When is surgery indicated in the treatment of cystic lesions of the knee?

Updated: Dec 29, 2018
  • Author: David M Gonzalez, MD, FACS; Chief Editor: Thomas M DeBerardino, MD  more...
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Surgical indications for the excision of cysts about the knee depend on the origin and cause of the cyst. Treatment of bursal cysts is nonoperative and aimed at the etiology, whether it is mechanical, biochemical, or immunologic. An adventitial bursa can occur over any prominence (eg, osteochondroma, large osteophyte, surgically placed hardware). Removing the prominence treats the bursitis. Bursal cysts that become inflamed because of a systemic reason are treated by addressing the systemic cause for the swelling and inflammation. Local measures to control swelling also can be used, such as rest, heat, compression, elevation, and immobilization.

Indications for surgical treatment of a meniscal cyst are pain that interferes with activity and a palpable mass along the lateral or medial joint line. The diagnosis can be confirmed with an MRI, although an MRI is not necessary with the presence of every knee cyst.

Popliteal cysts are usually not surgically excised. Surgical treatment is aimed at the inciting cause of the cyst and typically involves knee arthroscopy to look for an intra-articular process. MRI can be helpful in guiding and developing a treatment plan. Smith et al reported safe and effective treatment of symptomati popliteal cysts with ultrasound-guided aspiration of fluid through a spinal needle, fenestration of the cyst walls and septations, and injection of 1 mL triamcinolone and 2 mL 0.5% bupivacaine into the decompressed remnant. [16]

Surgical treatment is usually indicated for more rare types of cysts, such as the following:

  • Intraneural cysts
  • Popliteal artery cystic adventitial disease
  • Arterial aneurysms
  • Symptomatic ganglia

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