Arthroscopic Treatment of Popliteal Cysts: Clinical and Magnetic Resonance Imaging Results
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.
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.
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).
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 IV, therapeutic case series.
Available from: Marco Kawamura Demange
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ABSTRACT: Os cistos de Baker localizam-se na região posteromedial do joelho, entre o ventre medial do músculo gastrocnêmio e o tendão semimembranoso. No adulto, esses cistos estão relacionados a lesões intra-articulares, quais sejam, lesões meniscais ou artrose. Nas crianças, geralmente são achados de exame físico ou de exames de imagem, apresentando pouca relevância clínica. O exame de ultrassonografia é adequado para identificar e mensurar o cisto poplíteo. Para o tratamento, a abordagem principal deve ser relacionada ao tratamento da lesão articular. Na maioria dos casos não há necessidade de se abordar diretamente o cisto. Os cistos no joelho são, quase na sua totalidade, benignos (cistos de Baker e cistos parameniscais). Porém, a presença de alguns sinais demanda que o ortopedista suspeite da possibilidade de malignidade: sintomas desproporcionais ao tamanho do cisto, ausência de lesão articular (ex.: meniscal) que justifique a existência do cisto, topografia atípica, erosão óssea associada, tamanho superior a 5cm e invasão tecidual (cápsula articular).
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ABSTRACT: In our observational study, we performed the clinical and functional examination, analyzed imagistic and histological findings and evaluated the correlation between previous aspects in patients with primary knee osteoarthritis (PKOA) and Baker's cyst (BC). The correlations were made to better understanding of BC in patients with PKOA and optimal choosing for treatment. Seventy patients with painful PKOA (ACR criteria) and BC were assessed. We evaluated knee pain using a 100 mm VAS and functional status using the pain, stiffness and functional subscales of WOMAC index. All patients were imagistic examined (ultrasonography and MRI). Thirty-eight patients with PKOA and simple BC respond to conservative treatments. Thirty-two patients with PKOA and complex BC need surgical removal (arthroscopic decompression ± open excision in larger cysts). For these patients, it is performed histological assessment. Any medical team that manages a PKOA patient with BC may develop the treatment plan based upon not only the size of BC, symptoms and other associated conditions but also on the WOMAC scoring and complex anatomic and histological data about BC.
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