Clinical outcome of arthroscopic internal drainage of popliteal cysts with or without cyst wall resection

Abstract

Background This study aimed to compare the arthroscopic internal drainage of popliteal cysts alone or in combination with cyst wall resection in terms of clinical outcomes. Methods Forty-two consecutive patients with symptomatic popliteal cysts received arthroscopic treatment. Specifically, 20 of them received arthroscopic internal drainage (AI group) alone and 22 received arthroscopic internal drainage combined with cyst wall resection (AICR group) through double posteromedial portals. Magnetic resonance imaging (MRI) was performed to identify recurrence of popliteal cysts. The Lysholm score and Rauschning-Lindgren grade were used to assess the clinical outcomes. The median of the follow-up period was 24 months (12–48 months). Results The two groups (AI group and AICR group) were similar in age, gender, cyst diameter, associated joint disorder, preoperative Lysholm score, preoperative Rauschning-Lindgren grade and follow-up period (P > 0.05). Relative to the AI group, the AICR group had a significantly prolonged operation time (P < 0.05) and a higher incidence of complications (P < 0.05). In both groups, the Rauschning-Lindgren grade at the last follow-up significantly differed from the preoperative grade (P < 0.05) and the Lysholm knee score remarkably increased compared to the preoperative score (P < 0.05); however, there were no differences between the two groups at the last follow-up (P > 0.05). According to the MRI results, the cyst disappeared in 11 (55%), shrank in size in 6 (30%) and existed in 3 (15%) patients in the AI group, and was absent in 18 (81.8%) and shrank in size in 4 (18.2%) patients in the AICR group, suggesting a significant difference between the two (P < 0.05). Conclusion Additional resection of cyst wall can result in a lower recurrence rate of cysts but extend the operation time and increase the incidence of perioperative complications compared with arthroscopic internal drainage of popliteal cysts alone.

Arthroscopic internal drainage of popliteal cysts with cyst wall resection in pediatric patients

“…Zhou et al 21 suggested in a Meta analysis of published works on surgical treatment of popliteal cysts between 1980 and July 2015 that arthroscopy was an ideal option to treat intra-articular lesions, expand the communication port and resect the cyst wall. Su C et al 22 reported in a recent study that popliteal cysts disappeared completely and shrunk in 81.8% and 18.2% of all patients when combining AID with CWR, and the cyst survival rate was 0%, which indicated a further decline in the recurrence rate compared with arthroscopic decompression of simple intra-articular lesions without giving rise to such intra-operative complications as nerve and vascular injury mentioned in other published studies. This finding was proven by this study.…”

“…Recently, AID has been extensively recognized as a treatment strategy for patients with popliteal cysts. [15][16][17][18][19] However, AID combined with treatment of intra-articular lesions without CWR remains controversial as this may lead to the recurrence of the cyst. Zhang et al 20 discovered that the popliteal cyst wall was histologically comprised of thickened tissues of glassy degeneration, without any synovial cells.…”

An arthroscopic Resection Technique for Popliteal Cysts

“… 3 , 5 In contrast, arthroscopic treatment of intra-articular lesions, arthroscopic popliteal cyst resection or internal drainage, or open popliteal cyst resection have achieved satisfactory clinical results. 4 , 5 , 6 , 8 Nonetheless, the latter approach is rarely used because it requires altering the surgical position of the patient, and secondary disinfection needs to be performed during the operation.…”

“…Compared with arthroscopic popliteal drainage, the arthroscopic popliteal cyst resection has a lower postoperative recurrence rate, but it significantly increases the operation time and postoperative complications. 4 , 6 We propose the knee medial double approach for removal of popliteal cysts, which can be completed about 5 minutes, thus significantly reducing the operation time. At the same time, as the intraoperative perfusion time is greatly shortened, the incidence of postoperative complications is also lower and the recovery faster.…”

“…Arthroscopic resection of a popliteal cyst or internal drainage can simultaneously treat intra-articular lesions 1 , 2 and reduce the recurrence rate of a popliteal cyst compared with open surgery. 3 , 4 , 5 , 6 However, locating the popliteal cyst is relatively challenging and may lead to complications, such as vascular injury. 7 Popliteal cysts commonly occur in the space between the semimembranosus tendon and the medial head of the gastrocnemius muscle.…”