Popliteal cysts (Baker's cysts) in adults. II. Capsuloplasty with and without a pedicle graft.

In 15 adult patients, undergoing surgery for symptomatic popliteal cysts of fairly long duration, the communication into the joint was closed by two different procedures: In the early series, Series A (8 patients), the opening was tightly sutured, and in Series B (7 patients) a new type of capsuloplasty was performed, using a proximally based flap from the gastrocnemius tendon for additional reinforcement. One minor postoperative complication occurred in Series A, whereas all patients in Series B made an uneventful recovery. The results were assessed clinically and arthrographically almost 2 years postoperatively. All patients were relieved of their popliteal symptoms. In Series A three clinically asymptomatic recurrences were found at arthrography. No recurrence occurred in Series B (the capsuloplasty series). A modified postero-medial approach facilitated access to the communication. Postoperative immobilization for 3 weeks promotes uneventful healing of the capsular repair. The importance of meticulous closure of the gap is emphasized, whereas radical excision of the cyst does not seem essential for the therapeutic result.