Efficacy and Safety of Musculoskeletal Ultrasound Guided Aspiration and Intra-Lesional Corticosteroids Injection of Ruptured Baker’s Cyst: A Retrospective Observational Study

Abstract

Objective: The aim of the work was to demonstrate the effectiveness and safety of ultrasonographic guided aspiration performed with corticosteroid injection intra-lesional for ruptured Baker cysts (BCs). Methods: Single-center retrospective study that included 42 patients with knee joint disorder associated with ruptured BCs were treated by ultrasonographic guided aspiration of fluid from the cyst and different points from the calf then intra-lesional injection of corticosteroids once or twice, 1 week apart. Follow up were done weekly until complete resolution of symptoms. Visual analog scale (VAS) and Rauschning-Lindgren and Lysholm Knee Scoring Scales (RLC) were used for assessment. Results: Clinical parameters (VAS and RLC) improved significantly in all patients at both post injection evaluation visits (1 week and 12 weeks). Ultrasonographic features improved significantly with complete disappearance of free fluid in the calf in 35 (83.3%) cases 1 week after the injection, and in 41 (97.6%) after 12 weeks. As regards BCs only 4 (9.5%) cases showed complete disappearance after 1 week and there was recurrent BCs in 38 (90.5%) cases which required reaspiration. While after 12 weeks, BCs were completely disappeared in 23 (54.8%) cases, most of the relapsed BCs were complex BCs. No side effects were reported in all cases. Conclusion: Ultrasonographic guided aspiration followed by injection of corticosteroids intra-lesional is an efficient and safe method for managing ruptured BCs.

Ruptured Baker’s Cyst: A Diagnostic Dilemma

“…Unlike other bursae of the knee joint, this bursa communicates with the cavity of the knee joint [ 1 ]. The incidence of Baker’s cyst ranges from 5 to 38% [ 5 ] and it increases with age since the integrity of the joint capsule decreases with age. Most cases of Baker’s cyst do not require any active intervention, but in rare cases, it can rupture and may require urgent attention.…”

Die Bakerzyste – das stumpfe Damoklesschwert bei der Radiosynoviorthese (RSO)?

“…Insbesondere das seltene Ereignis einer spontanen Ruptur oder Dissektion mit konsekutiver Freisetzung der Zystenflüssigkeit in die umgebenden Unterschenkellogen, in manchen Fällen auch mit einer Einblutung in die Muskulatur stellt jedoch ein für den Patienten akutes und sehr schmerzhaftes Ereignis dar. Die entsprechenden Beschwerden mit plötzlichen Schmerzen und Umfangszunahme der Wade werden in der Literatur auch als "Pseudothrombophlebitis" bezeichnet und können den Symptomen einer Thrombose der tiefen Unterschenkelvenen sehr ähnlich sein [8].…”

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“…While MRIs are the gold standard for confirming the presence of a Baker's Cyst and differentiating it from other conditions, the main disadvantage is high cost [2,6,7]. Ultrasonography is a viable alternative for its very low cost; however, it lacks the differentiation power of an MRI [2,3,7,8]. The general consensus is that ultrasound should be considered as a screening modality if an assessment of intra-articular structures is not required.…”

“…Surgical modalities include arthroscopic debridement, cyst decompression, meniscal repair/meniscectomy, or open cystectomy [2][3][4][5][6][7]. There is no consensus on which surgical modality is the best [5,8,10].…”