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Arthroscopy Techniques Nov 2018Popliteal cysts, often referred to as Baker's cysts, are a common occurrence in the adult knee. Although controversy exists as to the exact indications for treatment,...
Popliteal cysts, often referred to as Baker's cysts, are a common occurrence in the adult knee. Although controversy exists as to the exact indications for treatment, these structures can cause extreme discomfort and morbidity, including pain from rupture and symptoms from neurovascular compromise. Prior to the development of the arthroscope, open treatment of popliteal cysts was not uncommon. Complications such as poor wound healing, cyst recurrence, and knee flexion contractures were reported after such treatment. Owing to the presence of a valve-type structure, also called the , there is 1-way flow of synovial fluid into the cyst. Although seldom described, there is a reproducible and relatively straightforward arthroscopic treatment for this pathology. This technical report will describe the arthroscopic treatment of popliteal cysts and clarify the posterior knee anatomy that gives the surgeon the landmarks to perform safe and effective arthroscopic treatment of popliteal cysts.
PubMed: 30533356
DOI: 10.1016/j.eats.2018.07.006 -
Stem Cells International 2020Mesenchymal stem cells (MSCs) are multipotent progenitor cells in adult tissues. The aim of this study is to isolate and identify synovial fluid-derived mesenchymal...
Mesenchymal stem cells (MSCs) are multipotent progenitor cells in adult tissues. The aim of this study is to isolate and identify synovial fluid-derived mesenchymal stromal cells (SF-MSCs) from the popliteal cyst fluid of pediatric patients. SF-MSCs were collected from the popliteal cyst fluid of pediatric patients during cystectomy surgery. After cyst fluid extraction and adherent culturing, in vitro morphology, growth curve, and cell cycle were observed. The expression of stem cell surface markers was analyzed by flow cytometry, and expression of cell marker protein was detected by immunofluorescence. SF-MSCs were cultured in osteogenic, adipogenic, and chondrogenic differentiation medium. The differentiation potential of SF-MSCs was analyzed by alkaline phosphatase (Alizarin Red), Oil Red O, and Alcian blue. Antibody detection of human angiogenesis-related proteins was performed compared with bone marrow mesenchymal stem cells (BM-MSCs). The results show that SF-MSCs from the popliteal cyst fluid of pediatric patients showed a shuttle appearance and logarithmic growth. Flow cytometry analysis revealed that SF-MSCs were negative for hematopoietic lineage markers (CD34, CD45) and positive for MSC markers (CD44, CD73, CD90, and CD105). Interstitial cell marker (vimentin) and myofibroblast-like cell marker alpha-smooth muscle actin (-SMA) were positive. These cells could differentiate into osteogenic, adipogenic, and chondrogenic lineages, respectively. Several types of human angiogenesis-related proteins were detected in the cell secretory fluid. These results show that we successfully obtained SF-MSCs from the popliteal cyst fluid of pediatric patients, which have the potential to be a valuable source of MSCs.
PubMed: 33014069
DOI: 10.1155/2020/7416493 -
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 -
Indian Journal of Orthopaedics 2016Management of popliteal cyst is controversial. Owing to high failure rates in open procedures, recent trend is towards arthroscopic decompression and simultaneous...
BACKGROUND
Management of popliteal cyst is controversial. Owing to high failure rates in open procedures, recent trend is towards arthroscopic decompression and simultaneous management of intraarticular pathology. We retrospectively analysed clinical results of symptomatic popliteal cysts after arthroscopic management at 24 month followup.
MATERIALS AND METHODS
Retrospective analysis of hospital database for patients presenting with pathology suggestive of a popliteal cyst from June 2007 to December 2012 was done. Twelve cases of popliteal cyst not responding to NSAIDS and with Rauschning and Lindgren Grade 2 or 3 who consented for surgical intervention were included in the study. All patients underwent arthroscopic decompression using a posteromedial portal along with management of intraarticular pathologies as encountered. Furthermore, the unidirectional valvular effect was corrected to a bidirectional one by widening the cyst joint interface. The results were assessed as per the Rauschning and Lindgren criteria.
RESULTS
All patients were followed for a minimum of 24 months (range 24-36 months). It revealed that among the study group, six patients achieved Grade 0 status while five had a minimal limitation of range of motion accompanied by occasional pain (Grade 1). One patient had a failure of treatment with no change in the clinical grading.
CONCLUSION
Arthroscopic approach gives easy access to decompression with the simultaneous management of articular pathologies.
PubMed: 27053804
DOI: 10.4103/0019-5413.177568 -
Pakistan Journal of Medical Sciences 2022To evaluate the efficacy of arthroscopic internal drainage (AID) and cyst wall resection (CWR) in children with popliteal cysts.
OBJECTIVES
To evaluate the efficacy of arthroscopic internal drainage (AID) and cyst wall resection (CWR) in children with popliteal cysts.
METHODS
This study included 16 pediatric patients with popliteal cysts and received arthroscopy using the double posteromedial (PM) portal system during June 2020 and June 2021 at The General Hospital of Northern Theater Command. Among these pediatric patients, 14 were males and two were females, with the mean age of nine years (range: 7-12 years). The left knee was affected in 12 cases, while the right knee was involved in the rest four cases. All patients underwent MR imaging before the procedure to assess whether there was intra-articular trauma and whether the popliteal cyst communicated with the knee-joint cavity. The MRI results showed that each patient had a simple popliteal cyst that involved a single knee joint without intra-articular trauma, which was classified as Grade-1 (n=3), Grade-2 (n =10) or Grade-3 (n =3) according to the Rauschning and Lindgren grading of knee joint symptoms. Arthroscopy was performed through anterolateral (AL) and PM portals to the knee joint for AID plus CWR, and the surgical outcomes were evaluated based on the Rauschning and Lindgren criteria.
RESULTS
No major vascular or nerve injury occurred during the operation. Postoperative complications such as wound infection and lower-extremity deep venous thrombosis were not recorded in these patients. Complications involving the saphenous nerve or the great saphenous vein or pseudocyst formation were not observed during the follow-up period. All patients completed the follow-up ranging from 3-12 months and were identified to have grade-0 (n=15) and grade-1 (n=1) popliteal cysts based on the Rauschning and Lindgren criteria, indicating significant improvement compared with the preoperative levels (all p<0.05). Moreover, no recurrence was recorded after operation.
CONCLUSION
AID plus CWR is a minimally invasive and safe approach for pediatric patients with popliteal cysts to promote postoperative recovery and reduce the recurrence rate.
PubMed: 36415283
DOI: 10.12669/pjms.38.8.5354 -
Journal of Vascular Surgery Dec 2011The purpose of this study was to perform a comprehensive search of the literature for all studies, case reports, and series describing Baker cyst compression of the... (Review)
Review
BACKGROUND
The purpose of this study was to perform a comprehensive search of the literature for all studies, case reports, and series describing Baker cyst compression of the neurovascular bundle in the popliteal fossa and index their findings according to the structures compressed.
METHOD
Case reports and series obtained after a thorough MEDLINE search were indexed according to compressed structures. Patient demographics, main findings, method of diagnosis, cyst size, outcomes, and follow-up were recorded for each publication.
RESULTS
Signs and symptoms related to popliteal vein and tibial nerve compression were the most frequent presentation of symptomatic Baker cysts, due to the anatomic vulnerability of these structures within the popliteal fossa and their relative sensitivity to compression. Patients with tibial nerve entrapment demonstrated gastrocnemius muscle atrophy, paresthesias, and pain. Those with popliteal vein compression experienced swelling, pain, and rarely, venous thromboembolism. Isolated arterial compression, presenting with intermittent claudication, is a rare occurrence because it is a relatively stiff-walled vessel, has a higher pressure, and is located deep in the popliteal fossa. Combinations of these compression syndromes are most frequently encountered in the context of cyst rupture and resulting compartment syndrome.
CONCLUSIONS
Baker cyst is an important pathology for the differential diagnosis of popliteal neurovascular compression phenomena. It has a wide spectrum of presentation, therefore requiring accurate diagnosis for proper patient management. Because Baker cyst is by definition a chronic disorder, long-term follow-up is necessary to monitor patient recovery and prevent recurrence.
Topics: Humans; Leg; Nerve Compression Syndromes; Popliteal Cyst; Vascular Diseases
PubMed: 21958564
DOI: 10.1016/j.jvs.2011.07.079 -
Cureus Oct 2021A ruptured Baker's cyst is a rare presentation and may mimic deep vein thrombosis (DVT) or acute thrombophlebitis. In rare cases, it may present with infection or...
A ruptured Baker's cyst is a rare presentation and may mimic deep vein thrombosis (DVT) or acute thrombophlebitis. In rare cases, it may present with infection or compartment syndrome. We present our experience related to a case of a ruptured Baker's cyst and its management. A 54-year-old female presented to us with knee pain, which was initially managed conservatively. After six weeks, she came to us with severe pain and swelling in her left calf and foot. It was an acute presentation and DVT was suspected initially. Ultrasound color Doppler showed no DVT and then MRI revealed it to be a ruptured Baker's cyst. The patient was subsequently managed conservatively and her condition improved in 12 weeks of follow-up. A high index of suspicion and knowledge is required to diagnose a ruptured Baker's cyst, and most of the patients respond well to conservative management.
PubMed: 34754661
DOI: 10.7759/cureus.18501 -
Cureus Feb 2024Popliteal cysts are a collection of synovial fluid found in the popliteal fossa that typically form in adults in association with traumatic injuries, degenerative...
Popliteal cysts are a collection of synovial fluid found in the popliteal fossa that typically form in adults in association with traumatic injuries, degenerative conditions, or inflammatory arthritis of the knee. While often asymptomatic, popliteal cysts may become problematic as enlarging and ruptured cysts may compress surrounding neurovascular structures, resulting in lower extremity edema or peripheral neuropathy. We report a unique case of a symptomatic popliteal cyst in a patient with both compressive neuropathy and venous congestion in the setting of a non-ruptured popliteal cyst after a surgically repaired intraarticular injury. Magnetic resonance imaging (MRI) showed a synovial cyst abutting the posterior neurovascular bundle and evidence of avascular necrosis. An open posterior cyst decompression was done, and the patient was able to report significant symptomatic improvement over the course of two weeks postoperatively. The previously noted varicose veins also demonstrated noticeable resolution. While relatively common, popliteal cysts may require prompt surgical decompression in order to provide effective symptomatic relief.
PubMed: 38439999
DOI: 10.7759/cureus.53499 -
Anatomy & Cell Biology Sep 2014Ganglion cysts are tumor-like lesions in the soft tissues, generated by mucoid degeneration of the joint capsule, tendon or tendon sheaths on the dorsum of hand, wrist...
Ganglion cysts are tumor-like lesions in the soft tissues, generated by mucoid degeneration of the joint capsule, tendon or tendon sheaths on the dorsum of hand, wrist and foot. However, an intratendinous origin for a ganglion cyst is extremely rare. During dissection of the popliteal fossa, a cyst of 2.5 cm×2 cm×0.5 cm was observed in the tendon of right semimembranosus, 3.5 cm above the insertion of the muscle. Contrast X-ray revealed the cyst as not communicating with the knee joint or any adjacent bursae. Histopathological examination confirmed the diagnosis of ganglion cyst.
PubMed: 25276481
DOI: 10.5115/acb.2014.47.3.207 -
EJVES Vascular Forum 2022Cystic adventitial disease (CAD) is an uncommon non-atherosclerotic peripheral vessel disease, most often seen in the popliteal artery. Only a small number of cases... (Review)
Review
OBJECTIVE
Cystic adventitial disease (CAD) is an uncommon non-atherosclerotic peripheral vessel disease, most often seen in the popliteal artery. Only a small number of cases involving the (ilio) femoral artery have been reported. The case of a 48 year old female with CAD of the left femoral artery with a connection of the disease to the hip joint on pre-operative imaging confirmed during surgery is described. A literature review of CAD of the (ilio) femoral artery with patient demographic data, symptoms, management, presence of a joint connection, and long term outcomes was performed.
METHODS
Multiple databases (Medline, CINAHL, EMBASE) were searched and each article was cross referenced to collect the literature on CAD of the (ilio) femoral artery. Case studies or series of CAD of the (ilio) femoral artery in English between 1995 and 2021 were included.
RESULTS
Sixteen case reports with 17 patients were included; 71% were male. CAD was unilateral in all case reports, with 53% on the right side. Patients presented with vascular symptoms including claudication (88%), a palpable pulsating mass (18%), acute limb ischaemia (6%) or limb swelling (8%). Computed tomography angiography (CTA) (76%) and duplex ultrasonography (47%) were the most commonly used imaging modalities. The common femoral artery was the most affected site (88%). Reported treatments were cyst resection and autologous vein reconstruction (six, one recurrence), cyst resection and patch repair (five, one recurrence), cyst resection with synthetic graft reconstruction (three, no recurrence), cyst resection (two, one recurrence), and cyst incision and decompression (one, one recurrence). In 18% of the cases, a connection between the CAD and hip joint was seen.
CONCLUSION
Cyst resection and ligation with interposition of an autologous vein graft, synthetic graft or patch repair (in only locally affected arteries) seems to be the preferred treatment, with a low reported recurrence rate. CTA and magnetic resonance imaging are the imaging modalities of choice when suspecting CAD to determine an appropriate pre-operative plan and identify joint connections.
PubMed: 35257122
DOI: 10.1016/j.ejvsvf.2022.01.014