Der intraartikuläre Verschluß der Poplitealzyste

Summary

Goal of Surgery

Surgical treatment of a symptomatic Baker's cyst without its removal.

Indications

Symptomatic Baker's cyst resistant to conservative care and causing swelling or limitation of motion.

Contraindications

Baker's cyst in patients with rheumatoid arthritis. In these cases the Baker's cyst must be removed completely.

Baker's cyst caused by intraarticular lesions.

Positioning and Anaesthesia

Supine.

Tourniquet.

Free draping.

General or regional anaesthesia.

Surgical Technique

The opening of the cyst will be localized through arthroscopy. Closure of the communication of the cyst with the joint through posteromedial approach after freshening of the cyst edges. Pedicled tendinous graft from the medial gastrocnemius can also be used to cover the opening.

Postoperative Management

Elevation of the leg on a frame.

After 4 days partial and 14 days full weight bearing.

After 6 weeks return to full activities.

Possible Complications

Division of the infrapatellar branch of the saphenous nerve.

Injury to the saphenous nerve.

Needle breakage during closure of the cyst.

Recurrence.

Lack of extension after closure of the cyst.

Omission to freshen the edges.

Results

9 men and 6 women having a mean age 34 years were operated. The simple closure was done 12 times and a plastic covering 3 times.

2 subcutaneous haematomas and 1 superficial infection were seen. Follow-up examination after a mean of 26 months. 3 recurrences were noted, 2 in patients with rheumatoid arthritis and 1 in patients with lupus. 3 patients had disturbances of sensibility in the territory of the infrapatellar branch of the saphenous nerve. No patient had a lack of extension.