Marc Darrow MD, JD 

A Baker’s cyst can be a very confusing knee ailment for some patients. First, it has nothing to do with being a baker, but rather it was named for the surgeon who first described it, Dr. William Baker. Secondly, often it is not explained by the attending physician that the Baker’s cyst itself is not the cause of the patient’s knee problems, but rather a symptom of knee instability and developing osteoarthritis.

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Typically a patient will call or email our office asking for help for the problems of Baker’s Cyst. Some of these patients have had the cyst drained before and it has returned. Most tell us that the orthopedist who drained the cyst the first or even second time warned them that the cyst will return and that they will need some type of knee surgery to prevent it from coming back.

What is a Baker’s Cyst
In the knee, between the thigh bone and the shin bone, is the synovial sac. Filled with a thick (synovial) fluid, the synovial sac acts as a shock absorber, protecting the knee from excessive wear and damage. A Baker’s cyst (also referred to as a Popliteal cyst – simply meaning “back of the knee” cyst,) develops when the knee becomes weakened through meniscal (cartilage tear) or developing arthritis. As inflammation in the knee develops, fluid collects; the synovial sac expands and pushes its way into the back of the knee. The characteristic bulge of the cyst is easy to identify and depending on the discomfort or pressure a treatment is recommended. Treating the symptoms and not the cause.

In our chronic pain center we see many recurring cases of Baker’s cysts.

The typical treatment for a Baker’s cyst can range from rest to aspiration. In cases where the cyst is causing pressure on the nerves of the knee or general discomfort, aspiration is performed to drain the fluid. This is usually followed by an anti-inflammatory to bring down swelling. Ironically, it is this very treatment that causes the Cyst to return.

As pointed out, the Baker’s cyst formed as a response to damage in the knee. Aspiration, anti-inflammatories, even arthroscopy to remove portions of damaged cartilage or meniscus suspect in causing the cyst does not fix the problem. When a Baker’s cyst is recurring, that means the knee is trying, through inflammation (swelling) to stabilize the knee. When the swelling is removed, the body’s attempt at fixing the problem is removed. The very cause of the swelling – damage to the soft tissue, a bone on bone situation – is allowed to continue unimpeded. It then becomes only a matter of time before the knee is in advanced osteoarthritic distress and a total knee replacement is called for.

Ultrasound Guidance
A Baker’s Cyst is usually caused by excess fluid from the anterior portion of the knee. When there is no more room for that fluid, it will commonly be pressured to the back of the knee causing the Baker’s Cyst. We can easily remove this fluid under ultrasound guided aspiration. After aspiration of the cyst or fluid from the anterior portion of the knee, there is typically immediate relief and increase in range of motion of the knee joint.

Do you have questions? Ask Dr. Darrow

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