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Parameniscal Cyst – Causes, Symptoms, Diagnosis, Treatment

Parameniscal Cyst/Baker Cyst also is known as a popliteal or parameniscal cyst, is a fluid-filled sac that forms in the posterior aspect of the knee, typically located between the semimembranosus and medial head of the gastrocnemius. [rx][rx][rx] In adults, Baker’s Cysts tend to form in association with degenerative conditions of the knee. One of the most common associations seen is secondary to degenerative meniscal tears. Inflammatory conditions and arthritides are also known causes of popliteal cyst formation. When the cyst forms in association with a meniscal tear, the meniscus serves as a one-way valve and the extruded synovial fluid localizes and consolidates to form a viscous, gel-like material.

Baker cysts, or popliteal cysts, are fluid-filled distended synovial-lined lesions arising in the popliteal fossa between the medial head of the gastrocnemius and the semimembranosus tendons via communication with the knee joint. They are usually located at or below the joint line.

Causes of Parameniscal Cyst

Baker’s cysts are encountered most frequently in adults with a history of

Trauma – (e.g., cartilage or meniscus tears, injury to the knee),
Degenerative/co-existing knee joint disease – (e.g., osteoarthritis, rheumatoid arthritis, infectious arthritis, pigmented villonodular synovitis, meniscal tears), or asymptomatically as an incidental finding.[rx]
Swelling in the knee – This happens when the fluid that lubricates your knee joint increases. When pressure builds up, fluid squeezes into the back of the knee and creates the cyst.
Arthritis – People with all forms of arthritis often have Baker’s cysts.
Injury – A sports-related injury or other blow to the knee can cause A Baker’s cyst.
Gout –This a type of arthritis, which results from the buildup of uric acid in the blood, can lead to a Baker’s cyst.
Baker’s cysts arise between the tendons of the medial head of the gastrocnemius and the semimembranosus muscles. They are posterior to the medial femoral condyle.

Symptoms of Parameniscal Cyst

In some cases, a Baker’s cyst causes no pain, and you may not notice it. If you do have signs and symptoms, they might include:

Swelling behind your knee, and sometimes in your leg
Knee pain
Stiffness and inability to fully flex the knee
mild to severe pain
stiffness
limited range of motion
swelling behind the knee and calf
bruising on the knee and calf
rupturing of the cyst

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Diagnosis of Parameniscal Cyst

A Baker’s cyst can often be diagnosed with a physical exam. However, because some of the signs and symptoms of a Baker’s cyst mimic those of more serious conditions, such as a blood clot, aneurysm or tumor, your doctor may order noninvasive imaging tests, including

Ultrasound
X-ray
Magnetic resonance imaging (MRI)

Treatment of Popliteal Cyst

Treatment is not usually necessary for Baker’s Cyst unless the patient is symptomatic.[rx][rx][rx] Incidental findings in the asymptomatic patient are managed with observation and reassurance alone.

Non-operative management

Keep it cold – Apply a cold pack to the affected area. It’ll help keep the swelling down. A compression wrap might also help.
Rest your leg – Keep it raised above your heart level when possible. This will keep down swelling. Use a cane or crutch when you walk to keep pressure off your leg.
Rest/activity modification
NSAIDs – For pain (and to reduce inflammation), take an over-the-counter medication like ibuprofen.
PT/rehab – regimens are often effective in patients with minimal symptoms, and in the setting of smaller degenerative meniscal tears
Medication – Your doctor may inject corticosteroid medication, such as cortisone, into your knee to reduce inflammation. This may relieve pain, but it doesn’t always prevent the recurrence of the cyst.
Fluid drainage – Your doctor may drain the fluid from the knee joint using a needle. This is called needle aspiration and is often performed under ultrasound guidance.
Aspiration and steroid injection – The knee joint itself can be treated with a cortisone injection in the setting of moderate to advanced tri compartmental degenerative knee arthritic conditions. This can help manage patients’ symptoms and clinically differentiate the contribution of the popliteal cyst itself on the patients daily symptoms
Ultrasound-guided aspiration and injection – can be performed by an experienced interventional radiologist
- Recurrence rates are much lower in younger patient populations
- Recurrence rates are higher in older patient populations and degenerative meniscal tears with associated cysts

Operative management

Arthroscopic debridement, cyst decompression, meniscal repair vs partial meniscectomy
- less invasive than the open approach
- often results in cyst recurrence, especially in older patients with moderate-advanced knee degenerative conditions
Open cyst excision
- Posterior approach to the knee is utilized
- Not indicated in the setting of underlying knee degenerative conditions secondary to the risk of cyst recurrence

It is important to treat the underlying joint disorder, if one exists, in all patients with symptomatic Baker’s cysts. This will help reduce the accumulation of synovial fluid and enlargement of the cyst.

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Physical therapy

Icing, a compression wrap, and crutches may help reduce pain and swelling. Gentle range-of-motion and strengthening exercises for the muscles around your knee also may help to reduce your symptoms and preserve knee function.

Exercises

Exercises that focus on preserving the knee’s range of motion may ease pain and prevent muscle weakness. However, before trying any exercise for a Baker’s cyst, speak to a doctor or physical therapist. The wrong exercise may injure the knee, intensifying pain. The following exercises may benefit a person with a Baker’s cyst:

Standing calf stretch

Stand up straight in front of a chair or another heavy piece of furniture, and use it for balance, if necessary.
Step back with the right leg, then bend both knees until there is a stretch.
Hold this stretch for 20 seconds, then switch sides.

Heel lift

Sit in a chair with both feet flat on the floor and the knees at a 90-degree angle.
Lift one heel while keeping the ball of the foot on the floor.
Push the top of the knee down to flatten the foot. Repeat this 10 times, then switch sides.

Calf stretch

Sit on the floor with the legs extended straight out in front of you.
Loop a towel or exercise band under the balls of the feet, then gently pull backward.
Hold the stretch for 10 seconds, then switch sides.

Walking

Baker’s cysts often form as a result of a knee injury. During recovery, walking may help a person gradually regain strength and mobility. However, if a person needs to change their gait or contort a knee into an unusual position to walk comfortably, it may not be safe to walk yet. Consult a doctor or physical therapist.

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Remedies

The following home care strategies may help alleviate symptoms of a Baker’s cyst or prevent one from forming:

Apply ice or cold packs to the cyst to reduce pain and swelling.
Apply heat to the area. Some people find that alternating ice and heat works well.
Take nonsteroidal anti-inflammatory drugs such as acetaminophen or ibuprofen.
Avoid any activities that cause pain. If walking is painful, use crutches to reduce pressure on the injured knee.
Gently massage the area around the cyst to ease any pain and help reduce inflammation.

Prevention

A Baker’s cyst often appears following a knee injury. Preventing knee injuries is, therefore, the best way to prevent these cysts from developing.

To avoid injuring the knee:

Wear supportive shoes that fit well.
Warm-up before exercise and sports, and cool down afterward.
Refrain from exercising on a knee that is already tender and painful.
Seek treatment for any knee, leg, or foot injuries — an injury to one area of the body can increase the risk of falls and further harm.

References

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Parameniscal Cyst – Causes, Symptoms, Diagnosis, Treatment

Parameniscal Cyst – Causes, Symptoms, Diagnosis, Treatment

Causes of Parameniscal Cyst

Symptoms of Parameniscal Cyst

Diagnosis of Parameniscal Cyst