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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 -
Frontiers in Surgery 2023Popliteal cysts are secondary to degenerative changes in the knee joint. After total knee arthroplasty (TKA), 56.7% of patients with popliteal cysts at 4.9 years...
INTRODUCTION
Popliteal cysts are secondary to degenerative changes in the knee joint. After total knee arthroplasty (TKA), 56.7% of patients with popliteal cysts at 4.9 years follow-up remained symptomatic in the popliteal area. However, the result of simultaneous arthroscopic cystectomy and unicompartmental knee arthroplasty (UKA) was uncertain.
CASE PRESENTATION
A 57-year-old man was admitted to our hospital with severe pain and swelling in his left knee and the popliteal area. He was diagnosed with severe medial unicompartmental knee osteoarthritis (KOA) with a symptomatic popliteal cyst. Subsequently, arthroscopic cystectomy and unicompartmental knee arthroplasty (UKA) were performed simultaneously. A month after the operation, he returned to his normal life. There was no progression in the lateral compartment of the left knee and no recurrence of the popliteal cyst at the 1-year follow-up.
CONCLUSION
For KOA patients with a popliteal cyst seeking UKA, simultaneous arthroscopic cystectomy and UKA are feasible with great success if managed appropriately.
PubMed: 37066010
DOI: 10.3389/fsurg.2023.1109571 -
International Journal of Surgery Case... Apr 2023Baker's cyst, or popliteal cyst, is typically arising in the popliteal fossa located between the semi-membranous tendon and the medial head of the gastrocnemius....
INTRODUCTION AND IMPORTANCE
Baker's cyst, or popliteal cyst, is typically arising in the popliteal fossa located between the semi-membranous tendon and the medial head of the gastrocnemius. Asymptomatic Baker's cyst does not require treatment. Surgical treatment may be considered after the failure of conservative measures when the cyst causes persistent pain and rarely compresses the adjacent neurovascular structure.
CASE PRESENTATION
We report an unusual presentation of Baker's cyst in a 43-year-old patient who complained of knee pain and after several months of conservative treatment. Following a physical and radiological examination, a Baker cyst was confirmed that compresses the tibial nerve. A surgical decompression and excision of the cyst was performed using the posterior approach to allow complete removal of the cyst's stalk and wall. Histopathological report confirms dense collagen without true epithelial lining. The patient was asymptomatic at 6 months of follow-up.
CLINICAL DISCUSSION
It is important to recognize that a large Baker's cyst can be symptomatic and present as a compression syndrome of the adjacent neurovascular structure. The current case report described an early surgical management to treat a tibial nerve compression syndrome caused by a Baker cyst. A surgical decompression through a posterior approach may facilitate complete removal of the cyst wall.
CONCLUSIONS
Baker's cyst is a common knee pathology that could rarely compress the adjacent neurovascular structures. The surgical decompression through a posterior approach results in favorable outcomes in symptomatic patients with failed conservative measures.
PubMed: 36958143
DOI: 10.1016/j.ijscr.2023.108013 -
International Orthopaedics Jun 2023Arthroscopy in popliteal cyst surgery enables addressing all components of its pathomechanism: the cyst wall, valvular mechanism, and concomitant intra-articular...
Arthroscopic cystectomy and valve excision of popliteal cysts complemented with management of intra-articular pathologies: a low recurrence rate and good functional outcomes in a series of ninety seven cases.
PURPOSE
Arthroscopy in popliteal cyst surgery enables addressing all components of its pathomechanism: the cyst wall, valvular mechanism, and concomitant intra-articular pathologies. Techniques differ as to the management of the cyst wall and the valvular mechanism. This study aimed to assess the recurrence rate and functional outcomes of a cyst wall and valve excising arthroscopic technique with concurrent intra-articular pathology management. The secondary purpose was to assess cyst and valve morphology and concomitant intra-articular findings.
METHODS
Between 2006 and 2012, 118 patients with symptomatic popliteal cysts refractory to at least three months of guided physiotherapy were operated on by a single surgeon using a cyst wall and valve excising arthroscopic technique with intra-articular pathology management. Patients were evaluated preoperatively and at a mean follow-up of 39 months (range 12-71) by ultrasound, Rauschning and Lindgren, Lysholm, and VAS of perceived satisfaction scales.
RESULTS
Ninety-seven out of 118 cases were available for follow-up. Recurrence was observed on ultrasound in 12/97 cases (12.4%); however, it was symptomatic only in 2/97 cases (2.1%). Mean scores improved: Rauschning and Lindgren from 2.2 to 0.4, Lysholm from 54 to 86, and VAS of perceived satisfaction from 5.0 to 9.0. No persistent complications occurred. Arthroscopy revealed simple cyst morphology in 72/97 (74.2%) and presence of a valvular mechanism in all cases. The most prevalent intra-articular pathologies were medial meniscus (48.5%) and chondral lesions (33.0%). There were significantly more recurrences in grade III-IV chondral lesions (p = 0.03).
CONCLUSIONS
Arthroscopic popliteal cyst treatment had a low recurrence rate and good functional outcomes. Severe chondral lesions increase the risk of cyst recurrence.
Topics: Humans; Popliteal Cyst; Cystectomy; Treatment Outcome; Arthroscopy; Surgeons
PubMed: 36912920
DOI: 10.1007/s00264-023-05745-6 -
Cureus Jan 2023The prevalence of peripheral artery disease (PAD) has been increasing in parallel with the increasing prevalence of the atherosclerotic disease. Therefore, we have to be...
The prevalence of peripheral artery disease (PAD) has been increasing in parallel with the increasing prevalence of the atherosclerotic disease. Therefore, we have to be familiar with the diagnostic approach used for ischemic symptoms in the lower limbs. Adventitial cystic disease (ACD) is rare but not negligible as one of the differential diagnoses of intermittent claudication (IC). Although duplex ultrasound and magnetic resonance imaging (MRI) are helpful tools for the diagnosis of ACD, further imaging modality is needed to avoid misdiagnosis. A 64-year-old man with a mitral valve prosthesis presented to our hospital with a one-month history of IC in the right calf after walking for approximately 50 meters. On physical examination, the pulse in the right popliteal artery was not palpable, nor were the dorsal pedis artery and posterior tibial artery, although there were no other symptoms of ischemia. His right ankle-brachial index (ABI) was 1.12 at rest but decreased to 0.50 after exercise. Three-dimensional computed tomography (CT) angiography revealed a severe stenotic lesion approximately 70 mm long in the right popliteal artery. Therefore, we diagnosed PAD in the right lower limb and planned endovascular therapy. The stenotic lesion was markedly reduced on catheter angiography when compared with CT angiography. However, intravascular ultrasound (IVUS) detected little atherosclerosis and cystic lesions within the wall in the right popliteal artery that did not involve the arterial lumen. Especially, IVUS clearly demonstrated that the crescent-shaped cyst compressed the arterial lumen eccentrically and other cysts surrounded the lumen circumferentially like petals. Because IVUS revealed these cysts to be extravascular structures, the patient was subsequently thought to have ACD of the right popliteal artery. Fortunately, his cysts reduced in size spontaneously and his symptoms disappeared. We have monitored the patient's symptoms, ABI, and findings on duplex ultrasound for seven years, during which there has been no recurrence. In this case, we diagnosed ACD in the popliteal artery by IVUS rather than duplex ultrasound and MRI.
PubMed: 36874647
DOI: 10.7759/cureus.34362 -
Maedica Dec 2022Synovial osteochondromatosis is a rare benign pathology arising from the synovial membrane of the joints, synovial sheaths or uncommonly the bursae around the joints....
Synovial osteochondromatosis is a rare benign pathology arising from the synovial membrane of the joints, synovial sheaths or uncommonly the bursae around the joints. Baker's cysts are fluid filled, synovium-lined lesions arising in popliteal fossa. Synovial chondromatosis involving the Baker`s cyst is extremely rare. The aim of this case report is to document this exceedingly rare extra articular synovial pathology involving Baker's cysts of bilateral knees and to emphasize the importance of radiographs and sonography in the diagnosis.
PubMed: 36818241
DOI: 10.26574/maedica.2022.17.4.999 -
ARP Rheumatology 2023Parameniscal cysts are small cystic lesions, near the meniscus, involving medial and lateral compartments at equal frequency. Frequently, parameniscal cysts are so small...
INTRODUCTION
Parameniscal cysts are small cystic lesions, near the meniscus, involving medial and lateral compartments at equal frequency. Frequently, parameniscal cysts are so small that patients do not notice them, being asymptomatic. However, they can grow and exceed 2 centimeters in diameter, causing pain and alarm due to the slow growing mass. Magnetic Resonance Imaging (MRI) is the gold standard for diagnosis.
METHODS
Case report of a patient admitted to rheumatology department in the Centro Hospitalar e Universitário de Coimbra.
RESULTS
We report a case of a 47-year-old male with idiopathic juvenile arthritis, who presented with a slow-growing mass over the medial aspect of the right knee. MRI revealed a conspicuous cystic ovoid lesion, compatible with a parameniscal cyst, associated with structural heterogeneity of the posterior edge of the internal meniscus with a longitudinal fracture at this level.
CONCLUSION
This is the first case of parameniscal cyst reported in patients with inflammatory rheumatic disease and the differential diagnosis with synovial cyst, baker cyst, ganglion cyst, bursitis, hematoma and neoplasms is of utmost importance.
Topics: Male; Humans; Middle Aged; Diagnosis, Differential; Menisci, Tibial; Cysts; Knee Joint; Popliteal Cyst; Synovial Cyst
PubMed: 36809233
DOI: No ID Found -
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 -
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