Therapy
Since the secondary Baker’s cyst is always preceded by an inflammatory process in the interior of the joint, the previous disease or the reason for the inflammation should be treated, otherwise a new cyst can form. In most cases, a spontaneous regression of the cyst occurs during treatment of the knee joint. The Baker’s cyst in the knee can be treated conservatively (without surgery) or with surgery.
In most cases, the operation is preceded by a conservative therapy attempt. As already mentioned, an attempt is made to treat the cause in order to cause the cyst to recede. Non-steroidal anti-inflammatory drugs are used as medication.
These include ibuprofen or diclofenac, which have anti-inflammatory and analgesic effects. Whether a cortisone therapy, which temporarily stops the inflammatory process but has some side effects, is necessary, is a decision that has to be made by the treating physician. In this case, the cortisone would be injected directly into the knee joint in order to act locally against the inflammation.
It is also possible to puncture the Baker’s cyst in the knee. However, this procedure makes less sense, as the probability of the cyst returning is very high. If the cyst still does not recede after about 6 months, the swelling of the vascular or nerve tracts is trapped or there is too much restriction of movement, the complete cyst can also be removed surgically.
This is done by open surgery, whereby the cyst is separated from the joint capsule and removed. Furthermore, the knee damage, if present, should be treated. If the meniscus is damaged, for example, an arthroscopy (joint endoscopy) can be performed. In this case the cyst will recede by itself in about 60% of cases.
Diagnosis
Often the diagnosis of a Baker’s cyst in the knee is a chance finding by the orthopaedic surgeon when the knee is examined for other reasons, or by the internist who examines the swelling in the hollow of the knee for thrombosis. After a medical history, which reveals the medical history and any previous knee problems, a physical examination follows. The Baker’s cyst is normally felt in the hollow of the knee as a bulging, roundish structure.
Since the Baker’s cyst in the knee is usually preceded by a disease of the knee joint, the knee joint should be examined for damage. This can be done by arthrography (x-ray after prior administration of contrast medium into the joint). In addition, the joint and surrounding soft tissue can be visualized with other imaging techniques such as MRI of the knee or CT.
In this case the knee damage and also the size of the Baker’s cyst in the knee and its communication with the knee joint or vessels and nerves can be assessed. In addition, an ultrasound examination can exclude thromboses and tumours. The cause of a Baker’s cyst can only be reliably diagnosed by looking at all possible diagnoses together. In many cases, the MRI of the knee joint is the most valuable examination method, since Baker’s cyst and the damage in the knee (e.g. torn meniscus, damaged cartilage, torn cruciate ligament) can be seen in parallel.
