Abstract
This study was conducted to assess ultrasound (US) and clinical changes of Baker’s cyst (BC) of patients with knee osteoarthritis (OA) after steroid injection. Patients with knee OA complicated with symptomatic BC (40) were treated with US-guided direct (posterior) aspiration. The injection of 40 mg triamcynolone acetonide was in 20 patients direct into the BC and in other 20 subjects intra-articular (anterior). BC diameters (longitudinal, transverse, and thickness) were measured and followed up with US at baseline, 2, 4, and 8 weeks after injection. Swelling, pain, and range motion were scored at clinical examination with Rauschning and Lindgren classification (RLC, since 0 normal to 3 maximal signs). All US measures of BC and RLC significantly decreased after treatment, in comparison to baseline (p < 0.001) and during the follow-up, did not change through the time (no significant difference between 2, 4, and 8 weeks). At 4 and 8 weeks, diameters measured at US are lower when BC is directly infiltrated in comparison to intra-articular injection (p < 0.01). US steroid direct injection reduces US measures and clinics of BC in knee OA, in particular, when steroid is directly infiltrated into BC.
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Abbreviations
- US:
-
Ultrasound
- BC:
-
Baker’s cyst
- OA:
-
Osteoarthritis
- RLC:
-
Rauschning and Lindgren classification
- KL:
-
Kellgren e Lawrence score
References
Adams R (1840) Arthritis, chronic rheumatic, of the knee joint. Dublin J Med Sci 17:520–522
Baker WM (1877) On the formation of synovial cysts in the leg in connection with disease of the knee joint. St Bartholomew’s Hosp Rep 13:245–261
Moore CP, Sarti DA, Louie JS (1975) Ultrasonic demonstration of popliteal cysts in rheumatoid arthritis. Arthritis Rheum 18:577–580
Fam AD, Wilson SR, Holmberg S (1982) Ultrasound evaluation of popliteal cysts in osteoarthritis of the knee. J Rheumatol 9:428–434
Andonopoulos AP, Yarmenitis SY, Sfountouris H et al (1995) Baker’s cyst in rheumatoid arthritis: an ultrasonographic study with a high resolution technique. Clin Exp Rheumatol 13:633–636
Szer IS, Klein-Gitelman MK, DeNardo BA et al (1992) Ultrasonography in the study of prevalence and clinical evolution of popliteal cysts in children with knee effusions. J Rheumatol 19:458–462
Maffulli N, Regine R, Carrillo F, Minelli S et al (1992) Ultrasonographic scan in knee pain in athlete. Br J Sports Med 26:93–96
Katz RS, Zizic TM, Arnold WP et al (1977) The pseudothrombophlebitis syndrome. Medicine 56:151–164
Handy JR (2001) Popliteal cyst in adults: a review. Semin Arthritis Rheum 31:108–118
Rauschning W, Lindgren PG (1979) Popliteal cysts (Baker’s cysts) in adults, clinical and roentgenological results of operative excision. Acta Orthop Scand 50:583–591
Balconi G, Sansone V, De Ponti A (2001) Popliteal cysts: sonography evaluation after arthroscopic treatment. Radiol Med 101:255–259
Torregiani WC, Al-Isamil K, Munk PL et al (2002) The imaging spectrum of Baker’s cyst. Clin Radiol 57:681–691
Levitin PM (1976) Diagnosis of Baker cyst. JAMA 236:253
Gompels BM, Darlington LG (1982) Evaluation of popliteal cysts and painful calves with ultrasonography: comparison with arthrography. Ann Rheum Dis 41:355–359
Ward EE, Jacobson JA, Fessell DP et al (2001) Sonographic detection of Baker’s cysts: comparison with MR imaging. AJR 176:373–380
Grassi W, Farina A, Filippucci E et al (2001) Sonographically guided procedures in rheumatology. Semin Arthritis Rheum 30:347–353
Bliddal H (1999) Placement of intra-articular injections verified by mini air-arthrography. Ann Rheum Dis 58:641–643
Jones A, Regan M, Ledingham J et al (1993) Importance of placement of intra articular steroid injection. BMJ 307:1329–1330
Eustace JA, Brophy DP, Gibney RP et al (1997) Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms. Ann Rheum Dis 56:59–63
Altman R, Asch E, Bloch D et al (1986) Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum 29:1039–1049
Helbich TH, Breitenseher M, Trattnig S et al (1998) Sonomorphologic variants of popliteal cysts. J Clin Ultrasound 26:171–176
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthritis. Ann Rheum Dis 16:494–502
Acebes JC, Sanchez-Pernaute O, Diaz-Oca A et al (2006) Ultrasonography assessment of Baker’s cyst after intra-articular corticosteroid injection in knee osteoarthritis. J Clin Ultrasound 34:113–117
Gaffney K, Ledingham J, Perry JD (1995) Intra-articular triamcynolone hexacetonide in knee osteoarthritis: factors influencing the clinical response. Ann Rheum Dis 54:379–381
Jones A, Doherty M (1996) Intra-articular corticosteroids are effective in osteoarthritis but there are no clinical predictors of response. Ann Rheum Dis 55:829–832
Friedman DM, Moore ME (1980) The efficacy of intraarticular steroids in osteoarthritis: a double blind study. J Rheumatol 7:850–856
Sibbitt WL, Peisajovich A, Michael AA et al (2009) Does sonographic needle guidance affect the clinical outcome of intraarticular injections? J Rheumatol 36:1892–1902
Acknowledgment
We thank Dr. Patrizia Cerboni and Dr. Angela Del Rosso for generous free technical writing assistance. The study was conducted without any funding source public or private, and all authors had not any conflict of interest. Manuscript and all images are original, not previously referred by other editors or published.
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Bandinelli, F., Fedi, R., Generini, S. et al. Longitudinal ultrasound and clinical follow-up of Baker’s cysts injection with steroids in knee osteoarthritis. Clin Rheumatol 31, 727–731 (2012). https://doi.org/10.1007/s10067-011-1909-9
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DOI: https://doi.org/10.1007/s10067-011-1909-9