The Management of Baker`s Cyst in the Presence of Knee Joint Effusion

TOPIC: Baker’s cyst and knee joint effusion

PRESENTER: Dr. Reuven Lexier

WORD COUNT: 336

The management of Baker’s Cyst in the presence of knee joint effusion

Reuven Lexier1 & Sahil Patel2
1Lexier Medical Management Services Inc.

Toronto, Canada

Background:
The aim of this retrospective chart review was to determine the efficacy of aspiration and corticosteroid injection in patients presenting with symptoms of Baker’s Cyst and concomitant joint effusion.

Method:
A retrospective chart review was conducted to examine patient charts over a five-year period (2015-2019) from a single clinical practice. The variables of interest included age, sex, presence of Baker’s cyst, size of Baker’s cyst, relevant comorbidities, grade of effusion, imaging methods used for diagnoses, amount of fluid and/or blood aspirated, and other treatments provided.

Results:
Our study cohort consisted of 225 patients, with an average age of 63.6 years, where the condition was observed to be more prominent in females (65%) than males (35%). Of the 225 cases, 198 (88%) were treated with aspiration and corticosteroid injection, while 27 (12%) refused aspiration/injection and opted for alternative conservative treatment. There were a total of 67 confirmed cases of Baker’s Cyst of whom 59 (88%) included measurements obtained from imaging results. The average length, width, and depth of the Baker’s cyst was 3.6 CM, 2.3 CM, and 1.9 CM. Associated comorbidities included osteoarthritis (51%) and meniscus tears (22%). The most frequent imaging method used to identify and measure Baker’s cyst was Ultrasound (76%) followed by MRI (16%). The average amount of fluid aspirated in mild, moderate, and severe cases of joint effusion was 7.9 CCs, 22 CCs, and 107 CCs respectively. The average amount of blood aspirated in mild, moderate, and severe cases was 5 CCs, 20.8 CCs, and 32.5 CCs. Following aspiration and injection treatment, only 6 patients returned with effusion and/or Baker’s Cyst and were referred for a total knee replacement.

Conclusion:
A significant percentage of patients with effusion and coincident Baker’s cyst responded well to aspiration and injection, which resulted in a low referral rate for total knee replacement. Patients should be advised at the time of treatment that they may expect recurrence of the Baker’s Cyst at 1-2 years following treatment at which point they may decide to opt for re-aspiration/injection or total knee replacement.