In the Name of GOD

Department of Orthopedics, Guilan University of Medical Sciences Title: Comparing the Results of Open and Arthroscopic Surgery for Treating Popliteal Cyst and Its associated Intra-Articular Lesions Presented by: Mohsen Mardani Kivi MD Assistant Professor Department of Orthopedics, Guilan University of Medical Sciences Sohrab Keihani MD. Kamran Asadi MD. Khashayar Saheb Ekhtiari MD. Keyvan Hashemi Motlagh MD.

I n t r o d u c t I o n: The primary pathogenesis of popliteal cysts in adults is a one-way valvular mechanism allowing flow of joint fluid from knee to bursa. The therapeutic approach for Baker’s cyst has shifted towards arthroscopic techniques to confirm the associated intra-articular lesions.

I n t r o d u c t I o n:

I n t r o d u c t I o n: The aims of this study include determining the frequency of accompanying intra-articular lesions as well as comparing the outcomes of treating popliteal cyst with arthroscopy and open surgery.

Grade 0 Grade 1 Grade 2 Grade 3 Method and Materials: Design: Prospective Study Pilot Study (Rauschning and Lindgren’s Grading ) absence of swelling and pain, no limitation of range of motion; Grade 0 light swelling and/or a sense of posterior tension after intense activity, minimal limitation of range of motion; Grade 1 swelling and pain after normal activity, range of motion limitation less than 20° Grade 2 swelling and pain even when resting, range of motion limitation more than 20° Grade 3

Method and Materials: Inclusion Criteria: Exclusion Criteria: Cases: Symptoms (pain, swelling, and limited ROM) Sonographic Diagnosis Exclusion Criteria: Grade 0 and 1 of Raushning and Lindgren (treated conservatively) Any Other types of Cysts (Meniscal and Synovial Cysts) Cases: 45 patients

If NOT, Cysts were excised by open surgery (19 cases) Method and Materials: Arthroscopy was performed to evaluate the knee, inspect the valve and treat any coexistent Intra-articular pathologies. If valve was detected, Valvular structures were Shaved Arthroscopically using additional posteromedial portal (26 cases) If NOT, Cysts were excised by open surgery (19 cases)

Method and Materials: Evaluation of Outcomes: Demographic characteristics Associated lesions Rate of reduction of symptoms (using Rauschning and Lindgren scale) before and three months after surgery. Recurrence (One year after surgery using sonography)

Results: Age: 48.42 ± 8.55 years Gender: 26 men and 19 women Age Arthroscopy Open Excision Total No. Percent 30-39 3 11.5 15.8 6 13.3 40-49 12 46.2 8 42.1 20 44.5 50-59 30.8 5 26.3 13 28.9 60-69 26 100 19 45

Disorders associated with popliteal cyst in study population Results: Disorders associated with popliteal cyst in study population All patients (100%) had at least one associated knee lesion.

Results: Grade Rauschning and Lindgren’s Grading Arthroscopy Open Surgery Total before after Grade 19 13 32 1 7 6 2 17 10 27 3 9 18

Results: Treatment outcome: Grade 0 : Excellent Grade 1 : Good

Results: Rauschning and Lindgren’s grading before surgery: Treatment Group Total Arthroscopy Open Surgery No. Percent RL grade before 2 17 65.4 10 52.6 27 60 3 9 34.6 47.4 18 40 26 100 19 45 There was no statistically meaningful difference between 2 groups (P=0.388)

Rauschning and Lindgren’s grading after treatment: Results: Rauschning and Lindgren’s grading after treatment: Reduction in RL grade between groups was not significant. Mean t .d.f Sig. Arthroscopy 0.27± 0.45 0.33 43 P=0.74 (N.S.) Open Surgery 0.32± 0.48

Sansone et al. 1999  Anteromedial portal Discussion: Popliteal Cysts are always associated with intra-articular pathology. The most frequent concomitant lesion is medial meniscus tear. Sansone et al. 1999  Anteromedial portal Takahashi et al. 2005  Posteromedial portal Ahn et al. 2007  Posteromedial cystic portal Sinha et al. 2009  Methylene blue dye-assisted decompression

conclusion: According to non-meaningful statistical relation between treatment methods and 3months clinical evaluation results, it is revealed that executing the valve and evacuating the cyst would suffice to treat the popliteal cyst and further surgical excision of cyst is not necessary.

Thank You