Management of symptomatic Baker's cysts with ultrasound and fluoroscopic-guided aspiration followed by therapeutic injection with Depomedrone and Bupivacaine leads to a durable reduction in pain symptoms in a majority of patients; A case series and literature review.

ABSTRACT

Purpose: To evaluate the efficacy of ultrasound and fluoroscopic-guided aspiration and therapeutic injection of Baker's cysts in the relief of pain and pressure symptoms. Methods: A retrospective, observational, single-arm study of consecutive patients referred from the Orthopaedic service for image-guided aspiration followed by therapeutic injection of symptomatic Baker's cysts was performed with institutional approval in the context of a Quality Improvement project. Patients' pain was graded using a 10-point Likert scale. Under standard sterile conditions, a 10 cm 5 Fr Yueh centesis needle was advanced into the cyst under direct ultrasound guidance, septae disrupted as necessary, the contents of the cyst aspirated, and a sample sent for microbiological analysis. Bursography was performed in an attempt to identify the expected communication with the knee joint, the contrast was aspirated and 40 mg of DepoMedrone and 5 ml of Bupivacaine were injected. Results: Thirteen patients were referred, nine of whom satisfied the inclusion criteria (all female, average age 63.8 years). Over a 35-month period, 11 procedures were performed (bilateral in 1, repeated in another) yielding an average volume of 20.1 ml (range 10 - 50 mls). In 2/11 procedures the communication with the knee joint was outlined. The average follow up post-procedure was 8.3 months. The average patient's pain score reduced to zero from 5.7 for an average period of 5.96 months. After this period patients reported a gradual return of an ache, but none returned to the pre-procedure severity which, in some cases, had prevented them from sleeping. Conclusion: Aspiration of symptomatic Baker's cysts under Ultrasound and fluoroscopic guidance followed by therapeutic injection of DepoMedrone and Bupivacaine leads to a durable reduction in pain symptoms in a majority of patients.