Evaluation of simple, fast endoscopic technique of popliteal cyst resection: About 200 cases of 9 years of experience

Abstract

Popliteal cyst existence and high recurrence rate after its surgical excision is still matter of concern. The purpose of this study is to evaluate results and introduce simple, fast technique of popliteal cyst excision based on more than 200 cases of arthroscopic/endoscopic and about 9 years experience. From 2003, we prefer endoscopic excision of popliteal cyst as a treatment of choice. In 2006, we developed very simple technique of its treatment with use regular arthroscopic portals. Since this time we have used the procedure as a standard part of our each knee arthroscopy. We performed all in one procedures that included intra-articular pathologies treatment combined with valvular mechanism removal and endoscopic cystectomy. We treated and evaluated 240 patients with popliteal cyst in arthroscopic/endoscopic way but in 136 cases we have used our simple technique. One hundred and eleven of them were evaluated at the final follow-up. In all patients, we made MRI and ultrasound exam as a qualification. Observation time after surgery was between 6–71 months and patients age between 6–57 years. Intra-articular pathologies, valvular mechanism type and frequency of its occurrence were estimated. Rauschning and Lindgren criteria, Lysholm score and VAS were used for evaluation. We measured time of the cyst and valvular mechanism excision. Patients underwent following ultrasonography 6, 12 months after procedure and at the follow-up. All patients had coexisting intra-articular pathologies: medial meniscal tears, patellar chondral lesions, synovitis and synovial hypertrophy, ligament instabilities, plica syndrome, rheumatoid diseases and lateral meniscus tears, chondromatosis and OCD in order of incidence. Valvular mechanism was observed in all patients as transverse capsular fold, overgrowth synovium and coat-like synovial hypertrophy. Preoperatively Rauschning and Lindgren score was about 2.3 and about 0.5 at follow-up. Average VAS was preoperatively about 4.9 and 9 at follow-up. Average Lysholm knee score was 56 preoperatively and about 85 at follow-up. Full range of motion was gained in 2.5 days on average, mean time of pain elimination was 29 h. Ultrasound exam showed persistent cyst in 14 cases at follow-up. The time of “cyst procedure” depended on thickness of its walls and patients weight and was between 6–19 minutes (mean 9 min). There were no persistent complications in our material. We found statistically significant correlation between grades III/IV cartilage lesions and cyst recurrence after cystectomy (P = 0.02 exact Fisher test). We consider our endoscopic treatment of popliteal cyst as a treatment of choice and our technique as a save, fast and reproducible procedure that could be used as a part of standard arthroscopy.