Baker's Cyst Research Articles

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

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).

US of the Knee: Scanning Techniques, Pitfalls, and Pathologic Conditions.

Pain and other disorders of the knee are a common presenting complaint in the ambulatory setting. Although the cornerstones of imaging evaluation of the knee are radiographs and magnetic resonance (MR) imaging, ultrasonography (US) is less expensive than MR imaging, easily available, and of comparable accuracy in the evaluation of certain pathologic conditions of the knee. The benefits of US include portability, low cost, high spatial resolution, dynamic imaging, and ability to guide percutaneous interventions when indicated. US also allows direct patient contact, facilitating immediate clinical correlation and the ability to compare with the contralateral knee. US evaluation of the knee can be targeted to a specific region on the basis of the complaint or be a comprehensive review. For comprehensive evaluation, the knee is divided into anterior, medial, lateral, and posterior compartments for structured evaluation of the tendons, ligaments, joint space, osseous structures, as well as peripheral nerves and vasculature. US is particularly well suited for evaluating injuries of the quadriceps and patellar tendons, injuries of the medial and lateral collateral ligaments, joint effusions, and fluid collections around the knee. There is additional utility in evaluation of the distal hamstrings tendons, the iliotibial tract, the superficial patellar cortex, the common peroneal nerve, the popliteal vessels, and juxta-articular cystic collections including Baker cyst. In-depth appreciation of relevant sonographic anatomy, common pathologic conditions, knowledge of important pitfalls, and mastery of US technique will allow one to effectively use this powerful bedside tool for the evaluation of a wide variety of knee disorders. ©RSNA, 2016.

A Case Study of Baker Cysts With Intramuscular Extension into the Medial Head of the Gastrocnemius

Baker cysts are common pathological findings during sonography of the popliteal fossa. Although they can present as a typical, mild variant or have an atypical sonographic appearance, a common feature of them is that their expansion is usually limited in the intermuscular planes or spaces between muscles and knee capsule. Baker cysts extending into muscles are rare. Two cases of a Baker cyst with extension into the medial head of the gastrocnemius (MHG) are reported with sonographic findings. Both of the cases were discovered in females, who had anterior or bilateral knee pain and radiographic features of osteoarthritis. Knee effusion was identified sonographically in both of the patient cases. In the popliteal fossa, Baker cysts were found in both patients with intramuscular extension into the MHG. In the first case, a cystic penetration was noted into the MHG, near the neck of the cyst, having a cone shape and oriented toward the inferior aspect of the muscle. The second case had a cystic penetration into the MHG near the base of the cyst with a tube shape, along its long axis. The possible pathogenesis is discussed.

The fate of Baker's cyst after total knee arthroplasty.

It is widely held that most Baker's cysts resolve after treatment of the intra-articular knee pathology. The present study aimed to evaluate the fate of Baker's cysts and their associated symptoms after total knee arthroplasty (TKA). In this prospective cohort study, 102 patients with (105 were included, however three were lost to follow-up) an MRI-verified Baker's cyst, primary osteoarthritis and scheduled for TKA were included. Ultrasound was performed to evaluate the existence and the gross size of the cyst before and at one year after TKA. Additionally, associated symptoms of Baker's cyst were recorded pre- and post-operatively. After one year, a Baker's cyst was still present in 87 patients (85%). There was a significant reduction in associated symptoms arising from the Baker's cyst before (71%) to after surgery (31%). No patients developed a new Baker's cyst associated symptoms. However, of the 72 patients who had reported Baker's cyst associated symptoms pre-operatively, 32 patients (44%) still complained of such symptoms one year after surgery. Baker's cysts had resolved in only a small number of patients (15%) one year after TKA and symptoms from the cysts persisted in 31%. Cite this article: Bone Joint J 2016;98-B:1185-8.

Poster 169 Anticoagulation-Induced Dissecting Hematoma Following Rupture of a Baker's Cyst: A Case Report.

Poster 169 Anticoagulation-Induced Dissecting Hematoma Following Rupture of a Baker's Cyst: A Case Report.

Knee osteoarthritis in traumatic knee symptoms in general practice: 6-year cohort study.

AimTo identify degenerative knee abnormalities using MRI and radiography 6 years after knee trauma, their relation with persistent knee symptoms and baseline prognostic factors.MethodsAdults (18–65 years) with incident traumatic knee symptoms visiting their general practitioner were followed up for 6 years and underwent baseline MRI and 6-year follow-up MRI and radiography. Logistic regression was used to analyse associations between various degenerative abnormalities on 6-year MRI and radiography, persistent knee symptoms and baseline prognostic factors for knee osteoarthritis (OA) on 6-year MRI.ResultsOn 6-year radiography, 60% of patients showed no OA, 28% showed OA with Kellgren&Lawrence (K&L) grade 1 and 13% showed with K&L grade 2. On 6-year MRI, 55% of patients showed cartilage defect(s), 45% showed osteophyte(s), 36% showed subchondral cyst(s), 40% showed bone marrow oedema, 21% showed meniscal subluxation, 83% showed meniscal degeneration,11% showed effusion and 11% showed a Baker's cyst. Of these, most were significantly related with 6-year radiographic K&L grade, while only lateral cartilage defect(s), medial osteophyte(s) and medial meniscal subluxation were significantly related with persistent knee symptoms. 32% of patients showed new onset or progressive knee OA on 6-year MRI, for which age, history of non-traumatic knee symptoms and bone marrow oedema at baseline were independent prognostic factors.ConclusionsDegenerative knee abnormalities on MRI are related to the K&L score; however, not all abnormalities are reflected in clinical outcome. Age, history of non-traumatic knee symptoms and bone marrow oedema predict knee OA 6 years after knee trauma, present in 32% of the patients.

Role of Ultrasonography in Knee Osteoarthritis.

Ultrasound has become popular among rheumatologists as the first-choice imaging investigation for the evaluation and monitoring of osteoarthritis (OA). Because of recent improvement in technology, ultrasound has the ability to demonstrate and assess the minimal structural abnormalities, which involve the pathophysiology and progression of OA, such as articular cartilage, synovial tissue, bony cortex, and other soft tissue. Nowadays, ultrasonography is a promising technique for assessing soft tissue abnormalities such as joint effusion, synovial hypertrophy, Baker cyst, and other structural changes including the decrease in cartilage thickness, meniscus bulging, and formation of osteophyte. Ultrasonography not only possesses diagnostic potential in knee OA but also reveals long-term predictability for disease progress as imaging biomarker. Ultrasonography has also been proven as a useful tool in guiding therapeutic interventions and monitoring treatment effectiveness. This review addresses the utility, reliability, and potential utilization of ultrasonography as an imaging technique in knee OA.

Safe Exclusion of Deep Vein Thrombosis by a Rapid Sensitive ELISA D-dimer and Compression Ultrasonography in 1330 Outpatients With Suspected DVT

Of 1330 outpatients with suspected deep vein thrombosis (DVT), a normal enzyme-linked immunosorbent assay (ELISA) d-dimer (VIDAS) of <500 ng/mL was true negative in 382 of 384 and false negative in compression ultrasonography (CUS) in 2, indicating a sensitivity of 99.52% and a negative predictive value (NPV) of 99.48%, with a specificity of 36% irrespective of clinical score. In 1059 outpatients with no DVT, the CUS was positive for the alternative diagnoses (AD): Bakers cyst, muscle hematoma, or old DVT in 62 (5.8%); superficial vein thrombosis without DVT in 78 (7.4%), and leg edema or varices in 17%. A second CUS in 641 patients was positive in 26 (4.0%), indicating an NPV of 96% after a first negative CUS. The NPV of the combination of a negative first CUS and a ELISA d-dimer test <1000 ng/mL was 99.1% at a specificity of 66.9%. As this strategy is cost effective by reduction in the need to repeat CUS by 67%, we designed a novel algorithm for the safe exclusion and diagnosis of DVT and AD for subsequent evaluation in a large prospective study.

Bakers' cyst and tibiofemoral abnormalities are more distinctive MRI features of symptomatic osteoarthritis than patellofemoral abnormalities

ObjectiveTo investigate which structural MR abnormalities discriminate symptomatic knee osteoarthritis (OA), taking co-occurrence of abnormalities in all compartments into account.MethodsThe Netherlands Epidemiology of Obesity (NEO) study is a population-based cohort...

Intervencionismo en musculoesquelético. Ecografía y tac

We aim to describe imaging-guided (ultrasound and CT) interventional techniques in the musculoskeletal system that can be performed by general radiologists, whether in hospitals, primary care clinics, private offices, or other settings.The first requirement for doing these procedures is adequate knowledge of the anatomy of the musculoskeletal system. The second requirement is to inform the patient thoroughly about the technique, the risks involved, and the alternatives available in order to obtain written informed consent. The third requirement is to ensure that the procedure is performed in accordance with the principles of asepsis in relation to the puncture zone and to all the material employed throughout the procedure.The main procedures that can be done under ultrasound guidance are the following: fine needle aspiration cytology (FNAC), core needle biopsy (CNB), diagnostic and/or therapeutic arthrocentesis, drainage of juxta-articular fluid collections, drainage of abscesses, drainage of hematomas, treatment of Baker's cyst, treatment of ganglia, treatment of bursitis, infiltrations and treatment of plantar fasciitis, plantar fibrosis, epicondylitis, Achilles tendinopathy, and Morton's neuroma, puncture and lavage of calcifications in calcifying tendinopathy. We also review the following CT-guided procedures: diagnosis of spondylodiscitis, FNAC of metastases, arthrography, drainages. Finally, we also mention more complex procedures that can only be done in appropriate settings: bone biopsies, treatment of facet joint pain, radiofrequency treatment.

The prevalence of periarticular lesions detected on magnetic resonance imaging in middle-aged and elderly persons: a cross-sectional study.

BackgroundPrevious studies showed that among persons with radiographic knee OA, periarticular lesions were significantly more common among participants with knee pain than those without. However, data were derived mostly from persons with knee OA, and there were few normal participants without knee OA in the data analyses. The objectives of this study were to investigate the prevalence of periarticular lesions detected by magnetic resonance imaging (MRI), and to examine their prevalence according to the presence of knee pain and radiographic knee osteoarthritis (OA) in community residents in Korea.MethodsDemographic and knee pain data were obtained by questionnaire from 358 participants of the population-based Hallym Aging Study who were recruited irrespective of the presence of knee OA or pain. Radiographic evaluations consisted of weight-bearing knee anteroposterior radiographs and 1.5-T MRI scans. Periarticular lesions included prepatellar or anserine bursitis, Baker’s cyst, and tibiofibular cyst. The prevalence of each lesion in subjects with knee OA or knee pain compared to those without was examined by a chi-square test.ResultsThe mean age of the subjects was 72 years and 50.6 % were female. Radiographic knee OA was present in 34.5 %. The most prevalent peri-articular lesion was Baker’s cyst (27.9 %), followed by tibiofibular cyst (9.5 %). Anserine bursitis and tibulofibular cyst were more common in subjects with knee OA (17.5 % vs 2.2 % for anserine bursitis, 15.8 % vs 6.1 % for tibiofibular cyst in subjects with and without OA, respectively), while Baker’s cyst and anserine bursitis were more common in subjects with knee pain (36.3 % vs 21.8 % for Baker’s cyst, 14.4 % vs 2.5 % for anserine bursitis in subjects with and without knee pain, respectively).ConclusionsPeriarticular lesions on MRI of the knee are common in middle-aged and elderly persons. Anserine bursitis and Baker’s cysts are more common in subjects with knee pain compared to those without.

Sonographic Findings in Gouty Arthritis: Diagnostic Value and Association with Disease Duration

The objective of this work was to evaluate the sonographic features of gouty arthritis and correlate findings with disease duration. The study was conducted on 100 patients in ambulatory care aged ≥40 y. Inclusion criteria included mono- or oligo-arthritis with effusion of the knee or the first metatarsophalangeal (MTP) joint and no known history of gout. A complete medical history was obtained with emphasis on the known risk factors or causes of gouty arthritis. A 12-MHz Medison linear probe was used for ultrasonography (US). Synovial fluid analysis with polarizing light microscopy was performed on all patients. Ninety-eight knee joints and 33 first MTP joints were examined. Gouty arthritis was found by US in four forms: (i) floating echogenic foci in effusion fluid or Baker cysts, (ii) deposits on the cartilage surface (double contour sign), (iii) erosions and (iv) mature tophus/tophi. These were found in 78.9%, 42.3%, 39.4% and 28.2% of patients, respectively. The overall sensitivity and specificity of US in detecting gout (as defined by the clinical gold standard, i.e., detection of urate crystals by polarizing light microscopy) were 85.9% and 86.7%, respectively. Detection of echogenic foci in effusion fluid was associated with the shortest duration of symptoms (median duration 2 y) followed by double contour sign (3.5 y), erosions (4 y) and tophus (12.5 y). Sonographic findings in gout can be assigned a temporal pattern, with echogenic foci being associated with the shortest and full tophus formation with the longest disease duration.

Surgical treatment of popliteal cyst: a systematic review and meta-analysis.

BackgroundThis systematic review and meta-analysis of the clinical efficacy of different surgical methods in the therapy of popliteal cysts may provide evidence about effective surgical treatments.MethodsPubMed, EMBASE, and OVID were searched with the following terms: (popliteal cyst* OR baker’s cyst*) AND (arthroscopic OR excision OR operative OR treat* OR surgery). Inclusion criteria included the following: studies reported the efficacy of different surgical methods in popliteal cyst patients; patients were ≥16 years; and studies must have involved a minimum of 10 patients. Studies were grouped according to the surgical methods, and a meta-analysis was employed to identify the success rate based on the pooled data.ResultsA total of 11 studies were included: The communication between the cyst and the articular cavity was enlarged in 7 studies; this communication was closed in 3 studies; and only intra-articular lesions were managed in 1 study. After the data were pooled, the success rates were 96.7 and 84.6 % in the communication-enlargement group and communication-closure group, respectively. Studies with communication enlargement were subgrouped into the cyst wall resection group and the non-cyst wall resection group, for which the success rates were 98.2 and 94.7 %, respectively.ConclusionsBased on the current available evidence, at present, any how arthroscopic excision of the cyst wall, arthroscopic management of intra-articular lesions, and enlarging the communication between the cyst and the articular cavity is an ideal strategy for the popliteal cyst. The current literature on the treatment of popliteal cysts is limited to retrospective case series. Future prospective studies with high-quality methodology and uniform scoring system are required to directly compare communication-enlargement surgery and communication-closure surgery and determine the optimal treatment of popliteal cysts. Cyst wall resection may improve the therapeutic efficacy, to draw definitive conclusions, and high-level clinical researches with a large number of patients and long-term follow-up should be initiated.

Effects of Sono-feedback during aspiration of Baker's cysts: A controlled clinical trial.

To determine whether (diagnostic and interventional) ultrasound imaging can be used to provide visual feedback affecting treatment outcome (pain and disability). Controlled clinical trial. A total of 52 patients with (ultrasonographically confirmed) symptomatic Baker's cysts were enrolled. The cysts were drained under ultrasound guidance and, if necessary, corticosteroid injections were given on the follow-up visit. In group I (n = 26) the patients did not observe the procedures on the ultrasound (US) screen. In group II (n = 26) the US images/videos were shown and explained to the patients. The patients were included in one of the groups consecutively, unless they refused the protocol of that group. Treatment outcome was assessed via US measurements, aspirate volumes, visual analogue scale (VAS) (knee pain, procedure discomfort), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Rauschning-Lindgren Classification (RLC), Kellgren-Lawrence grading scale, Hospital Anxiety and Depression Scale, and paracetamol intake. The 2 groups were similar regarding US measurements, aspirate volume and paracetamol use (p-values > 0.05). In both groups all VAS (p < 0.001) and WOMAC (p < 0.05) scores decreased after treatment. Although initial VAS and WOMAC scores were similar between the groups, all VAS/WOMAC scores, except VAS-2, WOMAC-2 pain, and WOMAC-3 stiffness, were significantly lower in group II (all p < 0.05). Initial RLC scores were similar between the groups; however, group II had significantly lower scores at visits 2 and 3. In patients with Baker's cysts (diagnostic/interventional) US imaging can be used as a simple means of visual biofeedback, favourably affecting the treatment outcome (pain and disability).

Features of pathological changes of fibro-cartilaginous tissue knee in patients with Baker cyst

Using magnetic resonance imaging (MRI) to evaluate the characteristics of pathological changes of fibro-cartilage of the knee in patients with Baker cyst, to assess the compliance of degrees of damage stages of osteoarthritis on a scale of Kellgren–Lawrence (K–L), and compare the results with the data of other researchers. This study included patients (38–82 years) with a cyst Baker accidentally detected during ultrasound veins of the lower extremities. The subjects underwent a single knee MRI. MRI was made in three dimensions using 3D gradient-echo protocol. Independent radiologist evaluated the presence and severity of chondral defect osteophytosis, damage to the menisci and ligaments, intraosseous edema and subchondral cysts. The osteoarthritis stage of the knee were identified by X-ray performed in a standing position in the standard two projections, with K–L scale. In this study, the results of a survey of 20 people, whose average age was 57.2 years. According to the radiological scale of K–L two patients were assigned to the stage 0 degree, 5 people to stage 1, 2, 4 each, and 3 – to stage 3. Synovitis of various severity was detected in 85% of the studies. Nineteen visualized the patellar cartilage damage, the condyles of the femur and tibia are most commonly affects the joint area. Among the most commonly injured ligament anterior cruciate ligament was determined – 9 (45%) patients in the same amount of detected intramedullary edema condyles femur and tibia. Eighteen subjects had at least one anomaly meniscus detectable by MRI, while in 11 (55%) persons were deviations, at least two or more regions of the knee examined. Our results suggest that not all visualized on MRI degenerative damage to intra fibro-cartilaginous tissue correlate positively with the stages of osteoarthritis of the knee, identified by standard radiographs and may not significantly affect the onset and progression of synovial cyst of the popliteal region.

Bakers Cyst with Synovial Chondromatosis of Knee - A Rare Case Report.

Introduction:Synovial chondromatosis is a rare intraarticular benign condition arising from the synovial membrane of the joints, synovial sheaths or bursae around the joints. Primary synovial chondromatosis typically affects the large joints in the third to fifth decade of life, although involvement of smaller joints and presentation in younger age group is also documented. The purpose of this case report is to document this rare extra articular synovial pathology present inside the baker’s cyst which required open synovectomy and debridement to eradicate it.Case Report:A 43 yearold male presented with a two year history of pain, swelling and restriction of right knee joint. After the clinical and radiological assessment, open synovectomy, removal of cyst and thorough joint debridement procedure was performed. Histopathological study confirmed the findings of synovial chondromatosis.Conclusion:Synovial chondromatosis is a rare benign condition. Complete synovectomy offers reliable cure rate.

Arthroscopic patterns of the poster-medial aspect of the knee joint: classification of the gastrocnemiussemimembranosus gateway and its relationship with Baker�s cyst

The gastrocnemius-semimembranosus bursa may communicate with the knee joint. The arthroscopic anatomy of the posteromedial aspect varies depending on the angle of the oblique popliteal ligament, the level at which it crosses the medial gastrocnemius tendon, and its relationship with the capsular joint and synovia. The aim of this paper is to identify possible patterns, and to evaluate their characteristics and their relationship with Baker's cyst. data archived from 185 consecutive arthroscopies were evaluated; an anatomic description and classification was carried out; the percentages of association with BC and the associated pathologies were reported. The different anatomies were classified into six groups based on the relationship above the medial gastrocnemius tendon, the capsular joint and synovia. The prevalence of Baker's cyst was 28.3%. The main associated intra-articular pathological condition was the contemporary presence of a meniscal tear and chondropathy. Exploration of the posterior aspect of the knee must be performed routinely. Knowing the possible anatomy patterns of the posteromedial arthroscopic aspect of the knee joint could help to identify the cyst and its gateway, thus facilitating its treatment. III.

A Baker Cyst Accompanied by Venous Thromboembolism.

A Baker Cyst Accompanied by Venous Thromboembolism.

Changes in ultrasound assessed markers of inflammation following intra-articular steroid injection combined with exercise in knee osteoarthritis: exploratory outcome from a randomized trial

Knee osteoarthritis (KOA) is a multifactorial joint disease affecting many people worldwide. Recommended treatments for KOA include exercise and steroid injections, or a combination of these. The objective of this exploratory outcome analysis of a randomized trial was to assess changes in inflammation markers assessed by ultrasound imaging (US) in KOA secondary to intra-articular corticosteroid injection given prior to exercise therapy. This study is a sub-study to a larger clinical trial which compared the clinical effects of steroid injection in KOA to placebo injection, both given prior to exercise therapy. The US outcomes were changes from baseline in US-assessed synovial size, Doppler activity presence in the synovial membrane, and numbers of US-detected Baker's cysts. US was performed at baseline, week 14 (exercise stop), and week 26 (follow-up). Fifty participants received steroid injection, and 50 received placebo injection. All participants received 12 weeks of exercise. Forty-five and 44, respectively, completed the study. At week 14, the group difference in the change in synovium thickness was 2.2 mm (95%, confidence interval (CI) -0.5 to 4.8), P = 0.11. There were no group differences in the changes in distribution of patients with presence of synovial Doppler activity (P = 0.98) or Baker's cysts (P = 0.35). There were no statistically significant differences between groups at week 26 in any outcome. Intra-articular steroid injection of KOA-patients prior to a 3 months exercise programme did not reduce synovial hypertrophy, synovial Doppler activity, or Baker's cyst presence more than a placebo saline injection according to US-assessments. EudraCT: 2012-002607-18.

Unusual Presentation of Brucellosis in Baker's Cyst

A 55-year-old diabetic male came with history of left knee pain and swelling for 7 days, fever for 3 days, and no history of trauma. He was complaining of tenderness on the left popliteal fossa, and the surrounding area was red and soft to firm swelling; he was limping, and could not bear weight on the left leg. The ultrasound showed that there was a well-defined heterogeneous hypoechoic cystic lesion. Under aseptic technique, continuous US guidance and local anesthesia, we aspirated almost all the fluid of the left calf collection, which was reported as complicated baker cyst. The patient was put on ciprofloxacin, gentamycin, and doxycycline. The patient was cleared from infectious diseases’ team and discharged after 7 days. J Med Cases. 2015;6(10):450-452 doi: http://dx.doi.org/10.14740/jmc2252w