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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