BAKERS CYST --- R/O SURGERY?

Hi  All  ..

I am 2 months post uni-compartmental left medial knee replacement.  Surgery went well.  Rehab'ed w/ CPM and cryogenic sleeve, followed by PT.  Had to stop PT after 1mo due to pain related to Bakers cyst and serious swelling to lateral side.   New knee joint feeling fine, but follow-up MRI revealed 5.4 cm Bakers cyst.  Aspiration under ultrasound removed 12.5 cc fluid.  GREAT relief for abt 1 week. Pain completely remitted, allowing full flexion and extension.  It was like heaven!!!!!   Cyst refilled (as per usual).  Pain behind the knee is fairly intense  ----  7/10 --   intermittent, dull, throb, occasional stabbing pain.   Follow-up MRI (and ultrasound during aspiration) also found loose bodies and debris.

I have a couple of technical Q's.   I am seeing surgeon in 2 wks for re-eval after cyst drainage.   1)  Is it likely that arthroscopy will ameliorate the problem (with removal of free/loose bodies and debris).   2)  Can the cyst (and associated dead tissue) be removed during arthroscopic surgery? 3) Without some type of attention (surgically) to the cyst, I assume it will continue to fill?

All ligaments are intact.  There is some irregularity to the cartilage at the posterior horn -- but there appears to be no outright tear.

Here are my limitations -- no interference with ADL's.  Sex is painful (because of the KNEE - LOL), no sports because I'm afraid to push the knee -- Unable to walk long distance.  Quite painful at the end of the day.  

Any advice would be helpful..

Tnx.

Seemore48

[S. Kaul, MD]

Hi there!

Hopefully the arthoscopy and arthoplasty may help ameliorate the problem. Whether a cyst can be removed on arthoscopy would depend on its size and is reserved for cysts that are highly discomfort causing. Surgery may not be the only option, since bakers cyst do respond well to conservative management where the primary cause such as arthritis etc can be corrected. It would be best to consult your orthopedician for a current evaluation and possible treatment option(s) that would suit you the best.
Hope this helps.

Take care!