relevant articles published as of April 2020. STATA v15.1 was used for all statistical analyses. Relative risk (RR) and corresponding 95% confidence intervals (CIs) pertaining to study outcomes were calculated. Study heterogeneity was evaluated using the I2 statistic and the χ2 test, with I2 > 50% and P

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.

CME Rheumatology 26: Rheumatological Cases

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.

Introduction: In patients who have undergone a total knee arthroplasty (TKA), any swelling occuring in or adjacent to the joint needs thorough investigation and a wear debris-induced cyst or pseudotumor should be suspected. Case History: A 75-year-old man, who underwent primary TKA for osteoarthritis three years back, presented with a swelling in the popliteal fossa extending into calf region of his left knee. Radiographs showed medial space narrowing, component loosening and osteolysis. Magnetic resonance imaging showed a popliteal cyst communicating with the knee joint and extending into the calf. A two stage procedure was done, excision of cyst followed by revision TKA after three weeks. At one year follow-up, the patient had a painless knee without cyst recurrence. Conclusion: Long term follow-up is critical for patients with TKA for early detection of occult polyethylene wear and prosthesis loosening. Joint effusion and synovial cyst formation should be considered a preceding sign of periprosthetic osteolysis. Keywords: Calf, Loosening, Polyethylene wear, Revision, Synovial cyst, Total knee arthroplasty.

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.

A popliteal cyst, otherwise known as a Baker’s cyst, is a fluid-filled sac that forms behind the knee between the medial head of the gastrocnemius and the semimembranosus muscles. These cysts have a high prevalence in the adult population and are frequently associated with a variety of degenerative conditions of the knee, which complicates the diagnosis. Our patient is an elderly male initially evaluated for a deep venous thrombosis. Further evaluation revealed a baker’s cyst abscess, which was diagnosed on imaging and confirmed post-operatively. A culture growth of the abscess was obtained that grew Streptococcus anginosus. The patient presented with right leg swelling, erythema and knee pain. His physical exam showed significant effusion of the right knee, with tenderness to palpation of the right posterior knee and a limited range of motion with flexion. The venous duplex was negative for deep venous thrombosis (DVT) and the patient continued to experience significant pain with ambulation. A knee aspiration was done with purulent joint fluid sent for culture. A computed tomography (CT) scan without contrast of his right leg revealed a Baker’s cyst abscess within a collection of fluid. The patient was taken to the operating room (OR) with a diagnosis of right septic knee and popliteal cyst abscess where arthroscopic irrigation and debridement with extensive synovectomy of the right knee was performed. Aspiration cultures were positive for Streptococcus anginosus, which has a unique ability to promote abscesses formation. Patient tolerated the procedure well and was discharged from the hospital in good condition with instructions to take Rocephin IV for six weeks. The patient ambulated without difficulty and showed significant improvement after 2 months.

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.

Objective To explore the therapeutic effect of the fire needling with the three-edged needle and the cupping on popliteal cyst. Methods A total of 60 patients of popliteal cyst were divided into two groups, 30 cases in each one according to the random number table. In the fire needling group, the burnt-red three-edged needle was inserted to the deep layer of the cyst. After the fluid was squeezed out, the cupping was exerted. The treatment was given 1 to 2 times a week, for 4 weeks totally. In the western medication group, prednisolone acetate 25 mg was injected in the cyst capsule, once a week, for 4 weeks totally. The effective rate, recurrence rate and Rauschning–Lindgren grading were evaluated before and after treatment. Results The total effective rate was 80.0% in the fire needling group and was 83.3% in the western medication group, without statistical significance in comparison (P > 0.05). The recurrence rate was 6.7% in the fire needling group and was 30% in the western medication group. The recurrence rate in the fire needling group was lower than that in the western medication group, indicating the statistical significance (P Conclusion The combined treatment with the fire needling combined with cupping therapy achieves the satisfactory effect on popliteal cyst and the very low recurrence rate and it is easy in operation and deserves to be promoted in primary care.

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

Purpose: To investigate the effect of ultrasound-guided unidirectional valve cleft enlargement in the treatment of popliteal cysts. Methods: Forty-eight patients with popliteal cysts who met the inclusion criteria and were admitted to our hospital from December 2018 to June 2020 were randomly divided into group A (24 cases) and group B (24 cases). Group A was treated with a central venous catheter dilator, and group B was treated with traditional open surgery to remove the popliteal cyst. Visual analogue scale (VAS) was used to evaluate discomfort. The VAS, Lysholm score of knee joint and Rauschning-Lindgren grade 0~I improvement rate were compared at 6 months after operation. Results: The postoperative VAS in group A was significantly better than that in group B (P < 0.05), and the postoperative Lysholm score and Rauschning-Lindgren grade 0~I in group A were higher than those in group B (P < 0.05). There was no recurrence or other complications in either group. Conclusions: Ultrasound-guided central venous catheter dilator is more effective than traditional surgical resection of popliteal cysts.

This case report describes 3 pediatric patients presenting with acute calf or knee pain, calf swelling, and a ruptured popliteal cyst diagnosed by magnetic resonance imaging. Lyme disease was serologically confirmed in each case. In all instances, treatment was delayed because of atypical presentation. All patients responded favorably after antibiotic therapy.The differential diagnosis of Lyme disease should be considered in the context of children presenting with atraumatic unilateral calf pain and a ruptured popliteal cyst. Otherwise, this unusual presentation could delay diagnosis or result in unnecessary surgical intervention, particularly in pediatric patients.

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.

The existence of a popliteal Baker's cyst was regarded as a contraindication for radiosynoviorthesis of the knee joint since decades. A so-called "ventile mechanism" was discussed leading to a significant concentration of the intraarticularly applied, high energy beta emitting radiopharmaceutical yttrium-90-colloid in the cyst. This cyst arises from a bursa beneath the tendon of the medial head of the gastrocnemius muscle, normally communicating with the knee joint space. Since the cyst wall is much thinner than the knee joint capsule, a radiogenic rupture of the cyst was feared, leading to severe radiogenic necroses of the surrounding soft tissue. Due to this potential hazard, knee joint ultrasound is mandatory prior to radiosynoviorthesis to check for any popliteal cysts. New studies however decline the risk of a radiogenic cyst rupture after an appropriately performed radiosynoviorthesis of the knee joint.In case of a preexistent cyst rupture, the risk of a radiogenic tissue damage remains an issue and magnetic resonance imaging (MRI) is the method of choice to exclude this potential hazard. However, MRI sometimes leads to equivocal results. Scintigraphy of the knee joint after intraarticular application of Tc-99m-nanocolloid offers the possibility to check for the integrity of the Baker's cyst in these patients to be sure that radiosynoviorthesis will not lead to a relevant extraarticular leakage with soft tissue necroses. This study describes the procedure of intracavitary distribution scintigraphy by means of representative case reports.Die popliteale Bakerzyste galt lange Zeit als Kontraindikation bei der Durchführung einer Radiosynoviorthese (RSO). Insbesondere bei einem vorliegenden „Ventilmechanismus“ der Zyste fürchtete man eine vermehrte Anreicherung des intraartikulär injizierten Radiopharmazeutikums Yttrium-90-Kolloid in der Zyste, die aus einer mit der Kniegelenkhöhle kommunizierenden Bursa unter dem medialen Kopf des M. gastrocnemius bei chronischer Arthritis mit Ergussneigung entstehen kann. Aufgrund der im Vergleich zur Kniegelenkkapsel deutlich dünneren Zystenwand wurde die Gefahr einer radiogenen Zystenruptur mit konsekutiver Freisetzung des hoch energetischen Betastrahlers in die umgebenden Weichteile und einer dadurch hervorgerufenen Weichteilnekrose diskutiert. Daher ist vor der Kniegelenk-RSO zwingend die sonografische Abklärung einer möglichen Bakerzyste erforderlich. Neue Studien zeigen hingegen keinen Hinweis auf die Gefahr einer Zystenruptur durch eine lege artis durchgeführte Kniegelenk-RSO.Bei bereits präexistierender Zystenwandruptur ist jedoch die Gefahr eines unkontrollierten Austritts des Radiopharmazeutikums mit nachfolgender Radionekrose auch weiterhin gegeben. Die Magnetresonanztomografie (MRT) ist die Methode der Wahl, um eine solche Zystenruptur im Vorfeld auszuschließen, liefert aber nicht immer zuverlässige Befunde. In derartigen Fällen ist die Binnenraumszintigrafie unter Verwendung von Tc-99m-Nanokolloid geeignet, die Integrität der Bakerzyste nachzuweisen und einen möglichen Aktivitätsaustritt aus der Zyste mit hinreichender Sicherheit auszuschließen. Die vorliegende Arbeit erläutert diese Methode an repräsentativen Fallbeispielen.

Background The principal aim of this study was to investigate the presence of factors affecting Baker’s cyst volume in young and middle-aged populations. Methods Open cyst excision with valve and capsule repair, as well as knee arthroscopy, were used to treat eighty-five patients. The cases were categorized in terms of age, effusion, chondral lesion degree, meniscal tear degree, and Lindgren scores. An ultrasonography (USG) device was used to calculate the cyst volume. The IBM-SPSS 22 program was used for statistical analysis and to assess the relationships between variables using Spearman’s correlation tests. Results The degree of chondral lesion was moderately and positively correlated with cyst volume in the total population (correlation coefficient: 0.469; p < 0.05). The degree of the chondral lesion was moderately and positively correlated with the degree of effusion (correlation coefficient: 0.492; p < 0.005). The cyst volume was weakly and positively correlated with the degree of effusion (correlation coefficient: 0.20; the correlation was at the limits of statistical significance p = 0.07 < 0.08). Conclusions This study revealed that an increase in chondral lesion severity increases the amount of effusion and cyst volume.

Background Osteoarthritis (OA) of the knee is the most common form of knee arthritis and a leading cause of chronic disability. Objective The aim of the current study is to reassess the utility of the updated ultrasound in the patients with knee osteoarthritis and outline its clinical application. Patients and Methods The studied group included 36 patient 23females and 13 males with their ages ranged between 39 and 58 years (average age 44 years). The patients were referred to US examination fulfilling the ACR clinical criteria for knee OA after orthopedic and /or rheumatologist consultation. The study was performed in Radiodiagnosis department Ain Shams University Hospitals (20 patients ) and at one private center (16 patients). Results There was a discrepancy between the results obtained by clinical examination and those demonstrated by ultrasonography. Clinical examination detected 22 (61.1%) of our cases. Prevalence of US findings in our cases were femoral articular degeneration in 28 (77.7%) patients, Tibiofemoral osteophytes were seen in 26 patients (72.2%), knee effusion in 22 patients (61.1%),meniscal extrusion in 22 patients (61.1%) meniscal degeneration in 17 patients (47.2%) and synovial hypertrophy in 15patients (41.6%). Baker’s cysts were demonstrated in 14patients (38.8%) while pes anserine syndrome was demonstrated in 4 cases. Meniscal degeneration and meniscal extrusion were correlated significantly with femoral cartilage degeneration (P 0.05). Baker's cysts is statistically related to the presence and severity of mensical changes and also related to the degree of femoral articular cartilage degeneration. Conclusion US is a valuable technique that can assess soft tissue structures within the knee and their involvement in the osteoarthritic process .US enables in guiding and monitoring therapy through detection of knee structural damage.

This guide to ultrasound imaging of the knee describes the basic scanning planes and contains corresponding high-resolution ultrasound images. The patient and probe positionings are explained in a simplified step-by-step manner using schematic drawings. This standard and simple examination technique seems to be an appropriate way to improve the learning curve of novice musculoskeletal sonographers. In this manuscript, an emphasis is placed on Baker's cyst and knee effusion detection and on how to diagnose collateral ligament injuries. Key words: tendons, knee joint, tendinopathy, Baker's cyst, popliteal cyst, menisci, tibial, medial collateral ligament, musculoskeletal, protocol, ultrasound.

This chapter covers hip and knee replacement procedures. It includes the indications, implant design, complications of hip replacements, osteolysis, hip resurfacing, periprosthetic fractures and revision hip replacement. Knee replacement section covers patient assessment, surgical approach, implant design, concept of alignment and balancing, complications, unicompartmental replacements, and revision knee arthroplasty.

This patient was a 73-year-old man who initially came to our service with acute respiratory failure secondary to COVID-19. Soon after hospitalization, he was submitted to orotracheal intubation and placed in the prone position to improve hypoxia, due to severe acute respiratory syndrome (SARS). On the third day of hospitalization, he developed acute oliguric kidney injury and volume overload. The nephrology service was activated to obtain deep venous access for renal replacement therapy (RRT). The patient could not be placed in the supine position due to significant hypoxemia. A 50-cm Permcath (MAHURKARTM, Covidien, Massachusetts, USA) was inserted through the left popliteal vein. This case report describes a possible challenging scenario that the interventional nephrologist may encounter when dealing with patients with COVID-19 with respiratory impairment in the prone position.