Assessment of knee osteoarthritis by ultrasonography and its association with knee pain.

BACKGROUND: Pain is a significant cause of disability in knee osteoarthritis. Conventional radiography is widely used in the assessment of knee osteoarthritis, however radiographic findings do not correlate well with pain. Ultrasonography can be used to evaluate the soft tissue structures of the knee that can be related to pain. OBJECTIVE: To evaluate pain-related soft tissue structures of the knee with ultrasonography. METHODS: This cross-sectional study included a total of 198 knees from 99 patients with knee osteoarthritis. Knee pain and functional status were evaluated by performing visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). On the ultrasound, cartilaginous thickness, knee effusion and presence of Baker's cyst were assessed and the correlation to pain was investigated. RESULTS: Baker's cyst was significantly more frequent in symptomatic knees (13.9%) compared to asymptomatic knees (2.5%). Patients with Baker's cyst had a significantly more limited degree of knee flexion, significantly higher resting VAS pain scores and worse WOMAC scores compared to patients without Baker's cyst. In log-linear analysis, presence of Baker's cyst increased the risk of pain by 2.94 times. CONCLUSION: Ultrasound as a modality that is easily accessible, inexpensive and without radiation exposure is helpful to demonstrate factors related to pain in knee osteoarthritis by allowing assessment of soft tissue structures.

The popliteal cyst.

A popliteal cyst, originally called Baker's cyst, is a synovial fluid-filled mass located in the popliteal fossa. The most common synovial popliteal cyst is considered to be a distension of the bursa located beneath the medial head of the gastrocnemius muscle. Usually, in an adult patient, an underlying intra-articular disorder is present. In children, the cyst can be isolated and the knee joint normal. The anatomy, etiopathogenesis, clinical presentation, differential diagnosis, imaging and treatment modalities of the popliteal cyst are presented. The authors try to answer some questions dealing with this condition. Is the cyst isolated, can it be treated as such, is its origin always well-defined and does surgical excision provide a permanent cure?

Arthroscopic repair of chronic capsular defect after popliteal cystectomy.

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.

Ganglion cysts associated with cruciate ligaments of the knee: a possible cause of recurrent knee pain.

Intraarticular ganglia of the knee are uncommon; however, these ganglion cysts may produce knee discomfort without a clear etiology. We present the cases of 10 patients with ganglion cysts arising from cruciate ligaments of the knee joint who underwent arthroscopic excision after MR examination. The MR findings, clinical features and arthroscopic findings were evaluated comparatively. Diagnoses were confirmed by means of a histological study after arthroscopic excision. The cysts were fluid-filled, with low T1-weighted signal intensity and high T2-weighted signal intensity. Except for two patients with recent accidents, the remaining eight presented chronic pain without any history of trauma. Pain was the most frequent clinical sign. It was associated with knee extension in 3 cases and with flexion in 3 cases. In 7 cases, cysts were exclusively associated with the anterior cruciate ligament (ACL). Only in one case was a cyst associated with an ACL rupture. Four patients presented meniscal lesions. All ganglia appeared solitary in each knee. Postarthroscopy evolution was painless in 8 patients. Histologic diagnoses corresponded to ganglion cysts. The tissues from the patient with the ACL rupture presented a fibrous reaction with myxoid degeneration forming intraligamentary ganglion cysts.

Ganglia of the posterior cruciate ligament. A report of three cases and a review of the literature.

Two cases of isolated symptomatic ganglia and one case of a combined asymptomatic ganglion arising from the posterior cruciate ligament (PCL) are reported. One patient was a 29-year-old male who complained of posteromedial radiating knee pain. The medial McMurray test was positive. A cystic mass, 1.5 cm in diameter, arising from the femoral insertion of the PCL was removed piece-by-piece. The second case involved a 29-year-old female who complained of medial knee pain and limitation of flexion. MR scans detected a soft mass around the PCL. This was found to be a ganglion cyst surrounding the PCL, measuring 30 mm by 25 mm; it was excised using a power shaver. The third patient was a 17-year-old male who had knee pain due to a large medial synovial plica. Two small cystic masses were present on the intermediate portion of the PCL, but they seemed to be asymptomatic because of their small size. Whether or not a ganglion produces symptoms is determined by its size and location. Intra-articular ganglia can be cured by piecemeal resection and do not recur.

Popliteal cysts in children: a retrospective study of 62 cases.

Popliteal cysts in children are usually asymptomatic and are usually found fortuitously by the parents. This study presents a series of 62 children with popliteal cysts. Among the 51 patients who received no treatment, the cysts had already disappeared at the time of the study in 43 patients; the remaining 8 patients are under 14 years of age and are without complaints. This study confirms the hypothesis that the primary popliteal cyst in children usually disappears before the age of 18. Surgery presents unnecessary risks for the patient ; moreover, the chance of recurrence after surgery is real.

[Spontaneous regression of a sub-adventitial cyst of the popliteal artery]. / Régression spontanée d'un kyste sous-adventiciel de l'artère poplitée.

We report a case of spontaneous regression of a cystic adventicial disease of a popliteal artery in a 37 years old man. The peroperative resection of the adventicia give us the histologic confirmation of the diagnostic. The cyst's content may have gone through either in the peri-arterial space or through a communication with the articulation of the knee. For us, it seems to confirm the embryologic theory for the pathogenic of this disease.

Aplicación clínica de la resonancia magnética en la rodilla: Parte II. Rodilla anormal / Clinical application of magnetic resonance imaging of the Knee: Part II. The abnormal knee

La imagen de la resonancia magnética es uno de los estudios con mayor exactitud y sensibilidad en el diagnóstico de patología de la rodilla, el conocimiento de las imágenes anormales más comunes permitirá una mejor interpretación que se reflejará en la correcta decisión en el tratamiento. Se describen las imágenes de la patología más frecuente en la rodilla, de las cuales debe de tener conocimiento el cirujano ortopedista