Therapy of the Baker cyst
In principle, a distinction can be made between conservative and operative treatment options for Baker’s cyst. Basically, one starts the therapy with conservative approaches and thus tries to avoid an operation. However, if these non-surgical methods cannot cure or at least provide a significant improvement of the symptoms (see: symptoms of a Baker’s cyst) after 6 months, a surgical intervention should be considered.
In some cases, it may be advisable to consider surgery directly, for example if the Baker’s cyst has developed as a result of meniscal damage, in order to prevent cysts from forming again. Of course, the cause of the Baker’s cyst (in addition to the extent of the symptoms such as pain and swelling) is generally a criterion on which the decision between conservative and surgical therapy is based, among other things. If a Baker’s cyst is diagnosed by chance or is not large and does not cause any symptoms, usually no therapy is necessary, which is not uncommon.
The focus of conservative treatment of a Baker’s cyst is not the removal of the cyst, but rather the elimination of the cause of the knee joint damage, as this is the only way to achieve a long-term improvement in symptoms. Any underlying disease, whether it is a disease of the knee joint itself or, as is very often the case, a disease from the rheumatic form, should always be treated first or at least simultaneously. In addition, painkillers are used in the drug therapy of a Baker’s cyst.
The first choice here are anti-inflammatory drugs from the group of non-steroidal anti-rheumatic drugs (NSAIDs). These preparations include ibuprofen and diclofenac. These have the advantage that they also have a positive effect on rheumatism, which is often found in parallel.
In contrast, steroids can also be given, the main representative of which is cortisone. Although this drug proves to be highly effective, it is not administered lightly by most doctors due to the long list of side effects. However, if you have decided to take this drug, it is advisable to inject the cortisone directly into the knee joint using a syringe.
The advantage of this is that the inflammatory process can be contained directly at the site of action. Due to the side effects, however, it is recommended to carry out this treatment no more than three times a year. In addition, the administration of hyaluronic acid has also proven to be effective.
This is a substance that also occurs naturally in the cartilage tissue and can reduce the formation of water, which is hoped that the Baker’s cyst will regress. It is also possible to puncture a Baker’s cyst. The water that has accumulated in the knee is removed with a syringe and the remaining “empty” cyst is then rinsed again with a cortisone containing medication.
If none of this has any effect, surgery is recommended. The aim of this procedure is to remove the entire cyst. The greatest difficulty for the surgeon is that the Baker’s cyst is connected to the joint capsule via a so-called stem, i.e. practically a connecting piece.
It is essential that this connecting piece is also removed by surgery, otherwise the risk of a new cyst developing (recurrence) increases massively. However, care must be taken not to damage the sensitive joint capsule. Despite correctly performed surgery, there is always a residual risk that a relapse will occur in the later life of a patient, especially if an underlying disease such as rheumatism is not or not adequately treated.
Once the tissue has been removed, it is usually sent to a laboratory for examination. This examination is done routinely to make sure that the cyst is not a malignant new formation, i.e. a tumour. Since the operation is not a major procedure, does not take long and is almost routine for orthopaedic surgeons, complications are rare.
However, as with any operation, there is of course a certain risk of developing a wound infection after the operation. The aim of the therapy is to relieve any pain and to stop the progression of inflammatory processes and swelling. Since the Baker’s cyst can often be caused by cartilage damage or meniscus lesions, the therapy includes not only the Baker’s cyst itself but also the underlying disease.
A Baker’s cyst in the hollow of the knee does not always require surgical treatment. If the patient is free of symptoms or if the swelling does not restrict his or her mobility, the Baker’s cyst is initially treated conservatively, i.e. without surgery. Drug therapy includes the administration of anti-inflammatory drugs.
These include diclofenac or ibuprofen, for example. Some doctors treat the cyst with drugs containing cortisone. These are then administered directly into the knee using a syringe.
This allows the medication to take effect directly on the spot and very quickly. Cortisone is a substance produced naturally in the body that reduces inflammatory reactions, but at the same time, depending on the dose, it also has some side effects. Therefore, a good consultation with the treating physician is necessary.
Cortisone treatment is controversial among medical specialists. Another locally acting drug is hyaluronic acid, a substance also produced by the body itself, but which can also be produced synthetically. Hyaluronic acid has the property of binding water.
This is used in the treatment and thus removes the excess fluid in the hollow of the knee. Often the Baker’s cyst successfully regresses. Further conservative possibilities for pain reduction are movement-adapted physiotherapy and cold treatments.
