Renal replacement therapy by the popliteal vein in a critical patient with COVID-19 in the prone position / Terapia renal substitutiva pela veia poplítea em paciente crítico com COVID-19 na posição de pronação

Abstract This patient was a 73-year-old man who initially came to our service with acute respiratory failure secondary to COVID-19. Soon after hospitalization, he was submitted to orotracheal intubation and placed in the prone position to improve hypoxia, due to severe acute respiratory syndrome (SARS). On the third day of hospitalization, he developed acute oliguric kidney injury and volume overload. The nephrology service was activated to obtain deep venous access for renal replacement therapy (RRT). The patient could not be placed in the supine position due to significant hypoxemia. A 50-cm Permcath (MAHURKARTM, Covidien, Massachusetts, USA) was inserted through the left popliteal vein. This case report describes a possible challenging scenario that the interventional nephrologist may encounter when dealing with patients with COVID-19 with respiratory impairment in the prone position.

Resumo O paciente era um homem de 73 anos de idade que inicialmente veio ao nosso serviço com insuficiência respiratória aguda secundária à COVID-19. Logo após a internação, ele foi submetido à intubação orotraqueal e pronado para melhorar a hipóxia devido à síndrome respiratória aguda grave (SARS - do inglês "severe acute respiratory syndrome"). No terceiro dia de internação, o mesmo desenvolveu lesão renal aguda oligúrica e sobrecarga de volume. O serviço de nefrologia foi acionado para realizar acesso venoso profundo para terapia renal substitutiva (TRS). O paciente não pôde ser colocado na posição de decúbito dorsal devido a uma hipoxemia significativa. Um Permcath de 50 cm (MAHURKARTM, Covidien, Massachusetts, EUA) foi inserido através da veia poplítea esquerda. Este relato de caso descreve um possível cenário desafiador com o qual o nefrologista intervencionista pode se deparar ao lidar com pacientes com COVID-19 com problemas respiratórios e colocados em pronação.

Comparison of the efficacy of total arthroscopy and traditional surgical treatment for the treatment of popliteal cyst / 中国骨伤

OBJECTIVE@#To compare the clinical efficacy of total arthroscopic surgery and traditional surgery for popliteal cyst.@*METHODS@#From August 2014 to July 2017, 60 cases of popliteal cyst were treated with total arthroscopy or traditional surgery respectively. In total arthroscopy group, there were 30 patients including 7 males and 23 females with an average age of (55.81±8.53) years old; the duration of the disease was (3.52±1.12) years;according to Rauschning-Lingdgren grading, 7 cases were grade I, 19 cases were grade II, 4 cases were grade III. In traditional surgical group, there were 30 patients including 5 males and 25 females with an average age of (57.93±9.84) years old; the duration of the disease was (3.48±1.34) years; according to Rauschning-Lingdgren grading, 5 cases were grade I, 21 cases were grade II, 4 cases were grade III. Preoperative symptoms involved such as arthralgia and swelling after knee joint and limited mobility. MRI confirmed a popliteal cyst. Arthroscopic surgery and traditional surgical was used respectively. Incision length, operation time, average stay, total hospital cost and Lysholm score of two groups were compared.@*RESULTS@#In the total arthroscopic group, 1 case suffered from nerve injury, and all cases' incision healed well. In the traditional surgical group, there was 1 case of incision infection, 2 cases of poor healing, 1 case of nerve injury and 1 case of recurrence. All 60 cases were followed up for 6 to 30 months with an average of (13.3±6.5) months. After operation, the symptoms of knee joint arthralgia and swelling, discomfort were significantly improved in the two groups. There were statistically significant differences in incision length, operation time, average stay, total hospitalcost and Lysholm score 6 months after surgery(<0.05).@*CONCLUSIONS@#The total arthroscopic resection of popliteal cyst, via anterior approach to having a knee joint cavity exploration and treatment of meniscus and bursa, while combined with posteromedial approach for cyst excision would promise a minimal surgery and less pain for patients. Patients will have a rapider recovery, lower recurrence rate and less complication. The total arthroscopic resection easy to accepting for the patient and having a better clinical curative effect is obviously superior to the traditional surgery.

Diagnosis and therapy of popliteal cyst / 中国骨伤

Popliteal cyst is a common peri-knee cyst, also known as a Baker's cyst. With the current development of popliteal cysts, the pathogenesis is mainly due to increased pressure in the knee joint caused by various reasons, leading to a fluid-filled sac that can form behind the knee as a result of enlargement of the gastrocnemius-semimembranosus bursa. The current diagnostic methods include X-ray computed, ultrasound, and magnetic resonance. Among them, magnetic resonance imaging is considered the gold standard for the diagnosis of popliteal cysts. There are various treatments, including conservative treatment, traditional surgical resection and arthroscopic surgery. In recent years, the focus of the treatment of popliteal cysts has gradually shifted from the simple removal of cysts to arthroscopic treatment of intra-articular lesions and the treatment of joint-cyst communication, and achieved a good effect. However, there are still controversies about the most effective treatment, and the best surgery method is still uncertained. It is hoped that high quality prospective studies will be able to directly compare different surgery methods, so as to select the best treatment for popliteal cyst. This article reviews past literature research and describes in detail the epidemiology, pathological mechanism, clinical manifestations and signs, auxiliary examination, diagnosis and differential diagnosis and clinical treatment of popliteal cysts. Different diagnosis methods and treatment methods are compared and summarized to provide basis for clinical diagnosis and treatment.

Arthroscopic Treatment of Popliteal Cysts with and without Cystectomy: A Systematic Review and Meta-Analysis

PURPOSE: To compare the clinical outcomes of the arthroscopic treatments for popliteal cysts with and without cystectomy. METHODS: PubMed/MEDLINE, EMBASE, KoreaMed, and Cochrane Library were searched from the earliest available date of indexing through August 2016. The methodological quality of all articles was assessed according to the Coleman methodology score (CMS). Studies were grouped according to the surgical method, and a meta-analysis was conducted to identify the unsuccessful clinical outcome and complication rates. RESULTS: Nine studies were included; the mean CMS was 67.33 (standard deviation, 8.75 points). Cystectomy was reported in five studies; cystectomy was not performed in four studies. The odds ratio of unsuccessful clinical outcomes evaluated by Rauschning and Lindgren score was 122.05 (p<0.001) with cystectomy and 58.12 (p<0.001) without cystectomy. The effect size of complications was 0.16 (p<0.001) with cystectomy and 0.03 (p<0.001) without cystectomy. The recurrence rate was 0% with cystectomy and 6.4% without cystectomy. CONCLUSIONS: All the currently available studies showed satisfactory outcomes in both with and without cystectomy groups. However, arthroscopic cystectomy concurrently performed with management of intra-articular lesions was associated with a relatively low recurrence rate and a relatively high incidence of complications.

Total arthroscopic internal drainage technique for the treatment of popliteal cyst / 中国骨伤

OBJECTIVE@#To compare the clinical effects of total arthroscopic internal drainage and arthroscopic combined with posterior small incision in the treatment of popliteal cyst.@*METHODS@#From January 2015 to January 2017, 60 patients with popliteal cyst were treated, including 29 males and 31 females, aged 30 to 65(47.8±2.5) years old, with a course of disease (8.5±4.2) months. Among them, 30 cases received total arthroscopic internal drainage for popliteal fossa cyst(total arthroscopic group), 30 cases received arthroscopic combined with posterior small incision for popliteal fossa cyst(arthroscopic combined with small incision group). The operation time, intraoperative bleeding volume, incision length, Rauschning and Lindgren grade 0 recovery rate and Lysholm score were compared between the two groups.@*RESULTS@#Twenty-nine patients in total arthroscopy group were followed up, and 28 patients in arthroscopy combined with small incision group were followed up for 8 to 20(12.8±2.1) months. Operation time: total arthroscopic group(45.32±5.71) min, arthroscopic combined small incision group (44.56±3.85) min; Rauschning and Lindgren grade 0 recovery: 23 cases in total arthroscopic group, 22 cases in arthroscopic combined small incision group; postoperative Lysholm score: total arthroscopic group 84.5±11.2, arthroscopic combined small incision group 83.2±12.7; there was no significant difference between the two groups(>0.05). Intraoperative bleeding volume: total arthroscopic group(5.32±1.25) ml, arthroscopic combined small incision group(20.75±8.18) ml; incision length: total arthroscopic group (1.51±0.34) cm, arthroscopic combined small incision group (7.34±0.75) cm; the difference between the two groups was significant(<0.05). At the last follow-up, the knee joint was examined by magnetic resonance imaging, and no recurrence of cyst was found.@*CONCLUSIONS@#Total arthroscopic internal drainage and arthroscopic combined with posterior small incision technique for popliteal fossa cyst with intra-articular lesions have the same clinical effect, but less trauma and faster recovery.

The effect of arthroscopic synovectomy on refractory knee arthritis with popliteal cyst in 153 patients / 中华内科杂志

Objective To investigate the efficacy of arthroscopic synovectomy on refractory knee arthritis complicated with popliteal cyst.Methods Patients diagnosed as rheumatoid arthritis (RA) or spondyloarthritis (SPA) with refractory knee arthritis who underwent knee arthroscopic synovectomy in our hospital from 2010 to 2017 were enrolled,including 20 patients (16 RA,4 SpA) with popliteal cyst.Clinical data,RA disease activity score (DAS28),SpA back pain score,etc,were collected to evaluate the efficacy of knee surgery.Results Erythrocyte sedimentation rate (ESR) [58(17,79)mm / 1h vs.19(9,30)mm/1h,P＜ 0.001],C reactive protein (CRP) [3.72(0.92,8.14) mg/L vs.0.85(0.10,3.08) mg/L,P＜0.001],rheumatoid factor [64.6(20.2,193.3) vs.20.5(10.0,58.4),P＜0.001],DAS28 score(4.67±1.25 vs.2.81±1.23,P＜0.001),knee joint discomfort score [5(4,6) vs.2(1,3),P＜0.001] and the volume of knee joint effusion by ultrasound (P＜0.05) in 95 RA patients were significantly decreased compared to those before operation.ESR [27(12,54)mm/1h vs.20 (16,28) mm/1 h,P＜0.001],CRP [3.27(1.06,6.95) mg/L vs.1.41(0.34,3.03)mg/L,P＜0.001],knee discomfort score [2(0,5) vs.1(0,3),P＜0.05],back pain visual analogue score (VAS) [5(4,5) vs.2(1,3),P＜0.001],and the volume of knee joint effusion by ultrasound (P＜0.001) in 58 SpA patients were significantly lower than those before the operation.The rate [16.84％(16/95) vs.6.32％(6/95),P=0.023] and grading (P=0.007) of popliteal cyst in RA were decreased after the operation.No statistically difference was observed in the rate [6.90％ (4/58) vs.5.17％(3/58),P=0.697] of popliteal cyst in patients with SpA,yet with a trend of decrease in 4 patients.Conclusion This study provide evidence that knee arthroscopic synovectomy has a good effect for refractory knee arthritis,which can reduce disease activity,improve joint symptoms and decrease the grading of popliteal cyst.

Quiste de Baker / Baker's cyst

RESUMEN Fundamento: el quiste de Baker es el tumor de partes blandas más frecuente de la fosa poplítea, su tratamiento puede ser conservador o quirúrgico, este último tanto por vía artroscópica o abierta. Objetivo: profundizar los conocimientos en relación al quiste de Baker en la articulación de la rodilla. Métodos: la búsqueda de la información se realizó en un periodo de tres meses (primero de octubre de 2017 al 31 de diciembre de 2017) y se emplearon las siguientes palabras: popliteal cyst y Baker's cyst, a partir de la información obtenida se realizó una revisión bibliográfica de un total de 316 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 50 citas seleccionadas para realizar la revisión, 45 de ellas de los últimos cinco años, donde se incluyeron cuatro libros. Resultados: se abordan la forma de presentación clínica de esta enfermedad y los estudios de tipo imaginológicos. Se hace referencia al diagnóstico diferencial entre el niño y el adulto; y entre el quiste de Baker y aneurisma de la arteria poplítea. Se describen las modalidades de tratamiento tanto conservador como quirúrgico, en relación a este último se plasman las indicaciones y variedades. Conclusiones: el quiste de Baker es el tumor de partes blandas más frecuente en la fosa poplítea, su presencia ocurre tanto en niños como en adultos y existen diferencias entre estos grupos. En el adulto se debe prestar especial interés con respecto al diagnóstico diferencial con el aneurisma de la arteria poplítea. El tratamiento en el paciente adulto por lo general es quirúrgico, tanto por vía abierta o artroscópica con muy buenos resultados.

ABSTRACT Background: Baker's cyst is the most common soft tissue popliteal tumor; treatment may be conservative or surgical by arthroscopy or open ways. Objective: to deep the knowledge about Baker's cyst in the knee joint. Methods: the search of the information was carried out in a period of three months (from October 1st, 2017 to December 31, 2017) and the following words were used: popliteal cyst and Baker's cyst, from the obtained information it was carried out a bibliographical review of a whole of 316 articles published in the databases PubMed, Hinari, SciELO and Medline by means of the information locator EndNote, of them 50 citations were selected to do the review, 45 of them of last five years, where four books were included. Development: important aspects related to clinical picture and imaging investigations were pointed out. Differential diagnosis between Baker's cyst in children and adults, and Baker's cyst and popliteal aneurysm were described. Treatment modalities were stated as well as surgical indications. Conclusions: Baker's cyst is the most common soft tissue popliteal tumor affecting children and adults with cardinal differences. Popliteal aneurysm should be always ruled out. Surgical treatment is usually needed in adults by open procedures or arthroscopy, both methods have good results.

Clinical prospective comparative study on short-term effectiveness of arthroscopic treatment of popliteal cyst between cyctectomy and internal drainage combined with cyctectomy / 中国修复重建外科杂志

Objective: To compare the short-term effectiveness between arthroscopic cystectomy and internal drainage combined with cystectomy in popliteal cyst. Methods: Between March 2014 and March 2017, 56 patients with symptomatic popliteal cyst were enrolled in the study, randomized block design was used to divided the patients into trial group (arthroscopic cystectomy combined with internal drainage group, n=28) and control group (arthroscopic internal drainage group, n=28). Excluding those who had incomplete follow-up and received surgery for other diseases postoperatively, 26 patients in the experimental group and 27 patients in the control group were finally enrolled in the study. There was no significant difference in gender, age, side, course of disease, maximum diameter and grade of popliteal cyst, and associated diseases between two groups ( P>0.05). The operation time, duration of popliteal ecchymosis and the middle back of calf tenderness were observed postoperatively. The circumference of calf at 1 day, 1 week, and 2 weeks after operation were measured and the differences were calculated with the measurement before operation. Lower extremity venous thrombosis was observed by color doppler ultrasonography at 1 week after operation. The effectiveness was evaluated by Rauschning and Lindgren grading criteria. And MRI was used to observe whether the popliteal cyst disappeared or decreased and measured its maximum diameter at 1 year after operation. Results: Patients in both groups were followed up 12-14 months, with an average of 12.5 months. The operation time, duration of popliteal ecchymosis, and the middle back of calf tenderness of the trial group were all longer than those in the control group ( P<0.05), the differences of circumference of calf at 1 day, 1 week, and 2 weeks after operation of the trial group were greater than those in the control group ( P<0.05). Color doppler ultrasonography of the lower extremity at 1 week after operation found that the intermuscular venous thrombosis occurred in 2 cases of the trial group, while no lower extremity thrombosis was found in the control group; and the difference between two groups was not significant ( P=0.236). According to the Rauschning and Lindgren grading criteria, there were 16 cases of grade 0, 6 cases of grade 1, and 4 cases of grade 2 in the trial group, and 17 cases of grade 0, 4 cases of grade 1, and 6 cases of grade 2 in the control group at 1 year after operation. There was no significant difference between 2 groups ( Z=-1.872, P=0.078). Nine cases (34.62%) of the trial group and 13 cases (48.15%) of the control group still have residual cysts by MRI, the maximum diameter of which was less than 2 cm. The cysts disappeared in the remaining patients in both groups, and there was no recurrence during the follow-up. There was no significant difference in cyst residual rate between 2 groups ( χ2=2.293, P=0.852). Conclusion: Compared with arthroscopic internal drainage, the short-term effectiveness of the arthroscopic internal drainage combined with cystectomy had no significant improvement, and the operation time was prolonged, the postoperative complications were obviously increased.

Therapeutic effects of internal drainage by expanding arthroscopic gastrocnemius-semimembranosus bursa and cyst wall resection for the treatment of 41 patients with popliteal cysts / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical curative effects of internal drainage by expanding arthroscopic gastrocnemius-semimembranosus bursa(GSB) and cyst wall resection for the treatment of popliteal cysts.</p><p><b>METHODS</b>A retrospective analysis of patients from May 2011 to December 2015. Arthroscopic treatment for 41 patients with popliteal fossa cysts, 18 males and 23 females, aged from 34 to 67 years old, averaged 42.6 years old. All the patients had preoperative magnetic resonance imagings to confirm the diagnosis and identify the valvular opening(Gastrocnemius-Semimembranosus bursa, GSB), as well as the associated intra-articular pathology. All the popliteal cysts were unilateral, including 26 cases of right knees and 15 cases of left knees. Five patients had recurrent popliteal cysts, and all of them underwent initial open Surgery. The duration from initial surgery to the recurrence ranged from 6 to 17 months(averaged, 11 months). All the patients had underwent arthroscopic treatment of internal drainage by expanding GSB and cyst wall resection. According to the Rauschning and Lindgren classification, 5 cases were grade I , 30 cases were grade II and 6 cases were grade III. Preoperative Lysholm score, 83.19±6.12 (ranged form 73 to 95).</p><p><b>RESULTS</b>The GSB structure was found in all patients with popliteal cysts during operation, including cartilage degeneration in 33 cases, medial meniscus injury in 27 cases, lateral meniscus injury in 7 cases, free body in 8 cases, pigmented villonodular synovitis in 2 cases, and synovial chondromatosis in 3 cases. There were no complications related to vascular, nerve or surgical incision. All the patients were followed up, and the duration ranged from 8 to 27 months, with an average of 18 months. No recurrence of cysts was found. According to the Rauschning and Lindgren classification, there were 9 cases of grade 0, 27 cases of grade I , 4 cases of grade II, 1 case of grade III. Postoperative Lysholm score:91.32±4.26(ranged from 82 to 98).</p><p><b>CONCLUSIONS</b>Arthroscopic internal drainage by expanding GSB and cyst wall resection surgery in the treatment of popliteal cysts has the advantages of less trauma, faster recovery and low relapse rate, which has a good short-term effect.</p>

Clinical research of popliteal cyst excision combined with debridement of the knee under arthroscopy with local anesthesia / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of popliteal cyst excision combined with debridement of the knee under arthroscopy with local anesthesia.</p><p><b>METHODS</b>From February 2009 to August 2014, 52 patients with popliteal cysts were treated in our hospital, including 34 males and 18 females with an average age of 43.6 years old ranging from 14 to 62 years old; 29 cases were on the right knee and 23 on the left knee. Preoperative diagnosis was performed according to MRI findings and to determine whether other knee disorders were associated with the disease, 52 patients were diagnosed as popliteal cyst before operation; 23 cases of simple meniscus injury or cartilage injury, 18 cases of osteoarthritis, 7 cases of cruciate ligament injury, 2 cases of gouty arthritis, 1 case of rheumatoid arthritis, 1 case of pigmented villonodular arthritis. The preoperative clinical manifestations involved knee swelling in 21 cases, knee joint pain in 16 cases, joint lock in 8 cases, leg weakness in 4 cases, and knee joint snapping in 4 cases. Cyst size was 4.0 cm× 3.3 cm to 6.2 cm× 5.3 cm. According to the Rauschning and Lindgren standards, 1 case was grade I, 9 cases were grade II, 42 cases were class III. The rehabilitation plan should be made according to the patient's specific injuries and intraoperative management. During the postoperative follow-up, the postoperative curative effect was evaluated by the standard grading of Rauschning and Lindgren of popliteal cyst.</p><p><b>RESULTS</b>All the incisions healed by first intention, and no complications occurred. All the cases were followed up from 25 to 64 months (averaged 39.6 months). For the Rauschning and Lindgren grading, 43 cases were grade 0, 8 cases were grade I, 1 case were grade II.</p><p><b>CONCLUSIONS</b>Local anesthesia under arthroscopy and popliteal cyst removal knee joint cavity debridement is effective, less trauma, quick recovery, short term effect is good. The recurrence rate is also low because of the primary disease of the knee joint is also treated. After the operation, the rehabilitation plan should be made according to the intraoperative treatment and actively trained so as to recover at an early date.</p>

Tibial Schwannoma Mimicking a Popliteal Cyst / 대한정형외과학회잡지

Schwannoma is the most common benign tumor of peripheral nerves and usually appears on the trunk, head and neck, or extremities. A mass arising at popliteal fossa can be misdiagnosed as a popliteal cyst. We report on a rare case of a popliteal schwannoma mimicking a popliteal cyst in a 39-year-old female who showed a clinical presentation similar to that of a popliteal cyst. Diagnosis was delayed until ultrasonographic evaluation was performed due to its anatomical location, the same as that of a popliteal cyst. We describe the clinical significance and ultrasonographic findings of the schwannoma for initial differential diagnosis from a popliteal cyst.

Surgical Treatment of Gouty Tophi in Bilateral Popliteal Cysts / 대한정형외과학회잡지

Gout often occurs in the first metatarsophalyngeal joint, and also in the ankle joint and posterior foot. Knee joint gouty arthritis is commonly reported, but gouty tophi in bilateral popliteal cysts, such as this case, are rare. We report on a case treated by cystectomy of gouty tophi in bilateral popliteal cysts and review.

Intermittent Claudication Caused by Popliteal Artery Compression of Popliteal Cyst

Peripheral arterial disease is caused by atherosclerosis in the arteries causing an insufficient blood flow to the muscles and tissues. Peripheral arterial disease in the lower limbs is the main cause of intermittent claudication. Less commonly, the etiology of intermittent claudication can be extrinsic to vascular structures such as arterial aneurysm, arterial dissection, embolism, popliteal entrapment syndrome, and adventitial cystic disease. A 69-year-old man was referred to Sanggye Paik Hospital because of intermittent claudication. He had a history of diabetes mellitus and dyslipidemia and he was current smoker. His right ankle brachial index is 0.74. Lower extremity artery computed tomography scan was performed and it revealed the right popliteal cyst compressing the right popliteal artery. We performed the arthroscopic cyst drainage and after the procedure, intermittent claudication resolved completely.

Osteochondrolipoma Presenting as a Popliteal Cyst

Here, we describe a popliteal mass that was initially misdiagnosed as a simple popliteal cyst, which finally turned out to be osteochondrolipoma. A 63-year-old housewife presented with sustained knee pain in association with a palpable mass on the popliteal fossa. The mass was in the posteromedial area and soft, non-tender, non-movable in the posteromedial area. Using plain radiography, the mass appeared as a round, soft tissue density lesion containing bony fragments. We performed an ultrasound-guided needle biopsy in conjunction with magnetic resonance imaging, followed by an open excisional biopsy. Microscopically, histological sections showed a lipoma with cartilaginous and osseous differentiation, finally diagnosed as osteochondrolipoma. In conclusion, popliteal masses are not always simple cysts, and the evaluation of masses in the popliteal fossa is always necessary.

Ruptured Popliteal Cyst Diagnosed by Ultrasound Before Evaluation for Deep Vein Thrombosis

Most popliteal cysts are asymptomatic. However, cysts may rupture, resulting in pain and swelling of the leg that could also arise from other diseases, including deep vein thrombosis, lymphedema, cellulitis, and tear of a muscle or tendon. Therefore, it is difficult to diagnose a ruptured popliteal cyst based on only a patient's history and physical examination. Musculoskeletal ultrasound has been regarded as a diagnostic tool for ruptured popliteal cyst. Here, we describe a patient who was rapidly diagnosed as ruptured popliteal cyst by ultrasonography. Therefore, ultrasound could be used to distinguish a ruptured popliteal cyst from other diseases in patients with painful swollen legs before evaluation for deep vein thrombosis.

Ultrasonographic diagnosis of pseudothrombophlebitis / 中华超声影像学杂志

Objective To investigate the ultrasound characteristics of pseudothrombophlebitis.Methods The ultrasound characteristics of thirty-two popliteal cyst cases with pseudothrombophlebitis which were confirmed by MRI or puncture were retrospectively analyzed.The former group was matched with a case control group of sixty-four patients with asymptomatic popliteal cysts,the ultrasound images were comparative analysis between the two groups.Results Compared to the control group,both the length and width of the case group were larger [(12.4 ± 4.7) ×(2.5±0.4)cm vs (5.3±2.9) × (1.2±0.4)cm,P ＜ 0.001],and there were 18(43.8％) cases with the cysts extension into the calf.The case group were more prone to show cyst with poor ultrasound penetration or solid-cystic echo (78.1％ vs 9.4％,P =0.000),which were diagnosed as popliteal cyst with hematoma or infection.Six cases of case group showed irregular anechoic area surrounding the inferior border of the cysts,which were diagnosed as ruptured popliteal cyst,no similar imaging detected in the control group(P =0.001).Both the two group showed septation in the cyst,but it did not differ significantly(P ＞0.05).Conclusions Ultrasonography is helpful to the diagnosis of pseudothrombophlebitis,the ultrasound characteristics include large cyst extension into the calf,cyst with poor ultrasound penetration or solid-cystic echo and irregular anechoic area surrounding the inferior border of the cysts.

Arthroscopic treatment of popliteal cyst / 中华骨科杂志

Objective To evaluate the clinical effect of arthroscopic treatment of popliteal cyst.Methods Data of 42 patients,who had undergone arthroscopic treatment for popliteal cyst from November 2005 to January 2010,were retrospectively analyzed.There were 13 males and 29 females,including 6 children,aged from 11 to 68 years (average,43.2 years).All popliteal cysts were unilateral,including 14 cases of right knee and 28 cases of left knee.Eleven patients had recurrent popliteal cyst,and all of them underwent initial open surgery,and the duration from the initial surgery to recurrence ranged from 6 to 35 months (average,18 months).According to the Rauschning and Lindgren classification,there were 3 cases of grade Ⅰ,18 cases of grade Ⅱ and 21 cases of grade Ⅲ.Based on the MRI,the long diameter of the popliteal cysts ranged from 4.2 to 7.9 cm (average,5.4 cm),the transverse diameter 2.1 to 2.5 cm (average,2.3 cm) and anteroposterior diameter 1.6 to 2.2 cm (average,2.0 cm).All popliteal cysts were at posteriomedial parts of the knees,and 11 cases of popliteal cyst communicated with the knee joint cavity.Before operation,1 to 2 ml methylene blue was injected into the cyst,which was used to determine the channel intraoperatively according to the site where methylene blue flowed out.The intraarticular diseases were thoroughly treated when the inner wall of the popliteal cyst was cleaned.Results The intraarticular diseases were found in all patients intraoperatively,including medial meniscus tear in 28 cases,lateral meniscus tear in 9 cases and lateral discoid meniscus in 4 cases.There were no blood vessel complications,nerve complications and incision complications.All patients were discharged 2 or 3 days postoperatively.All patients were followed up for 10 to 30 months (average,18 months).No recurrence of popliteal cyst occurred at final follow-up.According to the Rauschning and Lindgren classification,there were 38 cases of grade 0 and 4 cases of grade Ⅰ.Conclusion The arthroscopic treatment of popliteal cyst has several advantages,such as mini-invasion,fast recovery and low recurrence rate.

Compressive Neuropathy of the Posterior Tibial Nerve at the Lower Calf Caused by a Ruptured Intramuscular Baker Cyst

Baker cyst is an enlargement of the gastrocnemius-semimembranosus bursa. Neuropathy can occur due to either direct compression from the cyst itself or indirectly after cyst rupture. We report a unique case of a 49-year-old man with left sole pain and paresthesia who was diagnosed with posterior tibial neuropathy at the lower calf area, which was found to be caused by a ruptured Baker cyst. The patient's symptoms resembled those of lumbosacral radiculopathy and tarsal tunnel syndrome. Posterior tibial neuropathy from direct pressure of ruptured Baker cyst at the calf level has not been previously reported. Ruptured Baker cyst with resultant compression of the posterior tibial nerve at the lower leg should be included in the differential diagnosis of patients who complain of calf and sole pain. Electrodiagnostic examination and imaging studies such as ultrasonography or magnetic resonance imaging should be considered in the differential diagnosis of isolated paresthesia of the lower leg.

Clinical Results of Direct Arthroscopic Excision of Popliteal Cyst Using a Posteromedial Portal

PURPOSE: To evaluate the efficacy of the direct arthroscopic excision of a popliteal cyst without additional skin incision using a posteromedial portal based on minimum 2 year follow-up clinical results. MATERIALS AND METHODS: From January 2003 to January 2010, 105 patients (111 cases) with popliteal cyst have been treated by a direct arthroscopic excision. Direct arthroscopic excision using a 70 degree arthroscopy and posteromedial portal can correct the valvular mechanism of capsular fold and reduce the complications with no additional skin incision at the popliteal area. In all cases, preoperative magnetic resonance imaging (MRI) was performed to detect combined intraarticular pathology. At 2 years postoperatively, a follow-up ultrasonography or MRI was performed to detect the recurrence of cysts. We used Rauschning and Lindgren criteria for clinical evaluation. RESULTS: All cases had neither recurrence nor complaints of pain, swelling, or functional impairment more than 2 years after the surgery. At ultrasonography or MRI, no recurrence was found, and 5 complications were 1 skin lesion and 4 hematoma. Postoperatively, Rauschning and Lindgren criteria were more than grade 1. CONCLUSIONS: Direct arthroscopic excision using 70 degree arthroscope and posteromedial portal is an effective method for the treatment of popliteal cyst.

Candida Arthritis Presenting as a Huge Popliteal Cyst in a Patient with Rheumatoid Arthritis: A Case Report and Review of the Literature / 대한내과학회지

Candida arthritis is an uncommon cause of infectious arthritis that can occur in immunocompromised patients, such as those with rheumatoid arthritis. Candida arthritis arises in two ways: from direct inoculation or hematogenous dissemination. Direct inoculation is common in immunocompromised hosts during intra-articular injection or surgical procedures. The affected joints are generally swollen, tender, and mildly warm, with no evidence of disseminated candidiasis. Reported treatments include intravenous amphotericin B administration and drainage, or the use of 5-fluocytosine or ketoconazole to decrease amphotericin B toxicity. Surgical treatment has been necessary in some cases to eradicate candidal infection. Here, we report a case of candida arthritis combined with a huge popliteal cyst in a patient with rheumatoid arthritis and present a review of the relevant literature.