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Background: This study aimed to investigate a technique for treating pediatric popliteal cysts with a triple-channel knee arthroscopic approach, hypothesizing that this technique exhibits favorable clinical outcomes with reduced recurrence rates. Methods: A retrospective analysis was conducted on the clinical data of 14 patients with symptomatic pediatric popliteal cysts admitted to the joint surgery center using an arthroscopic minimally invasive technique from December 2017 to December 2020. Arthroscopy was employed for adequate enlargement of the posterior medial flap opening between the cyst and the joint cavity and to completely resect the cyst wall. The popliteal cyst recurrence was assessed through Magnetic Resonance Imaging(MRI) at 3 and 12 months post-surgery, and the Rauschning and Lindgren scores were recorded to evaluate the clinical prognosis. Results: A total of 14 children completed the follow-up, including 8 boys and 6 girls, with a mean age of 9.9 ± 1.1 years (5–12 years); 5 cases in the left knee and 9 cases in the right knee; the mean operative time was 19.2 ± 2.7 min (10–25 min); and the mean follow-up time was 15.1 ± 2.4 months (12–24 months). There was no intraoperative vascular or nerve injury and no incisional exudate infection. Postoperatively, posterior knee symptoms disappeared in the children, Rauschning and Lindgren scores significantly improved, and no recurrence signs were observed on MRI. Conclusions: This study determined that the arthroscopic three-channel minimally invasive technique is effective and safe for treating popliteal cysts in children, making it worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The differential diagnoses of popliteal ganglion cysts include Baker's cysts, popliteal artery aneurysms, popliteal tendinitis, popliteal lymphadenopathy, lipomas, and synovial sarcoma. [ABSTRACT FROM AUTHOR]

The popliteal cyst (PC) is an abnormal dilation of the gastrocnemio-semimembranosus bursa, which is located in the popliteal fossa. It may manifest as an acute and dramatic condition or a chronically persistent or relapsing swelling. Inadvertent diagnoses of cysts in children are common. The available treatments include arthroscopic and open surgical excision, as well as nonsurgical or less invasive methods. Children with PCs rarely have accompanying intra-articular pathology, in contrast to adults; hence, open surgical removal over arthroscopy is favored. Here, we highlight 10 cases of PCs as well as share our experiences regarding diagnosis and surgical outcomes.

Abstract Background This study aimed to investigate a technique for treating pediatric popliteal cysts with a triple-channel knee arthroscopic approach, hypothesizing that this technique exhibits favorable clinical outcomes with reduced recurrence rates. Methods A retrospective analysis was conducted on the clinical data of 14 patients with symptomatic pediatric popliteal cysts admitted to the joint surgery center using an arthroscopic minimally invasive technique from December 2017 to December 2020. Arthroscopy was employed for adequate enlargement of the posterior medial flap opening between the cyst and the joint cavity and to completely resect the cyst wall. The popliteal cyst recurrence was assessed through Magnetic Resonance Imaging(MRI) at 3 and 12 months post-surgery, and the Rauschning and Lindgren scores were recorded to evaluate the clinical prognosis. Results A total of 14 children completed the follow-up, including 8 boys and 6 girls, with a mean age of 9.9 ± 1.1 years (5–12 years); 5 cases in the left knee and 9 cases in the right knee; the mean operative time was 19.2 ± 2.7 min (10–25 min); and the mean follow-up time was 15.1 ± 2.4 months (12–24 months). There was no intraoperative vascular or nerve injury and no incisional exudate infection. Postoperatively, posterior knee symptoms disappeared in the children, Rauschning and Lindgren scores significantly improved, and no recurrence signs were observed on MRI. Conclusions This study determined that the arthroscopic three-channel minimally invasive technique is effective and safe for treating popliteal cysts in children, making it worthy of clinical promotion.

Introduction: The optimal arthroscopic management for popliteal cyst decompression remains uncertain, with ongoing debate between preserving the cyst wall or completely removing it. The purpose of this study is to compare the outcomes and complications of arthroscopic popliteal cyst decompression with cyst wall preservation and cyst wall resection. Methods: A systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted. It encompassed studies that focused on arthroscopic popliteal cyst decompression, considering both cyst wall preservation and cyst wall resection. The quality assessment of the included studies was carried out using the Methodology Index for Non-Randomized Research criteria. Following this, meta-analyses were conducted, employing odds ratios (ORs) for dichotomous outcomes and calculating mean differences (MDs) for continuous outcomes. Results: Four articles included a collective of 214 knees. Each of these studies presented level 3 evidence. The comparison between the cyst wall preservation group and the cyst wall resection group revealed similar clinical outcomes based on the Rauschning and Lindgren grade (grade 0 [OR = 0.66, 95% CI: 0.37–1.19, p = 0.17]; grade I [OR = 1.33, 95% CI: 0.66–2.67, p = 0.43]; grade II [OR = 1.39, 95% CI: 0.46–4.14, p = 0.56]; grade III [OR = 3.46, 95% CI: 0.13–89.95, p = 0.46]) and Lysholm score (MD = 0.83, 95% CI: -0.65–2.32, p = 0.27). However, MRI results indicated a significant improvement in the cyst wall resection group (cyst disappearance [OR = 0.50, 95% CI: 0.28–0.90, p = 0.02]; cyst shrinkage or decrease in size [OR = 1.41, 95% CI: 0.78–2.55, p = 0.26]; cyst persistence or recurrence [OR = 7.63, 95% CI: 1.29–45.08, p = 0.02]). Nevertheless, the operative time for cyst resection was significantly longer compared to cyst preservation (MD = -14.90, 95% CI: -21.96 – -7.84, p < 0.0001), and the cyst wall resection group experienced significantly higher complications than the cyst wall preservation group (OR = 0.24, 95% CI: 0.06 to 1.02, p = 0.05). Conclusion: During arthroscopic popliteal cyst decompression, cyst wall resection led to longer operative times and higher complication rates but lower recurrence rates and better MRI outcomes. The functional outcomes after surgery were found to be similar. [ABSTRACT FROM AUTHOR]

A ganglion cyst is a benign mass consisting of high-viscosity mucinous fluid. It can originate from the sheath of a tendon, peripheral nerve, or joint capsule. Compressive neuropathy caused by a ganglion cyst is rarely reported, with the majority of documented cases involving peroneal nerve palsy. To date, cases demonstrating both peroneal and tibial nerve palsies resulting from a ganglion cyst forming on a branch of the sciatic nerve have not been reported. In this paper, we present the case of a 74-year-old man visiting an outpatient clinic complaining of left-sided foot drop and sensory loss in the lower extremity, a lack of strength in his left leg, and a decrease in sensation in the leg for the past month without any history of trauma. Ankle dorsiflexion and great toe extension strength on the left side were Grade I. Ankle plantar flexion and great toe flexion were Grade II. We suspected peroneal and tibial nerve palsy and performed a screening ultrasound, which is inexpensive and rapid. In the operative field, several cysts were discovered, originating at the site where the sciatic nerve splits into peroneal and tibial nerves. After successful surgical decompression and a series of rehabilitation procedures, the patient's neurological symptoms improved. There was no recurrence. [ABSTRACT FROM AUTHOR]

Adventitial cystic disease (ACD), a rare vascular disease characterized by mucus accumulation in the adventitia of blood vessels, typically affects the popliteal artery. We present the case of a 61-year-old female diagnosed with ACD in 2018 who was initially treated with endovascular stenting and percutaneous aspiration of the cyst. The patient, who had been asymptomatic for 5 years, developed a stent fracture and pseudoaneurysm requiring surgical intervention. Despite initial successful treatment, complications such as stent fracture and recurrence can occur; therefore, surgical treatment is recommended to optimize outcomes in patients with ACD. Endovascular treatment and cyst aspiration should only be considered in cases with high surgical risk. After treatment, long-term follow-up and individualized management strategies are important to monitor ACD recurrence.

This article discusses the efficacy of focused extracorporeal shock wave therapy (fESWT) for the treatment of fabella syndrome, a condition characterized by persistent and atypical posterolateral knee pain. The fabella is a sesamoid bone found in 10%–30% of the population, and its function in humans is largely unknown. Conservative management options for fabella syndrome include injections, immobilization, and manual therapy, but surgical excision may be necessary in some cases. The article presents a case study of a 66-year-old male patient who experienced significant pain reduction and functional improvement after undergoing fESWT treatment. The study suggests that fESWT may be an effective and safe nonsurgical option for managing painful fabella syndrome. [Extracted from the article]

Schwannoma in the popliteal fossa is still rare, often diagnosed late because it grows slowly and has no symptoms. It is often misdiagnosed with connective tissue tumors or with neurological disorders originating in the spine or disorders of the peroneal nerve. Schwannoma within the common peroneal nerve is still rare in the popliteal fossa, with most tumor sizes around 2 cm in diameter due to their smaller size of nerve but can cause neurologic disturbance, especially when it is large. And over a long time, it can cause serious complaints like neurological deficits and make surgery difficult by leaving greater sequelae. There is no data yet showing the incidence of schwannoma in the common peroneal nerve. In this case, a 36-year-old woman, for 5 years, feels soreness in the popliteal fossa and pain in the right instep, suspected that a nerve was pinched, due to an abnormality in the spine. As time went on, there was a lump in the fold of the right knee, suspected to be a Baker's cyst. As time went by, the complaint was burning pain in the right instep to the lateral ankle and distal right lower leg, disturbing sleep. Tinel's sign was positive. The right instep has hypoesthesia and a slight drop in the foot. On radiological examination of the right knee, a circumferential mass appeared, measuring 5 cm × 4 cm. The diagnosis is suspicious for a common peroneal nerve tumor. The encapsulated operation to remove the tumor was carried out with a size measuring 5 cm × 4.5 cm × 4 cm. The histopathological examination showed schwannoma. After surgery, the pain disappeared, hypoesthesia and a slight drop in the foot underwent physiotherapy, and stimulation with the result gradually improved. A thorough early examination includes correct and systematic anamnesis, physical examination, and neurological evaluation such as paraesthesia, hypoesthesia, and Tinel's sign; also, additional examinations, such as radiographic, ultrasound, and MRI, are needed for early detection of schwannoma so that delays in diagnosis and surgery can be avoided to prevent neurological deficits. [ABSTRACT FROM AUTHOR]

There are many types of cysts in the leg; the most common is a popliteal (Baker's) cyst. This occurs when synovial fluid fills the tissue plane between the medial head of the gastrocnemius and the semimembranosus muscle and is often associated with intraarticular knee pathology. Treatment for various types of cysts includes aspiration with or without fenestration, injections with corticosteroids, dextrose, or various sclerosing agents, and surgical excision. This case describes a 58-yr-old man with a large cyst measuring 14.7 x 2.7 x 3.1 cm in size in the lateral calf, within the lateral gastrocnemius, with atypical size and location for a calf cyst. Computed tomography arthrogram showed intraarticular communication with the knee. The cyst recurred after two aspirations and injections with 25% dextrose/lidocaine. Aspiration and injection with doxycycline resulted in temporary relief followed by recurrence. Complete cyst resolution occurred after final aspiration without injectate. The cyst was likely synovial based on location, intraarticular communication, and fluid analysis. We suspect that complete resolution may have been due to repeated aspiration and injection, essentially performing longitudinal cyst fenestration, with possible contribution from doxycycline injection. Further study of intracyst doxycycline injection with reaspiration after 10 mins for treatment of refractory cysts may be warranted. [ABSTRACT FROM AUTHOR]

The article discusses a case of a 10-year-old girl initially diagnosed with Lyme arthritis who later developed symptoms suggestive of systemic joint disease. Topics include the association between Baker's cysts and underlying rheumatic conditions in children, the challenges of diagnosing pseudothrombophlebitis in pediatric patients, and the importance of considering systemic rheumatologic disease in the evaluation of joint symptoms in children.

Purpose To evaluate DVT mimicking disease in clinical practice by using ultrasonography Material and Methods Results Cystic Lesion • Baker's Cyst Enlargement of the gastrocnemio-semimembranosus bursa -Most common cystic lesions seen around the knee -Anechoic or hypoechoic fluid collection between semimembranosus and medial gastrocnemius tendons –Usually communicate with the knee joint • Ganglion Cyst Cystic structures lined by flat spindle-shaped cells and contain mucin or fluid -Usually attached to tendon sheaths -Well-defined uni- or multilocular cystic lesion without vascularity -Anechoic with hyperechoic septa, posterior enhancement Infection and Inflammation • Cellulitis - Usually results from a streptococcus pyogens or staphylococcus aureus infection - Diffuse swelling and increased echogenicity of the skin and subcutaneous tissue - Variable cobblestone appearance - Hyperemia within the subcutaneous tissues on color doppler image • Parasite infestation (cysticercosis) Caused by encysted larvae of pork tapeworm (Taenia solium) -Infection site – CNS (m/c), muslces, subcutaneous tissue, eyes, peripheral nervous system -Solitary muscular and soft tissue involvement is rare US findings -Cleary anechoic cystic lesion with well-defined smooth wall -Scolex: linear rounded structure in the cyst attached to the wall without post acoustic shadowing Lymphadenopathy Most common adenopathy in the inguinal region Differentiating between benign and malignancy by US findings • By measuring the length/transverse ratio • Malignancy ✓ Ratio <2, no echogenic hilum ✓ Rounded and marked hypoechoic lesion ✓ Irregular, blurred, angular, invasive margin • Benign ✓ Ratio >2, presence of echogenic hilum ✓ Oval and moderate echogenicity ✓ Sharp margin Neoplasm • Hemangioma • Common benign neoplasms (> 7% of all benign soft-tissue tumors) • Clinical manifestation • Pulsatile mass US findings -A complex mass with heterogeneous echogenicity -Acoustic shadowing (if phleboliths are abundant) -Low-resistance arterial flow with forward flow during Botox myonecrosis both systole and diastole Lymphoma Primary lymphoma arising in skeletal muscle is rare • Diffuse enlargement of involved structures • Typically, involve more than one muscle compartment over a long segment US findings • Ill-defined hypoechoic mass • Coarsening of fibroadipose septa • Swelling of muscle bundles Neurofibroma Benign peripheral nerve sheath tumor • 5% of all benign soft-tissue tumor • Most commonly affects patients 20–30 years of age • Malignant change is extremely rare except in neurofibromatosis 1 Localized type (m/c) • Well-circumscribed fusiform mass with entering and exiting nerve Diffuse type • Plaque-like elevation of the skin with thickening of the entire subcutis Muscular Injury Tennis Leg Caused by hyperextension of the knee and forced dorsiflexion of the ankle Rupture of the medial head of the gastrocnemius (66%) • Fluid collection between the aponeurosis of the medial head of the gastrocnemius muscle and an unruptured soleus (21%) • DVT associated with tennis leg (5%) • Snapping sensation ("pop") • Partial or complete discontinuity of involved muscle Miscellaneous Arterial aneurysm Popliteal artery aneurysms • Dilated arteries that have a transverse diameter of • 7 mm or more • Bilateral in 50%–70% • Communicating channel (neck) between the sac and the feeding artery on color Doppler scan Parrafinoma • Snowstorm appearance • Multiple, round hypoechoic nodules with calcifications Botox myonecrosis Summary Conclusion • Sonographic examination with high-frequency transducers provides detailed anatomical information of the lower extremity, and the ability to real time confirmation of the several DVT mimicking lesions. • The correlation of the clinical, laboratory and sonographic findings can help to make a specific diagnosis of DVT mimicking lesions and provide treatment strategy for these patients. [ABSTRACT FROM AUTHOR]

Introduction: Patients with posterior knee swellings are commonly encountered in clinical practice with the vast majority referred for an ultrasound scan to assess for a clinically suspected Baker's cyst. Aims: Our aim was to determine the incidence of different pathologies in patients investigated for a posterior knee swelling of a clinically suspected Baker's cyst using ultrasound. We also wanted to investigate the incidence of significant pathologies in the popliteal fossa to assess whether the ultrasound scan findings influenced patient management. Methodology: Retrospective analysis was performed on all patients who underwent an ultrasound scan for a suspected Baker's cyst or posterior knee swelling at our institution, between January 2017 and December 2018. Patient demographics, ultrasound findings, further imaging investigations and histopathology were recorded. Patient records were followed up for a minimum period of 3 years after ultrasound. Results: A total of 680 patients had a posterior knee ultrasound scan. Of that, 51% (347/680) had a Baker's cyst and 40% (273/680) had a normal ultrasound scan. Sixty (9%) patients had other abnormalities identified within the popliteal fossa. Four patients had significant findings on ultrasound that required a change of management. No malignancies identified. Conclusion: This study confirms the high incidence of Baker's cysts in patients presenting with a posterior knee swelling. In the absence of red flag symptoms, ultrasound of the posterior knee for a clinically suspected Baker's cyst is of limited clinical value. [ABSTRACT FROM AUTHOR]

Objective: Peripatellar fat pads are extrasynovial intracapsular fat tissues. Suprapatellar, perifemoral, and infrapatellar (Hoffa fat pad) fat pads are included in the peripatellar fat pad. This study aimed to describe the magnetic resonance imaging (MRI) signs of suprapatellar fat pad impingement syndrome, describe their prevalence and pattern, and look into the relationship between their MRI and clinical signs. Methods: Two radiologists retrospectively analyzed 5,700 patients’ knee MRI data between December 2010 and December 2015. We documented the MRI findings that were associated with suprapatellar fad pad impingement syndrome. The correlations between age, osteoarthritis, chondromalacia, and the patellofemoral joint were evaluated using Pearson’s correlations. Results: In our study group, the prevalence of suprapatellar fat pad impingement was 5.3%. Of the patients 52% were men and 48% were women. Patients who were admitted to the clinic complained of non-specific pain in 80.3% of patients. Twenty-seven patients (8.9%) presented with isolated suprapatellar impingement syndrome; 185 (60.9%) showed an increase in intra-articular fluid; 4 (1.3%) had synovitis findings; 17 (5.6%) had medial collateral ligament tears; 107 (35.2%) had quadriceps femoris tendinitis; 8 (2.6%) had patellar tendinitis; 80 (26.3%) had a medial meniscus tear; 23 (7.6%) had Baker’s cyst; and 30 (9.9%) had soft-tissue edema. Medial meniscus degeneration was observed in 51 (16.8%) patients, Hoffa edema was observed in 31 (10.2%) patients, and anterior cruciate ligament tears in 3 (1%) patients. There were positive correlations between age and osteoarthritis (r=0.4660, p<0.05), between chondromalacia and the grade of the chondromalacia (r=0.5198, p<0.05), and between lateral subluxation and lateral tilt as opposed to the normal patellofemoral relationship (r=0.3171, p<0.05).in patients with suprapatellar fat pad impingement. Conclusion: The most common symptom of suprapatellar impingement, that is one of the major causes of anterior knee pain, is non-specific pain. The most common additional MRI findings are increased intra-articular fluid and quadriceps femoris tendinitis. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of Baker's cyst in patients presenting with knee pain, considering MRI as imaging modality. Study Design: Descriptive, Cross-sectional study. Setting: Department of Radiology, JPMC, Karachi. Period: 03 January 2021 till 02 July 2021. Material & Methods: Total 113 patients presenting with knee pain for >4 weeks duration who were referred for knee MRI were selected in the study. Both male and female patients between 15-65 years included in the study. Post-surgical patients and those with contraindication to MRI were excluded from the study. MRI of effected knee was performed in every selected patient by using 1.5 Tesla MRI by placing the knee in extended position with slight external rotation to facilitate imaging. MR images were interpreted by one consultant radiologist for presence or absence of Baker's cyst. Results: Patients of 15 to 65 years age were included in the study with mean age of 44.94 ± 6.69 years. Out of 113 patients, 65 (57.52%) were male and 48 (42.48%) were female with male to female ratio of 1.4:1. Mean BMI of patients was 27.45 ± 3.02 kg/m2. Mean duration of pain was 5.78 ± 2.30 months. In our study, 22 patients with knee pain were found to have Baker's cyst on MRI with frequency of 19.47%. Conclusion: This study concluded that frequency of Baker's cyst on MRI in patients with knee pain is quite high. [ABSTRACT FROM AUTHOR]

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

Abstract Background As a common disease in orthopedic clinics, popliteal cysts often coexist with intra-articular lesions. Compared with traditional open surgery, arthroscopic treatment of popliteal cysts is less traumatic, and intra-articular lesions can be treated. The ‘one-way valve’ mechanism of the popliteal cyst can be removed by expanding the communication between the articular cavity and the cyst to avoid cyst recurrence. In terms of arthroscopic techniques, the comparison of clinical effects between the double posteromedial portal (DPP) and single posteromedial portal (SPP) has rarely been studied. The purpose of this retrospective study was to compare the clinical effects of DPP and SPP. Methods A total of 46 consecutive patients with symptomatic popliteal cysts who underwent arthroscopic treatment were included in this study and followed for approximately 1 year. All patients were divided into two groups according to the arthroscopic portals (DPP group and SPP group). The cyst size, Lysholm score and Rauschening–Lindgren (R–L) grade were evaluated before the operation for all patients, and the intra-articular lesions, operative time and complications were recorded after operation. At the last follow-up, the Lysholm score and R–L grade were recorded, and magnetic resonance imaging was used to evaluate the outcome of the cyst. The clinical data of the two groups was statistically compared and analyzed. Results There were no significant differences in preoperative cyst size, Lysholm score or R–L grade between the two groups (P > 0.05). The operation time of the DPP group (67.52 ± 18.23 min) was longer than that of the SPP group (55.95 ± 16.40 min) (P = 0.030), but the recurrence rate of cysts in the DPP group (0%) was obviously lower than that in the SPP group (19.0%) (P = 0.046). There were no significant differences in the Lysholm score, R–L grade or complication rate between the two groups at the last follow-up (P > 0.05). Conclusion Arthroscopic treatment of popliteal cysts using double posteromedial portals was a safe and effective surgical method. Trial registration: ChiCTR, ChiCTR2200060115. Registered 19 May 2022, https://www.chictr.org.cn/showproj.html?proj=133199

The cause of knee osteoarthritis (OA) and knee pain associated with OA is not well understood. Periarticular cystic lesions and bursae around the knee are among the most common morphologic features identified on MRI in the setting of OA. Despite widespread association of these lesions with knee OA and their inclusion in semiquantitative MRI scoring assessment systems for knee OA, the role that these lesions play in the development of knee pain and OA remains uncertain. In this discussion, we review the cystic lesions and bursae most commonly associated with OA of the knee, examine their relation and role in whole organ imaging assessments of OA, and present the literature investigating the associations of periarticular cysts and cyst-like lesions with knee pain and OA. [ABSTRACT FROM AUTHOR]

The Baker cyst (BC), also known as the popliteal cyst or parameniscal cyst, is a fluid-filled sac that normally develops in the back of the knee, between the semimembranosus and medial head of the gastrocnemius. We aimed to evaluate the effectiveness of physiotherapy (10 days of treatment) that associates intermittent vacuum therapy (IVT) on the lower limbs in the treatment of the BC, respectively, in its size reduction. Sixty-five patients with knee osteoarthritis using Kellgren–Lawrence criteria and the presence of BC (ultrasonography evaluation), were divided into the Control and Vacuum groups. We collected the following features: sex, age, level of education, occupation, environment, body mass index, Knee Injury and Osteoarthritis Outcome Score, Western Ontario, and McMaster Universities Osteoarthritis Index, the Functional Independence Measurement, the Fall Risk Score, and the Visual Analog Scale were recorded at baseline and after 10 days. Both groups are similar in terms of demographic features. Regarding the clinical functional parameters, the results elicit a statistically significant change in all parameters between admission and discharge, including the echo volume at BC. Physical medicine and rehabilitation increase the autonomy of patients with BC. Clinical-functional improvement begins in the first 10 days of complex rehabilitation treatment; it is statistically significant and is not different between the two groups, which brings an additional argument for the effectiveness of conservative therapy in the treatment of BC. Although IVT has not demonstrated its superiority over classical balneo-physical therapy, additional research, and long-term monitoring are needed to provide additional arguments regarding this aspect. [ABSTRACT FROM AUTHOR]

We describe a rare case of a disseminated Nocardia farcinica infection associated with hip osteomyelitis. A 91-year-old female patient was admitted with oedema of her right leg, fever of 38 °C and data consistent with ruptured Baker's cyst. A disseminated Nocardia farcinica infection including bloodstream infection, pneumonia and multiple abscesses along both lower limbs was observed. After a four-week course of 320 mg/1600 mg/12 h of intravenous trimethoprim/sulfamethoxazole and multiple chirurgic drainages the patient was discharged with oral trimethoprim/sulfamethoxazole. Nevertheless, the patient expired done month after being discharged from the hospital. The implementation of a combination of intravenous antibiotics and drainages resulted in an initial improvement in the patient's condition. However, despite these interventions, the patient ultimately passed away probably due to natural causes. [ABSTRACT FROM AUTHOR]

Background: As a common disease in orthopedic clinics, popliteal cysts often coexist with intra-articular lesions. Compared with traditional open surgery, arthroscopic treatment of popliteal cysts is less traumatic, and intra-articular lesions can be treated. The 'one-way valve' mechanism of the popliteal cyst can be removed by expanding the communication between the articular cavity and the cyst to avoid cyst recurrence. In terms of arthroscopic techniques, the comparison of clinical effects between the double posteromedial portal (DPP) and single posteromedial portal (SPP) has rarely been studied. The purpose of this retrospective study was to compare the clinical effects of DPP and SPP. Methods: A total of 46 consecutive patients with symptomatic popliteal cysts who underwent arthroscopic treatment were included in this study and followed for approximately 1 year. All patients were divided into two groups according to the arthroscopic portals (DPP group and SPP group). The cyst size, Lysholm score and Rauschening–Lindgren (R–L) grade were evaluated before the operation for all patients, and the intra-articular lesions, operative time and complications were recorded after operation. At the last follow-up, the Lysholm score and R–L grade were recorded, and magnetic resonance imaging was used to evaluate the outcome of the cyst. The clinical data of the two groups was statistically compared and analyzed. Results: There were no significant differences in preoperative cyst size, Lysholm score or R–L grade between the two groups (P > 0.05). The operation time of the DPP group (67.52 ± 18.23 min) was longer than that of the SPP group (55.95 ± 16.40 min) (P = 0.030), but the recurrence rate of cysts in the DPP group (0%) was obviously lower than that in the SPP group (19.0%) (P = 0.046). There were no significant differences in the Lysholm score, R–L grade or complication rate between the two groups at the last follow-up (P > 0.05). Conclusion: Arthroscopic treatment of popliteal cysts using double posteromedial portals was a safe and effective surgical method. Trial registration: ChiCTR, ChiCTR2200060115. Registered 19 May 2022, https://www.chictr.org.cn/showproj.html?proj=133199 [ABSTRACT FROM AUTHOR]

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Objective To explore the application and clinical effect of double posteromedial approach of one-way valve resection under arthroscopy in the treatment of popliteal cysts. Methods A retrospective study was performed on the clinical data of 24 patients with popliteal cysts undergoing arthroscopic double posteromedial approach of one-way valve resection at the First Affiliated Hospital of Xinxiang Medical University from January 2020 to March 2022. The visual analog scale (VAS), Lysholm score of knee joint and Rauschning-Lindgren grade for popliteal cysts were used to assess the pain degree and joint function before surgery, 1 week after surgery and 6 months after surgery. The postoperative recurrence rate and clinical outcomes were observed. Results After 6-month postoperative follow-up, VAS score were significantly lower than that before operation (1.75±0.85 vs 5.42±1.31, P＜0.05). Lysholm knee score were higher than that before operation (86.92±7.51 vs 53.33±9.37, P＜0.05). Rauschning-Lindgren grade at 6 months after surgery (grade 0 in 17 cases, grade Ⅰ in 4 cases, grade Ⅱ in 2 cases, and grade Ⅲ in 1 case) was significantly better than that before surgery (grade Ⅱ in 19 cases and grade Ⅲ in 5 cases) (Z =3.724, P＜0.01). All patients had no postoperative complications such as joint infection, intra-articular hematoma, lower limb deep vein thrombosis or neurovascular injury and recurrence of popliteal cysts. Conclusion In the treatment of popliteal cysts, arthroscopic double posteromedial approach of one-way value resection has a good clinical effect, low recurrence rate and significant improvement in postoperative knee joint function.

Objective: Recanalization of flush ostial superficial femoral artery (SFA) occlusion is a very challenging procedure. Using the ipsilateral antegrade approach in such lesions has some difficulties. This study aimed to assess the feasibility, efficacy, and outcomes of duplex-guided ipsilateral antegrade access for endovascular treatment of atherosclerotic flush occlusion of the SFA. Methods: This is a prospective two-center study that included chronic lower extremity ischemia patients with flush occlusion of SFA who underwent duplex-guided ipsilateral antegrade endovascular revascularization due to unfeasible contralateral femoral approach. Flush occlusions were preoperatively documented by duplex ultrasound and computed tomography angiography in all patients. The outcome measures were technical success, patency rates, perioperative morbidity and mortality, limb salvage, and amputation free survival rates. Results: Between April 2019 and March 2021, 49 patients were enrolled in the current study with a mean age of 63.7 ± 5.7 years. Diabetes was the most common risk factor and was found in 40 (81.6%) patients. Associated popliteal lesions were found in seven (14.3%) patients, while 10 (20.4%) patients had combined tibial disease. Selective stenting was done in nine (18.4%) patients. Technical success was achieved in 43 (87.8%) patients. All failures were due to inability to cross the lesion rather than failure to access the common femoral artery. All complications were minor and occurred in seven (14.3%) patients. Primary, assisted primary, and secondary patency rates were 63.9% ± 7.1%, 82.8% ± 5.6%, and 93.5% ± 3.7% at 12 months, respectively. The overall 12-month limb salvage and amputation free survival rates were 91.8% and 83.3% ± 5.4%, respectively. Conclusion: Duplex-guided ipsilateral antegrade femoral access is a feasible, safe, and effective endovascular treatment option for flush SFA occlusion when contralateral femoral access is not possible. [ABSTRACT FROM AUTHOR]

The posteromedial corner (PMC) is a common location for knee joint pain, and accurate diagnosis is essential for appropriate treatment. The frequent causes of pain in the PMC include pathologies of the posterior part of the medial meniscus, damage to articular cartilage, popliteal cysts and the semimembranosus tendinopathy. Currently, magnetic resonance imaging is the gold standard for assessing knee joint disorders, but its availability and cost can limit its use in some cases. In this pictorial essay, we presented the use of ultrasonography as an alternative method for assessing PMC. We present a series of images to demonstrate the value of ultrasonography and describe the methods used for assessing PMC with a particular focus on semimembranosus tendinopathy. [ABSTRACT FROM AUTHOR]

Purpose : Arthroscopy in popliteal cyst surgery enables addressing all components of its pathomechanism: the cyst wall, valvular mechanism, and concomitant intra-articular pathologies. Techniques differ as to the management of the cyst wall and the valvular mechanism. This study aimed to assess the recurrence rate and functional outcomes of a cyst wall and valve excising arthroscopic technique with concurrent intra-articular pathology management. The secondary purpose was to assess cyst and valve morphology and concomitant intra-articular findings. Methods: Between 2006 and 2012, 118 patients with symptomatic popliteal cysts refractory to at least three months of guided physiotherapy were operated on by a single surgeon using a cyst wall and valve excising arthroscopic technique with intra-articular pathology management. Patients were evaluated preoperatively and at a mean follow-up of 39 months (range 12–71) by ultrasound, Rauschning and Lindgren, Lysholm, and VAS of perceived satisfaction scales. Results: Ninety-seven out of 118 cases were available for follow-up. Recurrence was observed on ultrasound in 12/97 cases (12.4%); however, it was symptomatic only in 2/97 cases (2.1%). Mean scores improved: Rauschning and Lindgren from 2.2 to 0.4, Lysholm from 54 to 86, and VAS of perceived satisfaction from 5.0 to 9.0. No persistent complications occurred. Arthroscopy revealed simple cyst morphology in 72/97 (74.2%) and presence of a valvular mechanism in all cases. The most prevalent intra-articular pathologies were medial meniscus (48.5%) and chondral lesions (33.0%). There were significantly more recurrences in grade III–IV chondral lesions (p = 0.03). Conclusions: Arthroscopic popliteal cyst treatment had a low recurrence rate and good functional outcomes. Severe chondral lesions increase the risk of cyst recurrence. [ABSTRACT FROM AUTHOR]

I Purpose or Learning Objective: i Baker's cysts, also known as popliteal cysts, are common and can be treated with ultrasonography-guided aspiration and steroid injection via a posterior approach. I Conclusion: i Our study found no difference in self-reported pain reduction immediately after injection and 14 days later between patients who underwent posterior popliteal cyst aspiration followed by corticosteroid injection and those who received a subsequent anterior knee joint corticosteroid injection. [Extracted from the article]

In this dynamic scanning protocol, ultrasound examination of the knee is described using various maneuvers to assess different conditions. Real-time patient examination and scanning videos are used for better simulation of the daily clinical practice. The protocol is prepared by several/international experts in the field of musculoskeletal ultrasound and within the umbrella of European Musculoskeletal Ultrasound Study Group in Physical and Rehabilitation Medicine/Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine. [ABSTRACT FROM AUTHOR]

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

Introduction: within musculoskeletal disorders there are, with high frequency, conditions that affect the shoulder and knee joints; in its diagnosis, ultrasound is of vital importance as an auxiliary means. Objective: to characterize shoulder and knee affections by ultrasound. Methods: a descriptive and cross-sectional study was carried out in the Imaging Service of the "Arnaldo Milián Castro" Hospital in the Province of Villa Clara. The population was made up of all the patients (434) referred to the Ultrasound Clinic of the osteomyoarticular system during the period from October 2018 to July 2021. The historical and inductive-deductive methods were used, as well as the documentary analysis of clinical histories and reports. ultrasonographic, observational and statistical. Results: shoulder and knee conditions affected mainly those aged 50 to 59 years, the most frequent shoulder condition was omarthrosis and calcifications and tendinitis prevailed in supraspinatus lesions. Knee conditions were more frequent at 60 years of age and over, and gonarthrosis predominated, significantly related to the popliteal cyst, and lateral and medial ligament injury. The agreement between diagnostic impression and ultrasonographic diagnosis was good for the shoulder and moderate for the knee. Conclusions: ultrasound was a useful means to characterize shoulder and knee conditions. [ABSTRACT FROM AUTHOR]

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

Abstract Background The purpose of this study was to introduce the arthroscopic internal drainage with anterior-anteromedial approach for the treatment of popliteal cysts in children. To compare its clinical efficacy with open surgery. Methods This was a retrospective case–control study of 102 patients diagnosed with popliteal cysts from January 2018 to February 2020 who received surgery. The study included 27 cases with minimally invasive group (MI group) and 75 cases with open surgery group (OS group). The MI group included 21 males and 6 females, age 6.71 ± 2.16 years who received arthroscopic internal drainage of the cysts to adequately widen the valve opening between the cyst and the articular cavity, excised the fibrous diaphragm without complete excision of the cyst wall. The OS group included 57 males and 18 females, age 6.21 ± 1.67 years who received open excision. The clinical parameters regarding the preoperative characteristics and surgical results were compared. Ultrasound or MRI was used to identify the recurrence of the popliteal cysts. Rauschning-Lindgren grade was recorded to evaluate the clinical outcome. Results All patients were followed up for at least 24 months. There were no significant differences between the two groups in age, gender, left and right sides, disease time, cyst size, length of hospitalization, preoperative Rauschning-Lindgren grade (p > 0.05). At the last follow-up, the preoperative and postoperative Rauschning-Lindgren grade was improved in both groups. Compared with the OS group, operation time was significantly shortened in the MI group (28.89 ± 4.51 min vs 52.96 ± 29.72 min, p

Certain types of popliteal cysts do not possess the common pathophysiology of Baker's cysts, such as location or the presence of a one-way valve lesion. The traditional arthroscopic approach and excision of such atypical popliteal cysts are difficult because they do not communicate with the knee joint, especially when located behind the popliteal neurovascular structure. In this case report, we introduce a direct posterior endoscopic technique for the excision of atypical popliteal cysts when accessing them through the traditional arthroscopic approach is unfeasible. In this case, the popliteal cyst was not located between the gastrocnemius medial head and the semimembranosus muscle and did not communicate with the knee joint. Passage of the popliteal artery was observed running on the anteromedial side of the popliteal cyst. Therefore, a direct posterior endoscopic approach was decided for the surgical treatment of the popliteal cyst, and the atypical popliteal cyst was successfully excised without any complications. We also describe the possible advantages and pitfalls of the direct posterior endoscopic approach. Clinical relevance: Direct posterior endoscopic excision using an intra-cystic portal in the prone position is considered a safe and effective treatment method for atypical popliteal cysts.

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

Venous cystic adventitial disease (VCAD) is a rare vascular anomaly located in the common femoral vein in most cases. We describe the case of a 59-year-old female patient with right leg edema who was misdiagnosed with deep vein thrombosis of the lower extremity at another hospital. Magnetic resonance angiography revealed a round mass in the popliteal vein, with a narrow lumen. Considering the location of the lesion, absence of a history of deep venous thrombosis and trauma, and clinical manifestations, the diagnosis is likely a popliteal vein adventitial cyst. Segmental popliteal vein resection and reconstruction were performed using a cylindrical great saphenous vein graft. No joint connection was found during the operation, and the postoperative pathology confirmed VCAD. [ABSTRACT FROM AUTHOR]

Introduction: 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. Materials and methods: 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. Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]

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

Tenosynovial giant cell tumor (TGCT) is a rare neoplasm of the joint synovium that has a wide clinical spectrum including pain and stiffness in the affected joint, joint swelling, periarticular erosions, and cartilage loss, which can severely impact quality of life. The mainstay treatment for TGCT has been surgery involving partial or total synovectomy using arthroscopic or open techniques. However, surgical resection alone is associated with high recurrence rates, particularly in diffuse-TGCT (D-TGCT) cases. The 3 cases presented here summarize a combination approach (surgery+pexidartinib [tyrosine kinase inhibitor]) in patients with previously unresectable or inoperable D-TGCT. Case 1-Hip. A 29-year-old male was treated with pexidartinib prior to surgery, resulting in tumor reduction. A left total hip arthroplasty (THA) was then performed with a lack of recurrence in 12 months postoperative, and the patient currently on pexidartinib treatment. Case 2-Foot. A 35-year-old female, nearly a decade following a left foot mass resection, was treated with pexidartinib following disease recurrence. A decrease in soft tissue lesions at the midfoot and decreased marrow enhancement at the first metatarsal head were seen within 4–5 months of pexidartinib treatment; the patient is currently on pexidartinib (400 mg/day) with improved symptom control. Case 3-Knee. A 55-year-old male patient received pexidartinib pre- and postoperatively. A reduction in swelling and the size of the popliteal cyst was significant and maintained, with the synovial disease growing when pexidartinib was discontinued. Surgery and adjuvant therapy eliminated the disease as of the last follow-up visit (11 months postoperative). These cases provide a unique perspective based on tumor location, type/timing of treatment strategy, and patient outcomes. Optimal treatment strategies for this debilitating disease may entail utilizing a combination approach (surgery+systemic treatment) to reduce surgical morbidity and the risk of postoperative disease recurrence. [ABSTRACT FROM AUTHOR]