Nurmuhammet TAŞ, Hülya UZKESER, Akın ERDAL

Is USG-guided aspiration more effective than physiotherapy in the treatment of Baker’s cyst?

Aim: Previous publications have described various therapeutic modalities for symptomatic cysts, including non-steroidal anti-inflammatory drugs, cystostomy, physical therapy, and exercises. The objective of thise study was to elucidate the effectiveness of shrinking the cyst without steroidal injection and to compare aspiration with classic physiotherapy and exercises. Material and Method: This randomized, controlled trial involved 40 patients with Baker’s cyst. The participants were randomized into two groups, (I) an aspiration group (n=20) and (II) a control group (n=20). In the aspiration group, Baker’s cyst content was aspirated percutaneously under USG guidance, while no aspiration was performed in the control group. Pain was evaluated with a visual analog scale, while the Lysholm knee scoring scale and Cincinnati knee rating system were employed to determine functional status. Quality of life and disability were evaluated using the Nottingham Health Profile and the Western Ontario and McMaster Universities Arthritis Index . Results: Differences were observed in USG measurements (width, length, and area) and clinical parameters before and after treatment in both groups. However, although these differences were greater in the aspiration group, they were not statistically significant. Conclusion: Our results indicate that cyst aspiration performed with USG provides no additional effect to those of physical exercises and cold application. Exercise therapy and cold application should be considered before proceeding with an invasive procedure.

Keywords:

Baker’s cyst, Cyst aspiration, Cold pack Knee exercises, Physical therapy, Ultrasonography,

PDF

___

Handy JR. Popliteal cysts in adults: a review. Semin Arthritis Rheum 2001; 31: 108-18.
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.
Burleson RJ, Bickel WH, Dahlin DC. Popliteal cyst; a clinicopathological survey. J Bone Joint Surg Am 1956; 38-A: 1265-74.
Gristina AG, Wilson PD. Popliteal cysts in adults and children. a review of 90 cases. Arch Surg 1964; 88: 357-63.
Canoso JJ, Goldsmith MR, Gerzof SG, Wohlgethan JR. Foucher’s sign of the Baker’s cyst. Ann Rheum Dis 1987; 46: 228-32.
Scheible W. Diagnostic ultrasound. In: Diagnosis of bone and joint disorders (2nd ed) Resnick D, Niwa-yama G, eds. Phildelphia Saunders 1988; 1: 247-9
Acebes JC, Sanchez-Pernaute O, Diaz-Oca A, Herrero-Beaumont G. Ultrasonographic assessment of Baker’s cysts after intra-articular corticosteroid injection in knee osteoarthritis. J Clin Ultrasound 2006; 34: 113-7.
Good AE. Rheumatoid arthritis, Baker’s cyst, and “thrombophlebitis”. Arthritis Rheum 1964; 7: 56-64.
Macfarlane DG, Bacon PA. Popliteal cyst rupture in normal knee joints. Br Med J 1980; 281: 1203-4.
Takano Y, Oida K, Kohri Y, et al. Is Baker’s cyst a risk factor for pulmonary embolism? Intern Med 1996; 35: 886-9.
Kirkham B, Churchill M, Dasgupta B, Wedderburn L, Spencer J, Macfarlane DG. Anterolateral rupture of popliteal cysts in rheumatoid arthritis. Ann Rheum Dis 1991; 50: 187-8.
Dash S, Bheemreddy SR, Tiku ML. Posterior tibial neuropathy from ruptured Baker’s cyst. Semin Arthritis Rheum 1998; 27: 272-6.
Scott WN, Jacobs B, Lockshin MD. Posterior compartment syndrome resulting from a dissecting popliteal cyst. Case report. Clin Orthop Relat Res 1977; 122: 189-92.
Nakano KK. Entrapment neuropathy from Baker’s cyst. JAMA 1978; 239: 135.
Köroglu M, Callıoglu M, Eris HN, et al. Ultrasound-guided percutaneous treatment and follow-up of Baker’s cyst in knee osteoarthritis. Eur J Radiol 2012; 81: 3466-71.
Cooling efficiency of 4 common cryotherapeutic agents. J Athl Train 2007; 42: 343–8.
Cina-Tschumi B. (Evidence-based impact of cryotherapy on postoperative pain, swelling, drainage, and tolerance after orthopedic surgery). Pflege 2007; 20: 258–67.
Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med 2007; 41: 365–9.
Calvisi V, Lupparelli S, Giuliani P. Arthroscopic all-inside suture of symptomatic Baker’s cysts: a technical option for surgical treatment in adults. Knee Surg Sports Traumatol Arthrosc 2007; 15: 1452-60.