Arthroscopic Decompression of a Popliteal Cyst

Popliteal (Baker) cysts are enlarged gastrocnemius-semimembranosus bursae leading to swelling in the popliteal fossa. Surgical decompression and capsulectomy is the definitive treatment for symptomatic cysts with arthroscopic or open decompression. Arthroscopic decompression is minimally invasive, entails lower risks, and allows for earlier and more aggressive rehabilitation compared with open excision.

Indications for popliteal cyst decompression include pain and mechanical discomfort refractory to conservative treatment. Further indications are neurovascular compromise secondary to bursal enlargement, including thrombophlebitis, compartment syndrome, limb ischemia, and nerve entrapment. Additional considerations include concurrent pathology requiring surgical intervention.

Following standard diagnostic arthroscopy, a Gillquist maneuver is performed to visualize the posteromedial compartment and transverse synovial fold. The operative limb is placed in a modified figure-of-four position. A posteromedial portal is established under spinal needle localization and utilized to debride the anterior capsular wall and cyst contents with an arthroscopic shaver. Attention is paid to the removal of the posterior transverse synovial infold to reduce risk of recurrence.

The literature reports favorable outcomes in arthroscopic decompression of popliteal cysts. In comparison of arthroscopic and open decompression, You et al. reported reduced mean operative time and reduced recurrence rate following arthroscopic management. In a retrospective study, Rupp et al. reported increased rates of cyst recurrence with concurrent meniscal and/or chondral injuries highlighting the importance of addressing concurrent intra-articular pathologies during decompression.

Arthroscopic decompression of symptomatic popliteal cysts can be performed safely and effectively. Arthroscopic approach allows for treatment of concurrent pathologies that predispose to increased rates of cyst recurrence. Nonetheless, rates of recurrence vary widely and therefore further study in treatment technique is necessary.

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