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

Abstract

BackgroundAssociated 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.MethodsOne 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.ResultsCyst 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.ConclusionsOur 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 evidenceIV (Retrospective clinical study without comparison group).

A comparison of clinical efficacy between different surgical approaches for popliteal cyst

“…In the combination group, patients needed to be turned over and disinfected again, resulting in much longer procedure time, with increased the risk of infection [ 17 ]. Therefore, although very good outcomes of the combination treatment were observed here and others [ 18 ], the shorter operation duration and low infection rates favored arthroscopic internal drainage. Additionally, because of less pain scores in arthroscopic internal drainage, patients were able to walk earlier, which effectively prevented vein thrombosis in lower limbs.…”

Possible Approaches to Endoscopic Treatment of Popliteal Cysts: From the Basics to Troublesome Cases

“…Arthroscopic surgery is more effective and allows for a faster recovery and early introduction of rehabilitation 3 . Even if open posterior cystectomy can reach a rate of recurrence as low as 2%, it still has some disadvantages, such as a wide surgical approach, increased risk of wound infection and delayed healing, and poorer visualization of anatomic landmarks in comparison with arthroscopy 7 . Among other arthroscopic techniques, our technique is distinguished by its simplicity.…”

Arthroscopic Treatment of Popliteal Cysts

“… 3 , 4 Although there have been a few modifications of the description of these cysts, the popliteal cyst is best defined as an enlargement of the gastrocnemius-semimembranosus bursa, which communicates with the knee joint via a valve-like structure. 4 , 5 It is the presence of this valve-like structure that allows the cysts to be successfully treated via arthroscopic surgery.…”

“…Previous surgical treatment of popliteal cysts via an open approach has been previously described 5 , 6 and can cause complications such as fistula formation, recurrence, abscess, and saphenous nerve injury. 7 Many of these complications can be avoided by use of an arthroscopic approach.…”