Description
A popliteal cyst, also known as a Baker's cyst, is a fluid-filled swelling that appears behind the knee joint, often resulting from underlying conditions such as arthritis or a meniscal tear. The cyst can cause discomfort, swelling, and limited movement of the knee. When conservative treatments like rest, ice, compression, elevation (RICE), and non-steroidal anti-inflammatory drugs (NSAIDs) do not alleviate symptoms, or if the cyst is large and causes significant discomfort, surgical intervention may be considered.
Arthroscopic excision of a popliteal cyst is a minimally invasive surgical technique used to remove the cyst. This procedure is typically performed under general or regional anesthesia. During the surgery, the surgeon makes small incisions around the knee to insert an arthroscope (a small camera) and specialized instruments. The arthroscope provides a clear view inside the knee, allowing the surgeon to carefully excise the cyst and address any underlying intra-articular pathology, such as meniscal tears or cartilage damage, which could be contributing to the formation of the cyst.
Résumé
- Dr. Muhammad Emra discussed complete cysts, a fluid collection on the back of the knee, also known as Baker's cysts. He emphasized that while often attributed to Baker, Adams initially described the condition. The cyst is typically located between the semimembranosus and gastrocnemius muscles, arising from an inflamed bursa.
- The incidence of Baker's cysts is higher in patients with rheumatoid arthritis, knee pain, and knee effusion. Causes include joint inflammation, injury, osteoarthritis, meniscus tears, infection, and any condition leading to fluid overproduction in the knee joint.
- Symptoms commonly include swelling and pain at the back of the knee, a feeling of fullness, and knee stiffness, which worsen with prolonged standing or walking but may alleviate with knee flexion. Complications can arise, such as cyst rupture, leading to calf pain and swelling, mimicking deep vein thrombosis.
- Diagnosis involves ultrasonography to assess size and fluid volume, X-rays to check for osteoarthritis, and MRI to evaluate detailed anatomy and other potential issues like meniscus tears or ligament injuries. Initial treatment is generally conservative, involving analgesics, rest, and physiotherapy.
- Dr. Emra highlighted the importance of addressing the underlying inter-articular pathology, not just excising the cyst itself. Arthroscopic treatment is indicated for cysts larger than 5 cm, causing intermittent pain, pressing on neurovascular structures, or occurring with other conditions like patellofemoral cartilage damage.
- He contrasted arthroscopic with open surgical methods, noting that open surgery involves a larger incision, potential for scarring, and a higher recurrence rate (63%) due to neglecting the intra-articular cause. Arthroscopic treatment has a recurrence rate of only 4% and requires careful planning based on MRI findings to confirm the cyst's origin.
- He described the arthroscopic procedure, including portal placement and techniques for accessing the posterior compartment of the knee, such as piter sting of the medial collateral ligament. He emphasized the importance of identifying key landmarks like the posterior transverse meniscal fold and the medial head of the gastrocnemius.
- Dr. Emra outlined two schools of thought regarding arthroscopic treatment: one involves simply shaving the posterior transverse fold, while the other advocates for complete shaving of the cyst itself. He prefers the latter approach for better results. He also cautioned against shaving too deeply to avoid injury to the skin at the back of the knee.
Exemple de certificat
À propos des intervenants
Dr. Mohammed Imran
Specialist in Orthopedics, NMC Royal Family Medical Center, AUH
Divulgation financière
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