Bakers or popliteal cysts represent an extrusion of synovial fluid into a false cavity.
Bakers or popliteal cysts represent an extrusion of synovial fluid into a false cavity. This most commonly occurs between the medial head of the gastrocnemius and semimembranosus muscles and communicate with articular joint space. They are associated with intra-articular conditions such as osteoarthritis, meniscus tear, and rheumatoid arthritis.
Typical presentation is vague posterior knee pain with or without soft tissue mass or swelling. Diagnosis is made with ultrasound or MRI. These are notoriously stubborn to treat.
Example of ultrasound of a bakers cyst (adopted from semanticscholar.org) Ultrasound guided aspiration with corticosteroid injection. Corticosteroid injections are generally considered first line therapy. The addition of ultrasound provides easy visualization of the fluid collection and needle guidance for aspiration and injection.
Bandinelli showed that injecting directly into the cyst under ultrasound guidance was superior to injecting into the joint space. Re-aspiration rate was 12.9% in this study. Ultrasound image of aspiration of a bakers cyst (adopted from youtube.com) Sclerotherapy.
There are several case series using sclerotherapy with dextrose to shrink the size of the cyst. This is level 4 evidence and requires more thorough investigation to demonstrate the utility. Open excision is associated with high recurrence rates so surgical management revolves around an arthroscopic approach.
If you are experiencing symptoms that may be related to treatment options for bakers cyst, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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