Comparing the Results of Open with Arthroscopic Surgery for Popliteal Cyst and the Associated Intra-Articular Lesions

The Valvular mechanism and associated intra-articular lesions has shifted therapeutic approach for Baker’s cyst towards arthroscopic technique.

The aims of this study include determining the frequency of accompanying intra-articular lesions as well as comparing the outcomes of treating popliteal cyst with arthroscopy and open surgery.

This is a prospective study on 45 patients referred with symptoms of pain، swelling، and limited range of motion in knees and underwent arthroscopy with a diagnosis of Baker’s cyst confirmed by clinical examination and sonography. The accompanying intra-articular lesions were documented and treated and، whenever possible، the cyst’s valve was removed (26 cases). Otherwise، the cyst would be excised by open surgery (19 cases). On arthroscopy، we used the anterolateral and anteromedial portals to treat accompanying lesions، and the additional posteromedial portal for removing cyst’s valve. We recorded and analyzed the patients’ demographic characteristics، associated lesions and rate of reduction of symptoms (using Rauschning and Lindgren scale) before and three months after surgery. One year after surgery، recurrence was studied through sonography.

The arthroscopic group consisted of 11 women and 15 men (mean age: 48. 27±8. 27years) and 8 women and 11 men (mean age: 48. 63±9. 15 years) were in open surgery group. They all had at least one intra-articular lesion. The most frequent associated lesion was medial meniscus tear (75. 6%)، followed by sinovitis and chondral lesions. In both groups، the patients recovered considerably after three months (p<0. 0001); in both modes of therapy symptoms were reduced almost equally (P=0. 74) and no case of recurrence after one year was found.

The results suggest that arthroscopic treatment of intra-articular pathologies may result in lower rate of recurrence for popliteal cyst. In case the valve is found and removed and the cyst is extracted through its entry into the knee، it is then not necessary to excise the cyst by open surgery.