1. In the Name of GOD

3. Department of Orthopedics, Guilan University of Medical Sciences
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 Professor
Department of Orthopedics, Guilan University of Medical Sciences
Sohrab Keihani MD.
Kamran Asadi MD.
Khashayar Saheb Ekhtiari MD.
Keyvan Hashemi Motlagh MD.

4. 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.

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

6. 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.

7. Grade 0 Grade 1 Grade 2 Grade 3 Method and Materials:
Design: Prospective Study
Pilot Study (Rauschning and Lindgren’s Grading )
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

8. Method and Materials: Inclusion Criteria: Exclusion Criteria: Cases:
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

9. If NOT, Cysts were excised by open surgery (19 cases)
Method and Materials:
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)

10. Method and Materials: 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)

11. Results: Age: 48.42 ± 8.55 years Gender: 26 men and 19 women Age
Arthroscopy
Open Excision
Total
No.
Percent
30-39 3
11.5
15.8 6
13.3
40-49 12
46.2 8
42.1 20
44.5
50-59
30.8 5
26.3 13
28.9
60-69 26
100 19 45

12. Disorders associated with popliteal cyst in study population
Results:
Disorders associated with popliteal cyst in study population
All patients (100%) had at least one associated knee lesion.

13. Results: Grade Rauschning and Lindgren’s Grading Arthroscopy
Open Surgery
Total
before
after
Grade 19 13 32 1 7 6 2 17 10 27 3 9 18

14. Results:
Treatment outcome:
Grade 0 : Excellent
Grade 1 : Good

15. Results: Rauschning and Lindgren’s grading before surgery:
Treatment Group
Total
Arthroscopy
Open Surgery
No.
Percent
RL grade
before 2 17
65.4 10
52.6 27 60 3 9
34.6
47.4 18 40 26
100 19 45
There was no statistically meaningful difference between 2 groups (P=0.388)

16. Rauschning and Lindgren’s grading after treatment:
Results:
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

17. Sansone et al. 1999  Anteromedial portal
Discussion:
Popliteal Cysts are always associated with intra-articular pathology. The most frequent concomitant lesion is medial meniscus tear.
Sansone et al  Anteromedial portal
Takahashi et al  Posteromedial portal
Ahn et al  Posteromedial cystic portal
Sinha et al  Methylene blue dye-assisted decompression

18. conclusion:
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.

20. Thank You