Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
JBJS Rev. 2020 Mar;8(3):e0139. doi: 10.2106/JBJS.RVW.19.00139.
Treatment methods for popliteal cysts have varied over the past several decades and have posed challenges to providers as recurrences were frequent. With greater understanding of relevant anatomy, both operative and nonoperative treatment methods have evolved to appropriately target relevant pathology and improve outcomes. The purposes of this review were to outline the evolution of treatment methods and to qualitatively summarize clinical outcomes.
We performed a systematic review on treatments for popliteal cysts to include publications from 1970 to 2019. Other inclusion criteria consisted of studies with ≥10 patients enrolled, studies with a patient age of ≥16 years, studies with an adequate description of the treatment technique, and studies with a Level of Evidence of IV or higher. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and literature quality was assessed using a modified Coleman methodology score.
Thirty studies met inclusion criteria in this review. Nine studies discussed nonoperative treatment, and 21 studies discussed operative treatment. Eight of the 9 nonoperative treatment studies utilized corticosteroid injections. The most recent studies have advocated for ultrasound-guided intracystic injection with possible cyst fenestration. Most operative studies utilized an arthroscopic approach to enlarge the communication with the joint space. However, alternative treatment techniques are still utilized.
The current literature on the treatment of popliteal cysts indicates that intracystic corticosteroid injection with cyst fenestration is an effective nonoperative treatment method. Arthroscopic surgical procedures with enlargement of the communication have been most widely studied, with positive results; however, further studies are needed to confirm superiority over other treatment methods.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
在过去几十年中，腘窝囊肿的治疗方法多种多样，由于复发频繁，给医疗提供者带来了挑战。随着对相关解剖结构认识的提高，手术和非手术治疗方法都得到了发展，可以针对相关病变进行适当治疗，并改善治疗效果。本文旨在概述治疗方法的演变，并对临床结果进行定性总结。
我们对腘窝囊肿的治疗方法进行了系统回顾，纳入的文献发表于 1970 年至 2019 年。其他纳入标准包括：纳入患者数≥10 例的研究、患者年龄≥16 岁的研究、充分描述治疗技术的研究、以及证据水平为 IV 级或更高的研究。本综述按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行，并使用改良 Coleman 方法学评分评估文献质量。
本综述共纳入 30 项研究。9 项研究讨论了非手术治疗，21 项研究讨论了手术治疗。9 项非手术治疗研究中有 8 项采用了皮质类固醇注射。最近的研究提倡超声引导下囊内注射联合可能的囊肿开窗术。大多数手术研究采用关节镜入路扩大与关节腔的连通。然而，仍在使用替代治疗技术。
目前关于腘窝囊肿治疗的文献表明，囊内皮质类固醇注射联合囊肿开窗术是非手术治疗的有效方法。扩大与关节腔连通的关节镜手术方法得到了最广泛的研究，结果也较为积极；然而，还需要进一步的研究来证实其优于其他治疗方法。
治疗性 IV 级。欲了解完整的证据等级描述，请参见作者须知。
