1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
2
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
3
|
Malinowski K, Mostowy M, Ebisz M, Pękala PA, Kennedy NI, LaPrade RF. Arthroscopic cystectomy and valve excision of popliteal cysts complemented with management of intra-articular pathologies: a low recurrence rate and good functional outcomes in a series of ninety seven cases. Int Orthop 2023. [PMID: 36912920 DOI: 10.1007/s00264-023-05745-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/22/2023] [Indexed: 03/14/2023]
Abstract
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.
Collapse
|
4
|
Liu C, Zhou D, Liu X, Huang J, Fang J, Zhou H, Luo J, Luo Y, Zhao L. Simultaneous arthroscopic cystectomy and unicompartmental knee arthroplasty for the management of partial knee osteoarthritis with a popliteal cyst: A case report. Front Surg 2023; 10:1109571. [PMID: 37066010 PMCID: PMC10097990 DOI: 10.3389/fsurg.2023.1109571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/08/2023] [Indexed: 04/18/2023] Open
Abstract
Introduction Popliteal 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 presentation A 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. Conclusion For KOA patients with a popliteal cyst seeking UKA, simultaneous arthroscopic cystectomy and UKA are feasible with great success if managed appropriately.
Collapse
Affiliation(s)
- Cai Liu
- Department of Orthopedic Surgery, The Affiliated Hospital of Panzhihua University, Panzhihua, China
| | - Dejie Zhou
- Department of Orthopedic Surgery, The Affiliated Hospital of Panzhihua University, Panzhihua, China
| | - Xinwei Liu
- Department of Physical Examination Center, The Affiliated Hospital of Panzhihua University, Panzhihua, China
| | - Jin Huang
- Department of Orthopedic Surgery, The Affiliated Hospital of Panzhihua University, Panzhihua, China
| | - Jianguo Fang
- Department of Spine Surgery, Yangpu District Shidong Hospital Affiliated to the University of Shanghai for Science and Technology, Shanghai, China
| | - Hongyu Zhou
- Department of Orthopedic Surgery, The Affiliated Hospital of Panzhihua University, Panzhihua, China
| | - Jianjun Luo
- Department of Orthopedic Surgery, The Affiliated Hospital of Panzhihua University, Panzhihua, China
| | - Yiqian Luo
- Department of Orthopedic Surgery, The Affiliated Hospital of Panzhihua University, Panzhihua, China
| | - Lianghu Zhao
- Department of Orthopedic Surgery, The Affiliated Hospital of Panzhihua University, Panzhihua, China
- Correspondence: Lianghu Zhao
| |
Collapse
|
5
|
Daniels P, Vlazny D, Meverden R, Bartlett M, Hesley G, Lekah A, Macedo T, Wysokinski WE, Houghton DE. Popliteal cysts are not a risk factor for lower extremity deep vein thrombosis. J Thromb Thrombolysis 2022. [PMID: 35932383 DOI: 10.1007/s11239-022-02685-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Popliteal cysts (PC) result from distension of the gastrocnemio-semimembranosous bursa. Published reports indicate coincident PC and deep vein thrombosis (DVT). Whether the presence of PC increase the risk of deep vein thrombosis (DVT) remains unclear. METHODS Lower extremity venous Duplex ultrasound (DUS) reports were evaluated across the Mayo Clinic Enterprise (Rochester, Minnesota, Jacksonville, Florida, Scottsdale, Arizona, and the Mayo Clinic Health System) in patients ≥ 18 years of age. Natural language processing (NLP) algorithms were created and validated to identify acute lower extremity DVT and PC from these reports. To determine whether there is a link between PC and lower extremity DVT, the frequency of PC among cases (ultrasounds with acute DVT) were compared to controls (ultrasounds without acute DVT). RESULTS A total of 357,703 lower extremities venous DUS were performed in 237,052 patients (mean age 63.3 ± 16.6, 54.4% were female) between 1992 and 2021. Acute DVT was identified in 32,572 (9.1%) DUS, and PC in 32,448 (9.1%). PC were seen in a lower frequency (8.0%) of ultrasounds with acute DVT than those without (9.2%) acute DVT (OR: 0.85, 95% CI: 0.82 to 0.89, p < 0.001). In a multivariate logistic regression model after adjusting for age, sex, and race, PCs were not positively associated with acute DVT (adjusted OR: 0.84, 95% CI: 0.81 to 0.88). CONCLUSIONS PC are an incidental finding or an alternative diagnosis on lower extremity venous DUS, a finding that increases significantly with age. PC were not a risk factor in the development of lower extremity DVT.
Collapse
|
6
|
You C, Cheng Z, Xia Y, Deng C, Zhou Y. Comparison of arthroscopic internal drainage and open excision for the treatment of popliteal cysts. BMC Musculoskelet Disord 2022; 23:732. [PMID: 35907946 PMCID: PMC9338577 DOI: 10.1186/s12891-022-05658-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/15/2022] [Indexed: 11/29/2022] Open
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 < 0.05). The MI group was superior to the OS group in terms of blood loss and plaster fixation, with statistical significance (p < 0.05). There was obvious difference in recurrence rate between the two groups (0% vs 17.33%, p = 0.018). No postoperative complications occurred during the follow-up period. Conclusions Compared with open excision, the treatment of popliteal cyst in children by arthroscopic internal drainage to expand the articular cavity and eliminate the “one-way valve” mechanism between the cyst and the articular cavity exhibits better clinical outcomes and significantly reduces the recurrence rate, which is worthy of further clinical promotion.
Collapse
Affiliation(s)
- Chao You
- Department of Orthopedics, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China.
| | - Zhen Cheng
- Department of Orthopedics, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China.,China Medical University, Shenyang, Liaoning Province, China
| | - Yongjie Xia
- Department of Orthopedics, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Chao Deng
- Department of Orthopedics, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Yibiao Zhou
- Department of Orthopedics, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| |
Collapse
|
7
|
Li H, Zhang M, Li Y, Wang H. 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; 141:1741-52. [PMID: 33620529 DOI: 10.1007/s00402-021-03812-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [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.
Collapse
|
8
|
Zhang M, Li H, Wang HH, Xi G, Li YK, Zhao B. Arthroscopic Internal Drainage with Cyst Wall Resection and Arthroscopic Internal Drainage with Cyst Wall Preservation to Treat Unicameral Popliteal Cysts: A Retrospective Case-Control Study. Orthop Surg 2021; 13:1159-1169. [PMID: 33942543 PMCID: PMC8274174 DOI: 10.1111/os.12917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/04/2020] [Accepted: 12/02/2020] [Indexed: 11/28/2022] Open
Abstract
Objective To compare the clinical efficacy and safety of arthroscopic internal drainage for the treatment of unicameral popliteal cysts with or without cyst wall resection. Methods This was a retrospective case–control study of 73 patients diagnosed with unicameral popliteal cysts from January 2012 to January 2019 who received arthroscopic treatment. The study included 38 cases with cyst wall resection (CWR group) and 35 cases with cyst wall preservation (CWP group). The CWR group consisted of 14 men and 24 women with an average age of 51.8 years, while the CWP group consisted of 13 men and 22 women with an average age of 52.0 years. All patients were examined for intra‐articular lesions and communicating ports by magnetic resonance imaging (MRI) prior to surgery, and recurrence of cysts was evaluated at the last follow‐up examination. Rauschning and Lindgren grade (R–L grade) and Lysholm score were used to evaluate clinical outcomes. In addition, operation time and complications were recorded. Results The average length of follow‐up was 24.2 months (range, 16 to 32 months). There were no considerable differences in age, gender, cyst size, Lysholm score, R–L grade and concomitant intra‐articular cases between the CWR group and CWP group prior to surgery (P > 0.05). The last follow‐up MRI scans showed that in the CWR group, the cyst disappeared in 25 cases and shrunk in 13 cases. In the CWP group, the cyst disappeared in 22 cases, shrunk in 12 cases and persisted in one case. There was no obvious difference in recurrence rate between the two groups (0% vs 2.9%, P = 0.899). At the last follow‐up, there were no differences in the R–L grade (P = 0.630) and Lysholm score (88.3 ± 5.6 points vs 90.1 ± 3.8 points, P = 0.071) between the two groups. Compared with the CWP group, operation time was significantly prolonged in the CWR group (38.3 ± 3.1 min vs 58.3 ± 4.4 min, P < 0.05). In the CWR group, three cases occurred fluid infiltration under the gastrocnemius muscle, which improved after pressure bandaging and cold compress. In another three cases, hematoma was found. The incidence of complications in the CWR group was markedly higher than that in the CWP group (15.8% vs 0%, P < 0.05). During the follow‐up period, none of the patients developed serious complications such as neurovascular injury, deep venous thrombosis, or infection. Conclusion For unicameral popliteal cysts, arthroscopic internal drainage combined with resection of the cyst wall did not further improve the clinical outcomes or reduce the recurrence rate, while prolonging the operation time and increasing the possibility of complications.
Collapse
Affiliation(s)
- Min Zhang
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Hao Li
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Hao-Hao Wang
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Gang Xi
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Ya-Kun Li
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Bin Zhao
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| |
Collapse
|
9
|
Abate M, Di Carlo L, Di Iorio A, Salini V. Baker's Cyst with Knee Osteoarthritis: Clinical and Therapeutic Implications. Med Princ Pract 2021; 30:585-591. [PMID: 34348320 PMCID: PMC8739941 DOI: 10.1159/000518792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 07/23/2021] [Indexed: 11/19/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Michele Abate
- Medical Facilities Delfino Pescara 1936, Pescara, Italy
- *Michele Abate,
| | | | - Angelo Di Iorio
- Department of Medicine and Science of Aging, University “G. d'Annunzio,”, Chieti Scalo, Italy
| | - Vincenzo Salini
- Division of Orthopedics and Traumatology, San Raffaele Hospital, Milan, Italy
| |
Collapse
|
10
|
Goto K, Saku I. Ultrasound-guided arthroscopic communication enlargement surgery may be an ideal treatment option for popliteal cysts - indications and technique. J Exp Orthop 2020; 7:93. [PMID: 33251554 PMCID: PMC7701204 DOI: 10.1186/s40634-020-00314-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Several 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. METHODS After 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. CONCLUSIONS Ultrasound-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.
Collapse
Affiliation(s)
- Kazumi Goto
- Department of Orthopaedic Surgery, Yaizu City Hospital, 1000, Dohbara, Yaizu-shi, Shizuoka, 425-8505, Japan.
| | - Isaku Saku
- Department of Orthopaedic Surgery, Yaizu City Hospital, 1000, Dohbara, Yaizu-shi, Shizuoka, 425-8505, Japan
| |
Collapse
|
11
|
Guo D, Cheng L, Chen G, Yu X, Zhang H, She Y. A comparison of the clinical effects of arthroscopic treatment for popliteal cyst between techniques using one posteromedial portal and two posteromedial portals. Medicine (Baltimore) 2020; 99:e20020. [PMID: 32443304 PMCID: PMC7253777 DOI: 10.1097/md.0000000000020020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There is a lack of research comparing the clinical effects of arthroscopic treatment of popliteal cysts between the one posteromedial portal (OPP) technique and the two posteromedial portals (TPP) technique. The aim of this study was to evaluate and compare the clinical efficacy of arthroscopic treatment for popliteal cysts between the 2 techniques.Patients with symptomatic popliteal cysts after surgery were retrospectively invited to participate in this study. They received arthroscopy treatment via the OPP technique or the TPP technique. At the final follow-up, the Rauschning and Lindgren criteria and the Lysholm score were used for clinical evaluation. Moreover, magnetic resonance imaging was performed to detect the recurrence of cysts postoperatively.Finally, 53 patients with symptomatic popliteal cysts were included in this study, including 25 in the OPP group and 28 in the TPP group. The operation time of the TPP group was significantly longer than that of the OPP group (P < .001). In the OPP group, the cysts disappeared in 17 patients and reduced in size in 8 patients. In the TPP group, the cysts disappeared in 23 patients and reduced in size in 5 patients. According to the Rauschning and Lindgren classification, the recurrence rate was significantly lower in the TPP group (0%) than in the OPP group (4%) (P = .03). In addition, there was no significant difference in the Lysholm score between the OPP group and the TPP group (P = .77).TPP technique is more effective and superior than OPP technique for the treatment of popliteal cysts.
Collapse
Affiliation(s)
- Dongsheng Guo
- The Affiliated Suzhou Hospital of Nanjing Medical University
| | - Liang Cheng
- The Affiliated Suzhou Hospital of Nanjing Medical University
| | - Guangxiang Chen
- Department of Orthopedic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Xiao Yu
- Department of Orthopedic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Hong Zhang
- Department of Orthopedic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yuanshi She
- Department of Orthopedic Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| |
Collapse
|
12
|
Hommel H, Becker R, Fennema P, Kopf S. The fate of Baker's cysts at mid-term follow-up after total knee arthroplasty. Bone Joint J 2020; 102-B:132-136. [PMID: 31888367 DOI: 10.1302/0301-620x.102b1.bjj-2019-0273.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
Collapse
Affiliation(s)
- Hagen Hommel
- Department of Orthopaedics, Märkisch-Oderland Hospital, Brandenburg Medical School Theodor Fontane, Wriezen, Germany
| | - Roland Becker
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Peter Fennema
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Sebastian Kopf
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| |
Collapse
|
13
|
Han DY, Ryu KN, Park JS, Jin W, Park SY, Yun SJ. The prevalence of Baker cyst in relation to the arrangement pattern between the medial head of gastrocnemius tendon and the semimembranosus tendon. Eur Radiol 2019; 30:1544-1553. [PMID: 31811432 DOI: 10.1007/s00330-019-06472-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/27/2019] [Accepted: 09/20/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to investigate whether Baker cyst (BC) was related to the specific arrangement of the medial head of gastrocnemius tendon (MHGT) and the semimembranosus tendon (SMT). MATERIALS AND METHODS Patients who underwent knee MRI with "Baker cyst" in PACS from August 2017 to February 2018 were included in this study. Patients who did not have BC in a knee MRI performed during the same period were included in the control group. A total 210 patients were selected for inclusion in this study. For the imaging analysis, the arrangement pattern between MHGT and SMT was classified into three types: type 1, concave; type 2, flat; and type 3, convex. When imaging analysis was performed, the amount of effusion, the presence of osteoarthritis, and major ligament and meniscal tears were also described. Univariate and multivariate logistic regression analyses were performed. Statistical significance was considered at p < 0.05. RESULTS The frequency of types 1, 2, and 3 was statistically significant depending on the presence or absence of BC (p < 0.001). The frequency of type 3 was the highest in the presence of BC, while that of type 1 was the highest in the absence of BC. BC was more common in type 2 (OR = 2.54; 95% CI = 1.27-5.07) and type 3 (OR = 4.09; 95% CI = 1.88-8.89). CONCLUSION BC is more likely to occur in patients with SMT having a convex shape for MHGT. KEY POINTS • Based on axial image of MRI only, one can predict which patients are morphologically more prone to develop a Baker cyst. • On axial images of MRI, Baker cyst is more likely to occur in patients with semimembranosus tendon having a convex shape for medial head of gastrocnemius tendon. • Baker cyst is not associated with the amount of effusion, OA, or internal derangement.
Collapse
Affiliation(s)
- Dong Yoon Han
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, #26 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, #26 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, #26 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, #892, Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, #892, Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea
| | - Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, #892, Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea
| |
Collapse
|
14
|
Chen Y, Lee PY, Ku MC, Wu NY, Lo CS. Extra-articular endoscopic excision of symptomatic popliteal cyst with failed initial conservative treatment: A novel technique. Orthop Traumatol Surg Res 2019; 105:125-128. [PMID: 30639028 DOI: 10.1016/j.otsr.2018.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 09/02/2018] [Accepted: 09/18/2018] [Indexed: 02/02/2023]
Abstract
To reduce the damage to posteromedial knee capsule, we developed a direct extra-articular arthroscopic approach for excision of symptomatic popliteal cysts. This study aimed to demonstrate the surgical technique and present the 2-year follow-up results. Cystectomy is performed by extra-articular surgical approach through a high posteromedial portal. Twenty-one consecutive patients diagnosed of symptomatic popliteal cysts with failed initial conservative treatments were included. At a median follow-up of 29.4 months, all knees had improved clinical function assessed by Rauschning and Lindgren knee classification (p<0.001). The cysts were either disappeared (95.2%) or reduced in size (4.8%). Only one (4.8%) patient had recurrent cyst, which was solved after ultrasound-guided aspiration. This direct extra-articular arthroscopic technique could be a feasible alternative for treatment of symptomatic popliteal cysts.
Collapse
Affiliation(s)
- Yueh Chen
- Department of Orthopedic Surgery, Show Chwan Memorial Hospital, No. 542, Section 1, Chung-shan Road, Changhua City, Changhua County 500, Taiwan
| | - Pei-Yuan Lee
- Department of Orthopedic Surgery, Show Chwan Memorial Hospital, No. 542, Section 1, Chung-shan Road, Changhua City, Changhua County 500, Taiwan
| | - Ming-Chou Ku
- Department of Orthopedic Surgery, Show Chwan Memorial Hospital, No. 542, Section 1, Chung-shan Road, Changhua City, Changhua County 500, Taiwan
| | - Nai-Yuan Wu
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Sheng Lo
- Department of Orthopedic Surgery, Show Chwan Memorial Hospital, No. 542, Section 1, Chung-shan Road, Changhua City, Changhua County 500, Taiwan.
| |
Collapse
|
15
|
Gu H, Bi Q, Chen J. Arthroscopic treatment of popliteal cyst using a figure-of-four position and double posteromedial portals. Int Orthop 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
16
|
Ciszkiewicz A, Lorkowski J, Milewski G. A novel planning solution for semi-autonomous aspiration of Baker's cysts. Int J Med Robot 2018; 14. [PMID: 29316179 DOI: 10.1002/rcs.1882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 07/10/2017] [Accepted: 08/15/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND A Baker's cyst is a pathological structure located near a kneepit, which causes discomfort and reduces mobility of the knee. It is commonly treated with aspiration, which often requires MRI scanning and US guidance. The aim of this study was to propose a novel planning solution for semi-autonomous aspiration of the Baker's cyst using only MRI imaging. METHODS The proposed method requires minimal user input and offers automatic cyst segmentation with collision-free path planning for the assumed robotic structure with four degrees of freedom. RESULTS The prepared software was tested on four image sets obtained from patients eligible for cyst aspiration. It was possible to accurately segment the cyst in the considered cases. The collision-free path planning method was investigated in numerical scenarios. CONCLUSIONS The simulations verified the proposed software solution. Future work will be devoted to experimental verification of the path planning procedure.
Collapse
Affiliation(s)
- Adam Ciszkiewicz
- Institute of Applied Mechanics, Cracow University of Technology, Cracow, Poland
| | - Jacek Lorkowski
- Department of Orthopaedics and Traumatology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
| | - Grzegorz Milewski
- Institute of Applied Mechanics, Cracow University of Technology, Cracow, Poland
| |
Collapse
|
17
|
Abstract
Background The purpose of this study was to evaluate the efficacy of arthroscopic knee cavity internal drainage and cyst cavity debridement operation of popliteal cyst in knee osteoarthritis patients. Methods From August 2007 to March 2013, 58 knee osteoarthritis patients with popliteal cyst were treated with arthroscopic knee cavity internal drainage through posteromedial portal and popliteal cyst cavity debridement through superior posteromedial portal. In all patients, preoperative magnetic resonance imaging (MRI) was performed to detect combined intra-articular pathology and the communication between popliteal cyst and knee cavity. Clinical efficacy was evaluated through VAS score and Lysholm score. Results All patients had neither recurrence of popliteal cyst nor complaints of pain, swelling, or functional impairment at average 24 months follow-up after surgery. Postoperatively, VAS score was decreased significantly and Lysholm score was raised significantly comparing preoperatively. Conclusion Arthroscopic knee cavity internal drainage operation through posteromedial portal and popliteal cyst cavity debridement through superior posteromedial portal is an effective minimally invasive surgery method for the treatment of popliteal cyst without recurrence in knee osteoarthritis patients.
Collapse
Affiliation(s)
- Jun Jiang
- Arthritis Clinic & Research Center, Peking University People Hospital, #11 Xizhimen South Avenue, Xicheng District, Beijing, 100044, China
| | - Lei Ni
- Arthritis Clinic & Research Center, Peking University People Hospital, #11 Xizhimen South Avenue, Xicheng District, Beijing, 100044, China.
| |
Collapse
|
18
|
Wu XD, Yu JH, Zou T, Wang W, LaPrade RF, Huang W, Sun SQ. Anatomical Characteristics and Biomechanical Properties of the Oblique Popliteal Ligament. Sci Rep 2017; 7:42698. [PMID: 28205540 PMCID: PMC5311875 DOI: 10.1038/srep42698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 01/12/2017] [Indexed: 01/13/2023] Open
Abstract
This anatomical study sought to investigate the morphological characteristics and biomechanical properties of the oblique popliteal ligament (OPL). Embalmed cadaveric knees were used for the study. The OPL and its surrounding structures were dissected; its morphology was carefully observed, analyzed and measured; its biomechanical properties were investigated. The origins and insertions of the OPL were relatively similar, but its overall shape was variable. The OPL had two origins: one originated from the posterior surface of the posteromedial tibia condyle, merged with fibers from the semimembranosus tendon, the other originated from the posteromedial part of the capsule. The two origins converged and coursed superolaterally, then attached to the fabella or to the tendon of the lateral head of the gastrocnemius and blended with the posterolateral joint capsule. The OPL was classified into Band-shaped, Y-shaped, Z-shaped, Trident-shaped, and Complex-shaped configurations. The mean length, width, and thickness of the OPL were 39.54, 22.59, and 1.44 mm, respectively. When an external rotation torque (18 N·m) was applied both before and after the OPL was sectioned, external rotation increased by 8.4° (P = 0.0043) on average. The OPL was found to have a significant role in preventing excessive external rotation and hyperextension of the knee.
Collapse
Affiliation(s)
- Xiang-Dong Wu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- The First College of Clinical Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Jin-Hui Yu
- The First College of Clinical Medicine, Chongqing Medical University, Chongqing, 400016, China
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Tao Zou
- The First College of Clinical Medicine, Chongqing Medical University, Chongqing, 400016, China
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Wei Wang
- The First College of Clinical Medicine, Chongqing Medical University, Chongqing, 400016, China
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | | | - Wei Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Shan-Quan Sun
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Human Gross Morphology Lab, National Class Preclinical Medicine Experimental Teaching Demonstration Center, Chongqing Medical University, Chongqing 400016, China
| |
Collapse
|
19
|
Abstract
AIMS It is widely held that most Baker's cysts resolve after treatment of the intra-articular knee pathology. The present study aimed to evaluate the fate of Baker's cysts and their associated symptoms after total knee arthroplasty (TKA). PATIENTS AND METHODS In this prospective cohort study, 102 patients with (105 were included, however three were lost to follow-up) an MRI-verified Baker's cyst, primary osteoarthritis and scheduled for TKA were included. Ultrasound was performed to evaluate the existence and the gross size of the cyst before and at one year after TKA. Additionally, associated symptoms of Baker's cyst were recorded pre- and post-operatively. RESULTS After one year, a Baker's cyst was still present in 87 patients (85%). There was a significant reduction in associated symptoms arising from the Baker's cyst before (71%) to after surgery (31%). No patients developed a new Baker's cyst associated symptoms. However, of the 72 patients who had reported Baker's cyst associated symptoms pre-operatively, 32 patients (44%) still complained of such symptoms one year after surgery. CONCLUSION Baker's cysts had resolved in only a small number of patients (15%) one year after TKA and symptoms from the cysts persisted in 31%. Cite this article: Bone Joint J 2016;98-B:1185-8.
Collapse
Affiliation(s)
- H Hommel
- Hospital Märkisch Oderland, Sonnenburger Weg 3, 16269 Wriezen, Germany
| | - C Perka
- Charité - University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - S Kopf
- Charité - University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| |
Collapse
|
20
|
Abstract
BACKGROUND This systematic review and meta-analysis of the clinical efficacy of different surgical methods in the therapy of popliteal cysts may provide evidence about effective surgical treatments. METHODS PubMed, EMBASE, and OVID were searched with the following terms: (popliteal cyst* OR baker's cyst*) AND (arthroscopic OR excision OR operative OR treat* OR surgery). Inclusion criteria included the following: studies reported the efficacy of different surgical methods in popliteal cyst patients; patients were ≥ 16 years; and studies must have involved a minimum of 10 patients. Studies were grouped according to the surgical methods, and a meta-analysis was employed to identify the success rate based on the pooled data. RESULTS A total of 11 studies were included: The communication between the cyst and the articular cavity was enlarged in 7 studies; this communication was closed in 3 studies; and only intra-articular lesions were managed in 1 study. After the data were pooled, the success rates were 96.7 and 84.6 % in the communication-enlargement group and communication-closure group, respectively. Studies with communication enlargement were subgrouped into the cyst wall resection group and the non-cyst wall resection group, for which the success rates were 98.2 and 94.7 %, respectively. CONCLUSIONS Based on the current available evidence, at present, any how arthroscopic excision of the cyst wall, arthroscopic management of intra-articular lesions, and enlarging the communication between the cyst and the articular cavity is an ideal strategy for the popliteal cyst. The current literature on the treatment of popliteal cysts is limited to retrospective case series. Future prospective studies with high-quality methodology and uniform scoring system are required to directly compare communication-enlargement surgery and communication-closure surgery and determine the optimal treatment of popliteal cysts. Cyst wall resection may improve the therapeutic efficacy, to draw definitive conclusions, and high-level clinical researches with a large number of patients and long-term follow-up should be initiated.
Collapse
Affiliation(s)
- Xiao-nan Zhou
- Department of Orthopaedics, Shengjing Hospital, China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning, 110004, People's Republic of China.
| | - Bin Li
- Department of Orthopaedics, Shengjing Hospital, China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning, 110004, People's Republic of China.
| | - Jia-shi Wang
- Department of Orthopaedics, Shengjing Hospital, China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning, 110004, People's Republic of China.
| | - Lun-hao Bai
- Department of Orthopaedics, Shengjing Hospital, China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning, 110004, People's Republic of China.
| |
Collapse
|
21
|
Calvisi V, Zoccali C. Arthroscopic patterns of the poster-medial aspect of the knee joint: classification of the gastrocnemius-semimembranosus gateway and its relationship with Baker's cyst. Muscles Ligaments Tendons J 2016; 6:492-498. [PMID: 28217572 DOI: 10.11138/mltj/2016.6.4.492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The gastrocnemius-semimembranosus bursa may communicate with the knee joint. The arthroscopic anatomy of the posteromedial aspect varies depending on the angle of the oblique popliteal ligament, the level at which it crosses the medial gastrocnemius tendon, and its relationship with the capsular joint and synovia. The aim of this paper is to identify possible patterns, and to evaluate their characteristics and their relationship with Baker's cyst. METHODS data archived from 185 consecutive arthroscopies were evaluated; an anatomic description and classification was carried out; the percentages of association with BC and the associated pathologies were reported. RESULTS The different anatomies were classified into six groups based on the relationship above the medial gastrocnemius tendon, the capsular joint and synovia. The prevalence of Baker's cyst was 28.3%. The main associated intra-articular pathological condition was the contemporary presence of a meniscal tear and chondropathy. CONCLUSION Exploration of the posterior aspect of the knee must be performed routinely. Knowing the possible anatomy patterns of the posteromedial arthroscopic aspect of the knee joint could help to identify the cyst and its gateway, thus facilitating its treatment. LEVEL OF THE EVIDENCE III.
Collapse
Affiliation(s)
- Vittorio Calvisi
- Department of Orthopaedic and Traumatology School, University of L'Aquila, Italy
| | - Carmine Zoccali
- Regina Elena National Cancer Institute, Oncological Orthopedic Department, Rome, Italy
| |
Collapse
|
22
|
Liebensteiner MC, Thaler M, Putzer D, Wurm A, Nogler M. [Arthroscopic procedure for Baker's cysts : surgical technique. Video article]. Orthopade 2015; 44:803-5. [PMID: 26306606 DOI: 10.1007/s00132-015-3155-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Baker's cysts are related to increased intra-articular pressure. The causes may be inflammatory, degenerative or traumatic disorders. Owing to the increased intra-articular pressure a cyst protrudes between the semimembranosus and the medial gastrocnemius tendons. The traditional treatment for a Baker's cyst is open resection. As an alternative, an arthroscopic procedure can be performed, which is demonstrated by the video on surgical technique that accompanies this short report. SURGICAL TECHNIQUE From the anterolateral portal the arthroscope is advanced through the intercondylar notch (below the posterior cruciate ligament) to the posteromedial recess. Under visual control, a posteromedial portal is created followed by identification of the capsular fold separating the cyst from the joint cavity. This fold (valvular mechanism) is resected with a shaver from the posteromedial portal until a large enough connection exists between the joint and the cyst (cyst decompression). After the decompression, the arthroscope is inserted from the posteromedial portal directly into the cyst cavity. Subsequently, the inner wall of the cyst is removed with the shaver via an additional far posterior cystic portal. It is obligatory to treat the associated intra-articular pathological condition. In our video a medial meniscal lesion is treated with partial meniscectomy.
Collapse
Affiliation(s)
- M C Liebensteiner
- Universitätsklinik für Orthopädie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - M Thaler
- Universitätsklinik für Orthopädie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - D Putzer
- Universitätsklinik für Orthopädie, Experimentelle Orthopädie, Medizinische Universität Innsbruck, Innsbruck, Österreich.
| | - A Wurm
- Universitätsklinik für Orthopädie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - M Nogler
- Universitätsklinik für Orthopädie, Experimentelle Orthopädie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| |
Collapse
|
23
|
Abstract
Context: Popliteal synovial cysts, also known as Baker’s cysts, are commonly found in association with intra-articular knee disorders, such as osteoarthritis and meniscus tears. Histologically, the cyst walls resemble synovial tissue with fibrosis evident, and there may be chronic nonspecific inflammation present. Osteocartilaginous loose bodies may also be found within the cyst, even if they are not seen in the knee joint. Baker’s cysts can be a source of posterior knee pain that persists despite surgical treatment of the intra-articular lesion, and they are routinely discovered on magnetic resonance imaging scans of the symptomatic knee. Symptoms related to a popliteal cyst origin are infrequent and may be related to size. Evidence Acquisition: A PubMed search was conducted with keywords related to the history, diagnosis, and treatment of Baker’s cysts—namely, Baker’s cyst, popliteal cyst, diagnosis, treatment, formation of popliteal cyst, surgical indications, and complications. Bibliographies from these references were also reviewed to identify related and pertinent literature. Study Design: Clinical review. Level of Evidence: Level 4. Results: Baker’s cysts are commonly found associated with intra-articular knee disorders. Proper diagnosis, examination, and treatment are paramount in alleviating the pain and discomfort associated with Baker’s cysts. Conclusion: A capsular opening to the semimembranosus–medial head gastrocnemius bursa is a commonly found normal anatomic variant. It is thought that this can lead to the formation of a popliteal cyst in the presence of chronic knee effusions as a result of intra-articular pathology. Management of symptomatic popliteal cysts is conservative. The intra-articular pathology should be first addressed by arthroscopy. If surgical excision later becomes necessary, a limited posteromedial approach is often employed. Other treatments, such as arthroscopic debridement and closure of the valvular mechanism, are not well studied and cannot yet be recommended.
Collapse
Affiliation(s)
- Todd J Frush
- Porretta Center for Orthopaedic Surgery, Novi, Michigan
| | - Frank R Noyes
- Cincinnati SportsMedicine Research and Education Foundation/Noyes Knee Institute, Cincinnati, Ohio
| |
Collapse
|
24
|
Ohishi T, Takahashi M, Suzuki D, Fujita T, Yamamoto K, Ushirozako H, Banno T, Matsuyama Y. Treatment of popliteal cysts via arthroscopic enlargement of unidirectional valvular slits. Mod Rheumatol 2015; 25:772-8. [PMID: 25661740 DOI: 10.3109/14397595.2015.1008779] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate the efficacy of arthroscopic enlargement of unidirectional valvular slits for the treatment of popliteal cysts and to evaluate potential factors affecting the outcomes of our arthroscopic procedure. METHODS Twenty-nine patients aged 43-77 years with popliteal cysts were treated with arthroscopic cyst decompression. Surgery was performed via two posterior portals after creating a transseptal portal. Rauschning and Lindgren clinical score, magnetic resonance images, and osteoarthritic grade were evaluated pre- and postoperatively, and cartilage degeneration class was confirmed via arthroscopy. The mean follow-up period was 22.9 ± 14.6 months (range, 9-60 months). RESULTS Twelve cysts disappeared completely (group D), while 16 reduced and one enlarged (group R) in size by the final follow-up. Twenty-two (75.9%) of 29 popliteal cysts diminished to a volume that was less than 10% of the preoperative volume. Clinical scores improved in 93.1% of the patients, and more patients (68.8%) in group R had positive joint effusion at the final follow-up compared with group D (17.7%; p < 0.01). CONCLUSIONS Arthroscopic cyst decompression was effective in the treatment of symptomatic popliteal cysts. Intra-articular pathologies associated with joint effusion should be corrected simultaneously.
Collapse
Affiliation(s)
- Tsuyoshi Ohishi
- a Department of Orthopaedic Surgery , Enshu Hospital , Hamamatsu, Shizuoka , Japan
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
Baker's cyst, or popliteal cyst, is a fluid-filled mass that is a distention of a preexisting bursa in the popliteal fossa, most commonly the gastrocnemio-semimembranosus bursa. This bursa is unique in that it communicates with the knee joint, unlike other periarticular bursae, via an opening in the joint capsule posterior to the medial femoral condyle. Many have theorized that this opening creates a valve-like mechanism in the presence of effusion that contributes to the formation of these cysts in adults. Popliteal cysts rarely manifest alone and are most often found in conjunction with other intra-articular pathologies and inflammatory conditions, such as osteoarthritis, meniscus tears, and rheumatoid arthritis. In children, popliteal cysts are only occasionally associated with these conditions and are more often an incidental finding discovered during a routine physical examination. Popliteal cysts may present as either a chronically persistent or relapsing condition or as an acute and dramatic condition that can occur in the case of cyst rupture presenting as pseudothrombophlebitis. Ultrasound and magnetic resonance imaging have proven to be consistent and accurate in the confirmation of popliteal cysts, with magnetic resonance imaging becoming the modern imaging modality of choice. This review discusses the anatomy and etiology of popliteal cysts, describes the common clinical presentations, reviews the differential diagnoses, and provides guidance for proper diagnostic imaging. It also provides a comparison of current conservative, minimally invasive, and invasive treatment options, along with a discussion of results. Postoperative rehabilitation depends largely on the condition associated with the popliteal cyst.
Collapse
|
26
|
Kim KI, Lee SH, Ahn JH, Kim JS. Arthroscopic anatomic study of posteromedial joint capsule in knee joint associated with popliteal cyst. Arch Orthop Trauma Surg 2014; 134:979-84. [PMID: 24781525 DOI: 10.1007/s00402-014-2001-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to examine the arthroscopic anatomy of posteromedial capsule and magnetic resonance imaging (MRI) findings in internal derangement of the knee joint and to analyze the relationship between popliteal cysts and the posteromedial capsule. METHODS From 2011 to 2012, a prospective study included 194 knees of consecutive arthroscopic surgeries for assorted knee problems. The anatomy of the posteromedial joint capsule was evaluated arthroscopically and divided into three types by the presence of capsular fold and opening: no capsular fold and no opening (type I), capsular fold without opening (type II), capsular fold with opening (type III). The presence and size of popliteal cyst were documented by MRI. RESULTS Type I was observed in 160 knees (82.5 %), type II in 10 (5.1 %) and type III in 24 (12.4 %). Popliteal cysts were found in 25 knees (12.9 %) by MRI. Of these cases, symptomatic popliteal cysts were identified in 12 knees (6.9 %). On 160 knees demonstrated to be type I, only 3 knees (1.9 %) had popliteal cysts in MRI, 6 knees (60 %) in 10 knees of type II and 16 knees (66.7 %) in 24 knees of type III. Therefore, there was a statistically significant relationship between the type of anatomy in the posteromedial capsule and the popliteal cyst (p < 0.001). CONCLUSION An association between popliteal cyst and arthroscopic anatomy of posteromedial capsule was demonstrated. Comprehensive understanding and knowledge of the arthroscopic anatomy of posteromedial capsule would contribute to the arthroscopic approach in understanding the pathogenesis of popliteal cyst. STUDY DESIGN Development of diagnostic criteria on basis of consecutive patients. LEVEL OF EVIDENCE 2.
Collapse
|
27
|
Snir N, Hamula M, Wolfson T, Sherman O, Feldman A. Popliteal cyst excision using open posterior approach after arthroscopic partial medial meniscectomy. Arthrosc Tech 2013; 2:e295-8. [PMID: 24266002 DOI: 10.1016/j.eats.2013.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/09/2013] [Indexed: 02/03/2023] Open
Abstract
Popliteal cysts are known to be associated with intra-articular pathology, which must be addressed to prevent cyst recurrence. Indications for popliteal cyst excision include cases in which the popliteal cyst does not respond to conservative treatment or arthroscopic intervention or cases in which an underlying cause cannot be found. Several techniques have been described to excise these cysts. Traditionally, open techniques have been associated with cyst recurrence. More recently, arthroscopic cystectomy has been described. However, the risk of recurrence persists because arthroscopy may not afford complete surgical excision. This technical note presents an open posterior technique for popliteal cyst excision that allows for better visualization and complete removal of the cyst while minimizing the risk of neurovascular complications and soft-tissue damage. It is a safe, effective, and straightforward method to achieve symptomatic relief for refractory popliteal cysts.
Collapse
|
28
|
Kim TW, Suh JT, Son SM, Moon TY, Lee IS, Choi KU, Kim JI. Baker's Cyst with Intramuscular Extension into Vastus Medialis Muscle. Knee Surg Relat Res 2012; 24:249-53. [PMID: 23269965 PMCID: PMC3526764 DOI: 10.5792/ksrr.2012.24.4.249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 07/06/2012] [Accepted: 07/16/2012] [Indexed: 11/26/2022] Open
Abstract
Baker's cysts are one of the most common cystic lesions around the knee joint and mainly caused by fluid distension of the gastrocnemius-semimembranous bursa that is situated along the medial side of the popliteal fossa. Typically, a Baker's cyst extends along the intermuscular planes around the knee joint and may enlarge any direction. However, it is mostly located in the inferomedial or superficial layers of the knee joint and less commonly extends laterally or proximally. Expansion of the cyst tends to respect the intermuscular planes, and Baker's cysts along the intramuscular route have been rarely reported. Thus, we report a case of Baker's cyst with intramuscular extension into the vastus medialis muscle.
Collapse
Affiliation(s)
- Tae Wan Kim
- Department of Orthopaedic Surgery, Pusan National University School of Medicine, Busan, Korea
| | | | | | | | | | | | | |
Collapse
|
29
|
Cho JH. Clinical results of direct arthroscopic excision of popliteal cyst using a posteromedial portal. Knee Surg Relat Res 2012; 24:235-40. [PMID: 23269962 PMCID: PMC3526761 DOI: 10.5792/ksrr.2012.24.4.235] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/16/2012] [Accepted: 08/16/2012] [Indexed: 11/05/2022] Open
Abstract
Purpose To evaluate the efficacy of the direct arthroscopic excision of a popliteal cyst without additional skin incision using a posteromedial portal based on minimum 2 year follow-up clinical results. Materials and Methods From January 2003 to January 2010, 105 patients (111 cases) with popliteal cyst have been treated by a direct arthroscopic excision. Direct arthroscopic excision using a 70 degree arthroscopy and posteromedial portal can correct the valvular mechanism of capsular fold and reduce the complications with no additional skin incision at the popliteal area. In all cases, preoperative magnetic resonance imaging (MRI) was performed to detect combined intraarticular pathology. At 2 years postoperatively, a follow-up ultrasonography or MRI was performed to detect the recurrence of cysts. We used Rauschning and Lindgren criteria for clinical evaluation. Results All cases had neither recurrence nor complaints of pain, swelling, or functional impairment more than 2 years after the surgery. At ultrasonography or MRI, no recurrence was found, and 5 complications were 1 skin lesion and 4 hematoma. Postoperatively, Rauschning and Lindgren criteria were more than grade 1. Conclusions Direct arthroscopic excision using 70 degree arthroscope and posteromedial portal is an effective method for the treatment of popliteal cyst.
Collapse
Affiliation(s)
- Jin Ho Cho
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| |
Collapse
|
30
|
Di Sante L, Paoloni M, Ioppolo F, Dimaggio M, Di Renzo S, Santilli V. Ultrasound-Guided Aspiration and Corticosteroid Injection of Baker's Cysts in Knee Osteoarthritis: A Prospective Observational Study. Am J Phys Med Rehabil 2010; 89:970-5. [DOI: 10.1097/phm.0b013e3181fc7da2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
31
|
Ahn JH, Lee SH, Yoo JC, Chang MJ, Park YS. Arthroscopic treatment of popliteal cysts: clinical and magnetic resonance imaging results. Arthroscopy 2010; 26:1340-7. [PMID: 20869836 DOI: 10.1016/j.arthro.2010.02.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 02/01/2010] [Accepted: 02/10/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE This study examined the functional and magnetic resonance imaging (MRI) outcomes of popliteal cysts with combined intra-articular pathologies that were treated arthroscopically by decompression and a cystectomy through an additional posteromedial cystic portal. METHODS From January 2003 to March 2008, 31 patients were treated with a modified arthroscopic technique to decompress a popliteal cyst. The connecting valvular mechanism was found in all cases at the posteromedial compartment through the anterolateral viewing portal, and it was corrected by resecting the capsular fold through the posteromedial working portal. For cysts with multiple fibrous septa, an additional portal, the so-called posteromedial cystic portal, was used for complete cyst removal. The functional outcome was evaluated by use of the Rauschning and Lindgren knee score. All patients were evaluated by MRI, which documented the popliteal cyst and associated intra-articular lesions preoperatively and at follow-up. RESULTS All patients could return to their previous daily activities with few or no limitations, and no additional surgery was required after a mean follow-up of 36.1 months (range, 12 to 72 months). The Rauschning and Lindgren knee score showed improved clinical features at the final follow-up in 94% of patients. The follow-up MRI study showed that the cyst had disappeared in 17 knees (55%) and had reduced in size in 14 knees (45%) in the 31 patients. The mean cyst size was reduced significantly from 6.8 to 0.8 cm (P < .0001). CONCLUSIONS The described arthroscopic technique with or without an additional posteromedial cystic portal is effective for treating popliteal cysts with combined intra-articular lesions. More importantly, follow-up MRI showed that the cyst size was reduced or it had disappeared in all cases, although there was no association between the cyst's disappearance and the follow-up clinical score. LEVEL OF EVIDENCE Level IV, therapeutic case series.
Collapse
Affiliation(s)
- Jin Hwan Ahn
- Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | | | | | | | | |
Collapse
|
32
|
Chatzopoulos D, Moralidis E, Markou P, Makris V, Arsos G. Baker’s cysts in knees with chronic osteoarthritic pain: a clinical, ultrasonographic, radiographic and scintigraphic evaluation. Rheumatol Int 2008; 29:141-6. [DOI: 10.1007/s00296-008-0639-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Accepted: 06/15/2008] [Indexed: 11/26/2022]
|
33
|
Calvisi V, Lupparelli S, Giuliani P. Arthroscopic all-inside suture of symptomatic Baker's cysts: a technical option for surgical treatment in adults. Knee Surg Sports Traumatol Arthrosc 2007; 15:1452-60. [PMID: 17671780 DOI: 10.1007/s00167-007-0383-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 06/21/2007] [Indexed: 10/23/2022]
Abstract
Synovial fluid caused by repeated effusions may replete the gastrocnemius-semimembranosus bursa (GSB) communicating with the knee joint. Fluid trapped inside the GSB through an alleged unidirectional valve-like mechanism forms a so-called Baker's cyst. Since a significant association of Baker's cysts with knee joint disorders has been reported, treatment should primarily address articular lesions causing recurrent effusions. Arthroscopic surgery provides an effective treatment in that both the cyst and associated joint disorders can be optimally visualized and accordingly treated. In the present paper an all-inside arthroscopic technique for suturing the gateway to the GSB through an anterolateral viewing portal and a posteromedial working portal is proposed. The rationale underlying this technique is that no conclusive evidences exist that the one-way valve-like mechanism is purely anatomical. A retrospective study was conducted on 22 patients (9 males and 13 females, mean age 56 +/- 10 SD years) affected by a symptomatic Baker's cyst associated to knee joint disorders. Pre- and post-operative evaluation at 2 year follow-up consisted of clinical assessment by Rauschning and Lindgren criteria and magnetic resonance imaging (MRI). The results showed that 96% of patients showed clinical improvement. Baker's cyst disappeared in 64% of patients, reduced in 27% and persisted in 9% on MRI. All patients with cyst reduction exhibited clinical amelioration. Our results suggest the all-inside arthroscopic suture technique would improve Baker's cyst-related symptoms by either disappearance or reduction of the cyst. We believe the availability of multiple arthroscopic techniques to treat symptomatic Baker's cysts could broaden the therapeutic armamentarium of knee arthroscopists.
Collapse
Affiliation(s)
- Vittorio Calvisi
- Cattedra di Malattie dell'Apparato Locomotore, Dipartimento di Scienze Chirurgiche, Facoltà di Medicina e Chirurgia, Università degli Studi dell'Aquila, Piazzale Salvatore Tommasi 1, 67010, Coppito, L'Aquila, Italy.
| | | | | |
Collapse
|
34
|
Abstract
In regard to arthroscopic treatment of popliteal cysts, we explored the refuted pathology for popliteal cysts proposed by others. Here we introduce an arthroscopic technique using posterior portals to treat a popliteal cyst based on our observation that the opening of the cyst in the joint is a slit-like structure in the posterior wall of the capsule. By disrupting this slit-like structure with our procedure, the popliteal cyst ceased to be palpable and was no longer symptomatic. This technique also provides excellent arthroscopic visualization of the cavity of the popliteal cyst through the knee joint approach. After completion of the resection of the opening, we can easily insert an arthroscope into the cavity of the popliteal cyst from the posteromedial portal through the resected opening. Arthroscopic visualization of the cavity of the cyst showed that the inside wall of the cavity was smooth and had no synovitis. We believe that to disrupt this slit structure is the most pathologically reasonable procedure to treat popliteal cysts surgically.
Collapse
Affiliation(s)
- Masaaki Takahashi
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | | |
Collapse
|
35
|
Abstract
We present an arthroscopic repair technique (all inside suture) for chronic capsular defect of posterolateral space of knee joint developed after previous popliteal cystectomy. We use a transseptal posteromedial viewing portal, and two posterolateral working portals. This procedure can be an alternative to an open repair technique for a posterior capsular defect after open cystectomy.
Collapse
Affiliation(s)
- Sung-Jae Kim
- Department of Orthopaedic Surgery, College of Medicine, Yonsei University, Seoul, South Korea
| | | |
Collapse
|
36
|
Abstract
Abstract
Background
This prospective study was designed to investigate the aetiology of popliteal (Baker's) cysts.
Methods
Some 426 legs in 312 individuals were investigated with ultrasonography for the presence of a popliteal cyst. Participants included healthy volunteers, patients with a painful knee, and a group of patients with signs and symptoms of deep vein thrombosis (DVT). The location, thickness and content of all cysts were recorded. In addition, the popliteal fossa was dissected in four cadaver knees.
Results
The prevalence of popliteal cyst increased with age and was significantly higher in those aged over 50 years (P < 0·001). Compared with controls (incidence 3·0 per cent), cysts were more common in patients with DVT symptoms (9·5 per cent; P = 0·141) and those with painful knees (19·8 per cent; P < 0·001). All cysts were located in the posteromedial aspect of the popliteal fossa; the majority extended between the deep fascia and the medial head of the gastrocnemius muscle. At this level an area without external support of the posterior capsule was identified between the two expansions of the semimembranosus muscle from the medial side (the oblique popliteal ligament and the expansion over the popliteus muscle) and the posterior cruciate ligament from the lateral side. This area was also located in the knee dissections. No association was found between popliteal cyst and acute DVT.
Conclusion
Popliteal cysts are relatively common in patients over 50 years old with a painful knee or with signs and symptoms of DVT. They form in the posteromedial popliteal fossa because the synovial capsule does not provide anatomical support in this region.
Collapse
Affiliation(s)
- N Labropoulos
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
| | | | | |
Collapse
|
37
|
Abstract
Baker's cysts are fluid distensions of the gastrocnemius-semimembranosus bursa and are the most common cystic lesion around the knee. Typically cysts enlarge along intermuscular planes around the knee. We report three cases in which the expanding cyst did not respect these planes and dissected along an intramuscular route as confirmed by MR imaging. Such behaviour by Baker's cysts is hitherto unreported in the literature. Possible mechanisms to account for this phenomenon are discussed.
Collapse
|
38
|
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness of cystoscopic excisional debridement and removal of unilateral flow of the capsular fold of valvular mechanism in the posteromedial corner of the recurrent popliteal cyst. TYPE OF STUDY Retrospective review. METHODS From March 1998 to May 2000, we treated 14 cases of popliteal cyst by cystoscopic excisional debridement. The cysts were relatively large cysts, about 5 cm in diameter on sonography. Conservative treatment for about 1 year, with about 3 aspirations failed. The mean follow-up duration was 29.7 (24 to 36) months. We used Rauschning and Lindgren criteria for evaluations. We estimated surgical time. Patients underwent sonography 6 months and 1 year after surgery. Pain, range of motion, and recurrence were checked 1 year after surgery. RESULTS The average surgical time was 45 (31 to 58) minutes. The time to pain elimination and full range of motion was 1 or 2 days after surgery. No recurrence was noted in any patients. At the last follow-up, patients reported no discomfort or pain, and all had free range of motion. Preoperatively, Rauschning and Lindgren criteria were grade 0 in 0 cases; grade 1 in 3 cases; grade 2 in 10 cases; and grade 3 in 1 case. At 2 weeks after surgery, criteria were grade 0 in 13 cases and grade 1 in 1 case; at final follow-up evaluation, all were grade 0. Hematoma occurred in 1 case. However, in cases lost to follow-up and in short-term follow-up cases, technical errors occurred: not entering within the cyst in 2 cases, extravasion in 1 case, and recurrence in 1 case. CONCLUSIONS A popliteal cystoscopic excisional debridement by motorized shaver and removal of the capsular fold of the valvular mechanism is an effective alternative to the open technique of treating popliteal cysts.
Collapse
Affiliation(s)
- SangHun Ko
- Department of Orthopedic Surgery, Ulsan University College of Medicine, Ulsan, South Korea.
| | | |
Collapse
|
39
|
|
40
|
Abstract
The objective of this prospective study was to determine the prevalence of popliteal cysts and the associated intraarticular lesions in a group of 100 patients scheduled for arthroscopic surgery of the knee and to evaluate the results of arthroscopic treatment for these intraarticular lesions without removal of the cyst. One hundred patients without any knee complaints served as a control group. The diagnosis of a popliteal cyst was made on the basis of ultrasonography. The prevalence of popliteal cysts was 20% in the study group and 0% in the control group. Patients with a popliteal cyst had a significantly higher prevalence of medial meniscal tears (70% versus 19%) and of chondral lesions (85% versus 28%). Tears of the lateral meniscus, however, were more evenly distributed (20% versus 36%). Sixteen of 20 patients with a popliteal cyst were available for a follow-up examination 1 to 3 years after the arthroscopic procedure. Eleven popliteal cysts had persisted. Chondral lesions were the most relevant prognostic factor; all patients with persisting cysts had grade III or grade IV lesions. We conclude that the popliteal cyst is a secondary phenomenon and that treatment should address the underlying intraarticular lesions. In cases of osteoarthritis it may be impossible to treat the chondral lesion successfully in terms of eliminating the effusion.
Collapse
Affiliation(s)
- Stefan Rupp
- Department of Orthopaedic Surgery, University of Saarland, Homburg/Saar, Germany
| | | | | | | |
Collapse
|
41
|
Abstract
OBJECTIVE To review the epidemiology, clinical presentation, pathogenesis, imaging, differential diagnosis, complications, and treatment of popliteal cysts. METHODS References were taken from MEDLINE from 1985 to 1998 under the subject "Popliteal Cyst" with subheadings of Radiography, Ultrasonography, and Radionuclide Imaging. Other pertinent references were used. Childhood cysts were excluded. RESULTS Depending on the studied population and the imaging technique, 5% to 32% of knee problems may have these cysts, with 2 age-incidence peaks of 4 to 7 years and 35 to 70 years. In older patients there is usually coexistent joint pathology. Symptoms may arise in the popliteal fossa from the cyst itself or be dominated by knee pain from coexisting knee pathology. Many cysts are asymptomatic. Physical examination will miss one half of these cysts. Pathogenesis depends on the connection between the joint and bursa, with a valvelike effect allowing passage of fluid from the joint into the bursa with subsequent distention producing these cysts. Some bursae have no such joint-bursal communication, and the cysts arise primarily as bursitis of the gastrocnemio-semimembranosus bursa. Imaging is performed by plain x-ray, ultrasound, arthrography, computerized axial tomography, magnetic resonance imaging, or nuclear scan; sonography is the method of choice. Complicated cysts with extension or rupture into the calf mimic phlebitis, an important differential diagnosis. Asymptomatic cysts found incidentally need no treatment; most symptomatic cysts respond to intra-articular corticosteroid injections. Surgical excision is rarely necessary. CONCLUSIONS AND RELEVANCE Popliteal cysts are fairly common, may not be found on physical examination, require imaging (preferably sonography) to be identified, mimic phlebitis when extending into the calf, and often respond to intra-articular steroid or, rarely, surgical resection.
Collapse
Affiliation(s)
- J R Handy
- Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta, GA, USA
| |
Collapse
|
42
|
Olmos EM, Martí-bonmatí L, Aís RL, Muñoz RD. Prevalencia y características de las complicaciones de los quistes de Baker mediante resonancia magnética. Rev Clin Esp 2001; 201:179-183. [DOI: 10.1016/s0014-2565(01)70788-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
43
|
Martí-Bonmatí L, Mollá E, Dosdá R, Casillas C, Ferrer P. MR imaging of Baker cysts --prevalence and relation to internal derangements of the knee. MAGMA 2000; 10:205-10. [PMID: 10873212 DOI: 10.1007/bf02590647] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the prevalence of popliteal cysts in patients studied with magnetic resonance (MR) imaging. Cyst presence and volume will be related to other internal derangement of the knee. MATERIALS AND METHODS Three hundred and eighty-two consecutive patients with a MR study of the knee were included. Images were obtained in the three spatial orthogonal planes and evaluated through consensus. Four categories were established for the Baker cyst and synovial fluid (absence, minimum, moderate and massive), and the presence of meniscal, cruciate ligaments and cartilage lesions were recorded. Statistical analysis was carried out with bivariate analysis (chi(2) of Pearson and Gamma tests). RESULTS From the 382 patients, 145 had Baker cysts (38.0%). Cyst content was minimum in 99, moderate in 34 and massive in 12. Joint effusion was observed in 269 patients (70.4%), being minimal in 140 patients, moderate in 119 and massive in ten. Meniscal lesions were observed in 195 patients (51%), while 58 patients (15%) had a cruciate ligament lesion. Baker cyst had a statistically significant direct relationship with the presence and quantity of synovial fluid (P=0.002) and with the presence and type of meniscal lesion (P=0.01) but not with cruciate ligaments or cartilage lesions. CONCLUSIONS The prevalence of Baker cysts in MR studies of the knee is high. Its presence and volume are related to the quantity of synovial fluid, and to the presence and severity of meniscal lesions.
Collapse
Affiliation(s)
- L Martí-Bonmatí
- Magnetic Resonance Service, ATQ-Clínica Quirón, 46010, Valencia, Spain.
| | | | | | | | | |
Collapse
|
44
|
Conroy BP, Sharpe RC, Kenter K, Griffiths HJ. Radiologic case study. Popliteal cyst (Baker's cyst). Orthopedics 2000; 23:296, 288, 291. [PMID: 10741374 DOI: 10.3928/0147-7447-20000301-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- B P Conroy
- Department of Orthopedic Surgery, University of Missouri-Columbia, 65212, USA
| | | | | | | |
Collapse
|
45
|
Abstract
OBJECTIVES To increase awareness of entrapment neuropathy caused by rupture of Baker's cyst. METHODS A patient with psoriatic arthritis, ruptured Baker's cyst, and entrapment neuropathy is reported and the literature on this complication is reviewed. RESULTS Nerve entrapment caused by rupture of Baker's cyst is rare. Neurological examination and demonstration of Baker's cyst by Color Doppler Duplex Ultrasound (CDDU) help in making the diagnosis. Nerve Conduction Study (NCS) may confirm the diagnosis of posterior tibial nerve entrapment. CONCLUSIONS Peripheral nerve entrapment should be considered in patients with Baker's cysts and loss of sensation along the plantar aspect of the foot or other neurological symptoms or findings.
Collapse
Affiliation(s)
- S Dash
- Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick 08903-0019, USA
| | | | | |
Collapse
|