IN THE NAME OF GOD

Title: Comparing the Results of Open and

Arthroscopic Surgery for Treating Popliteal Cyst and Its associated Intra-Articular

Lesions

Presented by:

Mohsen Mardani Kivi MD

Assistant ProfessorDepartment of Orthopedics, Guilan University of

Medical Sciences

Sohrab Keihani MD. Kamran Asadi MD. Khashayar Saheb Ekhtiari MD. Keyvan Hashemi Motlagh MD.

I n t r o d u c t I o n:

The primary pathogenesis of popliteal cysts in adults is a one-way valvular mechanism allowing flow of joint fluid from knee to bursa.

The therapeutic approach for Baker’s cyst has shifted towards arthroscopic techniques to confirm the associated intra-articular lesions.

I n t r o d u c t I o n:

I n t r o d u c t I o n:

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.

Design: Prospective StudyPilot Study (Rauschning and Lindgren’s Grading )

M e t h o d a n d M a t e r i a l s :

• absence of swelling and pain, no limitation of range of motion;

Grade 0

• light swelling and/or a sense of posterior tension after intense activity, minimal limitation of range of motion;

Grade 1

• swelling and pain after normal activity, range of motion limitation less than 20°

Grade 2

• swelling and pain even when resting, range of motion limitation more than 20°

Grade 3

Inclusion Criteria: Symptoms (pain, swelling, and limited ROM)Sonographic Diagnosis

Exclusion Criteria:Grade 0 and 1 of Raushning and Lindgren (treated conservatively)Any Other types of Cysts (Meniscal and Synovial Cysts)

Cases: 45 patients

M e t h o d a n d M a t e r i a l s :

M e t h o d a n d M a t e r i a l s :

Arthroscopy was performed to evaluate the

knee, inspect the valve and treat any coexistent

Intra-articular pathologies.

If valve was detected, Valvular structures were Shaved Arthroscopically using additional posteromedial portal (26 cases)

If NOT, Cysts were excised by open surgery

(19 cases)

M e t h o d a n d M a t e r i a l s :

Evaluation of Outcomes:

Demographic characteristics

Associated lesions

Rate of reduction of symptoms (using Rauschning and

Lindgren scale) before and three months after surgery.

Recurrence (One year after surgery using sonography)

R e s u l t s :

Age: 48.42 ± 8.55 years

Gender: 26 men and 19 women

Age Arthroscopy Open Excision Total

No. Percent No. Percent No. Percent

30-39 3 11.5 3 15.8 6 13.3

40-49 12 46.2 8 42.1 20 44.5

50-59 8 30.8 5 26.3 13 28.9

60-69 3 11.5 3 15.8 6 13.3

Total 26 100 19 100 45 100

Med. Meniscus

tear

Synovitis

Chondral Lesion

Lat. Meniscus

tear

ACL tear

0 10 20 30 40 50 60 70 80 90 100

60 %

46.7 %

40 %

15.6 %

8.9 %

Disorders associated with popliteal cyst in study population

All patients (100%) had at least one associated knee lesion.

R e s u l t s :

R e s u l t s :

Rauschning and Lindgren’s Grading

Arthroscopy Open Surgery Total

before after before after before after

Grade

0 0 19 0 13 0 32

1 0 7 0 6 0 13

2 17 0 10 0 27 0

3 9 0 9 0 18 0

Treatment outcome:

Grade 0 : Excellent Grade 1 : Good

%73

%27

ArthroscopyExcellent

Good

68 %

32 %

Open SurgeryExcellent

Good

R e s u l t s :

R e s u l t s :

Treatment GroupTotal

Arthroscopy Open Surgery

No. Percent No. Percent No. Percent

RL gradebefore

2 17 65.4 10 52.6 27 60

3 9 34.6 9 47.4 18 40

Total 26 100 19 100 45 100

Rauschning and Lindgren’s grading before surgery:

There was no statistically meaningful difference between 2 groups (P=0.388)

R e s u l t s :

Rauschning and Lindgren’s grading after treatment:

Reduction in RL grade between groups was not significant.

Mean t .d.f Sig.

Arthroscopy 0.27± 0.45

0.33 43 P=0.74(N.S).

Open Surgery 0.32± 0.48

Popliteal Cysts are always associated with intra-articular

pathology. The most frequent concomitant lesion is

medial meniscus tear.

Sansone et al. 1999 Anteromedial portal

Takahashi et al. 2005 Posteromedial portal

Ahn et al. 2007 Posteromedial cystic portal

Sinha et al. 2009 Methylene blue dye-assisted

decompression

D i s c u s s i o n :

According to non-meaningful statistical relation between

treatment methods and 3months clinical evaluation results,

it is revealed that executing the valve and evacuating the

cyst would suffice to treat the popliteal cyst and further

surgical excision of cyst is not necessary.

c o n c l u s i o n :

مقدمه :

Thank You