Arthroscopic Popliteal Cyst Excision: Technique and Outcomes with 2-Year Follow-Up

Abstract

This study describes an arthroscopic technique for popliteal cyst excision and reports preliminary outcomes data. We retrospectively identified patients with symptomatic popliteal cysts who underwent popliteal cyst excision at our institution between 2013 and 2020. Arthroscopic popliteal cyst excision was performed using dual posteromedial portals, expansion of the valvular mechanism, and cyst wall resection. International Knee Documentation Committee (IKDC) scores were collected preoperatively and at follow-up. We calculated the proportions of patients meeting Patient Acceptable Symptomatic State (PASS) cutoffs for the IKDC, compared baseline and follow-up IKDC scores and the proportions of patients meeting PASS cutoffs, and examined the association between demographic and injury variables and outcomes. Forty patients were eligible to be included in this study (mean age = 52.1 years; mean follow-up time = 3.7 years), and baseline IKDC data were available for 30 patients. The mean IKDC score at baseline was 42.6 ± 14.9, compared to 70.4 ± 22.4 at follow-up (p < 0.01). At baseline, 13% of the cohort met the PASS cutoff for the IKDC. The proportion of the cohort meeting the IKDC PASS significantly increased at follow-up to 70% (p < 0.01). Longer postsurgery time was associated with lower IKDC scores at follow-up (R ² = 12.7%; p = 0.02) and with lower odds of meeting IKDC PASS at follow-up (OR = 0.57; p = 0.04). Higher preoperative body mass index was associated with lower IKDC scores at follow-up (R ² = 10.2%; p = 0.04). No patients reported cyst recurrence or need for surgical revision. This arthroscopic technique, utilizing two posteromedial portals, expansion of the valvular mechanism, and cyst wall resection, demonstrates good clinical outcomes at a mean follow-up of 3.7 years in a cohort of 40 patients.

The level of evidence is IV (case series).

Keywords

arthroscopy - sports medicine - popliteal cyst

• References

• 1 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
• 2 Lindgren PG, Willén R. Gastrocnemio-semimembranosus bursa and its relation to the knee joint. I. Anatomy and histology. Acta Radiol Diagn (Stockh) 1977; 18 (05) 497-512
• 3 Lindgren PG. Gastrocnemio-semimembranosus bursa and its relation to the knee joint. III. Pressure measurements in joint and bursa. Acta Radiol Diagn (Stockh) 1978; 19 (02) 377-388
• 4 Sansone V, De Ponti A. Arthroscopic treatment of popliteal cyst and associated intra-articular knee disorders in adults. Arthroscopy 1999; 15 (04) 368-372
• 5 Sansone V, de Ponti A, Paluello GM, del Maschio A. Popliteal cysts and associated disorders of the knee. Critical review with MR imaging. Int Orthop 1995; 19 (05) 275-279
• 6 Tschirch FT, Schmid MR, Pfirrmann CW, Romero J, Hodler J, Zanetti M. Prevalence and size of meniscal cysts, ganglionic cysts, synovial cysts of the popliteal space, fluid-filled bursae, and other fluid collections in asymptomatic knees on MR imaging. AJR Am J Roentgenol 2003; 180 (05) 1431-1436
• 7 Frush TJ, Noyes FR. Baker's cyst: diagnostic and surgical considerations. Sports Health 2015; 7 (04) 359-365
• 8 Van Nest DS, Tjoumakaris FP, Smith BJ, Beatty TM, Freedman KB. Popliteal cysts: a systematic review of nonoperative and operative treatment. JBJS Rev 2020; 8 (03) e0139
• 9 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370 (9596) 1453-1457
• 10 Irrgang JJ, Anderson AF, Boland AL. et al. Development and validation of the International Knee Documentation Committee subjective knee form. Am J Sports Med 2001; 29 (05) 600-613
• 11 Higgins LD, Taylor MK, Park D. et al; International Knee Documentation Committee. Reliability and validity of the International Knee Documentation Committee (IKDC) subjective knee form. Joint Bone Spine 2007; 74 (06) 594-599
• 12 Dwyer T, Zochowski T, Ogilvie-Harris D, Theodoropoulos J, Whelan D, Chahal J. Determining the patient acceptable symptomatic state for patients undergoing arthroscopic partial meniscectomy in the knee. Am J Sports Med 2020; 48 (04) 847-852
• 13 Rauschning W. Anatomy and function of the communication between knee joint and popliteal bursae. Ann Rheum Dis 1980; 39 (04) 354-358
• 14 Calvisi V, Zoccali C. Arthroscopic patterns of the poster-medial aspect of the knee joint: classification of the gastrocnemius-semimembranosus gateway and its relationship with Baker's cyst. Muscles Ligaments Tendons J 2016; 6 (04) 492-498
• 15 Takahashi M, Nagano A. Arthroscopic treatment of popliteal cyst and visualization of its cavity through the posterior portal of the knee. Arthroscopy 2005; 21 (05) 638
• 16 Yang B, Wang F, Lou Y. et al. A comparison of clinical efficacy between different surgical approaches for popliteal cyst. J Orthop Surg Res 2017; 12 (01) 158
• 17 Ahn JH, Lee SH, Yoo JC, Chang MJ, Park YS. Arthroscopic treatment of popliteal cysts: clinical and magnetic resonance imaging results. Arthroscopy 2010; 26 (10) 1340-1347
• 18 Cho JH. Clinical results of direct arthroscopic excision of popliteal cyst using a posteromedial portal. Knee Surg Relat Res 2012; 24 (04) 235-240
• 19 Ohishi T, Takahashi M, Suzuki D. et al. Treatment of popliteal cysts via arthroscopic enlargement of unidirectional valvular slits. Mod Rheumatol 2015; 25 (05) 772-778
• 20 Rauschning W. Popliteal cysts (Baker's cysts) in adults. II. Capsuloplasty with and without a pedicle graft. Acta Orthop Scand 1980; 51 (03) 547-555
• 21 Mei ZF, Lei WT, Ma W, Ni LZ, Pan GB, Han ZW. [Comparison of therapeutic effects of arthroscopic popliteal cyst internal drainage and capsular wall resection]. Zhongguo Gu Shang 2023; 36 (09) 833-838
• 22 Gu H, Bi Q, Chen J. Arthroscopic treatment of popliteal cyst using a figure-of-four position and double posteromedial portals. Int Orthop 2019; 43 (06) 1503-1508
• 23 Li H, Zhang M, Li Y, Wang H. Comparison of clinical outcomes associated with arthroscopic cyst wall preservation or resection in the treatment of popliteal cyst: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2021; 141 (10) 1741-1752
• 24 Kongmalai P, Chernchujit B. Arthroscopic treatment of popliteal cyst: a direct posterior portal by inside-out technique for intracystic debridement. Arthrosc Tech 2015; 4 (02) e143-e148
• 25 Johnson LL, van Dyk GE, Johnson CA, Bays BM, Gully SM. The popliteal bursa (Baker's cyst): an arthroscopic perspective and the epidemiology. Arthroscopy 1997; 13 (01) 66-72
• 26 Stone KR, Stoller D, De Carli A, Day R, Richnak J. The frequency of Baker's cysts associated with meniscal tears. Am J Sports Med 1996; 24 (05) 670-671
• 27 Artul S, Jabaly-Habib H, Artoul F, Habib G. The association between Baker's cyst and medial meniscal tear in patients with symptomatic knee using ultrasonography. Clin Imaging 2015; 39 (04) 659-661
• 28 Rauschning W, Lindgren PG. The clinical significance of the valve mechanism in communicating popliteal cysts. Arch Orthop Trauma Surg 1979; 95 (04) 251-256