-
Skeletal Radiology Nov 2023The cause of knee osteoarthritis (OA) and knee pain associated with OA is not well understood. Periarticular cystic lesions and bursae around the knee are among the most... (Review)
Review
The cause of knee osteoarthritis (OA) and knee pain associated with OA is not well understood. Periarticular cystic lesions and bursae around the knee are among the most common morphologic features identified on MRI in the setting of OA. Despite widespread association of these lesions with knee OA and their inclusion in semiquantitative MRI scoring assessment systems for knee OA, the role that these lesions play in the development of knee pain and OA remains uncertain. In this discussion, we review the cystic lesions and bursae most commonly associated with OA of the knee, examine their relation and role in whole organ imaging assessments of OA, and present the literature investigating the associations of periarticular cysts and cyst-like lesions with knee pain and OA.
Topics: Humans; Osteoarthritis, Knee; Knee Joint; Knee; Bursa, Synovial; Magnetic Resonance Imaging; Pain
PubMed: 36764945
DOI: 10.1007/s00256-023-04295-7 -
The Ulster Medical Journal Jan 2023To evaluate the efficacy of ultrasound and fluoroscopic-guided aspiration and therapeutic injection of Baker's cysts in the relief of pain and pressure symptoms. (Review)
Review
Management of symptomatic Baker's cysts with ultrasound and fluoroscopic-guided aspiration followed by therapeutic injection with Depomedrone and Bupivacaine leads to a durable reduction in pain symptoms in a majority of patients; A case series and literature review.
PURPOSE
To evaluate the efficacy of ultrasound and fluoroscopic-guided aspiration and therapeutic injection of Baker's cysts in the relief of pain and pressure symptoms.
METHODS
A retrospective, observational, single-arm study of consecutive patients referred from the Orthopaedic service for image-guided aspiration followed by therapeutic injection of symptomatic Baker's cysts was performed with institutional approval in the context of a Quality Improvement project. Patients' pain was graded using a 10-point Likert scale. Under standard sterile conditions, a 10 cm 5 Fr Yueh centesis needle was advanced into the cyst under direct ultrasound guidance, septae disrupted as necessary, the contents of the cyst aspirated, and a sample sent for microbiological analysis. Bursography was performed in an attempt to identify the expected communication with the knee joint, the contrast was aspirated and 40 mg of DepoMedrone and 5 ml of Bupivacaine were injected.
RESULTS
Thirteen patients were referred, nine of whom satisfied the inclusion criteria (all female, average age 63.8 years). Over a 35-month period, 11 procedures were performed (bilateral in 1, repeated in another) yielding an average volume of 20.1 ml (range 10 - 50 mls). In 2/11 procedures the communication with the knee joint was outlined. The average follow up post-procedure was 8.3 months. The average patient's pain score reduced to zero from 5.7 for an average period of 5.96 months. After this period patients reported a gradual return of an ache, but none returned to the pre-procedure severity which, in some cases, had prevented them from sleeping.
CONCLUSION
Aspiration of symptomatic Baker's cysts under Ultrasound and fluoroscopic guidance followed by therapeutic injection of DepoMedrone and Bupivacaine leads to a durable reduction in pain symptoms in a majority of patients.
Topics: Humans; Female; Middle Aged; Bupivacaine; Retrospective Studies; Popliteal Cyst; Ultrasonography; Pain
PubMed: 36762137
DOI: No ID Found -
Journal of Vascular Surgery Cases and... Mar 2023Adventitial cystic disease (ACD) is a rare condition that typically presents in young healthy men with symptoms of claudication. ACD is characterized by formation of a...
Adventitial cystic disease (ACD) is a rare condition that typically presents in young healthy men with symptoms of claudication. ACD is characterized by formation of a mucinous cyst within the adventitia of a blood vessel, usually in the popliteal artery, causing compression of the vessel's lumen and leading to reduced flow and symptoms of claudication. We have presented a rare case of ACD of the common femoral artery in a young female patient that was treated successfully with resection and femoral vein graft interposition reconstruction.
PubMed: 36718217
DOI: 10.1016/j.jvscit.2022.11.008 -
The American Journal of the Medical... Jun 2023
Topics: Humans; Popliteal Cyst; Osteoarthritis, Knee; Diagnosis, Differential
PubMed: 36702350
DOI: 10.1016/j.amjms.2023.01.006 -
Journal of the College of Physicians... Dec 2022Compression of the common peroneal nerve by lateral meniscal cysts is rare. We report a 29-year male patient who complained of a gradually enlarging mass in the right...
Compression of the common peroneal nerve by lateral meniscal cysts is rare. We report a 29-year male patient who complained of a gradually enlarging mass in the right popliteal fossa. He was diagnosed with a lateral meniscal cyst and a common peroneal nerve injury. The patient underwent arthroscopic surgery, including lateral partial meniscectomy and cyst drainage. When followed up at 3 months, the dorsal extensor strength of the right foot recovered to grade 5, and sensation of the distal right lower limb returned to normal. No recurrence of the cyst was found at the last follow-up at 18 months. This is a rare case of common peroneal nerve paralysis caused by a lateral meniscal cyst. Key Words: Meniscal cyst, Common peroneal nerve, Nerve injury.
Topics: Humans; Male; Peroneal Neuropathies; Peroneal Nerve; Cysts; Menisci, Tibial; Arthroscopy
PubMed: 36597339
DOI: 10.29271/jcpsp.2022.Supp0.SS203 -
BMJ Case Reports Dec 2022Cystic adventitial disease (CAD) is a rare cause of claudication in which a mucinous cyst forms within the adventitial layer of a blood vessel, most commonly the...
Cystic adventitial disease (CAD) is a rare cause of claudication in which a mucinous cyst forms within the adventitial layer of a blood vessel, most commonly the popliteal artery, resulting in luminal narrowing. This paper presents a case of a man in his mid-50s with unilateral lower limb popliteal artery CAD, which was not initially identified on either duplex ultrasonography or CT angiography. He was successfully treated with surgical resection of the affected segment of the popliteal artery and autologous vein grafting.
Topics: Male; Humans; Intermittent Claudication; Ultrasonography, Doppler, Duplex; Autografts; Popliteal Artery; Mucocele
PubMed: 36585048
DOI: 10.1136/bcr-2022-251707 -
Case Reports in Orthopedics 2022Tenosynovial giant cell tumor (TGCT) is a rare neoplasm of the joint synovium that has a wide clinical spectrum including pain and stiffness in the affected joint, joint...
Tenosynovial giant cell tumor (TGCT) is a rare neoplasm of the joint synovium that has a wide clinical spectrum including pain and stiffness in the affected joint, joint swelling, periarticular erosions, and cartilage loss, which can severely impact quality of life. The mainstay treatment for TGCT has been surgery involving partial or total synovectomy using arthroscopic or open techniques. However, surgical resection alone is associated with high recurrence rates, particularly in diffuse-TGCT (D-TGCT) cases. The 3 cases presented here summarize a combination approach (surgery+pexidartinib [tyrosine kinase inhibitor]) in patients with previously unresectable or inoperable D-TGCT. A 29-year-old male was treated with pexidartinib prior to surgery, resulting in tumor reduction. A left total hip arthroplasty (THA) was then performed with a lack of recurrence in 12 months postoperative, and the patient currently on pexidartinib treatment. A 35-year-old female, nearly a decade following a left foot mass resection, was treated with pexidartinib following disease recurrence. A decrease in soft tissue lesions at the midfoot and decreased marrow enhancement at the first metatarsal head were seen within 4-5 months of pexidartinib treatment; the patient is currently on pexidartinib (400 mg/day) with improved symptom control. A 55-year-old male patient received pexidartinib pre- and postoperatively. A reduction in swelling and the size of the popliteal cyst was significant and maintained, with the synovial disease growing when pexidartinib was discontinued. Surgery and adjuvant therapy eliminated the disease as of the last follow-up visit (11 months postoperative). These cases provide a unique perspective based on tumor location, type/timing of treatment strategy, and patient outcomes. Optimal treatment strategies for this debilitating disease may entail utilizing a combination approach (surgery+systemic treatment) to reduce surgical morbidity and the risk of postoperative disease recurrence.
PubMed: 36510622
DOI: 10.1155/2022/7768764 -
Journal of Orthopaedic Surgery and... Dec 2022Baker's cyst is the most common cystic disease of the knee, and a fast and accurate diagnosis of Baker's cyst is essential for a better management. Ultrasound is a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Baker's cyst is the most common cystic disease of the knee, and a fast and accurate diagnosis of Baker's cyst is essential for a better management. Ultrasound is a rapid, portable, widely available, inexpensive and noninvasive imaging modality. However, the diagnostic accuracy of ultrasound on Baker's cyst still remains undetermined. We conducted the first meta-analysis to comprehensively assess the accuracy of ultrasound for the detection of Baker's cyst.
METHODS
PubMed, Embase and Web of Science were searched from inception to July 14, 2022, without language restrictions. Studies providing cross-tabulations of ultrasound versus pathology (gold standard) or MRI (standard imaging technique) for diagnosis of Baker's cyst were included. Indicators for the diagnostic accuracy of ultrasound, including sensitivity, specificity and area under the curve, were calculated using a bivariate model. Sensitivity analysis was conducted to evaluate the heterogeneity and robustness of the results.
RESULTS
A total of 13 studies with 1,011 subjects (mean age 32.2 years; men 53.5%) met the inclusion criteria. The pooled sensitivity, specificity and area under the curve of ultrasound for diagnosis of Baker's cyst, compared with pathology, were 0.97 (95% confidence intervals: 0.73-1.00), 1.00 (0.98-1.00) and 1.00 (0.99-1.00), respectively. The pooled estimates of ultrasound versus MRI were 0.94 (0.87-0.98) for sensitivity, 1.00 (0.83-1.00) for specificity and 0.97 (0.95-0.98) for area under the curve. Sensitivity analysis did not change the results materially.
CONCLUSION
Ultrasound shows excellent diagnostic accuracy for the assessment of Baker's cyst and provides similar diagnostic information (absent or present) compared to MRI. Because of its advantages of low cost, portability and accessibility, ultrasound is likely to be a choice of imaging technique for screening Baker's cyst in clinical and population settings as well as in follow-ups.
Topics: Male; Humans; Adult; Popliteal Cyst; Ultrasonography; Osteoarthritis, Knee; Knee Joint; Knee
PubMed: 36510299
DOI: 10.1186/s13018-022-03430-9 -
Frontiers in Cardiovascular Medicine 2022Intramuscular ganglion cyst (IMGC) is a very rare lesion with an unidentified pathogeny that originates within the muscle. We encountered a case of 49-year-old man who...
Intramuscular ganglion cyst (IMGC) is a very rare lesion with an unidentified pathogeny that originates within the muscle. We encountered a case of 49-year-old man who complained of intermittent claudication in the right lower limb for 2 months. An intramuscular ganglion cyst in the biceps femoris muscle was diagnosed and located by Computed tomography angiography (CTA) and magnetic resonance imaging (MRI), which compressed the popliteal artery and resulted in ischemia in the right lower limb. Six months after surgical resection, there was no recurrence of the cyst and the popliteal artery was patency. We describe this case with a review of the relevant literature.
PubMed: 36505376
DOI: 10.3389/fcvm.2022.1018694 -
Journal of Visualized Experiments : JoVE Nov 2022Unicompartmental knee arthroplasty (UKA) is an established treatment option for anteromedial osteoarthritis, and popliteal cysts are a common finding in the knee among...
Unicompartmental knee arthroplasty (UKA) is an established treatment option for anteromedial osteoarthritis, and popliteal cysts are a common finding in the knee among patients with chronic osteoarthritis pain. The two are so closely related that popliteal cysts are commonly discovered during the unicompartmental knee arthroplasty preoperative examination. However, only a few reports exist on the management and outcome of popliteal cysts in the patients receiving UKA for knee osteoarthritis (OA) and popliteal cysts. As such, it is crucial to evaluate different treatment strategies and their management of popliteal cysts. In this paper, we evaluate a surgical strategy for patients with knee anteromedial osteoarthritis and symptomatic popliteal cysts. These patients were treated with UKA and internal drainage of the popliteal cyst. The results shown here, spanning 1-year post-operation follow-up, demonstrated that UKA and internal drainage is an effective surgical protocol for treating anteromedial osteoarthritis with symptomatic popliteal cysts.
Topics: Humans; Popliteal Cyst; Knee Joint; Osteoarthritis, Knee; Chronic Pain
PubMed: 36504231
DOI: 10.3791/64725