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Kim MS, Lee JW, Ahn JH, Min KU, Lee SH. Risk factors for residual popliteal cyst after arthroscopic decompression and cystectomy: Associated with degenerative cartilage lesions. Orthop Traumatol Surg Res 2023; 109:103595. [PMID: 36921759 DOI: 10.1016/j.otsr.2023.103595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND In previous studies, good results have been reported after arthroscopic treatment of popliteal cysts and concomitant intra-articular pathology. However, only a few studies have reported the associated factors with residual popliteal cysts. The aim of this study was to examine the clinical and radiographic outcomes and investigate the factors associated with the recurrence of popliteal cyst after arthroscopic cyst decompression and cyst wall resection. HYPOTHESIS The authors hypothesized that residual popliteal cyst after arthroscopic decompression and cystectomy would be associated with degenerative cartilage lesions. PATIENTS AND METHODS From December 2010 to December 2018, 54 patients with popliteal cysts were treated with arthroscopic decompression and cyst wall resection through an additional posteromedial cystic portal. Magnetic resonance imaging (MRI) or ultrasonography was used to observe whether the popliteal cyst had disappeared or decreased. The maximum diameter of the popliteal cyst was measured after surgery. The patients were classified into the disappeared and reduced groups according to the treatment outcome. Age, sex, symptom duration, preoperative degenerative changes based on the Kellgren-Lawrence (K-L) grade, cartilage lesions according to the International Cartilage Repair Society (ICRS) grades, synovitis, functional outcomes, and associated intra-articular lesions were compared between the two groups. The functional outcome was evaluated on the basis of the Rauschning and Lindgren knee score. The study included 22 men and 32 women, with mean age of 49.6 years (range, 5-82 years). According to the ICRS grade system, 28 (51.8%) patients had grade 0 to II, 26 (48.2%) patients had grade III to IV. RESULTS Follow-up radiographic evaluation revealed that the cyst had completely disappeared in 20 patients (37%) and reduced in size in 34 (63%). The mean cyst size was decreased significantly from 5.7cm (range, 1.7-15cm) to 1.7cm (range, 0-6.4cm), and the Rauschning and Lindgren knee score showed improved clinical features in all the patients. Between the disappeared and reduced groups, the presence of degenerative cartilage lesions (p=0.022, odds ratio 8.702, 95% confidence interval: 1.368-55.362) showed statistically significant differences. DISCUSSION Through the posteromedial cystic portal, cysts were completely removed in approximately 40% of patients, and the size was reduced in 60% of patients. Presence of degenerative cartilage lesion represents an associated risk factor for residual popliteal cyst. These findings could be helpful in ensuring explaining poor prognostic factors. LEVEL OF EVIDENCE IIIb; retrospective cohort study.
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Affiliation(s)
- Myung-Seo Kim
- Department of Orthopedic Surgery, Kyung-Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, 05278 Seoul, Republic of Korea
| | - Joong-Won Lee
- Department of Orthopedic Surgery, Kyung-Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, 05278 Seoul, Republic of Korea
| | - Jin-Hwan Ahn
- Department of Orthopaedic Surgery, Saeum Hospital, 449, Siheung-daero, Geumcheon-gu, 08534 Seoul, South Korea
| | - Kyeong-Uk Min
- Department of Orthopedic Surgery, Kyung-Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, 05278 Seoul, Republic of Korea
| | - Sang-Hak Lee
- Department of Orthopedic Surgery, Kyung-Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, 05278 Seoul, Republic of Korea.
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Ma R, Zhu Z, Liu D, Wang K, Yang P. Double posteromedial portals versus single posteromedial portal for arthroscopic management of popliteal cysts. J Orthop Surg Res 2023; 18:658. [PMID: 37667310 PMCID: PMC10478402 DOI: 10.1186/s13018-023-04132-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023] Open
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.
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Affiliation(s)
- Rui Ma
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Zheyue Zhu
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Dan Liu
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Kunzheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Pei Yang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China.
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Saylik M, Gokkus K, Sahin MS. Factors affecting Baker cyst volume, with emphasis on cartilage lesion degree and effusion in the young and middle-aged population. BMC Musculoskelet Disord 2021; 22:851. [PMID: 34610817 PMCID: PMC8493719 DOI: 10.1186/s12891-021-04721-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 09/09/2021] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- Murat Saylik
- Department of Orthopaedic Surgery, Istinye University Medical Faculty, Topkapı Kampüsü, Maltepe Mah, Edirne Çırpıcı Yolu, No.9 Zeytinburnu, 34010, İstanbul, Turkey
| | - Kemal Gokkus
- Department of Orthopaedics and Traumatology, Baskent University Alanya Research and Practice Center, Saray Mahallesi Yunus Emre Caddesi No:1 07400, Alanya, Antalya, Turkey.
| | - M S Sahin
- Department of Orthopaedics and Traumatology, Baskent University Alanya Research and Practice Center, Saray Mahallesi Yunus Emre Caddesi No:1 07400, Alanya, Antalya, Turkey
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Comparison of clinical outcomes associated with arthroscopic cyst wall preservation or resection in the treatment of popliteal cyst: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2021; 141:1741-1752. [PMID: 33620529 DOI: 10.1007/s00402-021-03812-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE 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. METHODS 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 < 0.10 as respective significance threshold values. The risk of bias was gauged with the Cochrane Collaboration's risk of bias tool and the Newcastle-Ottawa Scale (NOS). RESULTS In total, 18 relevant studies were included in this meta-analysis, of which 16 were observational studies and 2 were randomized controlled trials (RCTs). These studies included 573 total patients, of whom 346 underwent arthroscopic cyst resection and 227 underwent arthroscopic cyst preservation. Pooled analyses revealed that clinical outcomes (RR = 0.98, 95% CI 0.94-1.00) and postoperative recurrence rates (RR = 0.90, 95% CI 0.85-0.95) were significantly better among patients that underwent cyst wall resection relative to those that underwent cyst wall preservation (RR = 0, 95% CI 0-0.02 and RR = 0.05, 95% CI 0.02-0.10, respectively). However, complications occurred more often in the cyst wall resection group relative to the cyst wall preservation group (RR = 0.05, 95% CI 0.01-0.12 vs. RR = 0.01, 95% CI 0-0.03). Sensitivity analyses confirmed the stability of these pooled results, and we detected no significant risk of publication bias. CONCLUSIONS Relative to cyst wall preservation, popliteal cyst wall arthroscopic resection can yield more satisfactory clinical results and decrease rates of recurrence, but can also increase the incidence of complications. Future prospective studies comparing the outcomes associated with cyst wall resection and preservation will be required to validate our results.
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Subchondral insufficiency fracture of the knee: grading, risk factors, and outcome. Skeletal Radiol 2019; 48:1961-1974. [PMID: 31250037 DOI: 10.1007/s00256-019-03245-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/03/2019] [Accepted: 05/14/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To propose an magnetic resonance imaging (MRI) grading system for subchondral insufficiency fracture of the knee (SIFK) to predict outcome and assess risk factors. MATERIALS AND METHODS A total of 50 SIFK patients were retrospectively reviewed utilizing two MRI examinations approximately a year apart and compared them with 51 control subjects. A grading system was introduced that classifies lesions as low- vs high-grade. Lesion location 3D dimensions, extent of bone marrow edema (BME), location of meniscal tears and associated extrusion, degree of chondrosis and among other parameters were stratified according to lesion grade and compared with follow-up examinations. Statistical analyses were performed (Pearson's correlation, binary logistic regression, and Chi-squared analysis). RESULTS The majority of SIFK lesions were low-grade (LG; 78%) and most of them (70%) were observed in the medial femoral condyle. Predictor variables comparing low-grade and high-grade SIFK lesions included meniscal tear (p = 0.01), degree of extrusion (p < 0.003), chondrosis (p = 0.01), medial chondrosis grade (p = 0.001), medial femoral condyle (p = 0.01), surface collapse (p < 0.0001), marrow edema improvement (p < 0.0001), first MRI anteroposterior dimension (p = 0.001), transverse dimension (p < 0.001), and ellipsoid volume (p = 0.02). Predictor variables found to be significantly different between controls and patients were meniscal tear (p = 0.024), location of the medial meniscal tear (p < 0.0001), degree of extrusion (p < 0.0001), chondrosis (p < 0.0001), joint effusion (p < 0.0001), Baker's cyst (p < 0.0001), knee lock (p = 0.03) and buckle (p = 0.01), and history of trauma (p = 0.01). CONCLUSION A SIFK grading system for MRI is introduced. Surrogate markers of high-grade lesions include medial meniscus posterior root tears with associated moderate to severe extrusion, high-grade chondrosis, larger lesion sizes (anteroposterior/transverse), and articular surface collapse. Improvement of BME on follow-up was highly predictive of low-grade disease.
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Gu H, Bi Q, Chen J. Arthroscopic treatment of popliteal cyst using a figure-of-four position and double posteromedial portals. INTERNATIONAL ORTHOPAEDICS 2018; 43:1503-1508. [PMID: 30088053 DOI: 10.1007/s00264-018-4087-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to introduce a modified arthroscopic treatment technique for popliteal cyst and hypothesize that this modified technique would provide good clinical efficacy and low recurrence rate. METHODS From January 2013 to January 2017, 34 patients with symptomatic popliteal cysts were treated with our technique. A figure-of-four position and double posteromedial portals were used to achieve adequate enlargement of the posteromedial valvular opening between the cyst and the joint cavity and complete excision of the cyst wall. MRI was used to detect the recurrence of the popliteal cyst, and the Rauschning and Lindgren score was recorded to evaluate the clinical outcome. RESULTS All patients were followed up with a mean period of 14.8 months (range, 12 to 36 months). Associated intra-articular lesions were found and treated in all cases. Degenerative cartilage damage was the most common pathology, which affected 23 (67.6%) of the cases. The Rauschning and Lindgren score improved significantly after surgery, and no evidence of recurrence was found from MRI in any case. CONCLUSIONS Our modified arthroscopic treatment technique, using a figure-of-four position and double posteromedial portals, is effective and safe for treating popliteal cyst.
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Affiliation(s)
- Haifeng Gu
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 ShangTang Road, Xiacheng District, Hangzhou, 310014, Zhejiang, China
| | - Qing Bi
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 ShangTang Road, Xiacheng District, Hangzhou, 310014, Zhejiang, China
| | - Jihang Chen
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 ShangTang Road, Xiacheng District, Hangzhou, 310014, Zhejiang, China.
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He L, Qi Y, Wang Q, Tian X, Zhang D, Yang L, Wang W, Ding H, Chang Q, Ma Y. The correlation between ultrasonographic findings and the Lysholm scores in knee osteoarthritis. JOURNAL OF TRADITIONAL CHINESE MEDICAL SCIENCES 2017. [DOI: 10.1016/j.jtcms.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Giant Baker's Cyst Associated with Rheumatoid Arthritis. Case Rep Orthop 2017; 2017:4293104. [PMID: 28116197 PMCID: PMC5237725 DOI: 10.1155/2017/4293104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/10/2016] [Accepted: 12/18/2016] [Indexed: 11/17/2022] Open
Abstract
We report a rare case of a "giant Baker's cyst-related rheumatoid arthritis (RA)" with 95 × 26 mm dimensions originating from the semimembranosus tendon. The patient presented with chronic pain and a palpable mass behind his left calf located between the posteriosuperior aspect of the popliteal fossa and the distal third of the calf. In MRI cystic lesion which was located in soft tissue at the posterior of gastrocnemius, extensive synovial pannus inside and degeneration of medial meniscus posterior horn were observed. Arthroscopic joint debridement and partial excision of the cyst via biomechanical valve excision were performed. The patient continued his follow-up visits at Rheumatology Department and there was no recurrence of cyst-related symptoms in 1-year follow-up. Similar cases were reported in the literature previously. However, as far as we know, a giant Baker's cyst-related RA, which was treated as described, has not yet been presented.
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