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The Israel Medical Association Journal... Nov 2021
Review
Topics: Humans; Popliteal Cyst; Radiopharmaceuticals; Rupture, Spontaneous; Single Photon Emission Computed Tomography Computed Tomography; Synovial Fluid; Technetium Tc 99m Medronate
PubMed: 34811992
DOI: No ID Found -
American Journal of Physical Medicine &... Apr 2024There are many types of cysts in the leg; the most common is a popliteal (Baker's) cyst. This occurs when synovial fluid fills the tissue plane between the medial head...
There are many types of cysts in the leg; the most common is a popliteal (Baker's) cyst. This occurs when synovial fluid fills the tissue plane between the medial head of the gastrocnemius and the semimembranosus muscle and is often associated with intraarticular knee pathology. Treatment for various types of cysts includes aspiration with or without fenestration, injections with corticosteroids, dextrose, or various sclerosing agents, and surgical excision. This case describes a 58-yr-old man with a large cyst measuring 14.7 × 2.7 × 3.1 cm in size in the lateral calf, within the lateral gastrocnemius, with atypical size and location for a calf cyst. Computed tomography arthrogram showed intraarticular communication with the knee. The cyst recurred after two aspirations and injections with 25% dextrose/lidocaine. Aspiration and injection with doxycycline resulted in temporary relief followed by recurrence. Complete cyst resolution occurred after final aspiration without injectate. The cyst was likely synovial based on location, intraarticular communication, and fluid analysis. We suspect that complete resolution may have been due to repeated aspiration and injection, essentially performing longitudinal cyst fenestration, with possible contribution from doxycycline injection. Further study of intracyst doxycycline injection with reaspiration after 10 mins for treatment of refractory cysts may be warranted.
Topics: Male; Humans; Popliteal Cyst; Sclerotherapy; Doxycycline; Leg; Cysts; Glucose
PubMed: 37903617
DOI: 10.1097/PHM.0000000000002358 -
Nuklearmedizin. Nuclear Medicine Feb 2022The existence of a popliteal Baker's cyst was regarded as a contraindication for radiosynoviorthesis of the knee joint since decades. A so-called "ventile mechanism" was...
The existence of a popliteal Baker's cyst was regarded as a contraindication for radiosynoviorthesis of the knee joint since decades. A so-called "ventile mechanism" was discussed leading to a significant concentration of the intraarticularly applied, high energy beta emitting radiopharmaceutical yttrium-90-colloid in the cyst. This cyst arises from a bursa beneath the tendon of the medial head of the gastrocnemius muscle, normally communicating with the knee joint space. Since the cyst wall is much thinner than the knee joint capsule, a radiogenic rupture of the cyst was feared, leading to severe radiogenic necroses of the surrounding soft tissue. Due to this potential hazard, knee joint ultrasound is mandatory prior to radiosynoviorthesis to check for any popliteal cysts. New studies however decline the risk of a radiogenic cyst rupture after an appropriately performed radiosynoviorthesis of the knee joint.In case of a preexistent cyst rupture, the risk of a radiogenic tissue damage remains an issue and magnetic resonance imaging (MRI) is the method of choice to exclude this potential hazard. However, MRI sometimes leads to equivocal results. Scintigraphy of the knee joint after intraarticular application of Tc-99m-nanocolloid offers the possibility to check for the integrity of the Baker's cyst in these patients to be sure that radiosynoviorthesis will not lead to a relevant extraarticular leakage with soft tissue necroses. This study describes the procedure of intracavitary distribution scintigraphy by means of representative case reports.
Topics: Humans; Knee Joint; Magnetic Resonance Imaging; Popliteal Cyst; Treatment Outcome; Ultrasonography
PubMed: 34715704
DOI: 10.1055/a-1650-9513 -
Anesthesia and Pain Medicine Apr 2020Baker's cysts are usually located in the posteromedial side of the knee and seldom cause neuropathy.
BACKGROUND
Baker's cysts are usually located in the posteromedial side of the knee and seldom cause neuropathy.
CASE
We describe the rare case of a 57-year-old woman with a popliteal cyst who presented with limping gait and pain in her lower leg. She was electronically diagnosed with common peroneal neuropathy and transferred to our pain clinic. On ultrasound examination, about 2.0 × 1.2 cm sized popliteal cyst was found to extend to the fibular head, compressing the common peroneal nerve. Therefore, ultrasound-guided aspiration of the cyst and a common peroneal nerve block were performed. Immediately after the procedure, the pain, dysesthesia, and limping gait were relieved. Although her pain and dysesthesia were relieved, she underwent the surgery because of limping gait.
CONCLUSIONS
In this case, we found the Baker's cyst, the cause of the common peroneal neuropathy, and treated it immediately by just simple ultrasound examination and aspiration.
PubMed: 33329814
DOI: 10.17085/apm.2020.15.2.199 -
World Journal of Clinical Cases Jul 2022One of the causes of foot drop is compression of the common peroneal nerve caused by space-occupying lesions such as a synovial cyst or a ganglion cyst. Most previous...
BACKGROUND
One of the causes of foot drop is compression of the common peroneal nerve caused by space-occupying lesions such as a synovial cyst or a ganglion cyst. Most previous reports have involved compressive common peroneal neuropathy by intraneural ganglion cysts and synovial cysts. Compression of the peroneal nerve by extraneural ganglion cysts is rare. We report a rare case of compressive common peroneal neuropathy by an extraneural ganglion cyst.
CASE SUMMARY
A 46-year-old man was hospitalized after he reported a right foot drop for 1 mo. Manual muscle testing revealed scores of 1/5 on dorsiflexion of the right ankle. Hypoesthesia and paresthesia on the right lateral leg and foot dorsum were noted. He was diagnosed with a popliteal cyst by using electrophysiologic study and popliteal ultrasound (US). To facilitate common peroneal nerve (CPN) decompression, 2 cc of sticky gelatinous material was aspirated from the cyst under US guidance. Electrical stimulation and passive and assisted active ROM exercises of the right ankle and strengthening exercises for weak muscles using elastic band were prescribed based on the change of muscle power. A posterior leaf spring ankle-foot orthosis was prescribed to assist the weak dorsiflexion of the ankle. Follow-up US revealed that the cystic lesion was growing and magnetic resonance imaging demonstrated compression of the CPN by the cystic mass. The cyst was resected to prevent impending compression of the CPN.
CONCLUSION
Precise diagnosis and immediate treatment are important in cases of compressive common peroneal neuropathy caused by an extraneural cyst.
PubMed: 36158030
DOI: 10.12998/wjcc.v10.i21.7539 -
Nuklearmedizin. Nuclear Medicine Dec 2020The study examines the influence of a radiosynoviorthesis of the knee joint on the Baker's cyst volume over time. (Clinical Trial)
Clinical Trial
AIM
The study examines the influence of a radiosynoviorthesis of the knee joint on the Baker's cyst volume over time.
METHODS
Patients with radiosynoviorthesis of the knee joint with simultaneous Baker's cyst were retrospectively selected and asked for a sonographic control. The presence of a pre-therapeutic sonography with imaging of the Baker's cyst in longitudinal and cross-sectional view to determine the volume was necessary. Exclusion criterion was an intermediate therapy with influence on the volume of the Baker's cyst. Groups were formed with a time interval of 3 months (2 to 4 months, 5 to 7 months, etc.) after radiosynoviorthesis. If the number of patients within a group was too small, the group was combined with the following group. Pre- and posttherapeutic Baker's cyst volumes were compared. In 4 evaluable groups, the significance level was determined to p = 0.0125 using Bonferoni-correction.
RESULTS
102 radiosynoviorthesis in 84 patients aged between 23 and 86 years could be evaluated. These could be assigned to groups with a distance to the radiosynoviorthesis of 2 to 4 months, 5 to 7 months, 8 to 16 months as well as 20 and more months. In group 1 the volume decreased by 53 % (p < 0.007), in group 2 by 47 % (p < 0.007), in group 3 by 18 % (p < 0.005) and in group 4 by 73 % (p < 0.0007). No serious complications occurred with any radiosynoviorthesis.
CONCLUSION
The study shows a positive effect of a radiosynoviorthesis on an existing Baker's cyst, even over a longer period of time. Therefore, it seems reasonable to establish radiosynoviorthesis as a component of a multimodal therapy, for example before surgical intervention.
Topics: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Female; Follow-Up Studies; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Middle Aged; Popliteal Cyst; Prospective Studies; Radiotherapy Dosage; Retrospective Studies; Time Factors; Treatment Outcome; Ultrasonography
PubMed: 32869226
DOI: 10.1055/a-1213-5641 -
Journal of Clinical Medicine Oct 2023The Baker cyst (BC), also known as the popliteal cyst or parameniscal cyst, is a fluid-filled sac that normally develops in the back of the knee, between the...
The Baker cyst (BC), also known as the popliteal cyst or parameniscal cyst, is a fluid-filled sac that normally develops in the back of the knee, between the semimembranosus and medial head of the gastrocnemius. We aimed to evaluate the effectiveness of physiotherapy (10 days of treatment) that associates intermittent vacuum therapy (IVT) on the lower limbs in the treatment of the BC, respectively, in its size reduction. Sixty-five patients with knee osteoarthritis using Kellgren-Lawrence criteria and the presence of BC (ultrasonography evaluation), were divided into the Control and Vacuum groups. We collected the following features: sex, age, level of education, occupation, environment, body mass index, Knee Injury and Osteoarthritis Outcome Score, Western Ontario, and McMaster Universities Osteoarthritis Index, the Functional Independence Measurement, the Fall Risk Score, and the Visual Analog Scale were recorded at baseline and after 10 days. Both groups are similar in terms of demographic features. Regarding the clinical functional parameters, the results elicit a statistically significant change in all parameters between admission and discharge, including the echo volume at BC. Physical medicine and rehabilitation increase the autonomy of patients with BC. Clinical-functional improvement begins in the first 10 days of complex rehabilitation treatment; it is statistically significant and is not different between the two groups, which brings an additional argument for the effectiveness of conservative therapy in the treatment of BC. Although IVT has not demonstrated its superiority over classical balneo-physical therapy, additional research, and long-term monitoring are needed to provide additional arguments regarding this aspect.
PubMed: 37892743
DOI: 10.3390/jcm12206605 -
Journal of Orthopaedic Case Reports Jan 2023Popliteal cysts (Baker cysts) causing compressive neuropathy of combined tibial and common peroneal nerves is an exceptional entity. Especially, an isolated...
INTRODUCTION
Popliteal cysts (Baker cysts) causing compressive neuropathy of combined tibial and common peroneal nerves is an exceptional entity. Especially, an isolated multi-septate unruptured cyst (usually posteromedially) dissecting posterolaterally, thereby causing compression of multiple components of the popliteal neurovascular bundle as seen in this case report is unique in clinical field and in the literature. Awareness and early diagnosis of such cases along with a prudent technique will preclude permanent impairment.
CASE REPORT
A 60-year-old man with a 5-year history of a symptomless popliteal mass in his right knee was hospitalized with aberrant gait and walking difficulty that had deteriorated during a 2-month period. The patient reported hypoesthesia across the sensory innervations of tibial and common peroneal nerves. Clinical examination indicated a prominent painless and unfixed cystic, fluctuant swelling extending around 10 × 7 cm in the popliteal fossa encroaching into the thigh. Motor examination showed decrease in the power of ankle dorsiflexion, plantar flexion as well as inversion and eversion of the foot resulted in progressive difficulty in walking with high stepping gait. The action potential amplitudes of the right peroneal and tibial compound muscles were dramatically decreased with a drop in motor conduction velocities and a prolonging of the F-response latencies, according to nerve conduction studies. Magnetic resonance imaging of the knee showed a multi septate popliteal cyst measuring 13.8*6.5*6.8 cm along the medial head of gastrocnemius, and the T2-weighted sagittal and axial sections revealed the cyst connecting with the right knee. He was planned and undergone open cyst excision with decompression of the peroneal and tibial nerves.
CONCLUSION
This exceptional case establishes that Baker's cyst very rarely can cause compressive neuropathy vandalizing both the common peroneal and tibial nerves. Excision of the cyst by open technique along with neurolysis may be a more judicious and successful strategy for resolving symptoms quickly as well as to prevent permanent impairment.
PubMed: 37143556
DOI: 10.13107/jocr.2023.v13.i01.3510 -
Acta of Bioengineering and Biomechanics 2022The Baker's cysts appear within the popliteal fossa along with the progression of degenerative changes. Removal of its contents through aspiration is often a necessary...
PURPOSE
The Baker's cysts appear within the popliteal fossa along with the progression of degenerative changes. Removal of its contents through aspiration is often a necessary complement to treatment at various stages of the development of gonarthritis.
METHODS
The paper presented a procedure for needle automatic needle path planning in cyst aspiration in transverse plane. The method was based on optimization and used a custom objective function, which utilized cost maps obtained from preprocessed, segmented images of the knee. The optimization was carried out with Differential Evolution. Furthermore, a preliminary sensitivity analysis was carried out. The obtained paths were compared to the reference paths proposed by an experienced surgeon.
RESULTS
The procedure was tested on 165 numerical simulations. In all of the obtained paths, the needle successfully avoided crucial objects, such as veins, arteries and nerves. Furthermore, the overall travel distance in the joint was also minimized. When compared to the reference from the surgeon, 90% of the paths were almost the same or only slightly different. Furthermore, the remaining 10% of the generated paths were viable but different.
CONCLUSION
Based on the obtained results, the proposed solution could be a viable solution for planning the aspiration of Baker's cyst.
Topics: Humans; Popliteal Cyst; Knee Joint
PubMed: 37341049
DOI: No ID Found -
International Journal of Rheumatic... Nov 2023
Topics: Humans; Popliteal Cyst; Arthritis, Rheumatoid
PubMed: 37491774
DOI: 10.1111/1756-185X.14843