Treatment Options for Bakers Cyst
Figure 1. Example of ultrasound of a bakers cyst (adopted from semanticscholar.org)
Ultrasound guided aspiration with corticosteroid injection. Corticosteroid injections are generally considered first line therapy. Acebes et al also found that intra-articular injections decreased the size of the bakers cyst at 4 weeks . The addition of ultrasound provides easy visualization of the fluid collection and needle guidance for aspiration and injection. Bandinelli showed that injecting directly into the cyst under ultrasound guidance was superior to injecting into the joint space . Smith et al demonstrated significant decreases in pain and improved function with ultrasound guided aspiration, fenestration and corticosteroid injection . Re-aspiration rate was 12.9% in this study. Koroglu et al had similar findings and also demonstrated that decrease in size of baker’s cyst correlated with degree of improvement in symptoms .
Figure 2. Ultrasound image of aspiration of a bakers cyst (adopted from youtube.com)
Sclerotherapy. There are several case series using sclerotherapy with dextrose to shrink the size of the cyst. This is level 4 evidence and requires more thorough investigation to demonstrate the utility .
Arthroscopy. Open excision is associated with high recurrence rates so surgical management revolves around an arthroscopic approach. In some cases, treatment is primarily directed toward intra-articular etiology such as meniscus or cartilage injuries. Indication for treating the cyst directly is usually failure of conservative therapy. Some surgeons will debridge the “one way valve” to allow open communication of the bakers cyst with the rest of the joint space. Alternatively, they may also attempt to close the communication between the cyst and the joint space. Cystectomy represents another option. Most of these treatment options are limited to case studies and there are no clear guidelines for surgical decision making .
Image 3. Arthroscopic view of a bakers cyst (adopted from azisks.com)