Baker's Cyst: Recurrence, Symptoms, and Treatment Options

Baker's cyst

I previously underwent surgery for a Baker's cyst located in front of my knee, which had hardened into a lump.
After the removal, it recurred about two months later.
The doctor at National Taiwan University advised me to just monitor it, and after approximately 1 to 2 years, the cyst disappeared.
It has now been 13 years since the surgery, and something has grown back, but this time the location is different.
Previously, the lump was visible to the eye, but now it is located within the bone, causing more pressure than before.
I often feel like my bone is pinching something, and when my leg is fully bent, it becomes very sore, but straightening it provides immediate relief.
I can feel its outline when I touch it, but since it is tightly adhered to the bone, I cannot determine its exact size or extent.
My questions are: Is the third growth also a Baker's cyst, or could it possibly be another type of tumor? If it is a cyst, will I need surgery again? Will it recur after surgery? Is it the same outcome after multiple surgeries?

Shi, 10~19 year old female. Ask Date: 2020/08/27

Dr. Chen Bochen reply Orthopedics

1.
The swelling in front of the knee is likely not a Baker's cyst, but rather bursitis.

2.
If the cyst is asymptomatic, surgery is not necessary; aspiration and local corticosteroid injection may be attempted.

3.
The recurrence rate after surgery is high, ranging from 30% to 50%.

Reply Date: 2020/08/27

More Info

Baker's cyst, also known as a popliteal cyst, is a fluid-filled sac that forms behind the knee. It is often associated with conditions that cause knee joint swelling, such as arthritis or meniscus tears. Understanding the recurrence, symptoms, and treatment options for Baker's cysts is essential for managing this condition effectively.

Recurrence of Baker's Cyst
Recurrence of a Baker's cyst after surgical removal is not uncommon. The cyst can reappear due to ongoing joint issues, such as arthritis or mechanical problems within the knee. If the underlying cause of the cyst, such as joint inflammation or injury, is not addressed, the cyst may reform. In your case, the cyst reappeared after two months, which suggests that the underlying knee condition may not have been fully resolved. The fact that the cyst has now formed in a different location and is causing increased pressure and discomfort indicates that it may be related to changes in the knee joint or surrounding structures.

Symptoms
The symptoms of a Baker's cyst can vary. Commonly, patients experience swelling behind the knee, which may be more pronounced when the knee is bent. Other symptoms can include:
- Pain or discomfort in the knee, especially when bending or straightening the leg.

- A feeling of tightness or pressure in the back of the knee.

- Limited range of motion in the knee joint.

- Swelling that may extend down the calf.

In your case, the sensation of your bones "clipping" something and the increased discomfort when the knee is bent could indicate that the cyst is pressing against surrounding structures or that there is another issue within the knee joint.

Differential Diagnosis
While it is possible that the new growth is another Baker's cyst, it is also important to consider other possibilities. These could include:
- Other types of cysts: Such as ganglion cysts, which can occur near joints and may feel similar.

- Tumors: While less common, tumors can develop in the knee region and may present with similar symptoms.

- Bursitis: Inflammation of the bursae, which are small fluid-filled sacs that cushion the knee joint.

Given the changes in your symptoms and the location of the new growth, it would be prudent to have imaging studies, such as an MRI, to evaluate the structure of the knee and determine the nature of the growth.

Treatment Options
If the growth is confirmed to be a Baker's cyst, treatment options may include:
1. Observation: If the cyst is not causing significant discomfort or functional impairment, monitoring it may be sufficient, especially if it has resolved on its own in the past.

2. Physical Therapy: Strengthening the muscles around the knee and improving flexibility can help alleviate symptoms and prevent recurrence.

3. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation associated with the cyst.

4. Aspiration: In some cases, the fluid within the cyst can be drained to relieve pressure and discomfort. However, this is often a temporary solution, as the cyst may refill.

5. Surgery: If the cyst is causing significant pain or functional limitations, surgical removal may be considered. However, as you noted, there is a risk of recurrence even after surgery. Addressing the underlying knee condition is crucial to minimize this risk.

Conclusion
In summary, while it is possible that the new growth is another Baker's cyst, it is essential to rule out other conditions through appropriate imaging and evaluation. If it is indeed a cyst, treatment options range from observation to surgical intervention, depending on the severity of symptoms and the underlying knee condition. Consulting with an orthopedic specialist who can assess your knee and recommend the best course of action is advisable.

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