Extra-articular endoscopic excision of symptomatic popliteal cyst with failed initial conservative treatment: A novel technique

Chen, Yueh; Lee, Pei-Yuan; Ku, Ming-Chou; Wu, Nai-Yuan; Lo, Chien-Sheng

doi:10.1016/j.otsr.2018.09.022

Cited by 11 publications

(6 citation statements)

References 14 publications

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“…Ahn et al reported that the cyst persisted on the MRI after arthroscopic surgical treatment in 45% of all cases at 12–72 months of follow-up [ 15 ]. Chen et al described a one case (4.8% of the whole cohort) of a recurrence of a relatively large cyst (3 cm) detected on ultrasonography three months after surgery [ 16 ]. In a study by Lie et al, no recurrence was reported at a mean follow-up of 13 months (range 8–32), although patients were only assessed clinically [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic cystectomy and valve excision of popliteal cysts complemented with management of intra-articular pathologies: a low recurrence rate and good functional outcomes in a series of ninety seven cases

Malinowski

Mostowy

Ebisz³

et al. 2023

International Orthopaedics (SICOT)

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Purpose Arthroscopy in popliteal cyst surgery enables addressing all components of its pathomechanism: the cyst wall, valvular mechanism, and concomitant intra-articular pathologies. Techniques differ as to the management of the cyst wall and the valvular mechanism. This study aimed to assess the recurrence rate and functional outcomes of a cyst wall and valve excising arthroscopic technique with concurrent intra-articular pathology management. The secondary purpose was to assess cyst and valve morphology and concomitant intra-articular findings. Methods Between 2006 and 2012, 118 patients with symptomatic popliteal cysts refractory to at least three months of guided physiotherapy were operated on by a single surgeon using a cyst wall and valve excising arthroscopic technique with intra-articular pathology management. Patients were evaluated preoperatively and at a mean follow-up of 39 months (range 12–71) by ultrasound, Rauschning and Lindgren, Lysholm, and VAS of perceived satisfaction scales. Results Ninety-seven out of 118 cases were available for follow-up. Recurrence was observed on ultrasound in 12/97 cases (12.4%); however, it was symptomatic only in 2/97 cases (2.1%). Mean scores improved: Rauschning and Lindgren from 2.2 to 0.4, Lysholm from 54 to 86, and VAS of perceived satisfaction from 5.0 to 9.0. No persistent complications occurred. Arthroscopy revealed simple cyst morphology in 72/97 (74.2%) and presence of a valvular mechanism in all cases. The most prevalent intra-articular pathologies were medial meniscus (48.5%) and chondral lesions (33.0%). There were significantly more recurrences in grade III–IV chondral lesions (p = 0.03). Conclusions Arthroscopic popliteal cyst treatment had a low recurrence rate and good functional outcomes. Severe chondral lesions increase the risk of cyst recurrence.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic cystectomy and valve excision of popliteal cysts complemented with management of intra-articular pathologies: a low recurrence rate and good functional outcomes in a series of ninety seven cases

Malinowski

Mostowy

Ebisz³

et al. 2023

International Orthopaedics (SICOT)

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“…Numerous researchers prefer complete cyst wall resection. Chen et al 43 . performed a resection of the cyst wall through a high posteromedial portal, and observed that most patients experienced significant improvement in clinical symptoms, with only one relapse.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous researchers prefer complete cyst wall resection. Chen et al 43 performed a resection of the cyst wall through a high posteromedial portal, and observed that most patients experienced significant improvement in clinical symptoms, with only one relapse. Ahn et al 30 introduced an improved arthroscopic technique, which used an additional portal known as the "posteromedial cystic portal" to perform a complete cystectomy on 24 patients with fibrous structures in the cyst.…”

Section: Arthroscopic Treatment With or Without Cystectomymentioning

confidence: 99%

Arthroscopic Internal Drainage with Cyst Wall Resection and Arthroscopic Internal Drainage with Cyst Wall Preservation to Treat Unicameral Popliteal Cysts: A Retrospective Case–Control Study

Zhang

Wang

et al. 2021

Orthopaedic Surgery

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Objective: To compare the clinical efficacy and safety of arthroscopic internal drainage for the treatment of unicameral popliteal cysts with or without cyst wall resection.Methods: This was a retrospective case-control study of 73 patients diagnosed with unicameral popliteal cysts from January 2012 to January 2019 who received arthroscopic treatment. The study included 38 cases with cyst wall resection (CWR group) and 35 cases with cyst wall preservation (CWP group). The CWR group consisted of 14 men and 24 women with an average age of 51.8 years, while the CWP group consisted of 13 men and 22 women with an average age of 52.0 years. All patients were examined for intra-articular lesions and communicating ports by magnetic resonance imaging (MRI) prior to surgery, and recurrence of cysts was evaluated at the last follow-up examination. Rauschning and Lindgren grade (R-L grade) and Lysholm score were used to evaluate clinical outcomes. In addition, operation time and complications were recorded. Results:The average length of follow-up was 24.2 months (range, 16 to 32 months). There were no considerable differences in age, gender, cyst size, Lysholm score, R-L grade and concomitant intra-articular cases between the CWR group and CWP group prior to surgery (P > 0.05). The last follow-up MRI scans showed that in the CWR group, the cyst disappeared in 25 cases and shrunk in 13 cases. In the CWP group, the cyst disappeared in 22 cases, shrunk in 12 cases and persisted in one case. There was no obvious difference in recurrence rate between the two groups (0% vs 2.9%, P = 0.899). At the last follow-up, there were no differences in the R-L grade (P = 0.630) and Lysholm score (88.3 AE 5.6 points vs 90.1 AE 3.8 points, P = 0.071) between the two groups. Compared with the CWP group, operation time was significantly prolonged in the CWR group (38.3 AE 3.1 min vs 58.3 AE 4.4 min, P < 0.05). In the CWR group, three cases occurred fluid infiltration under the gastrocnemius muscle, which improved after pressure bandaging and cold compress. In another three cases, hematoma was found. The incidence of complications in the CWR group was markedly higher than that in the CWP group (15.8% vs 0%, P < 0.05). During the follow-up period, none of the patients developed serious complications such as neurovascular injury, deep venous thrombosis, or infection. Conclusion:For unicameral popliteal cysts, arthroscopic internal drainage combined with resection of the cyst wall did not further improve the clinical outcomes or reduce the recurrence rate, while prolonging the operation time and increasing the possibility of complications.

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“…Open excision is historically a classical method, which needs to detect the integrity of the cyst and completely resect the cyst wall; however, large wounds and high recurrence rates (42-63%) have been reported [3][4][5][6]. Recently, arthroscopic intervention is being popularized and a lot of arthroscopic treatment methods for popliteal cysts have been proposed [7][8][9][10][11]. Several studies have reported excellent outcomes of arthroscopic internal drainage of popliteal cysts without cystectomy by broadening the opening of cysts to eliminate the unidirectional flow [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have reported excellent outcomes of arthroscopic internal drainage of popliteal cysts without cystectomy by broadening the opening of cysts to eliminate the unidirectional flow [7][8][9][10]. Concomitant cystectomy which may lower the recurrence rate has yielded satisfactory therapeutic outcomes [11][12][13]. Compared with arthroscopic decompression of cysts alone, the additional posterior open cystectomy has demonstrated a potential to reduce the recurrence of popliteal cysts [14].…”

Section: Introductionmentioning

confidence: 99%

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

Kuang

Zhao

et al. 2020

BMC Musculoskelet Disord

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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.

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Extra-articular endoscopic excision of symptomatic popliteal cyst with failed initial conservative treatment: A novel technique

Cited by 11 publications

References 14 publications

Arthroscopic cystectomy and valve excision of popliteal cysts complemented with management of intra-articular pathologies: a low recurrence rate and good functional outcomes in a series of ninety seven cases

Arthroscopic cystectomy and valve excision of popliteal cysts complemented with management of intra-articular pathologies: a low recurrence rate and good functional outcomes in a series of ninety seven cases

Arthroscopic Internal Drainage with Cyst Wall Resection and Arthroscopic Internal Drainage with Cyst Wall Preservation to Treat Unicameral Popliteal Cysts: A Retrospective Case–Control Study

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

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