Baker's cysts, or Baker's cysts, is a condition generally associated with musculoskeletal disorders of the knee such as l'osteoarthritis and the meniscal lesions therefore appears to be very common. Baker's cyst or popliteal cyst appears to have two affects adolescents and adults. In adolescence it is rare and often unrelated to a specific cause (it is discovered by chance during examinations or routine visits). In adulthood, on the other hand, Baker's cyst can be a source of posterior knee pain and in 94% of cases it is found in association with supracondylar problems of the joint itself. I will therefore guide you in understanding what it is, its causes and what to do if you realise you have it. 

Baker's cyst: what is it?

So what is a Baker's cyst? It is a knee cyst that is actually always present but fills with fluid when the knee is in an inflammatory state. This cyst behind the knee, or this bursa, communicates directly with the knee joint through an opening in the joint capsule that lines the knee, it is this anatomical peculiarity that allows a valve mechanism whereby in the presence of an inflammatory state there is an effusion that fills that bag with fluid. But you don't have to worry since this is a normal protective mechanism that our body puts in place to reduce the intra-articular pressure of the knee.  

Baker's cyst: causes

The causes of Baker's cyst are mechanical in adolescence and therefore mainly due to a excessive rubbing of the knee flexor tendons overload periods, for example. So if you are a young sports person, start thinking about your training loads in the last period. With regard to adulthood, on the other hand, a knee cyst is almost always (in 94% of cases) associated with an intra-articular pathology of the knee, the most common of which are osteoarthritis and meniscal injury. So if you recognise yourself in this category, start thinking about the medical history of your knee. 

Baker's cyst: Diagnosis and treatment

Diagnosis and treatment of this knee cyst is something I recommend you investigate in order to solve your problem as soon as possible, and certainly the physiotherapist can guide you in the process of understanding the underlying causes and point you towards early and decisive treatment for the knee cyst. You can be reassured that only occasionally are cysts associated with serious pathologies (which merit immediate referral to a physician) such as osteochondritis dissecans or arthropathy (seronegative or positive) as well as a simple meniscal lesion. Typically in adults, the clinical presentation of a baker's cyst is characterised by a vague posterior knee paina possible well localised swelling and a feeling of tension in the popliteal region.  

As in most cases, your physiotherapist will find a palpable mass in the popliteal region (a cyst behind the knee). There are numerous diagnostic examinations that can be useful in confirming the diagnosis, first and foremost the MRI scan, also because it allows any parallel intra pathologies to be investigated. Ultrasound is however advisable as it is less expensive and more usable. 

Baker's cyst: Need for physiotherapy

Is physiotherapy needed for Baker's cyst?

Once vascular or neuropathic causes or any serious pathology have been ruled out, treatment for the first six weeks should be physiotherapy rather than surgery. Physiotherapy for the management of baker's cyst is extremely helpful in promoting knee elasticity by reducing stiffness and maintaining full range of motion. That said, don't waste time and contact a physiotherapist in your area.

Physiotherapeutic treatment may also be accompanied by the use of infiltrative (anti-inflammatory) drugs. If physiotherapeutic/conservative treatment should fail, then minimally invasive surgical treatment aimed at echo-guided aspiration of intra-articular fluid (accompanied by an infiltration of anti-inflammatory drugs) is recommended, which has shown excellent success and minimal risks.

If the mini-invasive treatment of the cyst is not sufficient then surgical excision of the cyst can be performed arthroscopically. However, treatment involving surgical excision of the Baker's cyst alone without treatment of the intra-articular lesions of the knee tends to generate recurrences, so it is advisable to combine treatment of the intra-articular pathology with excision.

Conclusion

Coming to the end of this explanatory article I want to make you focus on a few key concepts that you have to keep in mind when you realise that you may be suffering from such a disorder. 

Firstly keep calm, Baker's cyst almost never hides serious pathologies but in 94% of cases it is associated with the most common knee disorders (arthrosis, tendinitis, meniscosis etc.). Secondly, don't waste time and contact a trusted physiotherapist who can help you understand the causes of your problem and intervene early on it to have a complete resolution. The correct conservative treatment solves the problem without the need for surgery.

Source

1. Herman AM, March JM. Popliteal cysts: A current review. Orthopedics. 2014;
2. Hill CL, Gale DG, Chaisson CE, Skinner K, Kazis L, Gale ME, et al. Knee effusions, popliteal cysts, and synovial thickening: Association with knee pain in osteoarthritis. J Rheumatol. 2001

 

 

 

Dr. Marco Gallotti

 

Graduated in Physiotherapy with 110/110 cum laude from the Catholic University of the Sacred Heart in Rome in 2015. Master in Neurorehabilitation at the University La Sapienza of Rome in 2017, Master in Rehabilitation of Musculoskeletal Disorders in 2019 at the Savona Campus. Teaching assistant at the Master's Degree in Musculoskeletal and Rheumatological Physiotherapy at Roma Tor Vergata, Lazio Regional Referent Manual Therapy Group. Master's Degree in Physiotherapy in progress.
A freelancer working in private practices in the Marconi and Laurentina areas, I also carry out home therapies.