Surgical treatment of popliteal cyst: a systematic review and meta-analysis

Journal of Orthopaedic Surgery and Research, Feb 2016

Background This systematic review and meta-analysis of the clinical efficacy of different surgical methods in the therapy of popliteal cysts may provide evidence about effective surgical treatments. Methods PubMed, EMBASE, and OVID were searched with the following terms: (popliteal cyst* OR baker’s cyst*) AND (arthroscopic OR excision OR operative OR treat* OR surgery). Inclusion criteria included the following: studies reported the efficacy of different surgical methods in popliteal cyst patients; patients were ≥16 years; and studies must have involved a minimum of 10 patients. Studies were grouped according to the surgical methods, and a meta-analysis was employed to identify the success rate based on the pooled data. Results A total of 11 studies were included: The communication between the cyst and the articular cavity was enlarged in 7 studies; this communication was closed in 3 studies; and only intra-articular lesions were managed in 1 study. After the data were pooled, the success rates were 96.7 and 84.6 % in the communication-enlargement group and communication-closure group, respectively. Studies with communication enlargement were subgrouped into the cyst wall resection group and the non-cyst wall resection group, for which the success rates were 98.2 and 94.7 %, respectively. Conclusions Based on the current available evidence, at present, any how arthroscopic excision of the cyst wall, arthroscopic management of intra-articular lesions, and enlarging the communication between the cyst and the articular cavity is an ideal strategy for the popliteal cyst. The current literature on the treatment of popliteal cysts is limited to retrospective case series. Future prospective studies with high-quality methodology and uniform scoring system are required to directly compare communication-enlargement surgery and communication-closure surgery and determine the optimal treatment of popliteal cysts. Cyst wall resection may improve the therapeutic efficacy, to draw definitive conclusions, and high-level clinical researches with a large number of patients and long-term follow-up should be initiated.

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Surgical treatment of popliteal cyst: a systematic review and meta-analysis

Zhou et al. Journal of Orthopaedic Surgery and Research Surgical treatment of popliteal cyst: a systematic review and meta-analysis Xiao-nan Zhou 0 Bin Li 0 Jia-shi Wang 0 Lun-hao Bai 0 0 Department of Orthopaedics, Shengjing Hospital, China Medical University , 36 Sanhao Street, Heping District, Shenyang, Liaoning 110004 , People's Republic of China Background: This systematic review and meta-analysis of the clinical efficacy of different surgical methods in the therapy of popliteal cysts may provide evidence about effective surgical treatments. Methods: PubMed, EMBASE, and OVID were searched with the following terms: (popliteal cyst* OR baker's cyst*) AND (arthroscopic OR excision OR operative OR treat* OR surgery). Inclusion criteria included the following: studies reported the efficacy of different surgical methods in popliteal cyst patients; patients were ≥16 years; and studies must have involved a minimum of 10 patients. Studies were grouped according to the surgical methods, and a meta-analysis was employed to identify the success rate based on the pooled data. Results: A total of 11 studies were included: The communication between the cyst and the articular cavity was enlarged in 7 studies; this communication was closed in 3 studies; and only intra-articular lesions were managed in 1 study. After the data were pooled, the success rates were 96.7 and 84.6 % in the communication-enlargement group and communication-closure group, respectively. Studies with communication enlargement were subgrouped into the cyst wall resection group and the non-cyst wall resection group, for which the success rates were 98.2 and 94.7 %, respectively. Conclusions: Based on the current available evidence, at present, any how arthroscopic excision of the cyst wall, arthroscopic management of intra-articular lesions, and enlarging the communication between the cyst and the articular cavity is an ideal strategy for the popliteal cyst. The current literature on the treatment of popliteal cysts is limited to retrospective case series. Future prospective studies with high-quality methodology and uniform scoring system are required to directly compare communication-enlargement surgery and communication-closure surgery and determine the optimal treatment of popliteal cysts. Cyst wall resection may improve the therapeutic efficacy, to draw definitive conclusions, and high-level clinical researches with a large number of patients and long-term follow-up should be initiated. Popliteal cysts; Surgical intervention; Systematic review; Clinical outcome Background Popliteal cysts are a common disease in orthopedics and the most prevalent cystic lesions around the knee joint [ 1 ]. They were first recognized by Adama in 1840, and Baker described them in detail in 1877. Accordingly, popliteal cysts are also known as Baker’s cysts [ 2, 3 ]. Popliteal cysts most commonly form by distention of the gastrocnemio-semimembranosus bursa, which is located in the medial aspect of the popliteal fossa. The gastrocnemiosemimembranosus bursa is situated between the tendons of the gastrocnemius and semimembranosus muscles and is a normal anatomic finding [4]. A series of studies on the pathogenesis of popliteal cysts revealed the valve structure bridging the cyst and the articular cavity [ 5, 6 ]. In adults, popliteal cysts usually occur concomitantly with intraarticular disease, resulting in persistent and excess production of synovial fluid [ 7, 8 ]. Sansone et al. found that 94 % of popliteal cysts were associated with a disorder of the knee. The most common disorder was meniscal lesions, followed by anterior cruciate ligament tear and/or chondral lesions. Of the meniscal lesions, 70.2 % were medial meniscal tears, often involving the posterior horn of the medial meniscus [ 9 ]. Moreover, the valve structure leads to a oneway flow of the synovial fluid, which finally causes synovial fluid accumulation and subsequent cyst formation. Although asymptomatic popliteal cysts incidentally detected do not require treatment, large cysts may cause popliteal pain or disturbance in the knee range of motion, and they can be the targets of surgical intervention. Direct excision of the cyst is associated with high rates of recurrence [ 10, 11 ]. In 1979, Rauschning and Lindgren reported that the postoperative recurrence rate was as high as 63 % in 40 patients who received open cyst resection via the posterior approach [11]. Several studies have reported frequently associated intra-articular pathologies with the cysts and warned of a high recurrence rate if the intraarticular pathologic condition is not addressed [ 10, 12, 13 ]. Lindgren reported on the valvular mechanism of the capsular fold on the posteromedial capsule and continuous unidirectional flow between the posterior joint capsule and gastrocnemius-semimembranosus bursa [ 14 ]. If the valvular mechanism or such a communication is not corrected during surgery, the continuous flow of j (...truncated)


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Xiao-nan Zhou, Bin Li, Jia-shi Wang, Lun-hao Bai. Surgical treatment of popliteal cyst: a systematic review and meta-analysis, Journal of Orthopaedic Surgery and Research, 2016, pp. 22, 11, DOI: 10.1186/s13018-016-0356-3