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Bakers Cyst
From WikiSM
Contents
Other Names
- Popliteal synovial cyst
- Ganglion cyst of the knee
- Synovial cyst of the knee
- Baker's Cyst
- Parameniscal cyst
- Perimeniscal cyst
- Meniscal cyst
- Pseudothrombophlebitis Syndrome
- Primary popliteal cyst
Background
- This page refers to a synovial or ganglion cyst of the knee, which when presenting posteriorly is referred to as a Baker's Cyst (BC)
History
- Named after British surgeon William Morant Baker’s case series published in 1877[1]
- First described by Robert Adams in 1840[2], and subsequently by Foucher in 1856[3]
- Further characterized by Wilson in 1938 who dissected 30 knees, of which 58% had a direct connection with the knee joint[4]
Epidemiology
- Found on 38% of knee MRIs on symptomatic patients[5]
- Found in 40-54% of adult knees based on cadaveric studies[6]
- Most commonly seen in adults between ages 35 and 70 (need citation)
- Pediatric
Pathophysiology
- Communication
- Occurs within a bursa between the Semimembranosus (SemiM) and medial head of the Gastrocnemius (Gastroc)
- Joint-cyst communication considered to function like a 1-way valve
- 1 way valve[9]
- Allows synovial fluid to pass into bursa where it is sequestered
- In flexion, valve is open allowing flow
- In extension, valve is closed due to muscle tension of SemiM and Gastroc
- Function
- May provide protective effect against hydraulic pressure from knee effusions
- Size of BC roughly correlates with size of knee effusion[10]
- Histology
- Cyst walls resemble synovial tissue with fibrosis suggesting chronic nonspecific inflammation[11]
- Cyst fluid is often thickened by the presence of fibrin
- Rauschnig et al found no difference in histopathology between symptomatic and asymptomatic knees
- Pediatric considerations
- Majority have no communication with the joint capsule and may arise spontaneously[12]
- When they do communicate with the joint, resemble those seen in adults
Pathoanatomy
- Cyst Anatomy
- Bursal communication between the Semimembranosus (SemiM) and medial head of the Gastrocnemius (Gastroc)
- There may be occasional involvement of the subgastrocnemius bursa[13]
- Case report of synvial cyst herniating out laterally through the Iliotibial Band[14]
Associated Pathology
- Associated with other knee disorders up to 94% of the time[5]
- Knee Osteoarthritis [15]
- Meniscus Injury [16]
- Knee Effusion
- Osteochondral Defect of the Knee
- Gout and other inflammatory arthropathies
- ACL Injury
- Failed Total Knee Arthroplasty
- Cysts can be loculated or very large[17]
- Thought to be due to macrophages digesting polyethylene
- May also suggests hardware loosening or wear
Risk Factors
- History of trauma
- Gout
- Meniscus Injury
- Knee Osteoarthritis
Differential Diagnosis
- Fractures
- Dislocations & Subluxations
- Patellar Dislocation (and subluxation)
- Knee Dislocation
- Proximal Tibiofibular Joint Dislocation
- Muscle and Tendon Injuries
- Ligament Pathology
- Arthropathies
- Bursopathies
- Patellofemoral Pain Syndrome (PFPS)/ Anterior Knee Pain)
- Neuropathies
- Other
- Bakers Cyst (Popliteal Cyst)
- Patellar Contusion
- Pediatric Considerations
- Patellar Apophysitis (Sinding-Larsen-Johnansson Disease)
- Patellar Pole Avulsion Fracture
- Tibial Tubercle Avulsion Fracture
- Tibial Tuberosity Apophysitis (Osgood Schalatters Disease)
- Proximal Tibial Metaphyseal Fracture
- Proximal Tibial Physeal Injury
Clinical Features
- History
- Patients may report insidious, posterior knee pain
- Additionally fullness, achiness, mass, and stiffness
- The most common symptoms are swelling (76%), posterior aching (32%)[18]
- Pain with full or terminal knee extension
- Often have symptoms consistent with meniscal or chondral injuries
- Physical Exam: Physical Exam Knee
- Findings often consistent with meniscal or chondral injuries
- With large cysts, posteromedial fullness may be present but many smaller cysts are not palpable
- Special Tests
- Foucher Sign: Examine posterior mass in full knee extension and flexion, should be soft in flexion
- Homan Sign: Extend knee, passively dorsiflex ankle and squeeze calf
Evaluation
Radiographs
- Standard Knee Radiographs
- Screening tool
- Not typically useful for evaluating a bakers cyst
- Can detect other pathology associated with bakers cyst
- E.g.: Osteoarthritis, Gout, Osteochondral Defect
- Loose bodies may be seen within the bakers cyst
- Arthrography
- Previously gold standard for evaluation[19]
- Has fallen out of favor for MRI, US
Ultrasound
- Advantages
- Cheap, lacks radiation, ease of use
- Disadvantages
- User dependent, cant evaluate all soft tissue injuries
- Findings
- Anechoic or hypoechoic, circumferential structure
- Lacks flow and doppler signal of vascular structures
- Accuracy[20]
- Sensitivity: 100%
- Specificity: 100%
- PPV: 100%
- NPV: 100%
- Accuracy: 100%
MRI
- Gold standard for evaluating BC and other soft tissue structures
- Findings
- Appear as a water-intensity fluid collection (low signal intensity on T1, high signal intensity on T2-weighted images)[16]
- Description
- Most are small, unilocular but can also be septated or multiloculated
- Size, sites of extension, rupture can change appearance of fluid collection
- Loose bodies/debris can be present
Classification
- No specific classification
- Important to characterize
- Communicating vs noncommunicating
- Loculated, multiloculated or septated
- Underlying etiology
Management
Nonoperative
- General
- Initial treatment of choice unless complications
- Important to target the underlying disorder
- Physical Therapy
- Maintain range of motion and knee flexibility
- Intra-articular Corticosteroid Injection
- Intra-articular has been found to decrease size, symptoms of cyst[21]
- Ultrasound-guided posterior cyst aspiration and Corticosteroid Injection
- This is particularly valuable in the uncommon noncommunicating, multiloculated or septated cyst
Operative
- Indications
- Failure of conservative therapy
- Complicated including infection, neurovascular insult
- Technique
- Arthroscopic debridement
- Arthroscopic cyst decompression or excision
- Less commonly, open cyst excision
- Correction of intra-articular pathology
Rehab and Return to Play
Rehabilitation
- There are no specific bakers cyst rehabilitation guidelines
- Important to maintain full knee flexion and range of motion
Return to Play
- There are no clear return to play guidelines
Complications and Prognosis
Prognosis
- Surgical
- Response to surgical excision seems to correlate with ability to correct intra-articular pathology
- Rauschning et al: 46 surgical excisions, 63% recurred, 33% had wound complications or pseudothrombophlebitis after[22]
- Rupp et al: Arthroscopic treatment for 16 intra-articular disorders, 11 cysts persisted of which 2 became larger at 1 year postop[23]
- Chondral lesions appeared to be most important prognostic factor, all patients had outerbridge III or IV lesions
Complications
- Infection
- Case reports related to Septic Arthritis[24]
- Rupture
- Neurovascular compression
- Thrombophlebitis
- Acute Compartment Syndrome
- Compressive Neuropathies of the Tibial Nerve, Peroneal Nerve have been reported[25]
- Deep Vein Thrombosis
- Compression of Popliteal Artery or Popliteal Vein
See Also
External
- Sports Medicine Review Knee Pain: https://www.sportsmedreview.com/by-joint/knee/
References
- ↑ Baker WM. On the formation of synovial cysts in the leg in connection with disease of the knee joint. 1877. Clin Orthop Relat Res. 1994;299:2-10.
- ↑ Adams R. Chronic rheumatic arthritis of the knee joint. Dublin J Med Sci. 1840;17:520-522.
- ↑ Foucher E. Memoire sur les kystes de la region poplitee. Arch Gen Med. 1856;2:313.
- ↑ Wilson PD, Eyre-Brook AL, Francis JD. A clinical and anatomical study of the semimembranosus bursa in relation to popliteal cyst. J Bone Joint Surg Am. 1938;20:963-984.
- ↑ 5.0 5.1 Sansone V, De Ponti A, Minio Paluello G, Del Maschio A. Popliteal cysts and associated disorders of the knee: critical review with MR imaging. Int Orthop. 1995;19:275-279.
- ↑ Taylor AR, Rana NA. A valve: an explanation of the formation of popliteal cysts. Ann Rheum Dis. 1973;32:419-421
- ↑ GRISTINA, ANTHONY G., and PHILIP D. WILSON. "Popliteal cysts in adults and children: a review of 90 cases." Archives of Surgery 88.3 (1964): 357-363.
- ↑ De Maeseneer, Michel, et al. "Popliteal cysts in children: prevalence, appearance and associated findings at MR imaging." Pediatric radiology 29.8 (1999): 605-609.
- ↑ Rauschning W. Anatomy and function of the communication between the knee joint and popliteal bursae. Ann Rheum Dis. 1980;39:354-358.
- ↑ Hill CL, Gale DG, Chaisson CE, et al. Knee effusions, popliteal cysts, and synovial thickening: association with knee pain in osteoarthritis. J Rheumatol. 2001;28:1330-1337.
- ↑ Rauschning W, Fredriksson BA, Wilander E. Histomorphology of idiopathic and symptomatic popliteal cysts. Clin Orthop Relat Res. 1982;164:306-311.
- ↑ Akagi, Ryuichiro, et al. "Natural history of popliteal cysts in the pediatric population." Journal of Pediatric Orthopaedics 33.3 (2013): 262-268.
- ↑ Akagi, Ryuichiro, et al. "Natural history of popliteal cysts in the pediatric population." Journal of Pediatric Orthopaedics 33.3 (2013): 262-268.
- ↑ Jensen KH, Jorgensen U. Lateral presentation of a Baker’s cyst. Clin Orthop Relat Res. 1993;287:202-203
- ↑ Tarhan S, Unlu Z. Magnetic resonance imaging and ultrasonographic evaluation of the patients with knee osteoarthritis: a comparative study. Clin Rheumatol. 2003;22:181-188.
- ↑ 16.0 16.1 Marti-Bonmati L, Molla E, Dosda R, Casillas C, Ferrer P. MR imaging of Baker cysts: prevalence and relation to internal derangements of the knee. MAGMA. 2000;10:205-210.
- ↑ Corten K, Vandenneucker H, Reynders P, Nijs S, Pittevils T, Bellemans J. A pyogenic, ruptured Baker’s cyst induced by arthroscopic pressure pump irrigation. Knee Surg Sports Traumatol Arthrosc. 2009;17:266-269
- ↑ Bryan RS, DiMichele JD, Ford GL., Jr. Popliteal cysts. Arthrography as an aid to diagnosis and treatment. Clin Orthop Relat Res. 1967;50:203-208.
- ↑ Torreggiani WC, Al-Ismail K, Munk PL, et al. The imaging spectrum of Baker’s (popliteal) cysts. Clin Radiol. 2002;57:681-691.
- ↑ Ward EE, Jacobson JA, Fessell DP, Hayes CW, van Holsbeeck M. Sonographic detection of Baker’s cysts: comparison with MR Imaging. AJR Am J Roentgenol. 2001;176:373-380.
- ↑ Acebes JC, Sanchez-Pernaute O, Diaz-Oca A, Herrero-Beaumont G. Ultrasonographic assessment of Baker’s cysts after intra-articular corticosteroid injection in knee osteoarthritis. J Clin Ultrasound. 2006;34:113-117
- ↑ Rauschning W, Lindgren PG. Popliteal cysts (Baker’s cysts) in adults: I. Clinical and roentgenological results of operative excision. Acta Orthop Scand. 1979;50:583-591
- ↑ Rupp S, Seil R, Jochum P, Kohn D. Popliteal cysts in adults: prevalence, associated intraarticular lesions, and results after arthroscopic treatment. Am J Sports Med. 2002;30:112-115.
- ↑ Eichinger JK, Bluman EM, Sides SD, Arrington ED. Surgical management of septic arthritis of the knee with a coexistent popliteal cyst. Arthroscopy. 2009;25:696-700.
- ↑ Ji JH, Shafi M, Kim WY, Park SH, Cheon JO. Compressive neuropathy of the tibial nerve and peroneal nerve by a Baker’s cyst: case report. Knee. 2007;14:249-252.
Created by:
John Kiel on 16 December 2020 21:18:39
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Last edited:
26 January 2023 19:57:13
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