Arthroscopic all-inside suture of symptomatic Baker’s cysts: a technical option for surgical treatment in adults

Calvisi, Vittorio; Lupparelli, Stefano; Giuliani, Pierandrea

doi:10.1007/s00167-007-0383-z

Cited by 39 publications

(36 citation statements)

References 11 publications

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“…1,2,4 Targeting the valve or stalk has proven to be insufficient. [4][5][6] A thorough excision of the cyst in its entirety appears to be the most effective treatment for recurrent or idiopathic popliteal cysts.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Popliteal Cyst Excision Using Open Posterior Approach After Arthroscopic Partial Medial Meniscectomy

Snir

Hamula

Wolfson

et al. 2013

Arthroscopy Techniques

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Popliteal cysts are known to be associated with intra-articular pathology, which must be addressed to prevent cyst recurrence. Indications for popliteal cyst excision include cases in which the popliteal cyst does not respond to conservative treatment or arthroscopic intervention or cases in which an underlying cause cannot be found. Several techniques have been described to excise these cysts. Traditionally, open techniques have been associated with cyst recurrence. More recently, arthroscopic cystectomy has been described. However, the risk of recurrence persists because arthroscopy may not afford complete surgical excision. This technical note presents an open posterior technique for popliteal cyst excision that allows for better visualization and complete removal of the cyst while minimizing the risk of neurovascular complications and soft-tissue damage. It is a safe, effective, and straightforward method to achieve symptomatic relief for refractory popliteal cysts.P opliteal cysts, also known as Baker cysts, are fluidfilled structures with a synovial lining typically located between the medial head of the gastrocnemius muscle and semimembranosus tendon. Although some popliteal cysts maintain a unidirectional valve communication with the joint cavity, preventing shifting of fluid from the cyst back into the knee joint, others communicate freely. 1 They can occur due to intraarticular pathology, including meniscal and anterior cruciate ligament tears, chondral lesions, and synovitis. 2 The underlying or associated intra-articular pathology must be addressed to prevent recurrence of the cyst.Surgical removal of popliteal cysts is indicated in rare cases when the cyst remains symptomatic despite treatment of intra-articular pathology or if no underlying cause is found. Historically, open surgical excision has been performed through a posterior approach or posteromedial approach. 1,3 Arthroscopic closure of the valve without removal of the cyst has shown poor results. [4][5][6] Arthroscopic valve closure with cyst excision has been described through a posteromedial cyst portal with good preliminary results. 7,8 However, there is still no surgical standard of care for patients with refractory cysts, and concern for recurrence persists.This technical note presents an open posterior technique for popliteal cyst excision that allows for complete removal of the cyst while minimizing the risk of neurovascular complications and soft-tissue damage. It is a safe, effective, and simple method to achieve symptomatic relief for refractory popliteal cysts. Surgical TechniqueThis technique is indicated for cases in which the intra-articular pathology associated with popliteal cysts has been corrected and patients continue to have symptoms from the popliteal cyst without an associated intra-articular lesion. Popliteal cyst excision is always preceded by knee arthroscopy to evaluate for recurrent intra-articular pathology. Popliteal cyst excision is not recommended as a first-line treatment for symptomatic knees. Most...

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Section: Discussionmentioning

confidence: 99%

“…1,3 Arthroscopic closure of the valve without removal of the cyst has shown poor results. [4][5][6] Arthroscopic valve closure with cyst excision has been described through a posteromedial cyst portal with good preliminary results. 7,8 However, there is still no surgical standard of care for patients with refractory cysts, and concern for recurrence persists.…”

mentioning

confidence: 99%

Popliteal Cyst Excision Using Open Posterior Approach After Arthroscopic Partial Medial Meniscectomy

Snir

Hamula

Wolfson

et al. 2013

Arthroscopy Techniques

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“…Historically, direct open excision has resulted in unacceptably high recurrence rates, as the intra-articular pathology that causes and sustains the cyst is not curable and the communication with the joint is not tightly closed [31][32][33]. Currently, arthroscopic procedures are most commonly used to treat the intra-articular pathology and to address the cysts directly by opening [32] or closing [34] the orifice of communication. However, we propose that open surgery combined with arthroscopic procedures is also necessary when the cysts are large.…”

Section: Intramuscular Cysts Arising From the Knee Jointmentioning

confidence: 99%

Intramuscular Cysts at the Proximal Calf: Two Case Reports and a Systematic Review of Literature

et al. 2018

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Intramuscular cysts at the proximal calf are rare; however, their etiology is diverse, making accurate diagnosis and treatment difficult. To our knowledge, there are no previous publications in literature about intramuscular cysts at the proximal calf, arising from different origins. This article describes two rare cases with intramuscular cysts. Case 1 was diagnosed as an intramuscular ganglion cyst arising from the proximal gastrocnemius medialis muscle, and arthroscopic examination as well as open cyst excision was performed. Case 2 was another type, which has never been reported in the literature. It was diagnosed as diffuse pigmented villonodular synovitis (PVNS), with the intramuscular cyst arising from PVNS, and only arthroscopic synovectomy was performed. The diagnoses for these cases were confirmed by histopathology. In addition, we have summarized intramuscular cysts at the proximal calf by a systematic literature review and divided them into five types based on their origin. The five types are, intramuscular cysts arising from the muscular tissue, knee joint, proximal tibiofibular joint, the neurilemma and PVNS. The treatment of intramuscular cysts varies based on their origin; hence, it is important to identify the origin.

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“…Several surgical approaches are available; the most of the Authors sustains the importance of treating intrarticular disease which, probably, causes the onset of the cyst. Our group and other surgeons prefer also to close the gateway 6,38,39 , otherwise other Authors suggest to enlarge the communication, removing the valve mechanism [40][41][42][43] . A recent review analyzed 11 studies valuing the results of the surgical approach; it evidenced a success rate of 96.7 and 84.6% in the communication-enlargement group and communication-closure group, respectively; considering just the first group, the percentage of success was 98.2% for the Authors sustaining resection of the cyst wall and 94.7% for the Authors which don't do it 44 .…”

Section: @ C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 99%

“…The arthroscopic anatomy varies depending on the angle of the OPL, the level at which it crosses the medial gastrocnemius tendon, and its relationship with the capsular joint and synovia. The aim of this paper is to describe the arthroscopic anatomy of the posterior aspect of the knee joint, and to perform a classification of the possible patterns and evaluate their relationship with the presence of the BC, in order to facilitate its recognition and the all-inside suture technique for suturing its gateway 6 .…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic patterns of the poster-medial aspect of the knee joint: classification of the gastrocnemiussemimembranosus gateway and its relationship with Baker�s cyst

Calvisi

Zoccali²

2016

MLTJ

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SummaryBackground: The gastrocnemius-semimembranosus bursa may communicate with the knee joint. The arthroscopic anatomy of the posteromedial aspect varies depending on the angle of the oblique popliteal ligament, the level at which it crosses the medial gastrocnemius tendon, and its relationship with the capsular joint and synovia. The aim of this paper is to identify possible patterns, and to evaluate their characteristics and their relationship with Baker's cyst. Methods: data archived from 185 consecutive arthroscopies were evaluated; an anatomic description and classification was carried out; the percentages of association with BC and the associated pathologies were reported. Results: The different anatomies were classified into six groups based on the relationship above the medial gastrocnemius tendon, the capsular joint and synovia. The prevalence of Baker's cyst was 28.3%. The main associated intra-articular pathological condition was the contemporary presence of a meniscal tear and chondropathy. Conclusion: Exploration of the posterior aspect of the knee must be performed routinely. Knowing the possible anatomy patterns of the posteromedial arthroscopic aspect of the knee joint could help to identify the cyst and its gateway, thus facilitating its treatment. Level of the evidence: III.

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Arthroscopic all-inside suture of symptomatic Baker’s cysts: a technical option for surgical treatment in adults

Cited by 39 publications

References 11 publications

Popliteal Cyst Excision Using Open Posterior Approach After Arthroscopic Partial Medial Meniscectomy

Popliteal Cyst Excision Using Open Posterior Approach After Arthroscopic Partial Medial Meniscectomy

Intramuscular Cysts at the Proximal Calf: Two Case Reports and a Systematic Review of Literature

Arthroscopic patterns of the poster-medial aspect of the knee joint: classification of the gastrocnemiussemimembranosus gateway and its relationship with Baker�s cyst

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