Ultrasound guided percutaneous treatment and follow-up of Baker's cyst in knee osteoarthritis

We report a rare case of a “giant Baker’s cyst-related rheumatoid arthritis (RA)” with 95 × 26 mm dimensions originating from the semimembranosus tendon. The patient presented with chronic pain and a palpable mass behind his left calf located between the posteriosuperior aspect of the popliteal fossa and the distal third of the calf. In MRI cystic lesion which was located in soft tissue at the posterior of gastrocnemius, extensive synovial pannus inside and degeneration of medial meniscus posterior horn were observed. Arthroscopic joint debridement and partial excision of the cyst via biomechanical valve excision were performed. The patient continued his follow-up visits at Rheumatology Department and there was no recurrence of cyst-related symptoms in 1-year follow-up. Similar cases were reported in the literature previously. However, as far as we know, a giant Baker’s cyst-related RA, which was treated as described, has not yet been presented.

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Ultrasound-Guided Diagnosis and Aspiration of Baker’s Cyst

American Journal of Physical Medicine & Rehabilitation ◽

10.1097/phm.0b013e318269d95b ◽

2012 ◽

Vol 91 (11) ◽

pp. 1002-1004 ◽

Cited By ~ 6

Author(s):

Chih-Kuang Chen ◽

Henry L. Lew ◽

Roanna I.H. Liao

Keyword(s):

Ultrasound Guided ◽

Baker’S Cyst ◽

Baker's Cyst

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Intra-articular corticosteroid injection and genicular nerve block under ultrasound guidance in pain control of knee osteoarthritis

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00577-z ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Abdel Rahman Ragab ◽

Sherif Hegab ◽

Rehab Elnemr ◽

Amr Abdel-Kerim

Keyword(s):

Knee Osteoarthritis ◽

Nerve Block ◽

Corticosteroid Injection ◽

Oxford Knee Score ◽

The Elderly ◽

Functional Improvement ◽

Ultrasound Guided ◽

Knee Oa ◽

Group 2

Abstract Background Chronic knee osteoarthritis (OA) is a frequent disease among the elderly. Intra-articular corticosteroid injection (IACSI) was commonly adopted to alleviate knee OA-related pains. Recently, Genicular nerve block (GNB) has emerged as a new alternative technique. The current study aimed to investigate the efficacy of those two approaches when guided with ultrasound and to determine which one offers better results. This study included 40 patients with painful chronic knee OA (Nine males and 31 females, age ranged from 44 to 65 years) and were randomly assigned to two equal groups. Groups 1 was managed with ultrasound-guided IACSI and group 2 with ultrasound-guided GNB using a mixture of lidocaine and Triamcinolone Acetonide. The baseline mean visual analogue scale (VAS) and Oxford knee score (OKS) for the group 1 were 87.10 and 51.3, while for group 2 were 87.75 and 53.25 respectively. Follow up values were obtained at 2, 4 and 8 weeks using VAS and OKS. Results The VAS score and OKS score were significantly lower in the GNB group and IACSI group at 2, and 4 weeks after the procedure (p < 0.001 for all), then returned near baseline values at 8 weeks. When the two groups were compared according to changes in VAS and OKS from baseline at 2, 4, and 8 weeks, GNB group showed significant alleviation of pain (mean reduction of 58.5, 53.3, and 9.25 points at 2, 4, and 8 weeks versus 44.9, 39.4, and 5.6 points at the IACSI groups, p < 0.001 at 2 and 4 weeks, p < 0.006 at 8 weeks). Similarly at the OKS, the GNB group showed significantly better results (33.50, 28.60, and 8.5 at GNB and 26.45, 20.10, 5.25 at IACSI. p < 0.001 at all periods). Conclusions Both GNB and IACSI are effective methods to relieve chronic knee osteoarthritis-related pains. When compared to each other, GNB showed more significant pain relief and functional improvement than IACSI.

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Baker’s Cyst with Knee Osteoarthritis: Clinical and Therapeutic Implications

Medical Principles and Practice ◽

10.1159/000518792 ◽

2021 ◽

Vol 30 (6) ◽

pp. 585-591

Author(s):

Michele Abate ◽

Luigi Di Carlo ◽

Angelo Di Iorio ◽

Vincenzo Salini

Keyword(s):

Hyaluronic Acid ◽

Conservative Treatment ◽

Knee Osteoarthritis ◽

Clinical Data ◽

Clinical Presentation ◽

Medium Term ◽

Baker’S Cyst ◽

Therapeutic Implications ◽

Baker's Cyst ◽

Ultrasound Evaluation

Objective: Several symptoms are common to knee osteoarthritis and Baker’s cyst. To what extent each condition contributes to the patient’s discomfort is still a matter of debate. The aim of the present study was twofold: first, to compare the burden of symptoms in patients with isolated knee osteoarthritis and patients with knee osteoarthritis associated with Baker’s cyst; second, to assess the outcomes after conservative treatments. Subject and Methods: Patients suffering from monolateral idiopathic knee osteoarthritis were enrolled. Demographic, anthropometric and clinical data (KOOS scale) were collected. Ultrasound evaluation was performed according to standard protocols. On the basis of the clinical presentation different therapeutic options were used (fluid withdrawal, hyaluronic acid and/or steroids injections). Results: One-hundred and thirty patients were included in the study (97 with isolated knee osteoarthritis, 33 with knee osteoarthritis and Baker’s cyst). In basal conditions, lower scores in KOOS sub-scales were observed in patients with knee osteoarthritis associated with Baker’s cyst and in patients with effusion compared with patients without effusion. At 3 months after therapy significant higher scores were observed in both groups. At 6 months the scores were unchanged in the patients without Baker’s cyst, but worsened in those with Baker’s cyst. Conclusions: The study shows that Baker’s cysts associated with knee osteoarthritis contribute to the burden of symptoms. The conservative treatment of both conditions allows significant improvements, but in the medium term (6 months) the efficacy of the therapy declines in patients with knee osteoarthritis associated with Baker’s cyst.

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Natural course of Baker’s cysts in a total knee arthroplasty population

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00286 ◽

2020 ◽

Vol 8 (5_suppl4) ◽

pp. 2325967120S0028

Author(s):

Hagen Hommel ◽

Sebastian Kopf

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Natural Course ◽

Cyst Size ◽

Baker’S Cyst ◽

Baker's Cyst ◽

Adjacent Structures ◽

Total Knee ◽

The Mean

Aims and Objectives: Baker’s cysts are known to be a source of discomfort and pain due to pressure on adjacent structures. They are not uncommon in patients eligible for total knee arthroplasty (TKA). Since there is a paucity of medium-term studies that assess the natural course of Baker’s cyst following TKA, in this study we report the one- and five-year outcomes of patients to elucidate the state of their Baker’s cyst following TKA. Materials and Methods: In this prospective case series, 102 TKA patients were included. All patients who received surgery had a diagnosis of primary osteoarthritis and had preoperatively presented with a Baker’s cyst. Sonography was performed to evaluate the existence and the gross size of the cyst before TKA, and sonography was repeated at one and five years after TKA. Symptoms potentially attributable to the Baker’s cyst were recorded at each assessment. In addition, the five-year assessment included a sonographic assessment of the anterior aspect of the knee to identify joint effusion. Results: Ninety-one patients were available for the five-year assessment (with an 89% follow-up rate). After one and five years, Baker’s cyst was still present in 87 (85%) and 30 (33%) patients, respectively. Of those patients who retained a Baker’s cyst at one-year follow up, 31 patients (36%) had sustained popliteal symptoms. Of those patients who continued to have a Baker’s cyst at five years, 17 patients (56.7%) were still symptomatic. The probability of entering remission was dependent on the size of the Baker’s cyst at baseline (odds ratio, 1.41; p = 0.025). The mean preoperative cyst size was 14.5 cm2. At one and five years postoperatively, the mean cyst size was 10.6 cm2 and 9.9 cm2, respectively. At five years, no association between cyst size and popliteal symptoms was found. Conclusion: Five years after TKA, the majority of the Baker’s cysts that were present at baseline had gone into remission. The probability of going into remission was dependent on the size of the Baker’s cyst at baseline.

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The fate of Baker’s cysts at mid-term follow-up after total knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.102b1.bjj-2019-0273.r2 ◽

2020 ◽

Vol 102-B (1) ◽

pp. 132-136

Author(s):

Hagen Hommel ◽

Roland Becker ◽

Peter Fennema ◽

Sebastian Kopf

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Case Series ◽

Short Term ◽

Cyst Size ◽

Baker’S Cyst ◽

Baker's Cyst ◽

Total Knee ◽

The Mean

Aims We report the natural course of Baker’s cysts following total knee arthroplasty (TKA) at short- and mid-term follow-up. Methods In this prospective case series, 105 TKA patients were included. All patients who received surgery had a diagnosis of primary osteoarthritis and had preoperatively presented with a Baker’s cyst. Sonography and MRI were performed to evaluate the existence and the gross size of the cyst before TKA, and sonography was repeated at a mean follow-up time of 1.0 years (0.8 to 1.3; short-term) and 4.9 years (4.0 to 5.6; mid-term) after TKA. Symptoms potentially attributable to the Baker’s cyst were recorded at each assessment. Results At the one-year follow-up analysis, 102 patients were available. Of those, 91 patients were available for the 4.9-year assessment (with an 86.7% follow-up rate (91/105)). At the short- and mid-term follow-up, a Baker’s cyst was still present in 87 (85.3%) and 30 (33.0%) patients, respectively. Of those patients who retained a Baker’s cyst at the short-term follow-up, 31 patients (35.6%) had popliteal symptoms. Of those patients who continued to have a Baker’s cyst at the mid-term follow-up, 17 patients (56.7%) were still symptomatic. The mean preoperative cyst size was 14.5 cm2 (13.1 to 15.8). At the short- and mid-term follow-up, the mean cyst size was 9.7 cm2 (8.3 to 11.0) and 10.4 cm2 (9.8 to 11.4), respectively. A significant association was found between the size of the cyst at peroperatively and the probability of resolution, with lesions smaller than the median having an 83.7% (36/43) probability of resolution, and larger lesions having a 52.1% (25/48) probability of resolution (p < 0.001). At the mid-term follow-up, no association between cyst size and popliteal symptoms was found. Conclusion At a mean follow-up of 4.9 years (4.0 to 5.6) after TKA, the majority (67.0%, 61/91) of the Baker’s cysts that were present preoperatively had disappeared. The probability of cyst resolution was dependent on the size of the Baker’s cyst at baseline, with an 83.7% (36/43) probability of resolution for smaller cysts and 52.1% (25/48) probability for larger cysts. Cite this article: Bone Joint J. 2020;102-B(1):132–136

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Efficacy and Safety of Ultrasound-Guided Radiofrequency Treatment for Chronic Pain in Patients with Knee Osteoarthritis: A Systematic Review and Meta-Analysis

Pain Research and Management ◽

10.1155/2020/2537075 ◽

2020 ◽

Vol 2020 ◽

pp. 1-13

Author(s):

Yuzhao Huang ◽

Qiufang Deng ◽

Liuqing Yang ◽

Jiahui Ma ◽

Ziyang Wang ◽

...

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Pain Relief ◽

Knee Osteoarthritis ◽

Meta Analysis ◽

Knee Function ◽

Cochrane Library ◽

Efficacy And Safety ◽

Ultrasound Guided

Background. Knee osteoarthritis (KOA) is a common degenerative disease associated with joint dysfunction and pain. Ultrasound-guided radiofrequency (RF) may be a promising therapy in the treatment of chronic pain for KOA patients. Objective. To evaluate the efficacy and safety of ultrasound-guided RF treatment for chronic pain in patients with KOA. Design. A systematic review was conducted, and a meta-analysis was carried out when possible. Setting. We examined the studies evaluating the clinical efficiency of ultrasound-guided RF on chronic pain in KOA population. Method. A systematic review for the efficacy and safety of ultrasound-guided RF treatment for pain management of KOA patients was carried out in PubMed, EMBASE, Cochrane Library, Web of Science, Wanfang Data, and China National Knowledge Infrastructure (CNKI) from the date of inception to February 2020, and a meta-analysis was conducted. The primary outcomes of pain intensity (visual analogue scale or numerical rating scale) and knee function [the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)] were evaluated from baseline to various follow-up times by random-effects model. Heterogeneity was assessed by I2 statistic and the potential sources of heterogeneity by subgroup and metaregression analyses, respectively. Results. Eight publications with 256 patients were included in the meta-analysis. RF could relieve pain with −4.196 of pooled mean difference and improve knee function by decreasing 23.155 points in WOMAC. Three patients had ecchymosis, two with hypoesthesia and one with numbness after the procedure, and improved within 6 months. Furthermore, study design and treatment target were the sources of heterogeneity by subgroup and metaregression analyses, accounting for 37% and 74% of variances, respectively. Target of genicular nerve achieved better pain relief than intra-articular or sciatic nerve. Sensitivity analysis showed that removal of any single study was unlikely to overturn the findings. Limitations. There were some limitations in the study. Firstly, the small number of relevant studies limited the confidence level of the meta-analysis. Also, the significant heterogeneity may not be explained due to the limited data. Secondly, the direct comparison of two different guidance methods (ultrasound vs. fluoroscopy) for RF therapy is lacking. In addition, the outcomes were blindly assessed in the meta-analysis from all studies according to evaluation of bias, which could affect the reality of the data. Finally, most of the studies only provided short follow-up times, so we could not analyze the long-term effectiveness of ultrasound-guided RF in the treatment of patients with KOA. Conclusions. Ultrasonography is an effective, safe, nonradiative, and easily applicable guidance method for RF in pain relief and functional improvement in KOA patients.

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Is There a Correlation Between the Clinical, Radiological and Ultra-Sonographic Findings of Osteoarthritis of the Knee?

International Journal of Pharmaceutical and Clinical Research ◽

10.25258/ijpcr.v9i5.8598 ◽

2017 ◽

Vol 9 (5) ◽

Author(s):

Anousheh Haghighi ◽

Nahid Dehghani Arani ◽

Nahid Kianmehr ◽

Mani Mofidi ◽

Mahgol Farjadnia ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Knee Pain ◽

Clinical Symptoms ◽

Pain Severity ◽

Ultrasound Finding ◽

Osteoarthritis Of The Knee ◽

Radiological Findings ◽

Baker’S Cyst ◽

Baker's Cyst ◽

Linear Regression Modeling

Objectives: The association between the severity of knee pain and the clinical and radiological findings can help to assess the severity of knee osteoarthritis. The present study aimed to assess the relationship between knee pain severity and clinical, radiological and ultra-sonographic findings in patients with knee osteoarthritis. Methods: We recruited 52 patients with primary osteoarthritis. Physical examination and ultrasonography were done. Plain radiography was done within 3 weeks of clinical examination. Results: The average age of participants was 59.27 ± 9.85 years. Using multivariable linear regression modeling, pain severity had no significant association with any of the covariates including epidemiological, clinical and ultrasound findings. The severity of clinical symptoms and stiffness was associated with the ultrasound finding of Baker’s cyst as well as with tenderness of internal compartment and suprapatellar effusion. In addition, the level of daily function remained to be associated with baker’s cyst in ultrasound assessment as well as with tenderness of internal compartment. Conclusion: Our study showed no association between ultra-sonographic, clinical or radiological findings and the level of knee pain; however, knee function, disability, and the level of quality of life are associated with some clinical and ultrasound evidences of knee osteoarthritis.

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