Baker's Cyst Research Articles

Polymyalgia Rheumatica Evolved into RS3PE Syndrome. What is the Culprit: Idiopathic or Secondary, Following mRNA-Based COVID-19 Vaccines? A Case Report and Brief Review of the Literature

We describe the clinical case of a 74-year-old male patient who received the second Comirnaty/Pfizer anti-COVID-19 vaccine dose. After 3 weeks he showed the clinical signs of polymyalgia rheumatica. The history included mild chronic normocytic normochromic anemia and hypogammaglobulinemia, osteoarthritis disease, livedo reticularis, hypercholesterolemia, and arterial hypertension. Despite prolonged treatment with NSAIDs and dexamethasone, the disease evolved into remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. Neoplastic diseases and associated collagen diseases were excluded. The clinical picture recurred, soon after, the booster dose of the Spikevax/Moderna vaccine. The inflammatory indices were high, the radiographs of the hands were free of erosions, the ultrasound investigations revealed bursitis of the shoulders, knee synovitis, marked subcutaneous edema of the lower limbs, hydrocele, bilateral Baker's cyst in the popliteal cavity, hematoma of a calf. The clinical picture, markedly improved, with oral prednisolone and was stabilized with the association of hydroxychloroquine. The finding of persistent hypomagnesemia was related to chronic intake of esomeprazole. The reports of rheumatological reactions in international databases and the rare cases of RS3PE <u>s</u>yndrome following the COVID-19 vaccine described in the literature are considered.

Arthroscopic Decompression of a Popliteal Cyst

Background: Popliteal (Baker) cysts are enlarged gastrocnemius-semimembranosus bursae leading to swelling in the popliteal fossa. Surgical decompression and capsulectomy is the definitive treatment for symptomatic cysts with arthroscopic or open decompression. Arthroscopic decompression is minimally invasive, entails lower risks, and allows for earlier and more aggressive rehabilitation compared with open excision. Indications: Indications for popliteal cyst decompression include pain and mechanical discomfort refractory to conservative treatment. Further indications are neurovascular compromise secondary to bursal enlargement, including thrombophlebitis, compartment syndrome, limb ischemia, and nerve entrapment. Additional considerations include concurrent pathology requiring surgical intervention. Technique Description: Following standard diagnostic arthroscopy, a Gillquist maneuver is performed to visualize the posteromedial compartment and transverse synovial fold. The operative limb is placed in a modified figure-of-four position. A posteromedial portal is established under spinal needle localization and utilized to debride the anterior capsular wall and cyst contents with an arthroscopic shaver. Attention is paid to the removal of the posterior transverse synovial infold to reduce risk of recurrence. Results: The literature reports favorable outcomes in arthroscopic decompression of popliteal cysts. In comparison of arthroscopic and open decompression, You et al. reported reduced mean operative time and reduced recurrence rate following arthroscopic management. In a retrospective study, Rupp et al. reported increased rates of cyst recurrence with concurrent meniscal and/or chondral injuries highlighting the importance of addressing concurrent intra-articular pathologies during decompression. Discussion/Conclusion: Arthroscopic decompression of symptomatic popliteal cysts can be performed safely and effectively. Arthroscopic approach allows for treatment of concurrent pathologies that predispose to increased rates of cyst recurrence. Nonetheless, rates of recurrence vary widely and therefore further study in treatment technique is necessary. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Ruptured baker cyst: A misdiagnosis

A ruptured Baker’s cyst is a presentation that can mimic deep vein thrombosis (DVT) or acute thrombophlebitis. It can complicate further with infection or compartment syndrome. Deep vein thrombosis (DVT) and Baker's cyst complicated by rupture present similar symptoms: acute pain and inflammation in the calf. We present 3 cases of ruptured Baker’s cyst presented to Department of Orthopaedics at SGRRIM&HS, Dehradun and its surgical management. Differential diagnosis is must and requires information from Doppler ultrasound imaging and for confirmation MRI because treating suspected DVT with therapeutic doses of low molecular weight heparins (LMWHs) can cause major bleeding and worsen the prognosis of complicated Baker's cyst.

Investigate the situation of knee osteoarthristic and evaluate the results of treatment in Ha Dong general hospital in 2021

Objective: To investigate the situation of knee osteoarthritis and evaluate the results of treatment of primary knee osteoarthritis at Ha Dong General Hospital in 2021.Subjects and methods: A retrospective descriptive study on 93 medical records with a diagnosis of knee osteoarthritis according to the standards of the American College of Rheumatology ACR 1991, VAS scale < 6 points, and Damp-Cold combined with Liver and Kidney deficiency according to TCM at Ha Dong General Hospital in 2021. Experimental group: Moxibustion-infrared lamp + Doc hoat ky sinh thang decoction + Electro- acupuncture for 20 days. Control group: Doc hoat ky sinh thang decoction + Electro-acupuncture for 20 days.Results: Physical workers and BMI ≥ 23 increase the risk of knee osteoarthritis. X-ray characteristics of the knee joint: mainly degeneration with 92.47% and inflammation with 60.81%. Features of knee joint ultrasound: Knee effusion accounted for 37.84%, Baker cyst accounted for 11.86%; 83.87% had osteophyte, 51.61% had endplate sclerosis and 39.78% had joint space narrowing. According to modern medicine: the number of patients with knee osteoarthritis and inflamed knee osteoarthritis has a similar incidence. According to traditional medicine: 81.72% were diagnosed with Damp-Cold combined with Liver and Kidney deficiency; 18.28% were Damp-Heat combined with Liver and Kidney deficiency, 9.68% were Damp-Cold standalone. The pain reduction efficiency according to VAS of the experimental group was 5.96 ± 1.09 points, higher than that of the control group which was 4.56 ± 0.77 points with statistical significance (p<0.05). In the experimental group, 30% of patients had no pain, 70% of patients had mild pain. In the control group, 10% of patients had moderate pain, 86.7% had mild pain and only 3.3% of patients had no pain. The difference between the two groups was statistically significant (p<0.05). The improvement effect of the experimental group was better than the control group, the difference was statistically significant (p < 0.05). During 20 days of treatment, there were no unwanted clinical effects.

A case of ruptured Baker's cyst induced by nivolumab and ipilimumab

Here, we presented the rare case of ruptured Baker's cyst induced by immune checkpoint inhibitors (ICIs). The history of more than one immune-related adverse event (irAE) like our case was reported to be associated with a more persistent course of arthritis. Mild persistent inflammation without subjective symptoms might exist after first ICI therapy followed by ruptured Baker's cyst. It is important to pay attention to potential musculoskeletal irAEs in ICI-treated patients with multiple irAEs. Emerging evidences have demonstrated the great efficacy of immune checkpoint inhibitors (ICIs) for various malignancies through enhancing antitumor immune responses. On the contrary, ICIs can cause immune-related adverse effects (irAEs) affecting various organ systems. Here, we report the rare case of ruptured Baker's cyst induced by ICIs. A 50-year-old Japanese woman referred to our department with a 3-month history of the vulvar enlarging nodule. She had no history of musculoskeletal diseases. Clinical examination revealed a 12 × 16 mm-sized black nodule on the right vulva (Figure 1A) and ipsilateral swollen inguinal lymph nodes. The tumor was resected with a 10-mm margin, and the sentinel lymph node biopsy (SLNB) was performed. The resection specimen showed massive invasion of round to oval tumor cells with melanin in the dermis (Figure 1B). The tumor thickness was 2.9 mm, and the SLNB was negative. Positron emission tomography-computed tomography (CT) found no evidence of distant metastasis. The diagnosis of malignant melanoma pT3bN0M0, stage IIB, was made. After surgery, she was followed up without additional treatment. Twenty months later, the metastasis appeared in right inguinal and external iliac lymph nodes (Figure 1C). The combination of nivolumab and ipilimumab every 3 weeks was started. After two courses, enteritis developed and she received oral prednisone 60 mg daily with the cessation of the chemotherapy, although lymph node metastases decreased in size (Figure 1D). During tapering prednisone, she developed pancreatitis, which was relieved by fasting and supplementation. Prednisone was tapered to 5 mg daily 2 months later and the administration of nivolumab alone was resumed. However, 2 days after the single nivolumab use, bilateral knee pain and right knee swelling appeared. Contrast-enhanced CT revealed that low-density areas with a light edge were present in both knees and that the right one extended inferiorly along the gastrocnemius muscle (Figure 1E). Rheumatoid factor and anticyclic citrullinated peptide antibody were negative. She was diagnosed as ruptured Baker's cyst induced by ICIs. The dose of prednisone was increased to 20 mg daily and salazopyrin was added, resulting in the gradual improvement. Although nivolumab was stopped, metastatic lesions have kept the decrease in size for more than 20 months (Figure 1F). Most musculoskeletal irAEs are mild arthralgia, whereas a minority of patients develop inflammatory arthritis (IA) with more pronounced pain.1, 2 In this report, we presented the seronegative IA case presenting as ruptured Baker's cyst during the ICI treatment. Baker's cysts rarely manifest alone and are usually associated with other articular inflammatory conditions.3 The history of more than one irAE like our case is associated with a more persistent course of arthritis.4 Mild persistent inflammation without subjective symptoms might exist after first ICI therapy in our case. There has been one report of ruptured Baker's cyst during the nivolumab treatment.1 Consistent with the above hypothesis, the patient developed occasional self-remitting bilateral knee joint pain preceded by several other irAEs prior to the onset of ruptured Baker's cyst. It is important to pay attention to potential musculoskeletal irAEs in ICI-treated patients with multiple irAEs. The authors declare no conflict of interest. Approval of the research protocol: No human participant was involved in this study. Informed Consent: Informed consent was obtained from the patient. Registry and the Registration No.: N/A. Animal Studies: N/A.

Magnetic Resonance Imaging of Internal Derangements and Other Knee Pathologies in Adult Nigerians.

Knee joint pathologies/injuries are one of the most common musculoskeletal complaints in adults worldwide. The aetiologies of knee joint disorders are diverse. Magnetic resonance imaging (MRI) is a sophisticated method of detecting and characterizing knee pathologies. This study was conducted to document the clinical presentation and MRI patterns of knee joint abnormalities in a group of adults in Lagos, Nigeria, and to juxtapose it with reports from other climes. A retrospective hospital-based analysis of the knee MRI of 158 adult Nigerians was conducted in a single health facility. The clinical history and knee MRI findings were extracted, analyzed, and documented. Statistical significance was established at P≤0.05. There were 158 participants comprising 92 males (58.2%) and 66 females (41.8%) between the ages of 18 and 79. The mean age of the males was 44.75 ± 14.41 years, while that of the females was 47.76 ± 13.72 years (P = 0.19). A history of previous trauma was elicited in 135 (85.4%) participants. Eighty-two right knees (51.9%) and 76 left knees (48.1%) were examined. The dominant joint pathologies detected include effusion (77.2%), medial meniscopathy (48.1%), tibial abnormalities (46.2%), femoral abnormalities (46.2%), patella abnormalities (46.2%), anterior cruciate ligament disorders (37.3%), lateral meniscopathy (27.2%), medial collateral ligament disorders (22.2%), and popliteal (Baker's) cysts (15.8%). ACL abnormalities were significantly more prevalent in male subjects. Knees with ruptured sACL had significantly more joint effusion and injuries to the medial meniscus, lateral meniscus, posterior cruciate ligament (PCL), medial retinacular ligament (MRL), femur, tibia, and fibula. There was no significant difference in the frequency of abnormalities between the right and left knees. Joint effusion, medial meniscopathy, osseous abnormalities (tibia, femur, patella), ACL abnormalities, lateral meniscopathy, and MCL abnormalities, in decreasing order, were the most frequent pathologies in the knee joints evaluated.

A 60 Years Old Woman with Ganglion Cyst of Popliteus Tendon Sinistra

The popliteal ganglion, also known as Baker's cyst, is an abnormal, fluid-filled distension of the gastrocnemius-semimembranosus bursa. These cysts rarely manifest alone and are often associated with intra-articular pathology and inflammatory conditions, such as osteoarthritis, meniscus tears, and rheumatoid arthritis. A 60-year-old woman came to the surgery clinic of Dr. Sayidiman Magetan hospital with complaints of lumps in the left knee crease. The patient noticed a lump in the crease of her left knee for two months. The patient said she did not feel pain in the lump, but the patient sometimes felt stiffness in the lump area when the patient worked in the fields. The localization status on inspection showed a mass in the popliteal area of the knee, which was round and well-defined. On palpation there is no pain, and can be moved mobile. Non-medical management is surgery/extirpation of the tumor mass.

Evaluation of the effects of dexamethasone iontophoresis, galvanic current, and conservative treatment on pain and disability in patients with knee osteoarthritis and Baker's cyst.

This study aims to evaluate the effectiveness of galvanic current and dexamethasone iontophoresis in the treatment of knee osteoarthritis and Baker's cyst (BC). This prospective, randomized, controlled, single-blind study included 37 patients (9 males, 28 females; mean age: 57.8+10.3 years; range 40 to 75 years) with knee osteoarthritis and BC, between January and August 2020. The patients were randomized into three groups: the iontophoresis group (n=13), the galvanic current group (n=11), and the control group (n=13). The numerical rating scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and ultrasonographic measurements of BC were recorded at baseline, two weeks, and six weeks. All groups received the same physiotherapy program. Dexamethasone iontophoresis and galvanic current therapy were administered to the patients in the iontophoresis and galvanic current groups, respectively, with a galvanic current at an intensity of 0.1-0.2 mA/cm2 for 10 days. There was no significant dissimilarity in demographic and clinical characteristics, basal NRS (resting and exercise) and WOMAC scores, and basal cyst volumes between groups. A significant temporal change was found in three groups for resting NRS, exercise NRS, and WOMAC scores and cyst volumes, except for the cyst volume in the control group. There was a notable difference in terms of improvement in cyst volumes between baseline and the second week in the iontophoresis group compared to the galvanic current group (p=0.046). There was a significant improvement in resting NRS and exercise NRS scores between baseline and the second week in the galvanic current group compared to the control group (p=0.015 and p=0.002, respectively). Additionally, a significant improvement was observed in resting NRS and exercise NRS scores between baseline and the second week in the iontophoresis group compared to the control group (p=0.009 and p=0.001, respectively). A significant clinical and functional improvement was detected with dexamethasone iontophoresis in the treatment of patients with knee osteoarthritis and BC.

Perforating Baker's cyst mimicking cutaneous malignancy

Perforating Baker's cyst mimicking cutaneous malignancy

Bilateral Ruptured Baker's Cysts Mimicking Deep Vein Thrombosis.

Bilateral Ruptured Baker's Cysts Mimicking Deep Vein Thrombosis.

Baker’s Cyst in Left Popliteal Fossa: A Case Report

INTRODUCTION: A popliteal cyst, also called a Baker cyst, is a benign uncontrolled swelling of the gluteus medius sac in the popliteal fossa at the back of the knee described this excess fluid and subsequent sac formation outside of the kneecap in the commencement.A Baker's (popliteal) cyst is a swelling of the knee's gastrocnemius-semimembranous bursa, which connects to the back of the synovial membrane. It commonly presents as a painless swelling in the popliteal fossa. Adults almost always develop an edema as a result of pathological changes to the knee joint. Sometimes, the cyst enlarges to the position in which it ruptures, releasing synovial fluid into the surrounding tissues and present physiologically as acute thrombophlebitis. Popliteal cyst infection is a rare complication that is often related to septic arthritis. Popliteal joint cysts, also known to as Baker's cysts, are sporadically together with intra-articular knee conditions like osteoarthritis and dislocated patella. Anatomically, the borders of the cyst resemble synovial tissue, and there may be chronic, non-specific inflammation. Even if they are not visible in the knee joint, osteocartilaginous loose bodies may be present within the cyst.CLINICAL FINDING: Pain in the back of knee were the main complaints of a 48-year-old female admitted to Tertiary Rural Hospital.DIAGNOSTIC EVALUATION: Chest x-ray and blood test including all tests are done. Were all performed as part of the physical evaluation to prevent acute and chronic post-surgical discomfort following Excision of Bakers cyst.THERAPEUTIC INTERVENTION: Post operative treatment advised 6 hours iv fluids normal saline, ringer lactate 500ml, antacids, antiemetic, analgesic given frequently advised as the first line of treatment following excision of baker cyst . It gives superior pain relief and allows for a speedier recovery.OUTCOMES: Patient condition was poor.CONCLUSION: Baker cyst is a benign uncontrolled enlargement of the bursa in the popliteal fossa at the back of the knee that is diagnosed in the hospital on the IPD based on the patient having symptoms of swelling and pain in the back of knee. Based on a patient admitted to Tertiary Rural Hospital for diagnostic tests are done as per doctor order blood test, surgery of the excision of cyst . To reduce acute and chronic post-surgical pain after excision baker cyst. Post operative medications advised.

Treatment Of A Cruciate Associated Cyst In A Collegiate Rower

HISTORY: A 20 year old female collegiate rower presents to the training room with gradual onset of right knee pain and decreased range of motion. She is unable to identify specific time or mechanism of injury. Her pain is in the posterior knee and worsens with knee flexion and extension against resistance. She particularly notices this while on the ergometer and has had to completely halt her training regimen. She has no history of prior knee injury. PHYSICAL EXAMINATION: The right knee is without obvious deformity, erythema or effusion. There is tenderness to palpation of the popliteal space, there is no palpable lesion. Range of motion is limited at full flexion. She has pain with full flexion and extension against resistance. Lachman is intact though produces pain. Posterior drawer and valgus/varus testing are intact. The remainder of the knee exam is unremarkable. DIFFERENTIAL DIAGNOSIS: 1. ACL sprain. 2. Popliteal cyst 3. Meniscus injury TEST AND RESULTS: Point of care US: No effusion. No Baker's cyst. Xray right knee: No osseous abnormalities. MRI right knee: Cystic lesion centered at the junction of the posteromedial ACL and lateral meniscal root bundles FINAL/WORKING DIAGNOSIS: Ganglion cyst associated with the ACL/meniscus. TREATMENT AND OUTCOMES: The athlete worked closely with her ATs on a rehab protocol with no improvement in symptoms. Injection therapy with corticosteroid versus arthroscopic intervention were discussed. Ultimately, she was taken to the operating room for successful arthroscopic debridement of the cyst. She was able to return to rowing within weeks of surgery and did not miss any competition.

MO804: Clinical and Ultrasonographic Features of 104 Knee Joints in Haemodialysis Patients and Their Association with Semiquantitative Measurement of Suprapatellar Effusion and Influence of Age, Gender and Duration of Haemodialysis

Abstract BACKGROUND AND AIMS Musculoskeletal disorders remain a major problem in haemodialysis (HD) patients. The aim of this study was to determine knee clinical and ultrasonographic (US) abnormalities in HD patients to evaluate the influence of age, gender and HD duration. METHOD This cross-sectional descriptive study was conducted on 52 patients (104 knee joints) who had been on regular HD for at least 6 months. Demographic, clinical, therapeutic and laboratory data were recruited. Participants were questioned about the presence of chronic knee pain and its duration, severity and laterality. Both knees were evaluated for the presence of joint swelling, crepitus and tenderness. All patients underwent musculoskeletal (MSUS) evaluation of both knees, which was conducted according to EULAR standardized procedures. MSUS was used to determine the presence of suprapatellar effusion, synovial thickening and Baker's cyst and to detect any abnormalities in the cartilage morphology. Quadriceps and patellar tendons and menisci were also sonographically assessed. Cartilage thickness was measured bilaterally from the central points of the medial condyle and lateral condyle patients were then compared according to age, gender and HD duration. RESULTS The mean age of the patients was 52.4 ± 14.15 years, 25 females and 27 males, and the median duration of HD was 3.5 (0.6–13) years. Chronic knee pain was present in 31/104 (29.8%) knees. Among the scanned 104 knee joints, there was at least one US abnormality in 91 (87.5%); suprapatellar effusion was found in 57 (54.8%), synovial thickening in 13 (12.5%), abnormal cartilage morphology in 68 (65.4%), quadriceps tendon abnormalities in 58 (55.8%), patellar tendon abnormalities in 34 (32.7), medial meniscus abnormalities in 30 (28.8%), lateral meniscus abnormalities in 13 (12.5%) and Baker’s cyst in 5 (4.8%) (Fig. 1). MSUS abnormalities were significantly more frequent in HD patients aged >40 years (94.9% versus 65.4; P = .000) than others. Chronic knee pain and abnormal cartilage morphology were more likely to occur in females (40% versus 20.4% and 74.1% versus 56%, respectively) than in males (Fig. 2). According to HD duration, quadriceps and patellar tendons showed more frequent US abnormalities in patients with HD duration > 3 years (86.5% versus 42% and 38.9% versus 26%, respectively) than in others. The prevalence of mild, moderate and severe suprapatellar effusion was 37.5%, 14.4% and 2.9%, respectively. There was a significant association between semiquantitative measurement of suprapatellar effusion and synovial thickening (P = .000), abnormal cartilage morphology (P = 0.023), quadriceps (0.002) and patellar tendon abnormalities (0.011) (Table 1). CONCLUSION Knee US abnormalities are prevalent among HD patients, especially those with female gender, older age and higher HD duration. These abnormalities may be subclinical. The severity of suprapatellar effusion is usually related to other knee structural abnormalities.

Application of Intra-articular Corticosteroid Injection in Juvenile Idiopathic Arthritis.

Juvenile idiopathic arthritis (JIA) is one of the common rheumatic diseases in pediatrics. Persistent synovitis and joint pain cause reduced range of motion, deformity and gait interruption, which are important reasons for children's disability and a decline in their quality of life. Rheumatology experts have explored good treatment strategies, among which intra-articular corticosteroid injections (IACIs) targeting joints can greatly reduce these systemic adverse reactions while still obtaining local anti-inflammatory effects. Local inhibition of synovitis by the use of steroid hormones in a joint cavity can avoid or reduce adverse reactions of systemic therapy, prevent or treat leg length variance and joint contracture, solve Baker's cyst, improve tenosynovitis, promote physical therapy and rehabilitation, make gait change smoothly, relieve pain, and restore joint function. Given the importance of IACIs in treating JIA, this paper reviewed the case selection, drug injection, dose selection, current anesthesia and injection techniques, the efficacy, recurrence, and influencing factors of IACIs, the management of physiotherapy intervention post-injection, the application of ultrasound guidance and the safety and complications of IACIs in children with JIA. This study aims to guide the use of IACIs for the best approach throughout the review.

Epidemiology of Generalized Ligamentous Laxity in Iran: A National Study Including Different Iranian Ethnic Groups and its Relationship with Musculoskeletal Disorders.

Ligamentous laxity is a condition that leads to joints' hypermobility beyond their average and normal range of motion. It can cause musculoskeletal and joint injuries. This national multi-centered study investigated the epidemiology of generalized ligamentous laxity and its relationship with musculoskeletal disorders among Iranian adults with different ethnic backgrounds. A total of 1,488 people (age range: 17-40 years) were selected from eight cities and six different ethnicities of Iran and included in this cross-sectional study. The presence of ligamentous laxity with clinical examinations was searched according to Beighton score criteria. They were also examined for any kind of musculoskeletal disorders that might accompany ligamentous laxity. The Chi-square test was used to compare the frequency of ligamentous laxity based on gender and ethnicity; moreover, the t-test was utilized to compare the frequency of ligamentous laxity based on age. In total, 280 (18.8%) participants had generalized ligamentous laxity, and it was more prevalent in women (22.7%), compared to men (14.4%). Regarding ethnicity, the highest and lowest prevalence rates were in Gilak (37.9%) and Persian-Arab (6%) ethnicities, respectively (P<0.001). Ligamentous laxity showed a significant relationship with sports injury, joint complaint, joint dislocation, ligament sprain, sciatica and back pain, Baker's cyst, and varicose veins (P<0.001). Most participants with generalized ligamentous laxity (93.6%) had no knowledge of their problem and its importance in choosing an appropriate sports activity. The prevalence of generalized ligamentous laxity seems to be relatively high among the 17-40-year-old population of Iran, especially in women. It seems to be significantly related to ethnicity. It is strongly recommended that examinations, screening, and information be provided at an early age in schools or at least in areas with a high prevalence as national programs.

Dynamics of Sonographic and Morphological Changes in Baker's Cyst Formation

Comparative analysis of sonographic and morphologic assessment in formation of Baker's cyst has been performed. There were 25 patients with gonarthrosis lasted 5.6 + years. In development of Bakers cyst 3 periods were defined. Each period is characterized by structural changes caused by cyst development age and gonarthrosis stage. The period has specific quantitative and qualitative patterns of cyst wall and content. Ultrasound diagnosis of cyst structural development was reliably verified by histologic data. Ultrasound assessment of synovial masses in popliteal area allows to differentiate Bakers cyst with other pathologic processes in deforming knee arthrosis of different genesis. Accurate definition of structural cyst development periods is useful for the detection of indications for cyst extirpation.

Роль костного метаболизма в патогенезе гонартроза

Актуальность проблем остеоартроза коленных сочленений (гонартроза) обусловлена широкой его распространенностью и высоким риском развития ограничений функции суставов с нарушением трудоспособности и снижением качества жизни пациентов. Целью и задачами данной работы стала оценка роли костного метаболизма при разных вариантах клинического течения гонартроза, связей с развитием остеопороза, с костно-деструктивными изменениями коленных суставов по данным рентгенографии, сонографии, магнитно-резонансной томографии, рентгеновской денситометрии. Материал и методы. Обследовано 104 больных остеоартрозом (47 % мужчин и 53 % женщин) в возрасте от 32 до 76 лет. Гонартроз установлен в 96 % наблюдений. Манифестный реактивный синовит по результатам клинико-сонографического исследования диагностирован в 62 % случаев, полиартроз — в 55 %, системный остеопороз — в 14 %, остеокистоз — в 91 %, а спондилопатия в виде остеохондроза и дугоотростчатого артроза — в 72 %. Результаты. У больных гонартрозом наблюдаются значительные изменения в крови маркеров костного метаболизма (МКМ), проявляющиеся дисбалансом остеоассоциированных макроэлементов (кальция, магния, фосфора) с развитием гипокальциемии, которая регистрируется соответственно в 98 %, высокой активностью щелочной фосфатазы (в 47 % случаев), признаками гиперпаратиреоидизма и гиперостеокальциемией. Нарушения костного метаболизма при остеоартрозе коленных сочленений связаны с темпами прогрессирования заболевания и распространенностью суставного синдрома, а показатели МКМ могут иметь прогностическое значение. МКМ (остеоассоциированные макроэлементы, гормоны — паратирин, кальцитонин, остеокальцин, а также фермент щелочная фосфатаза) участвуют в патогенетических построениях гонартроза, определяя развитие отдельных рентгенологических, сонографических и магнитно-резонансных артикулярных и периартикулярных признаков патологии коленных суставов (степень сужения суставных щелей, эпифизарный остеопороз, трабекулярный отек в мыщелках бедренной и большеберцовой костей, изменения рогов менисков, формирование кист Бейкера, интраартикулярных хондромных тел и тел Гоффа). Вывод. Нарушения костного метаболизма имеют клинико-патогенетическое значение при гонартрозе, что требует разработки специальной медицинской технологии проведения лечебно-реабилитационных мероприятий у таких больных.

Using Marker-Controlled Watershed Transform to Detect Baker's Cyst in Magnetic Resonance Imaging Images: A Pilot Study.

Nowadays, magnetic resonance imaging (MRI) has a high ability to distinguish between soft tissues because of high spatial resolution. Image processing is extensively used to extract clinical data from imaging modalities. In the medical image processing field, the knee's cyst (especially Baker) segmentation is one of the novel research areas. There are different methods for image segmentation. In this paper, the mathematical operation of the watershed algorithm is utilized by MATLAB software based on marker-controlled watershed segmentation for the detection of Baker's cyst in the knee's joint MRI sagittal and axial T2-weighted images. The performance of this algorithm was investigated, and the results showed that in a short time Baker's cyst can be clearly extracted from original images in axial and sagittal planes. The marker-controlled watershed segmentation was able to detect Baker's cyst reliable and can save time and current cost, especially in the absence of specialists it can help us for the easier diagnosis of MRI pathologies.

241. A Comparison of Staphylococcal and Streptococcal Septic Arthritis with Lyme Arthritis

BackgroundSeptic arthritis is considered the most important differential diagnosis in suspected Lyme arthritis. The present study sheds light on the most frequent misdiagnoses in Lyme arthritis cases and clues for differentiation from Staphylococcal and Streptococcal septic arthritis.MethodsWe studied patients with positive joint fluid cultures with Staphylococcus aureus (SA) and streptococci and Lyme polymerase chain reaction (PCR) positive joint fluid in 9 hospitals in Eastern Pennsylvania and 1 in Warren county, New Jersey over a 3 year period.ResultsOne hundred and thirty four out of 7000 SA and 21 out of 1321 streptococcal isolates were from joint fluid. Twenty nine had Lyme arthritis, ages 5-74 ( 24 males,5 females). Twelve out of 29 were ages 10-18 with 20/29 under age 40. Predominant joint affected was a single knee 27/29. All had pain with or without swelling and little erythema. Two had fever. One reported a tick bite. None had other manifestations of Lyme disease. The diagnosis at the initial visit was sprain or sports injury in 5, osteoarthritis in 5, inflammatory arthritis or gout in 2 each, i septic arthritis, 1 viral syndrome and 1 ruptured Baker's cyst. Joint fluid count range was 3500-77,360 with only 3 over 50,000. White blood cell count (wbc) range was 3200-14,580. SA arthritis involved knee in 66 (49.3%), hip 31(23.9%), elbow 19 (14.2%), shoulder 14 (10.4%) with 2 wrist, 1 ankle and 1 sterno-clavicular joint. Fifty seven had a history of joint surgery. Eighty six were male and 48 female. age range 14-95 with a median age 65. Synovial fluid cell count was 335-470,000 and wbc 5,200-28,410 . Streptococcal septic arthritis ( 13 male 8 female) involved the knee in 17/21 with one each of hip, elbow, shoulder. The ages were 36-86 with 15/21 over age 60. Synovial fluid count was15,242-641,425 . Wbc count 11,140-25,080 .Nine out 21 had prior joint surgery.ConclusionLyme arthritis patients were younger, mostly involving 1 knee, majority male without other manifestations of Lyme disease. Highest synovial fluid count was 77,360 and highest wbc count 14,580. Most frequent misdiagnoses were sports injury/sprain or osteoarthritis. SA and Streptococcal arthritis were mostly in elderly, with higher joint fluid cell and wbc counts. Only 1/29 Lyme arthritis was initially misdiagnosed septic arthritis.Disclosures All Authors: No reported disclosures

Factors affecting Baker cyst volume, with emphasis on cartilage lesion degree and effusion in the young and middle-aged population

BackgroundThe principal aim of this study was to investigate the presence of factors affecting Baker’s cyst volume in young and middle-aged populations.MethodsOpen cyst excision with valve and capsule repair, as well as knee arthroscopy, were used to treat eighty-five patients. The cases were categorized in terms of age, effusion, chondral lesion degree, meniscal tear degree, and Lindgren scores. An ultrasonography (USG) device was used to calculate the cyst volume. The IBM-SPSS 22 program was used for statistical analysis and to assess the relationships between variables using Spearman’s correlation tests.ResultsThe degree of chondral lesion was moderately and positively correlated with cyst volume in the total population (correlation coefficient: 0.469; p < 0.05).The degree of the chondral lesion was moderately and positively correlated with the degree of effusion (correlation coefficient: 0.492; p < 0.005). The cyst volume was weakly and positively correlated with the degree of effusion (correlation coefficient: 0.20; the correlation was at the limits of statistical significance p = 0.07 < 0.08).ConclusionsThis study revealed that an increase in chondral lesion severity increases the amount of effusion and cyst volume.