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Baker's cyst

A swelling in the popliteal region is often the symptom of a Baker’s cyst. This concerns a cystic (= blistered) protrusion from the joint capsule of the knee joint into the popliteal region. The Baker’s cyst gets its name from the English surgeon M. W. Baker, who first described these cysts.

Baker’s cysts usually occur as a result of chronic meniscus or cartilage damage, however they can also occur in the context of chronic-rheumatic knee diseases (chronic polyarthritis). Ordinarily, there is a weakness in the joint capsule (often in combination with meniscus damage) and the joint capsule can protrude outwards at this point. If the body then reacts to the constant friction (caused by the meniscus or cartilage damage) in the knee joint with increased production of articular fluid, just to reduce this friction, this leads to joint effusion and increased pressure in the knee joint. Eventually the joint capsule cannot withstand this increased internal pressure any further and a cystic protrusion occurs in the joint capsule - a Baker’s cyst.

Baker’s cysts usually occur in the popliteal region, as the connective tissue structures are the weakest in terms of formation there.


SYMPTOMS

 

The symptoms are usually dependent on the strain on the knee joint and often decrease again or disappear completely with immobilisation.

The most common are:

  • Pain or feelings of tension in the popliteal region or in the upper calf musculature
  • Recurring swelling that is tender on palpation in the popliteal region
  • Restriction of movement in the case of very large cysts.

If the Baker’s cyst bursts, sudden-onset severe pain can occur in the knee joint or in the whole lower leg and areas of inflammation can also occur.


DIAGNOSIS

Image: The MRI examination shows the exact extent of the Baker's cyst (white)

Precise documenting of the course of the disease and manual examination of the knee joint are important for diagnosis.

I recommend that all patients undergo an MRI examination: firstly, the exact size and precise spread of the Baker’s cyst can be visualised; secondly, the triggering underlying disease (such as existing meniscus damage) is firmly clarified.

TREATMENT

 

The treatment is aimed at the underlying disease on the one hand (cartilage damage, meniscus lesion or chronic inflammation), and at the cyst itself on the other hand. Analgesic and anti-inflammatory medications are available as conservative treatment.

In most cases, the Baker’s cyst regresses itself following successful treatment of the underlying disease (e.g. meniscus operation) and does not require surgical removal.

Image: Large Baker's cysts are removed from the popliteal region during the operation

If the Baker’s cyst is so large that it causes the patient persisting symptoms and e.g. there is also a restriction in movement, it must be removed surgically. This is rarely carried out by means of arthroscopy and more commonly in the form of an open procedure. During this operation, the cyst is freed from the joint capsule, removed completely and the joint capsule is fenestrated.

Please note that medical indications and treatments change constantly. Sometimes these changes occur more rapidly than I am able to update on my homepage. Some information regarding dosage, prescription and compositions of medications may have changed in the meantime. Reading an internet page cannot replace visiting a doctor - it may be that during an examination and subsequent discussion with your doctor, other information is also communicated as a result of new scientific knowledge.