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Charnock M, Kinsella M, Chopra A. Ultrasound for suspected Baker's cyst: A test of limited clinical value? ULTRASOUND (LEEDS, ENGLAND) 2024; 32:36-42. [PMID: 38314015 PMCID: PMC10836229 DOI: 10.1177/1742271x231183356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/25/2023] [Indexed: 02/06/2024]
Abstract
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.
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Affiliation(s)
- Mark Charnock
- Sheffield Teaching Hospital NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | | | - Annu Chopra
- Sheffield Teaching Hospital NHS Foundation Trust, Northern General Hospital, Sheffield, UK
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Liu B, Xu HY, Zhang R, Han L, Li Y, Sun XF. An Update on Clinical Utility of Musculoskeletal Ultrasonography in Knee Osteoarthritis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1413-1422. [PMID: 36715025 DOI: 10.1002/jum.16176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/27/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
In knee osteoarthritis (KOA), timely and accurate assessment of the severity is essential to help orthopedic surgeons determine the most appropriate therapeutic strategies and evaluate disease outcomes and responses for corresponding treatments. In KOA, musculoskeletal ultrasonography (MSUS) could effectively help detect various abnormalities, including synovitis, osteophytes, and cartilage damage. Further, MSUS could be used to monitor the response to different therapies in KOA, to guide local diagnostic and therapeutic procedures. In the future, applications based on continuously evolving US tools could enhance the clinical utility of MSUS in KOA.
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Affiliation(s)
- Bo Liu
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hui-Ying Xu
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Rui Zhang
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Lu Han
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yang Li
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiao-Feng Sun
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
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Liu K, Li X, Weng Q, Lei G, Jiang T. Diagnostic accuracy of ultrasound for the assessment of Baker's cysts: a meta-analysis. J Orthop Surg Res 2022; 17:535. [PMID: 36510299 PMCID: PMC9743685 DOI: 10.1186/s13018-022-03430-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Baker's cyst is the most common cystic disease of the knee, and a fast and accurate diagnosis of Baker's cyst is essential for a better management. Ultrasound is a rapid, portable, widely available, inexpensive and noninvasive imaging modality. However, the diagnostic accuracy of ultrasound on Baker's cyst still remains undetermined. We conducted the first meta-analysis to comprehensively assess the accuracy of ultrasound for the detection of Baker's cyst. METHODS PubMed, Embase and Web of Science were searched from inception to July 14, 2022, without language restrictions. Studies providing cross-tabulations of ultrasound versus pathology (gold standard) or MRI (standard imaging technique) for diagnosis of Baker's cyst were included. Indicators for the diagnostic accuracy of ultrasound, including sensitivity, specificity and area under the curve, were calculated using a bivariate model. Sensitivity analysis was conducted to evaluate the heterogeneity and robustness of the results. RESULTS A total of 13 studies with 1,011 subjects (mean age 32.2 years; men 53.5%) met the inclusion criteria. The pooled sensitivity, specificity and area under the curve of ultrasound for diagnosis of Baker's cyst, compared with pathology, were 0.97 (95% confidence intervals: 0.73-1.00), 1.00 (0.98-1.00) and 1.00 (0.99-1.00), respectively. The pooled estimates of ultrasound versus MRI were 0.94 (0.87-0.98) for sensitivity, 1.00 (0.83-1.00) for specificity and 0.97 (0.95-0.98) for area under the curve. Sensitivity analysis did not change the results materially. CONCLUSION Ultrasound shows excellent diagnostic accuracy for the assessment of Baker's cyst and provides similar diagnostic information (absent or present) compared to MRI. Because of its advantages of low cost, portability and accessibility, ultrasound is likely to be a choice of imaging technique for screening Baker's cyst in clinical and population settings as well as in follow-ups.
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Affiliation(s)
- Ke Liu
- grid.216417.70000 0001 0379 7164Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoxiao Li
- grid.216417.70000 0001 0379 7164Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
| | - Qianlin Weng
- grid.216417.70000 0001 0379 7164Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Guanghua Lei
- grid.216417.70000 0001 0379 7164Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China ,grid.216417.70000 0001 0379 7164Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China ,grid.216417.70000 0001 0379 7164National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ting Jiang
- grid.216417.70000 0001 0379 7164Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China ,grid.216417.70000 0001 0379 7164Department of Ultrasonography, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan China
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Sakellariou G, Scirè CA, Adinolfi A, Batticciotto A, Bortoluzzi A, Delle Sedie A, De Lucia O, Dejaco C, Epis OM, Filippucci E, Idolazzi L, Picchianti Diamanti A, Zabotti A, Iagnocco A, Filippou G. Differential Diagnosis of Inflammatory Arthropathies by Musculoskeletal Ultrasonography: A Systematic Literature Review. Front Med (Lausanne) 2020; 7:141. [PMID: 32457913 PMCID: PMC7221062 DOI: 10.3389/fmed.2020.00141] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/31/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Differential diagnosis in early arthritis is challenging, especially early after symptom onset. Several studies applied musculoskeletal ultrasound in this setting, however, its role in helping diagnosis has yet to be clearly defined. The purpose of this work is to systematically assess the diagnostic applications of ultrasonography in early arthritis in order to summarize the available evidence and highlight possible gaps in knowledge. Methods: In December 2017, existing systematic literature reviews (SLR) on rheumatoid arthritis (RA), osteoarthritis (OA), psoriatic arthritis (PsA), polymyalgia rheumatica (PMR), calcium pyrophosphate deposition disease (CPPD), and gout were retrieved. Studies on ultrasound to diagnose the target conditions and detecting elementary lesions (such as synovitis, tenosynovitis, enthesitis, bone erosions, osteophytes) were extracted from the SLRs. The searches of the previous reviews were updated and data from new studies fulfilling the inclusion criteria extracted. Groups of reviewers worked separately for each disease, when possible diagnostic accuracy (sensitivities, specificities) was calculated from primary studies. When available, the reliability of ultrasound to detect elementary lesions was extracted. Results: For all the examined disease, recent SLRs were available. The new searches identified 27 eligible articles, with 87 articles included from the previous SLRs. The diagnostic performance of ultrasound in identifying diseases was addressed by 75 studies; in most of them, a single elementary lesion was used to define diagnosis, except for PMR. Only studies on RA included consecutive patients with new onset of arthritis, while studies on gout and CPPD often focused on subjects with mono-arthritis. Most of the remaining studies enrolled patients with a defined diagnosis. Synovitis was the most frequently detected lesion; clinical diagnosis was the most common reference standard. The diagnostic performance of ultrasound across different conditions was extremely variable. Ultrasound to identify elementary lesions was assessed in 38 studies in OA, gout and CPPD. Its performance in OA was very variable, with better results in CPPD and gout. The reliability of ultrasound was moderate to good for most lesions. Conclusions: Although a consistent amount of literature investigated the diagnostic application of ultrasound, in only a minority of cases its additional value over clinical diagnosis was tested. This SLR underlines the need for studies with a pragmatic design to identify the placement of ultrasound in the diagnostic pathway of new-onset arthritis.
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Affiliation(s)
- Garifallia Sakellariou
- Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Carlo Alberto Scirè
- UOC e Sezione di Reumatologia - Dipartimento di Scienze Mediche, Università degli Studi di Ferrara, Ferrara, Italy.,Società Italiana di Reumatologia, Unità Epidemiologica, Milan, Italy
| | | | - Alberto Batticciotto
- Rheumatology Unit, Department of Internal Medicine, ASST-Settelaghi, "Ospedale di Circolo - Fondazione Macchi", Varese, Italy
| | - Alessandra Bortoluzzi
- UOC e Sezione di Reumatologia - Dipartimento di Scienze Mediche, Università degli Studi di Ferrara, Ferrara, Italy
| | | | - Orazio De Lucia
- Unit of Clinical Rheumatology, Department of Rheumatology and Clinical Sciences, ASST Centro Traumatologico Ortopedico G. Pini - CTO, Milan, Italy
| | - Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria.,Department of Rheumatology, Hospital of Bruneck, Bruneck, Italy
| | | | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Carlo Urbani Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Luca Idolazzi
- Rheumatology Unit, Ospedale Civile Maggiore, University of Verona, Verona, Italy
| | - Andrea Picchianti Diamanti
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, "Sapienza" University, Rome, Italy
| | - Alen Zabotti
- Department of Medical and Biological Science, Rheumatology Clinic, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Università degli Studi di Torino, Turin, Italy
| | - Georgios Filippou
- UOC e Sezione di Reumatologia - Dipartimento di Scienze Mediche, Università degli Studi di Ferrara, Ferrara, Italy
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Okano T, Mamoto K, Di Carlo M, Salaffi F. Clinical utility and potential of ultrasound in osteoarthritis. Radiol Med 2019; 124:1101-1111. [DOI: 10.1007/s11547-019-01013-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/21/2019] [Indexed: 02/06/2023]
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Décary S, Ouellet P, Vendittoli PA, Desmeules F. Reliability of physical examination tests for the diagnosis of knee disorders: Evidence from a systematic review. ACTA ACUST UNITED AC 2016; 26:172-182. [PMID: 27697691 DOI: 10.1016/j.math.2016.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/12/2016] [Accepted: 09/15/2016] [Indexed: 10/21/2022]
Abstract
Clinicians often rely on physical examination tests to guide them in the diagnostic process of knee disorders. However, reliability of these tests is often overlooked and may influence the consistency of results and overall diagnostic validity. Therefore, the objective of this study was to systematically review evidence on the reliability of physical examination tests for the diagnosis of knee disorders. A structured literature search was conducted in databases up to January 2016. Included studies needed to report reliability measures of at least one physical test for any knee disorder. Methodological quality was evaluated using the QAREL checklist. A qualitative synthesis of the evidence was performed. Thirty-three studies were included with a mean QAREL score of 5.5 ± 0.5. Based on low to moderate quality evidence, the Thessaly test for meniscal injuries reached moderate inter-rater reliability (k = 0.54). Based on moderate to excellent quality evidence, the Lachman for anterior cruciate ligament injuries reached moderate to excellent inter-rater reliability (k = 0.42 to 0.81). Based on low to moderate quality evidence, the Tibiofemoral Crepitus, Joint Line and Patellofemoral Pain/Tenderness, Bony Enlargement and Joint Pain on Movement tests for knee osteoarthritis reached fair to excellent inter-rater reliability (k = 0.29 to 0.93). Based on low to moderate quality evidence, the Lateral Glide, Lateral Tilt, Lateral Pull and Quality of Movement tests for patellofemoral pain reached moderate to good inter-rater reliability (k = 0.49 to 0.73). Many physical tests appear to reach good inter-rater reliability, but this is based on low-quality and conflicting evidence. High-quality research is required to evaluate the reliability of knee physical examination tests.
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Affiliation(s)
- Simon Décary
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Maisonneuve-Rosemont Hospital Research Center, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Montreal, Quebec, Canada.
| | - Philippe Ouellet
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Maisonneuve-Rosemont Hospital Research Center, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Montreal, Quebec, Canada.
| | - Pascal-André Vendittoli
- Maisonneuve-Rosemont Hospital Research Center, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Montreal, Quebec, Canada; Department of Surgery, Maisonneuve-Rosemont Hospital, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, University of Montreal Affiliated Hospital, Montreal, Quebec, Canada.
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Maisonneuve-Rosemont Hospital Research Center, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Montreal, Quebec, Canada.
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