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.

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.

Arthroscopic cystectomy for Baker's cysts with and without one-way valve lesions: incidence of one-way valve lesion, associated pathologies, and clinical outcomes.

INTRODUCTION: A one-way valve lesion plays an important role in the formation of Baker's cysts and serves as an important landmark for accessing these cysts during arthroscopic surgery. This study aimed to investigate the incidence of one-way valve lesions and their effect on clinical outcomes in patients who underwent arthroscopic cystectomy for Baker's cysts. MATERIALS AND METHODS: Patients who underwent arthroscopic cystectomy for Baker's cysts between June 2005 and November 2017 were retrospectively reviewed. Patient demographic characteristics, radiologic/arthroscopic findings (presence of one-way valve lesions, concurrent chondral and meniscal lesions, and cyst wall thickness), and clinical outcomes (clinical recurrence rate, Lysholm score, and complications) at the 2-year follow-up were evaluated. Subgroup analysis was performed to compare clinical outcomes between patients with and without one-way valve lesions. RESULTS: Thirty patients (mean age, 57.4 ± 9.4 years) were included in this study. One-way valve lesions were surgically documented in 11 patients (36.7%). Ten patients (33.3%) had chondral lesions with an International Cartilage Repair Society grade ≥ 3, and 23 patients (76.7%) had concurrent chondral and meniscal lesions. At the 2-year follow-up, none of the patients had experienced clinical recurrence; the mean Lysholm score was 76.3 ± 17.5 (48-100). Three patients reported persistent pain, while two reported numbness or paresthesia. Subgroup analysis showed no significant differences in clinical recurrence rates, Lysholm scores, and complication rates between the groups. CONCLUSIONS: The incidence of one-way valve lesions during arthroscopic cystectomy for Baker's cysts was lower than that previously reported. Arthroscopic cystectomy showed good clinical results in patients with and without these lesions.

Popliteal cysts are not a risk factor for lower extremity deep vein thrombosis.

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.

An unexpected event after deep vein thrombosis in spinal cord injury: Ruptured Baker's cyst.

Context: Deep vein thrombosis (DVT) is a well-known complication of spinal cord injury (SCI). Low-molecular-weight heparin (LMWH) may be used in SCI patients who develop DVT, but can lead to subcutaneous bleeding. If subcutaneous bleeding occurs, then lymphedema, cellulitis, muscle or tendon tearing, or baker's cyst rupture should be considered in the differential diagnosis.Findings: Herein, we present a 61-year-old female patient who was hospitalized for rehabilitation due to paraplegia, and used LMWH due to DVT development. The patient suddenly developed pain, swelling, and discoloration of the left lower extremity. Although subcutaneous hemorrhage was considered initially, ultrasound and MRI revealed a ruptured Baker's cyst. In addition to supportive therapy, ultrasound-guided aspiration was performed.Conclusion/Clinical Relevance: In this report, we present a case of clinically severe Baker's cyst rupture, which occurred in the lower extremity of a SCI patient using LMWH due to DVT in the same extremity. To our knowledge, no similar cases have been reported.

Baker's Cyst with Knee Osteoarthritis: Clinical and Therapeutic Implications.

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.

Leukocyte-rich platelet-rich plasma application in post-traumatic osteoarthritis with popliteal cyst: a case report.

Aim: To describe the successful treatment of a Baker's cyst in the setting of post-traumatic osteoarthritis using ultrasound-guided injection of platelet-rich plasma. Setting: Outpatient sports clinic. Patient: 29-year old male basketball player. Case description: The patient presented with 2-months history of right knee pain, 17 months after undergoing right knee anterior cruciate ligament reconstruction surgery. Exam revealed medial joint line and medial collateral ligament tenderness with posterior knee swelling. After aspiration, a corticosteroid injection was administered with temporary symptom relief. Diagnostic ultrasound examination confirmed the Baker's cyst. The patient then underwent two serial leukocyte-rich platelet-rich plasma injections into his right knee. Results: The patient reported complete resolution of pain and cyst size. Conclusion: Leukocyte-rich platelet-rich plasma may be considered as a treatment option for patients with Baker's cysts in the setting of post-traumatic osteoarthritis.

A potential risk factor of total knee arthroplasty: an infected Baker's cyst - a case report.

BACKGROUND: In adults, Baker's cyst development is attributable principally to secondary alterations after degenerative changes. The latter changes often accompany osteoarthritis, and we frequently encounter patients with Baker's cysts seeking total knee arthroplasty (TKA). Baker's cysts are not usually subject to extensive preoperative evaluation because the cysts often disappear naturally after surgery, unaccompanied by any adverse symptoms. CASE PRESENTATION: A 63-year-old woman presented with moderate pain in the left knee joint that had developed 1 year ago. Posterior knee pain was aggravated on maximum knee flexion. Three months previously, a popliteal mass had become palpable and the patient had undergone needle mass aspiration twice in a local orthopedic hospital, but the mass had recurred. We initially considered TKA for her severe degenerative osteoarthritis. However, we decided to perform only arthroscopic debridement and cyst excision because the patient was experienced severe pain only on maximal knee flexion, and did not want TKA. Pus gushed from the torn cyst during the operation. We diagnosed an infected Baker's cyst. The patient was treated with a first-generation cephalosporin postoperatively. CONCLUSIONS: A Baker's cyst that was aspirated and still causes symptoms with altered blood tests needs to be evaluated accurately before TKA.

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.

A Popliteal Cyst Responsible for Acute Lower Limb Ischemia.

We report the case of a 68-year-old man complaining of sudden intermittent claudication of the left limb. The patient was rapidly diagnosed with duplex ultrasound (DUS), computed tomography angiography, and magnetic resonance angiography as having a popliteal cyst (PC) compressing the popliteal artery, responsible for intermittent claudication. The patient underwent DUS-guided PC aspiration allowing symptoms resolution. However, he presented 3 recurrent ischemic syndromes from brutal claudication to more severe ischemia in a 3-month period, with increasing severity of the symptoms, treated with 3 DUS-guided PC aspirations. An extensive work-up excluded an atherosclerotic etiology. Consequently, due to increasing severity and quick recurrence of the symptoms and given the underlying knee osteoarthritis, the patient underwent radical treatment and got a total knee prosthetic replacement. One year later, follow-up was uneventful.

Successful arthroscopic treatment of refractory and complicated popliteal cyst associated with rheumatoid arthritis in combination with osteoarthritis: case series and literature review.

Although popliteal cysts are most frequently identified in patients with osteoarthritis (OA), they may occur in patients with rheumatoid arthritis (RA), in which serious complicated cases such as cyst rupture can be developed. The objective of this study was to report four patients with RA (six knees) in combination with OA with a brief review of literature of previous similar published cases. This is a retrospective review of case records of patients with refractory and/or complicated popliteal cysts, who have successfully treated with arthroscopic intervention. We suggest that arthroscopic interventions such as radical debridement, synovectomy, biomechanical valve excision, and/or cystectomy should be considered in patients with refractory and complicated popliteal cysts associated with RA or RA in combination with OA.

Rotura de quiste de Baker: complicaciones derivadas de un diagnóstico erróneo / Ruptured Baker's cyst: complications due to misdiagnosis

La trombosis venosa profunda (TVP) y el quiste de Baker complicado con rotura presentan una clínica similar: inflamación y dolor agudo en la pantorrilla. El diagnóstico diferencial se debe realizar mediante eco-doppler, ya que el tratamiento de una sospecha de TVP con dosis terapéuticas de heparina de bajo peso molecular (HBPM) puede provocar mayor sangrado y empeorar el pronóstico del quiste de Baker complicado. En este trabajo se recoge una serie consecutiva de 7 pacientes diagnosticados erróneamente de TVP en los que, sin realizar prueba de imagen, se instauró tratamiento con HBPM a dosis terapéutica. Estos pacientes desarrollaron un empeoramiento súbito de los síntomas tras el tratamiento, provocando un síndrome compartimental de la pierna, que en cuatro de ellos requirió fasciotomía urgente

Deep vein thrombosis (DVT) and ruptured Baker's cyst have similar clinical presentations: inflammation and acute pain in the calf. Differential diagnosis is necessary and requires information from Doppler ultrasound imaging because treating suspected DVT with therapeutic doses of low molecular weight heparins (LMWHs) can cause major bleeding and worsen the prognosis of complicated Baker's cyst. We present a series of 7 consecutive cases in which the patients were misdiagnosed with DVT without imaging. LMWHs were started at therapeutic doses in all cases. The patients' symptoms worsened abruptly after treatment, causing compartment syndrome in the leg. Four of the patients required urgent fasciotomy

Micro-fragmented adipose tissue for treatment of knee osteoarthritis with Baker's cyst: a case study.

Adipose-derived therapies have increased in popularity for treatment of painful orthopaedic conditions, such as osteoarthritis. We report the passage of fat into a Baker's cyst after injection of micro-fragmented adipose tissue in a patient with bilateral knee arthritis. Following fat grafting, the patient required drainage of fatty fluid from within the Baker's cyst on multiple occasions. Approximately 3 months postprocedure, she began to notice an improvement in her knee pain with no further recurrence of pain or swelling from her Baker's cyst.

Compression neuropathy of common peroneal nerve caused by a popliteal cyst: A case report.

RATIONALE: Popliteal cyst developing in the sheath of a peripheral nerve or joint capsule may cause compression neuropathy. Although popliteal cyst is very common lesion, it seldom causes serious complications. Common peroneal nerve compression is rarely caused by an extraneural popliteal cyst. PATIENT CONCERNS: We presented the case of a 52-year-old female with common peroneal nerve compression caused by an extraneural popliteal cyst. DIAGNOSES: Electromyography showed the damage of common peroneal nerve. MRI magnetic resonance imaging showed the lump to be a popliteal cyst. She was diagnosed as peroneal nerve injury and popliteal cyst. INTERVENTIONS: The patient was performed peroneal nerve decompression and popliteal cyst excision surgery. We excised the cyst completely and soluted the common peroneal nerve thoroughly. The cyst was filled with thick mucinous material. OUTCOMES: The pathological report showed that the excised mass was a popliteal cyst. There were no postoperative complications. Pain and hypoesthesia resolved 6 months after surgery. LESSONS: In this case, compression of the common peroneal nerve was due to an extraneural popliteal cyst, a situation rarely encountered. MRI can show in better detail their size and internal contents as well as their relation with surrounding anatomic structures. Patients with nerve entrapment caused by enlarged or ruptured cysts must be microsurgically excised if symptomatic.

Ruptured Baker's cyst: complications due to misdiagnosis. / Rotura de quiste de Baker: complicaciones derivadas de un diagnóstico erróneo.

EN: Deep vein thrombosis (DVT) and ruptured Baker's cyst have similar clinical presentations: inflammation and acute pain in the calf. Differential diagnosis is necessary and requires information from Doppler ultrasound imaging because treating suspected DVT with therapeutic doses of low molecular weight heparins (LMWHs) can cause major bleeding and worsen the prognosis of complicated Baker's cyst. We present a series of 7 consecutive cases in which the patients were misdiagnosed with DVT without imaging. LMWHs were started at therapeutic doses in all cases. The patients' symptoms worsened abruptly after treatment, causing compartment syndrome in the leg. Four of the patients required urgent fasciotomy.

ES: La trombosis venosa profunda (TVP) y el quiste de Baker complicado con rotura presentan una clínica similar: inflamación y dolor agudo en la pantorrilla. El diagnóstico diferencial se debe realizar mediante eco-doppler, ya que el tratamiento de una sospecha de TVP con dosis terapéuticas de heparina de bajo peso molecular (HBPM) puede provocar mayor sangrado y empeorar el pronóstico del quiste de Baker complicado. En este trabajo se recoge una serie consecutiva de 7 pacientes diagnosticados erróneamente de TVP en los que, sin realizar prueba de imagen, se instauró tratamiento con HBPM a dosis terapéutica. Estos pacientes desarrollaron un empeoramiento súbito de los síntomas tras el tratamiento, provocando un síndrome compartimental de la pierna, que en cuatro de ellos requirió fasciotomía urgente.

Arthroscopic internal drainage and cystectomy of popliteal cyst in knee osteoarthritis.

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.

Treatment of baker cyst, by using open posterior cystectomy and supine arthroscopy on recalcitrant cases (103 knees).

BACKGROUND: Associated joint disorders with popliteal cysts were stated approximately between the ranges of 41-83 % in all reported cases. Combined treatment strategies that eliminate intra-articular pathologies and cyst- associated valve mechanisms are thought to be a good option in treatment of the disease. In this study, our main objective is to present clinical results of our combined treatment results, which includes posterior cyst excision with supine arthroscopic intervention, targeting intra-articular pathologies on recalcitrant cases. METHODS: One hundred three knees of 100 patients treated with posterior open cystectomy with valve and repair of posterior capsule, in addition to arthroscopic treatment of intra-articular lesions, were included in the study. Preoperative magnetic resonance imaging (MRI) studies were performed in order to evaluate location of Baker cysts behind the knee. Rauschning-Lindgren and Lysholm Knee Scoring Scales were used to assess pre/post-operative knee functions. Mann-Whitney U test was used to evaluate the differences between genders in comparison of Lysholm and Lindgren scores. Mean age within gender groups was compared using independent samples t-test. Wilcoxon test was used to compare the change in Lysholm and Lindgren scores. A p-value of less than 0.05 was considered to show a statistically significant result. Over the 1-year follow-up period, US and MR imaging was performed only with symptomatic patients. RESULTS: Cyst recurrence was seen only in 2 (1.94 %) patients. Post-operative Lysholm Knee and Lindgren knee scores demonstrated improvement in knee function and general comfort level of the patients. CONCLUSIONS: Our midterm follow-up (Mean: 39 Months) results showed that open cyst excision with valve and capsule repair with knee arthroscopy that targets associated intra-articular pathologies reduced the pain and improved the knee function in those patients. LEVEL OF EVIDENCE: IV (Retrospective clinical study without comparison group).

The fate of Baker's cyst after total knee arthroplasty.

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.

Treatment of Popliteal (Baker) Cysts With Ultrasound-Guided Aspiration, Fenestration, and Injection: Long-term Follow-up.

BACKGROUND: The purpose of this study was to determine the efficacy of ultrasound-guided aspiration, fenestration, and injection as a treatment in patients with symptomatic popliteal cysts. HYPOTHESIS: Ultrasound-guided aspiration, fenestration, and injection (UGAFI) is an effective and safe treatment option for symptomatic popliteal cysts. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Patients who received a UGAFI of popliteal cysts from 2008 to 2011 were identified. Preaspiration (PA) and follow-up Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, cyst recurrence, complications, cyst complexity, and size were obtained and compared for statistical significance. UGAFI involved aspiration of fluid through a spinal needle, fenestration of the cyst walls and septations, and injection of 1 mL (40 mg) triamcinolone (Kenalog) and 2 mL 0.5% bupivacaine (Sensorcaine) into the decompressed remnant. RESULTS: The mean PA WOMAC score (48.55) improved significantly at final follow-up (FFU) to 17.15 (P < 0.0001) for 47 patients. Within the WOMAC subcategories, there was also a significant difference in pain (PA, 10.68; FFU, 3.94; P < 0.0001), stiffness (PA, 4.51; FFU, 1.77; P < 0.0001), and physical function (PA, 31.34; FFU, 12.17; P < 0.0001). There were 6 reaspirations for recurrence (12.7%), and 1 patient underwent unicompartmental knee arthroplasty. There were no infections or other complications. CONCLUSION: Significant clinical improvement in patients with symptomatic popliteal cysts can be achieved via UGAFI as the sole treatment. CLINICAL RELEVANCE: UGAFI is a safe and effective option as the sole treatment modality for symptomatic popliteal cysts.