ARTHROSCOPIC TREATMENT COMBINED WITH REPAIR OF JOINT CAPSULE USING TENDON FLAP OF MEDIAL HEAD OF GASTROCNEMIUS MUSCLE AFTER RESECTION OF POPLITEAL CYST_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANGLei , TANGXin , LIQi , CHENGang , FUWeili , JIANGHai , HUYanqing ,  LIJian

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

LIJian, Email: hxlijian@163.com

Keywords：

Knee; Popliteal cyst; Intra-articular lesion; Arthroscopy

DOI：

10.7507/1002-1892.20150313

Video：

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Objective To investigate the methods and the effectiveness of arthroscopic treatment combined with repair of the cyst wall using the tendon flap of medial head of gastrocnemius muscle after resection of popliteal cyst. Methods A retrospective analysis was made on the clinical data of 140 patients with popliteal cyst between August 2009 and June 2014, including 44 males and 96 females with a mean age of 54.68 years (range, 14-80 years). The median course of symptoms was 31 months (range, 20 days to 30 years). According to Rauschning and Lindgren criteria for popliteal cyst grade, 4 cases were rated as grade Ⅰ, 44 cases as grade Ⅱ, and 92 cases as grade Ⅲ. The preoperative Lysholm knee score was 68.99±8.23. Firstly, cyst was resected, then the hernia sac of joint capsule was repaired with the tendon flap of medial head of gastrocnemius muscle, and finally a knee arthroscopy was used for the diagnosis and treatment of intra-articular lesions. Results No complication of nerve or blood vessel injury, infection, or necrosis occurred. The mean follow-up was 26 months (range, 6-64 months). During follow-up, 1 case (0.71%) had cyst recurrence. According to Rauschning and Lindgren criteria for popliteal cyst grade, 37 cases were rated as grade 0, 92 cases as grade Ⅰ, 10 cases as grade Ⅱ, and 1 case as grade Ⅲ at 6 months after operation, showing significant difference when compared with preoperative one (Z=-14.303, P=0.000); the Lysholm knee score (85.51±9.23) was significantly higher than preoperative score (t=-15.798, P=0.000). Conclusion Arthroscopic treatment combined with repair of the cyst wall with the tendon flap of medial head of gastrocnemius muscle after resection of popliteal cyst is a better way to avoid recurrence.

Citation： YANGLei, TANGXin, LIQi, CHENGang, FUWeili, JIANGHai, HUYanqing, LIJian. ARTHROSCOPIC TREATMENT COMBINED WITH REPAIR OF JOINT CAPSULE USING TENDON FLAP OF MEDIAL HEAD OF GASTROCNEMIUS MUSCLE AFTER RESECTION OF POPLITEAL CYST. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(12): 1462-1465. doi: 10.7507/1002-1892.20150313 Copy

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2.	Handy JR. Popliteal cysts in adults:a review. Semin Arthritis Rheum, 2001, 31(2):108-118.
3.	Malinowski K, Synder M, Sibiński M. Selected cases of arthroscopic treatment of popliteal cyst with associated intra-articular knee disorders primary report. Ortop Traumatol Rehabil, 2011, 13(6):573-582.
4.	Rauschning W, Lindgren PG. Popliteal cysts (Baker's cysts) in adults. I. Clinical and roentgenological results of operative excision. Acta Orthop Scand, 1979, 50(5):583-591.
5.	谢洋, 李苏皖, 刘朝晖, 等. 关节镜下后侧入路治疗腘窝囊肿. 中国矫形外科杂志, 2012, 20(7):603-605.
6.	Neubauer H, Morbach H, Schwarz T, et al. Popliteal cysts in paediatric patients:clinical characteristics and imaging features on ultrasound and MRI. Arthritis, 2011, 2011:751593.
7.	Billières J, Lascombes P, Peter R. Popliteal cysts:etiologic and therapeutic approach. Rev Med Suisse, 2014, 28(432):1211-1215.
8.	Trăistaru R, Popescu R, Gruia C, et al. A complex assessment of patients with knee osteoarthritis and Baker's cyst:observational study. Rom J Morphol Embryol, 2013, 54(3):593-601.
9.	Lie CW, Ng TP. Arthroscopic treatment of popliteal cyst. Hong Kong Med J, 2011, 17(3):180-183.
10.	Cho JH. Clinical results of direct arthroscopic excision of popliteal cyst using a posteromedial portal. Knee Surg Relat Res, 2012, 24(4):235-240.
11.	Rupp S, Seil R, Jochum P, et al. Popliteal cysts in adults. Prevalence, associated intra-articular lesions, and results after arthroscopic treatment. Am J Sports Med, 2002, 30(1):112-115.
12.	Geiser J, Vogt M, Billeter R, et al. Training high-living low:changes of aerobic performance and muscle structure with training at simulated altitude. Int J Sports Med, 2001, 22(8):579-585.
13.	Takahashi M, Nagano A. Arthroscopic treatment of popliteal cyst and visualization of its cavity through the posterior portal of the knee. Arthroscopy, 2005, 21(5):638.
14.	Ohishi T, Takahashi M, Suzuki D, et al. Treatment of popliteal cysts via arthroscopic enlargement of unidirectional valvular slits. Mod Rheumatol, 2015, 25(5):772-778.
15.	Ahn JH, Lee SH, Yoo JC, et al. Arthroscopic treatment of popliteal cysts:clinical and magnetic resonance imaging results. Arthroscopy, 2010, 26(10):1340-1347.
16.	Snir N, Hamula M, Wolfson T, et al. Popliteal cyst excision using open posterior approach after arthroscopic partial medial meniscectomy. Arthrosc Tech, 2013, 2(3):e295-e298.

1. Wigley RD. Popliteal cysts:variations on a theme of Baker. Semin Arthritis Rheum, 1982, 12(1):1-10.
2. Handy JR. Popliteal cysts in adults:a review. Semin Arthritis Rheum, 2001, 31(2):108-118.
3. Malinowski K, Synder M, Sibiński M. Selected cases of arthroscopic treatment of popliteal cyst with associated intra-articular knee disorders primary report. Ortop Traumatol Rehabil, 2011, 13(6):573-582.
4. Rauschning W, Lindgren PG. Popliteal cysts (Baker's cysts) in adults. I. Clinical and roentgenological results of operative excision. Acta Orthop Scand, 1979, 50(5):583-591.
5. 谢洋, 李苏皖, 刘朝晖, 等. 关节镜下后侧入路治疗腘窝囊肿. 中国矫形外科杂志, 2012, 20(7):603-605.
6. Neubauer H, Morbach H, Schwarz T, et al. Popliteal cysts in paediatric patients:clinical characteristics and imaging features on ultrasound and MRI. Arthritis, 2011, 2011:751593.
7. Billières J, Lascombes P, Peter R. Popliteal cysts:etiologic and therapeutic approach. Rev Med Suisse, 2014, 28(432):1211-1215.
8. Trăistaru R, Popescu R, Gruia C, et al. A complex assessment of patients with knee osteoarthritis and Baker's cyst:observational study. Rom J Morphol Embryol, 2013, 54(3):593-601.
9. Lie CW, Ng TP. Arthroscopic treatment of popliteal cyst. Hong Kong Med J, 2011, 17(3):180-183.
10. Cho JH. Clinical results of direct arthroscopic excision of popliteal cyst using a posteromedial portal. Knee Surg Relat Res, 2012, 24(4):235-240.
11. Rupp S, Seil R, Jochum P, et al. Popliteal cysts in adults. Prevalence, associated intra-articular lesions, and results after arthroscopic treatment. Am J Sports Med, 2002, 30(1):112-115.
12. Geiser J, Vogt M, Billeter R, et al. Training high-living low:changes of aerobic performance and muscle structure with training at simulated altitude. Int J Sports Med, 2001, 22(8):579-585.
13. Takahashi M, Nagano A. Arthroscopic treatment of popliteal cyst and visualization of its cavity through the posterior portal of the knee. Arthroscopy, 2005, 21(5):638.
14. Ohishi T, Takahashi M, Suzuki D, et al. Treatment of popliteal cysts via arthroscopic enlargement of unidirectional valvular slits. Mod Rheumatol, 2015, 25(5):772-778.
15. Ahn JH, Lee SH, Yoo JC, et al. Arthroscopic treatment of popliteal cysts:clinical and magnetic resonance imaging results. Arthroscopy, 2010, 26(10):1340-1347.
16. Snir N, Hamula M, Wolfson T, et al. Popliteal cyst excision using open posterior approach after arthroscopic partial medial meniscectomy. Arthrosc Tech, 2013, 2(3):e295-e298.

Chinese Journal of Reparative and Reconstructive Surgery

ARTHROSCOPIC TREATMENT COMBINED WITH REPAIR OF JOINT CAPSULE USING TENDON FLAP OF MEDIAL HEAD OF GASTROCNEMIUS MUSCLE AFTER RESECTION OF POPLITEAL CYST

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