Department of Anatomy, International Evidence-Based Anatomy Working Group, Jagiellonian University Medical College, Kraków, Poland.
Artromedical Orthopaedic Clinic, Antracytowa 1, 97-400, Belchatow, Poland.
Int Orthop. 2023 Jun;47(6):1433-1440. doi: 10.1007/s00264-023-05745-6. Epub 2023 Mar 13.
Arthroscopy in popliteal cyst surgery enables addressing all components of its pathomechanism: the cyst wall, valvular mechanism, and concomitant intra-articular pathologies. Techniques differ as to the management of the cyst wall and the valvular mechanism. This study aimed to assess the recurrence rate and functional outcomes of a cyst wall and valve excising arthroscopic technique with concurrent intra-articular pathology management. The secondary purpose was to assess cyst and valve morphology and concomitant intra-articular findings.
Between 2006 and 2012, 118 patients with symptomatic popliteal cysts refractory to at least three months of guided physiotherapy were operated on by a single surgeon using a cyst wall and valve excising arthroscopic technique with intra-articular pathology management. Patients were evaluated preoperatively and at a mean follow-up of 39 months (range 12-71) by ultrasound, Rauschning and Lindgren, Lysholm, and VAS of perceived satisfaction scales.
Ninety-seven out of 118 cases were available for follow-up. Recurrence was observed on ultrasound in 12/97 cases (12.4%); however, it was symptomatic only in 2/97 cases (2.1%). Mean scores improved: Rauschning and Lindgren from 2.2 to 0.4, Lysholm from 54 to 86, and VAS of perceived satisfaction from 5.0 to 9.0. No persistent complications occurred. Arthroscopy revealed simple cyst morphology in 72/97 (74.2%) and presence of a valvular mechanism in all cases. The most prevalent intra-articular pathologies were medial meniscus (48.5%) and chondral lesions (33.0%). There were significantly more recurrences in grade III-IV chondral lesions (p = 0.03).
Arthroscopic popliteal cyst treatment had a low recurrence rate and good functional outcomes. Severe chondral lesions increase the risk of cyst recurrence.
腘窝囊肿手术中的关节镜检查可解决其发病机制的所有组成部分：囊肿壁、瓣膜机制以及伴随的关节内病变。技术在囊肿壁和瓣膜机制的处理上有所不同。本研究旨在评估一种切除囊肿壁和瓣膜的关节镜技术联合关节内病变处理的复发率和功能结果。次要目的是评估囊肿和瓣膜的形态以及伴随的关节内发现。
在 2006 年至 2012 年期间，由一位外科医生对 118 名患有症状性腘窝囊肿的患者进行了手术治疗，这些患者对至少三个月的引导式物理治疗有反应。这些患者采用了一种切除囊肿壁和瓣膜的关节镜技术联合关节内病变处理。患者在术前和平均 39 个月（范围 12-71）的随访中通过超声、Rauschning 和 Lindgren、Lysholm 和感知满意度的 VAS 评分进行评估。
118 例中有 97 例可随访。97 例中有 12 例（12.4%）在超声上观察到复发，但仅在 2 例（2.1%）中有症状。平均评分改善：Rauschning 和 Lindgren 从 2.2 分降至 0.4 分，Lysholm 从 54 分升至 86 分，感知满意度的 VAS 从 5.0 分升至 9.0 分。没有持续的并发症发生。关节镜检查显示 72/97 例（74.2%）为单纯囊肿形态，所有病例均存在瓣膜机制。最常见的关节内病变为内侧半月板（48.5%）和软骨病变（33.0%）。在 III-IV 级软骨病变中复发率明显更高（p=0.03）。
关节镜下腘窝囊肿治疗复发率低，功能结果良好。严重的软骨病变会增加囊肿复发的风险。
