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International Journal of Critical... 2019Baker's cyst is a distention or enlargement of the gastrocnemius-semimembranosus bursa toward the popliteal fossa which is usually associated with intra-articular...
Baker's cyst is a distention or enlargement of the gastrocnemius-semimembranosus bursa toward the popliteal fossa which is usually associated with intra-articular pathologies. Rupture or dissection of the Baker's cyst results in extravasation of the cyst content into the calf within intermuscular space under the fascia. This clinical entity, also called pseudothrombophlebitis, is a self-limited condition that usually resolves with supportive treatment. However, in patients using anticoagulants, excessive hemorrhage may cause compartment syndrome in case of cyst rupture. Early diagnosis of compartment syndrome is the most important step in preventing permanent disability. Therefore, compartment syndrome should be kept in mind and ruled out in a patient with pseudothrombophlebitis syndrome under anticoagulation therapy.
PubMed: 31334050
DOI: 10.4103/IJCIIS.IJCIIS_84_18 -
Annals of the Academy of Medicine,... May 2019
Topics: Arthroscopy; Chondromatosis, Synovial; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Middle Aged; Popliteal Cyst; Radiography; Range of Motion, Articular; Synovial Fluid; Treatment Outcome
PubMed: 31210254
DOI: No ID Found -
Journal of Cardiology Cases Jun 2019We report the case of a 68-year-old man with right intermittent claudication by adventitial cystic disease. We performed resection of the cyst and affected popliteal...
We report the case of a 68-year-old man with right intermittent claudication by adventitial cystic disease. We performed resection of the cyst and affected popliteal artery with interposing an autologous vein graft. Intraoperative findings revealed an intimal tear between the cyst and the compressed artery. His symptoms resolved after surgery, and the postoperative course was uneventful. Although adventitial cystic disease with intimal tear is rare, we consider that conventional surgical intervention remains the favorable treatment option for adventitial cystic disease. < We present a rare case of adventitial cystic disease (ACD) with intimal tear successfully treated with surgical repair. In the present case, intimal tear could not be detected preoperatively. Although this case is rare, we should pay attention to intimal tear in treating ACD. In case of ACD with intimal tear, resection of the affected artery and reconstruction with interposing graft are feasible.>.
PubMed: 31193993
DOI: 10.1016/j.jccase.2019.02.003 -
Arthroscopy Techniques Apr 2019Popliteal cysts can be an oppressive symptom in patients with concomitant intra-articular knee pathologies. Because isolated treatment of intra-articular lesions is...
Popliteal cysts can be an oppressive symptom in patients with concomitant intra-articular knee pathologies. Because isolated treatment of intra-articular lesions is usually not sufficient to resolve the problems associated with a large symptomatic popliteal cyst, a popliteal cyst should be concurrently addressed with other knee pathologies to maximize patient outcomes. Conservative treatment and open surgical excision are associated with high rates of recurrence, so arthroscopic techniques are the preferred treatment options for recalcitrant cases. Arthroscopic communication-enlargement surgery with cyst wall removal seems to be the most effective. We present a simple and effective basic technique for arthroscopic popliteal cyst treatment and some approaches that allow management of the more demanding cases.
PubMed: 31080721
DOI: 10.1016/j.eats.2018.11.015 -
Journal of Orthopaedic Case Reports 2018Baker's cyst has a high prevalence in adult population. Despite being usually asymptomatic, cyst complications may develop, such as an infection, rupture and content...
INTRODUCTION
Baker's cyst has a high prevalence in adult population. Despite being usually asymptomatic, cyst complications may develop, such as an infection, rupture and content dissemination into the calf. This clinical presentation has a low incidence with few reports in the literature. We have not found any publication describing a systematic approach for its treatment. The purpose of this study is to propose a new classification, diagnosis, and treatment recommendations based on a case report and a literature review to guide physicians on the best course of treatment.
CASE REPORT
A 53-year-old man presented with sudden left popliteal pain associated with progressive knee and calf swelling and limited knee flexion. After the initial evaluation, a Baker's cyst rupture and dissemination into the calf, associated with a septic arthritis, were diagnosed. An arthroscopic surgical irrigation of the knee and open debridement of the calf collection were performed.
CONCLUSION
Our classification may allow an accurate and structured description of the different stages of Baker's cyst presentations, with simplification of the clinical description, diagnosis, and treatment approaches.
PubMed: 30915286
DOI: 10.13107/jocr.2250-0685.1238 -
The Eurasian Journal of Medicine Feb 2019Baker's cyst (BC) is also known as popliteal cyst. To evaluate its effect on intra-articular pathology, it is important to have the exact volume of the cyst. As BC may...
OBJECTIVE
Baker's cyst (BC) is also known as popliteal cyst. To evaluate its effect on intra-articular pathology, it is important to have the exact volume of the cyst. As BC may change its shape due to mass effect of the surrounding anatomic structures, it is difficult to measure the exact volume of BC. This study examined the relationship between three-dimensionally measured BC volume and symptomatic intra-articular knee pathologies.
MATERIALS AND METHODS
The magnetic resonance (MR) images of 45 patients with symptomatic knees were retrospectively examined.The BC volumes were measured via volumetric analysis. The joint effusion was examined in the sagittal plane in T2-proton density-weighted images. The medial plicae were assessed in accordance with the modified Sakakibara classification. Using the MR images, the meniscuses were classified in accordance with the meniscus rupture classification of Stoller et al. The cartilaginous lesions were analyzed using an MR grading system.In this study, correlations between the following measures were analyzed: BC volume and effusion level, medial plica presence, medial femoral condyle, medial tibial condyle, lateral femoral condyle and lateral tibial condyle cartilage degeneration, and medial meniscus anterior horn, medial meniscus posterior horn, lateral meniscus anterior and posterior horn ruptures.
RESULTS
Cartilage degeneration, medial plicae, increase in intra-articular effusion, and increase in the BC volume were found to be statistically significant (p<0.01).
CONCLUSION
Cartilage degeneration, medial plicae, and increase in intra-articular effusion may increase the BC volume. We believe that this study may contribute to clinicians in understanding the relationship between BC volume changes and pathologies causing intra-articular knee symptoms.
PubMed: 30911260
DOI: 10.5152/eurasianjmed.2019.18385 -
Knee Surgery & Related Research Jun 2019To compare the clinical outcomes of the arthroscopic treatments for popliteal cysts with and without cystectomy.
PURPOSE
To compare the clinical outcomes of the arthroscopic treatments for popliteal cysts with and without cystectomy.
METHODS
PubMed/MEDLINE, EMBASE, KoreaMed, and Cochrane Library were searched from the earliest available date of indexing through August 2016. The methodological quality of all articles was assessed according to the Coleman methodology score (CMS). Studies were grouped according to the surgical method, and a meta-analysis was conducted to identify the unsuccessful clinical outcome and complication rates.
RESULTS
Nine studies were included; the mean CMS was 67.33 (standard deviation, 8.75 points). Cystectomy was reported in five studies; cystectomy was not performed in four studies. The odds ratio of unsuccessful clinical outcomes evaluated by Rauschning and Lindgren score was 122.05 (p<0.001) with cystectomy and 58.12 (p<0.001) without cystectomy. The effect size of complications was 0.16 (p<0.001) with cystectomy and 0.03 (p<0.001) without cystectomy. The recurrence rate was 0% with cystectomy and 6.4% without cystectomy.
CONCLUSIONS
All the currently available studies showed satisfactory outcomes in both with and without cystectomy groups. However, arthroscopic cystectomy concurrently performed with management of intra-articular lesions was associated with a relatively low recurrence rate and a relatively high incidence of complications.
PubMed: 30893988
DOI: 10.5792/ksrr.18.068 -
Orthopaedics & Traumatology, Surgery &... Feb 2019To reduce the damage to posteromedial knee capsule, we developed a direct extra-articular arthroscopic approach for excision of symptomatic popliteal cysts. This study...
To reduce the damage to posteromedial knee capsule, we developed a direct extra-articular arthroscopic approach for excision of symptomatic popliteal cysts. This study aimed to demonstrate the surgical technique and present the 2-year follow-up results. Cystectomy is performed by extra-articular surgical approach through a high posteromedial portal. Twenty-one consecutive patients diagnosed of symptomatic popliteal cysts with failed initial conservative treatments were included. At a median follow-up of 29.4 months, all knees had improved clinical function assessed by Rauschning and Lindgren knee classification (p<0.001). The cysts were either disappeared (95.2%) or reduced in size (4.8%). Only one (4.8%) patient had recurrent cyst, which was solved after ultrasound-guided aspiration. This direct extra-articular arthroscopic technique could be a feasible alternative for treatment of symptomatic popliteal cysts.
Topics: Aged; Aged, 80 and over; Arthroscopy; Female; Follow-Up Studies; Humans; Knee Joint; Male; Middle Aged; Popliteal Cyst; Recurrence; Treatment Outcome
PubMed: 30639028
DOI: 10.1016/j.otsr.2018.09.022 -
Emergencias : Revista de La Sociedad...Deep vein thrombosis (DVT) and ruptured Baker's cyst have similar clinical presentations: inflammation and acute pain in the calf. Differential diagnosis is necessary...
Deep vein thrombosis (DVT) and ruptured Baker's cyst have similar clinical presentations: inflammation and acute pain in the calf. Differential diagnosis is necessary and requires information from Doppler ultrasound imaging 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. We present a series of 7 consecutive cases in which the patients were misdiagnosed with DVT without imaging. LMWHs were started at therapeutic doses in all cases. The patients' symptoms worsened abruptly after treatment, causing compartment syndrome in the leg. Four of the patients required urgent fasciotomy.
Topics: Aged; Aged, 80 and over; Compartment Syndromes; Diagnosis, Differential; Diagnostic Errors; Female; Fibrinolytic Agents; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Popliteal Cyst; Retrospective Studies; Rupture, Spontaneous; Venous Thrombosis
PubMed: 30638346
DOI: No ID Found -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Oct 2018To compare the short-term effectiveness between arthroscopic cystectomy and internal drainage combined with cystectomy in popliteal cyst.
[Clinical prospective comparative study on short-term effectiveness of arthroscopic treatment of popliteal cyst between cyctectomy and internal drainage combined with cyctectomy].
OBJECTIVE
To compare the short-term effectiveness between arthroscopic cystectomy and internal drainage combined with cystectomy in popliteal cyst.
METHODS
Between March 2014 and March 2017, 56 patients with symptomatic popliteal cyst were enrolled in the study, randomized block design was used to divided the patients into trial group (arthroscopic cystectomy combined with internal drainage group, =28) and control group (arthroscopic internal drainage group, =28). Excluding those who had incomplete follow-up and received surgery for other diseases postoperatively, 26 patients in the experimental group and 27 patients in the control group were finally enrolled in the study. There was no significant difference in gender, age, side, course of disease, maximum diameter and grade of popliteal cyst, and associated diseases between two groups ( >0.05). The operation time, duration of popliteal ecchymosis and the middle back of calf tenderness were observed postoperatively. The circumference of calf at 1 day, 1 week, and 2 weeks after operation were measured and the differences were calculated with the measurement before operation. Lower extremity venous thrombosis was observed by color doppler ultrasonography at 1 week after operation. The effectiveness was evaluated by Rauschning and Lindgren grading criteria. And MRI was used to observe whether the popliteal cyst disappeared or decreased and measured its maximum diameter at 1 year after operation.
RESULTS
Patients in both groups were followed up 12-14 months, with an average of 12.5 months. The operation time, duration of popliteal ecchymosis, and the middle back of calf tenderness of the trial group were all longer than those in the control group ( <0.05), the differences of circumference of calf at 1 day, 1 week, and 2 weeks after operation of the trial group were greater than those in the control group ( <0.05). Color doppler ultrasonography of the lower extremity at 1 week after operation found that the intermuscular venous thrombosis occurred in 2 cases of the trial group, while no lower extremity thrombosis was found in the control group; and the difference between two groups was not significant ( =0.236). According to the Rauschning and Lindgren grading criteria, there were 16 cases of grade 0, 6 cases of grade 1, and 4 cases of grade 2 in the trial group, and 17 cases of grade 0, 4 cases of grade 1, and 6 cases of grade 2 in the control group at 1 year after operation. There was no significant difference between 2 groups ( =-1.872, =0.078). Nine cases (34.62%) of the trial group and 13 cases (48.15%) of the control group still have residual cysts by MRI, the maximum diameter of which was less than 2 cm. The cysts disappeared in the remaining patients in both groups, and there was no recurrence during the follow-up. There was no significant difference in cyst residual rate between 2 groups ( =2.293, =0.852).
CONCLUSION
Compared with arthroscopic internal drainage, the short-term effectiveness of the arthroscopic internal drainage combined with cystectomy had no significant improvement, and the operation time was prolonged, the postoperative complications were obviously increased.
Topics: Arthroscopy; Cystectomy; Drainage; Humans; Lower Extremity; Magnetic Resonance Imaging; Operative Time; Popliteal Cyst; Postoperative Period; Prospective Studies; Treatment Outcome; Ultrasonography, Doppler, Color; Venous Thrombosis
PubMed: 30600667
DOI: 10.7507/1002-1892.201804113