ARTHROSCOPIC TREATMENT OF POPLITEAL CYST EXCISION IN COMBINATION WITH DEBRIDEMENT OF THE KNEE UNDER LOCAL ANESTHESIA_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGJiangtao ^1,2 ,  LIUYujie ¹ , WANGJunliang ¹ , QIWei ¹ , QUFeng ¹ , SHENXuezhen ¹ , ZHAOGang ¹ , YUANBangtuo ¹ , LIUYang ¹ , ZHUJuanli ¹

1. Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, P. R. China;
2. Department of Orthopaedics, Chinese PLA Troops 66013 rd Hospital;

Corresponding?author：

LIUYujie, Email: liuyujie301@163.com

Keywords：

Popliteal cyst; Local anesthesia; Continuous epidural anesthesia; Arthroscopy; Debridement of the knee

DOI：

10.7507/1002-1892.20140205

Video：

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Objective To evaluate the arthroscopic treatment effectiveness of popliteal cyst excision in combination with debridement of the knee under local anesthesia by comparing with continuous epidural anesthesia. Methods Between June 2002 and January 2013,145 patients with popliteal cyst underwent arthroscopic popliteal cyst excision in combination with debridement of the knee under local anesthesia (local anesthesia group).In addition,51 patients with popliteal cyst were treated with the same surgery under continuous epidural anesthesia between February 2000 and August 2005 served as control group.No significant difference was found in gender,age,side,disease duration,or cyst size between 2 groups (P>0.05).Then,anesthesia time,analgesia effect,anesthesia satisfaction,operation time,bleeding volume,and anesthesia complication were compared between 2 groups.The guidelines of Rauschning and Lindgren were used to assess the effectiveness,and recurrence rate was recorded. Results All incisions healed primarily,no neurological or vascular injury was found.The patients were followed up 1 year and 1 month to 8 years (mean,3.7 years) in local anesthesia group,and 8 years to 13 years and 7 months (mean,10.8 years) in control group.Local anesthesia group had shorter anesthesia time,higher visual analogue scale (VAS) score,shorter operation time,and lower bleeding volume (P<0.05) than control group.Anesthesia satisfaction was reduced in local anesthesia group,but there was no significant difference (χ²=0.071,P=1.000).The anesthesia complication incidence of control group (15.7%,8/51) was significantly higher than that of local anesthesia group (0) (P=0.000).Recurrence was found in 12 patients of local anesthesia group (curative ratio 91.7%) and in 5 patients of control group (curative ratio 90.2%),showing no significant difference (χ²=0.111,P=0.774).According to the guidelines of Rauschning and Lindgren,there were 131 cases of grade 0,13 cases of grade I,and 1 case of grade Ⅱ in local anesthesia group,and 37 cases of grade 0,12 cases of grade I,and 2 cases of grade Ⅱ in control group; significant differences in grading were shown between at pre- and post-operation in 2 groups (Z=-10.683,P=0.000; Z=-6.385,P=0.000),and between 2 groups at post-operation (Z=-3.145,P=0.002). Conclusion Compared with under continuous epidural anesthesia,arthroscopic treatment of popliteal cyst excision under local anesthesia can obtain better results.Under local anesthesia,the condition of nerve and vessel can be timely and dynamically observed.Arthroscopic treatment of popliteal cyst excision in combination with debridement of the knee has the advantages of less trauma,lower recurrence rate,and satisfactory results.

Citation： WANGJiangtao, LIUYujie, WANGJunliang, QIWei, QUFeng, SHENXuezhen, ZHAOGang, YUANBangtuo, LIUYang, ZHUJuanli. ARTHROSCOPIC TREATMENT OF POPLITEAL CYST EXCISION IN COMBINATION WITH DEBRIDEMENT OF THE KNEE UNDER LOCAL ANESTHESIA. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(8): 933-937. doi: 10.7507/1002-1892.20140205 Copy

1.	胥少汀,葛寶豐.實用骨科學.3版.北京:人民軍醫出版社,2005:1596-1597.
2.	王勝,陳平泉,朱振康,等.關節鏡治療腘窩囊腫20例.中國骨傷,2012,25(6):447-450.
3.	李克珍.硬膜外麻醉并發癥的防治.中國醫藥指南,2013,11(1):236-237.
4.	Rauschning W,Lindgren PG.Popliteal cysts (Baker's cysts) in adults.I.Clinical and roentgenological results of operative excision.Acta Orthop Scand,1979,50(5):583-591.
5.	Fritschy D,Fasel J,Imbert JC,et al.The popliteal cyst.Knee Surg Sports Traumatol Arthrosc,2006,14(7):623-628.
6.	Labropoulos N,Shifrin DA,Paxinos O.New insights into the development of popliteal cysts.Br J Surg,2004,91(10):1313-1318.
7.	Marra MD,Crema MD,Chung M,et al.MRI features of cystic lesions around the knee.Knee,2008,15(6):423-438.
8.	Rupp S,Seil R,Jochum P,et al.Popliteal cysts in adults.Prevalence,associated intraarticular lesions,and results after arthroscopic treatment.Am J Sports Med,2002,30(1):112-115.
9.	Handy JR.Popliteal cysts in adults:a review.Semin Arthritis Rheum,2001,31(2):108-118.
10.	Sansone V,De Ponti A.Arthroscopic treatment of popliteal cyst and associated intra-articular knee disorders in adults.Arthroscopy,1999,15(4):368-372.
11.	Neubauer H,Morbach H,Schwarz T,et al.Popliteal cysts in paediatric patients:clinical characteristics and imaging features on ultrasound and MRI.Arthritis,2011,2011:751593.
12.	Alessi S,Depaoli R,Canepari M,et al.Baker's cyst in pediatric patients:Ultrasonographic characteristics.J Ultrasound,2012,15(1):76-81.
13.	Chalmeta Verdejo C,Alegre Sancho JJ,Román Ivorra JA,et al.Popliteal aneurysm simulating a Baker's cyst in a patient with rheumatoid arthritis:a case presentation.Reumatol Clin,2011,7(2):137-138.
14.	Singh VK,Apsingi S,Balakrishnan S,et al.Posterior dislocation of meniscal bearing insert in mobile bearing unicompartmental knee arthroplasty mimicking a Baker cyst.J Arthroplasty,2012,27(3):494.e13-494.e16.
15.	K?ro?lu M,Callio?lu M,Eri? HN,et al.Ultrasound guided percutaneous treatment and follow-up of Baker's cyst in knee osteoarthritis.Eur J Radiol,2012,81(11):3466-3471.
16.	Chen CK,Lew HL,Liao RI.Ultrasound-guided diagnosis and aspiration of Baker's cyst.Am J Phys Med Rehabil,2012,91(11):1002-1004.
17.	Chang CY,Shin YC,Wang HJ,et al.Popliteal cyst rupture in a haemophiliac presenting as refractory recurrent right lower leg haemorrhage.Haemophilia,2011,17(4):320-322.
18.	Mark Hamlet,Ilias Galanopoulos,Avinash Mahale,et al.Ruptured Baker's cyst with compartment syndrome:an extremely unusual complication.BMJ Case Reports,2012.doi:10.11361/bcr-2012-007901.
19.	Sanchez JE,Conkling N,Labropoulos N.Compression syndromes of the popliteal neurovascular bundle due to Baker cyst.J Vasc Surg,2011,54(7):1821-1829.
20.	Kim TW,Suh JT,Son SM,et al.Baker's cyst with intramuscular extension into vastus medialis muscle.Knee Surg Relat Res,2012,24(4):249-253.
21.	Abdelrahman MH,Tubeishat S,Hammoudeh M.Proximal dissection and rupture of a popliteal cyst:A case report.Case Rep Radiol,2012.doi:10.115512012/292414.
22.	Moon SH,Im S,Park GY,et al.Compressive neuropathy of the posterior tibial nerve at the lower calf caused by a ruptured intramuscular baker cyst.Ann Rehabil Med,2013,37(4):577-581.
23.	劉玉杰,王志剛,李眾利,等.關節鏡監視下射頻汽化腘窩囊腫摘除術.中華外科雜志,2004,42(4):224-226.
24.	張波,唐凱,周敬瀟.囊腫切除聯合關節鏡下有限清理術治療成人腘窩囊腫.中國修復重建外科雜志,2011,25(1):122-123.
25.	Cho JH.Clinical results of direct arthroscopic excision of popliteal cyst using a posteromedial portal.Knee Surg Relat Res,2012,24(4):235-240.
26.	Lie CH,Ng TP.Arthroscopic treatment of popliteal cyst.Hong Kong Med J,2011,17(3):180-183.

1. 胥少汀,葛寶豐.實用骨科學.3版.北京:人民軍醫出版社,2005:1596-1597.
2. 王勝,陳平泉,朱振康,等.關節鏡治療腘窩囊腫20例.中國骨傷,2012,25(6):447-450.
3. 李克珍.硬膜外麻醉并發癥的防治.中國醫藥指南,2013,11(1):236-237.
4. Rauschning W,Lindgren PG.Popliteal cysts (Baker's cysts) in adults.I.Clinical and roentgenological results of operative excision.Acta Orthop Scand,1979,50(5):583-591.
5. Fritschy D,Fasel J,Imbert JC,et al.The popliteal cyst.Knee Surg Sports Traumatol Arthrosc,2006,14(7):623-628.
6. Labropoulos N,Shifrin DA,Paxinos O.New insights into the development of popliteal cysts.Br J Surg,2004,91(10):1313-1318.
7. Marra MD,Crema MD,Chung M,et al.MRI features of cystic lesions around the knee.Knee,2008,15(6):423-438.
8. Rupp S,Seil R,Jochum P,et al.Popliteal cysts in adults.Prevalence,associated intraarticular lesions,and results after arthroscopic treatment.Am J Sports Med,2002,30(1):112-115.
9. Handy JR.Popliteal cysts in adults:a review.Semin Arthritis Rheum,2001,31(2):108-118.
10. Sansone V,De Ponti A.Arthroscopic treatment of popliteal cyst and associated intra-articular knee disorders in adults.Arthroscopy,1999,15(4):368-372.
11. Neubauer H,Morbach H,Schwarz T,et al.Popliteal cysts in paediatric patients:clinical characteristics and imaging features on ultrasound and MRI.Arthritis,2011,2011:751593.
12. Alessi S,Depaoli R,Canepari M,et al.Baker's cyst in pediatric patients:Ultrasonographic characteristics.J Ultrasound,2012,15(1):76-81.
13. Chalmeta Verdejo C,Alegre Sancho JJ,Román Ivorra JA,et al.Popliteal aneurysm simulating a Baker's cyst in a patient with rheumatoid arthritis:a case presentation.Reumatol Clin,2011,7(2):137-138.
14. Singh VK,Apsingi S,Balakrishnan S,et al.Posterior dislocation of meniscal bearing insert in mobile bearing unicompartmental knee arthroplasty mimicking a Baker cyst.J Arthroplasty,2012,27(3):494.e13-494.e16.
15. K?ro?lu M,Callio?lu M,Eri? HN,et al.Ultrasound guided percutaneous treatment and follow-up of Baker's cyst in knee osteoarthritis.Eur J Radiol,2012,81(11):3466-3471.
16. Chen CK,Lew HL,Liao RI.Ultrasound-guided diagnosis and aspiration of Baker's cyst.Am J Phys Med Rehabil,2012,91(11):1002-1004.
17. Chang CY,Shin YC,Wang HJ,et al.Popliteal cyst rupture in a haemophiliac presenting as refractory recurrent right lower leg haemorrhage.Haemophilia,2011,17(4):320-322.
18. Mark Hamlet,Ilias Galanopoulos,Avinash Mahale,et al.Ruptured Baker's cyst with compartment syndrome:an extremely unusual complication.BMJ Case Reports,2012.doi:10.11361/bcr-2012-007901.
19. Sanchez JE,Conkling N,Labropoulos N.Compression syndromes of the popliteal neurovascular bundle due to Baker cyst.J Vasc Surg,2011,54(7):1821-1829.
20. Kim TW,Suh JT,Son SM,et al.Baker's cyst with intramuscular extension into vastus medialis muscle.Knee Surg Relat Res,2012,24(4):249-253.
21. Abdelrahman MH,Tubeishat S,Hammoudeh M.Proximal dissection and rupture of a popliteal cyst:A case report.Case Rep Radiol,2012.doi:10.115512012/292414.
22. Moon SH,Im S,Park GY,et al.Compressive neuropathy of the posterior tibial nerve at the lower calf caused by a ruptured intramuscular baker cyst.Ann Rehabil Med,2013,37(4):577-581.
23. 劉玉杰,王志剛,李眾利,等.關節鏡監視下射頻汽化腘窩囊腫摘除術.中華外科雜志,2004,42(4):224-226.
24. 張波,唐凱,周敬瀟.囊腫切除聯合關節鏡下有限清理術治療成人腘窩囊腫.中國修復重建外科雜志,2011,25(1):122-123.
25. Cho JH.Clinical results of direct arthroscopic excision of popliteal cyst using a posteromedial portal.Knee Surg Relat Res,2012,24(4):235-240.
26. Lie CH,Ng TP.Arthroscopic treatment of popliteal cyst.Hong Kong Med J,2011,17(3):180-183.

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Chinese Journal of Reparative and Reconstructive Surgery

ARTHROSCOPIC TREATMENT OF POPLITEAL CYST EXCISION IN COMBINATION WITH DEBRIDEMENT OF THE KNEE UNDER LOCAL ANESTHESIA

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