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Medicine

An Effective Surgical Strategy for Anteromedial Osteoarthritis of the Knee with Simultaneous Popliteal Cysts Drainage

Published: November 25, 2022
doi:
10.3791/64725
, , , ,
1Department of Orthopaedic Surgery,Second Hospital of Shanxi Medical University

Summary

Popliteal cysts are frequently found during the pre-operative examination of patients with osteoarthritis being prepared for the unicompartmental knee arthroplasty. These symptomatic cysts usually require treatment. To do this, a unicompartmental knee arthroplasty was performed with internal drainage of the popliteal cyst under the same anesthetic.

Abstract

Unicompartmental knee arthroplasty (UKA) is an established treatment option for anteromedial osteoarthritis, and popliteal cysts are a common finding in the knee among patients with chronic osteoarthritis pain. The two are so closely related that popliteal cysts are commonly discovered during the unicompartmental knee arthroplasty preoperative examination. However, only a few reports exist on the management and outcome of popliteal cysts in the patients receiving UKA for knee osteoarthritis (OA) and popliteal cysts. As such, it is crucial to evaluate different treatment strategies and their management of popliteal cysts. In this paper, we evaluate a surgical strategy for patients with knee anteromedial osteoarthritis and symptomatic popliteal cysts. These patients were treated with UKA and internal drainage of the popliteal cyst. The results shown here, spanning 1-year post-operation follow-up, demonstrated that UKA and internal drainage is an effective surgical protocol for treating anteromedial osteoarthritis with symptomatic popliteal cysts.

Introduction

A popliteal cyst is a mass located in the popliteal area, filled with fluid, which is prevalent in locations of intra-articular lesions of the knee1. Multiple reports suggest a strong correlation between popliteal cysts and knee osteoarthritis (OA)2,3. As a result, ~20%-42% of patients with knee OA also experience popliteal cysts1,3,4,5,6,7,8. Most of the cysts are rarely symptomatic and do not generally require therapy, while the symptomatic cysts warrant surgical resection9.

Unicompartmental knee arthroplasty (UKA) is widely used in the treatment of anteromedial knee OA10,11. Popliteal cysts are commonly discovered during the UKA preoperative examination. However, only a few reports exist on the management and outcome of popliteal cysts in patients that received UKA for knee OA and popliteal cysts. This article describes a protocol on how to treat popliteal cysts together with UKA.

Protocol

The present study was approved by the ethics committee of Second Hospital of Shanxi Medical University and all the patients provided written informed consent. 1. Inclusion and exclusion criteria for patients Use the following inclusion criteria. Select patients diagnosed with anteromedial osteoarthritis of the knee where conservative treatment failed. Diagnose anteromedial osteoarthritis of the knee by anteroposterior x-ray, based on a narrowed medial c…

Representative Results

Clinical evaluation Each patient was followed up for at least 1 year after the operation. At 1 year postoperatively, the postoperative VAS score significantly decreased from 7.0 ± 0.9 to 0.6 ± 0.7 (P < 0.05); the HSS score improved from 48.3 ± 8.5 preoperatively to 87.8 ± 4.6 (P < 0.05); and the WOMAC score decreased from 56.0 ± 9.6 preoperatively to 11.6 ± 5.0 (P < 0.05). The symptoms of popliteal cysts were instantly relieved for all the eight patients af…

Discussion

A popliteal cyst, otherwise known as a Baker's cyst, is the knee joint disorder that is prevalent among the middle-aged and older population16,17. The incidence of popliteal cysts, in combination with symptomatic knee joint disease, is between 9.2% to 38%, depending on the location and the analysis18,19,20. Approximately 20%-42% of the patients with knee OA also have…

Disclosures

The authors have nothing to disclose.

Acknowledgements

This research was supported by a grant from the Fund Program for the Scientific Activities of Selected Returned Overseas Professionals in Shanxi Province (grant number: 20210008).

Materials

Excel Microsoft digital table software
Magnetic resonance inspection (MRI) General Electric Company Imaging examination of popliteal cyst before and after surgery.
Oxford® Partial Knee surgery system ZIMMER BIOMET NONE For the catalog numbers refer to Oxford Partial Knee Microplasty Instrumentation (femoral component, tibial component, meniscus bearing)
ultrasound General Electric Company we used ultrasound to observe changes in the postoperative cysts
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References

  1. Liao, S. -. T., Chiou, C. -. S., Chang, C. -. C. Pathology associated to the Baker’s cysts: a musculoskeletal ultrasound study. Clinical Rheumatology. 29 (9), 1043-1047 (2010).
  2. Jiang, J., Ni, L. Arthroscopic internal drainage and cystectomy of popliteal cyst in knee osteoarthritis. Journal of Orthopaedic Surgery and Research. 12 (1), 1-6 (2017).
  3. Razek, A. A. K. A., El-Basyouni, S. R. Ultrasound of knee osteoarthritis: interobserver agreement and correlation with Western Ontario and McMaster Universities Osteoarthritis. Clinical Rheumatology. 35 (4), 997-1001 (2016).
  4. Rupp, S., Seil, R., Jochum, P., Kohn, D. Popliteal cysts in adults. Prevalence, associated intraarticular lesions, and results after arthroscopic treatment. American Journal of Sports Medicine. 30 (30), 112-115 (2002).
  5. Gu, H., Bi, Q., Chen, J. Arthroscopic treatment of popliteal cyst using a figure-of-four position and double posteromedial portals. International Orthopaedics. 43 (6), 1503-1508 (2019).
  6. Johnson, L. L., Van Dyk, G. E., Johnson, C. A., Bays, B. M., Gully, S. M. The popliteal bursa (Baker"s cyst): An arthroscopic perspective and the epidemiology. Arthroscopy: The Journal of Arthroscopic & Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 13 (1), 66-72 (1997).
  7. Bui-Mansfield, L. T., Youngberg, R. Baker’s cyst. Magnetic Resonance Imaging (MRI). 5, 18 (2009).
  8. Fam, A., Wilson, S., Holmberg, S. Ultrasound evaluation of popliteal cysts on osteoarthritis of the knee. The Journal of Rheumatology. 9 (3), 428-434 (1982).
  9. Zhang, M., et al. Arthroscopic internal drainage with cyst wall resection and arthroscopic internal drainage with cyst wall preservation to treat unicameral popliteal cysts: A retrospective case-control study. Orthopaedic Surgery. 13 (4), 1159-1169 (2021).
  10. Murray, D. W., Parkinson, R. W. Usage of unicompartmental knee arthroplasty. Bone & Joint Journal. 100 (4), 432 (2018).
  11. Wal Hamilton, T., et al. Evidence-based indications for mobile-bearing unicompartmental knee arthroplasty in a consecutive cohort of thousand knees. The Journal of Arthroplasty. 32 (6), 1779-1785 (2017).
  12. Rauschning, W., Lindgren, P. G. Popliteal cysts (Baker’s cysts) in adults. I. Clinical and roentgenological results of operative excision. Acta Orthopaedica Scandinavica. 50 (5), 583-591 (1979).
  13. Crichton, N. Information point: Visual analogue scale (VAS). Journal of Clinical Nursing. 10 (5), 706 (2001).
  14. Bach, C. M., et al. Scoring systems in total knee arthroplasty. Clinical Orthopaedics and Related Research. 399 (1976-2007), 184-196 (2002).
  15. Ackerman, I. Western ontario and mcMaster universities osteoarthritis index (WOMAC). Australian Journal of Physiotherapy. 55 (3), 213 (2009).
  16. Baker, W. On the formation of synovial cysts in the leg in connection with disease of the knee joint. Clinical Orthopaedics and Related Research. (299), 2-10 (1877).
  17. Herman, A. M., Marzo, J. M. Popliteal cysts: a current review. Orthopedics. 37 (8), 678-684 (2014).
  18. Johnson, L. L., Van Dyk, G. E., Johnson, C. A., Bays, B. M., Gully, S. M. The popliteal bursa (Baker’s cyst): an arthroscopic perspective and the epidemiology. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 13 (1), 66-72 (1997).
  19. Sansone, V., De Ponti, A., Paluello, G. M., Del Maschio, A. Popliteal cysts and associated disorders of the knee. International Orthopaedics. 19 (5), 275-279 (1995).
  20. Sansone, V., de Ponti, A., Paluello, G. M., del Maschio, A. Popliteal cysts and associated disorders of the knee. Critical review with MR imaging. International Orthopaedics. 19 (5), 275-279 (1995).
  21. Hommel, H., Becker, R., Fennema, P., Kopf, S. The fate of Baker’s cysts at mid-term follow-up after total knee arthroplasty. The Bone & Joint Journal. 102 (1), 132-136 (2020).
  22. Rauschning, W., Lindgren, P. G. Popliteal cysts (Baker’s cysts) in adults: I. Clinical and roentgenological results of operative excision. Acta Orthopaedica Scandinavica. 50 (5), 583-591 (1979).
  23. Lindgren, P. G., Willen, R. Gastrocnemio-Semimembranosus bursa and its relation to the knee joint: I. Anatomy and histology. Acta Radiologica: Diagnosis. 18 (5), 497-512 (1977).
  24. Ohishi, T., et al. Treatment of popliteal cysts via arthroscopic enlargement of unidirectional valvular slits. Modern Rheumatology. 25 (5), 772-778 (2015).
  25. Takahashi, M., Nagano, A. Arthroscopic treatment of popliteal cyst and visualization of its cavity through the posterior portal of the knee. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 21 (5), 638 (2005).
  26. Sansone, V., De Ponti, A. Arthroscopic treatment of popliteal cyst and associated intra-articular knee disorders in adults. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 15 (4), 368-372 (1999).
  27. Ahn, J. H., Lee, S. H., Yoo, J. C., Chang, M. J., Park, Y. S. Arthroscopic treatment of popliteal cysts: clinical and magnetic resonance imaging results. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 26 (10), 1340-1347 (2010).
  28. Jin, H. C. Clinical results of direct arthroscopic excision of popliteal cyst using a posteromedial portal. Knee Surgery & Related Research. 24 (4), 235-240 (2012).
  29. Ujjval, D., Harshvardhan, J., Chetan, R., Loya, N. Arthroscopic treatment of popliteal cyst and visualization of its cavity through the posterior portal of the knee. National Journal of Integrated Research in Medicine. 1 (1), 25-29 (2010).
  30. Herman, A. M., Marzo, J. M. Popliteal cysts: a current review. Orthopedics. 37 (8), 678 (2014).

Tags

Knee OsteoarthritisAnteromedial OsteoarthritisPopliteal CystsUnicompartmental Knee Arthroplasty (UKA)Surgical TreatmentCyst Drainage
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Wang, H., Yang, J., Feng, Y., Xi, G., Zhang, M. An Effective Surgical Strategy for Anteromedial Osteoarthritis of the Knee with Simultaneous Popliteal Cysts Drainage. J. Vis. Exp. (189), e64725, doi:10.3791/64725 (2022).
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