Baker’s Cyst

A Baker’s cyst can be a very confusing knee ailment for some patients. First, it has nothing to do with being a baker, but rather it was named for the surgeon who first described it, Dr. William Baker. Secondly, often it is not explained by the attending physician that the baker’s cyst itself is not the cause of the patient’s knee problems, but rather a symptom of other damage.

What is a Baker’s Cyst
In the knee, between the thigh bone and the shine bone, is the synovial sac. Filled with a thick (synovial) fluid, the synovial sac acts as a shock abosorber, protecting the knee from excessive wear and damage. A Baker’s cyst (also refered to as a Popliteal cyst – simply meaning “back of the knee” cyst,) develops when the knee becomes weakened through meniscal (cartilage tear) or developing arthritis. As inflammation in the knee develops, fluid collects; the synovial sac expands and pushes its way into the back of the knee. The characteristic bulge of the cyst is easy to identify and depending on the discomfort or pressure a treatment is recommended. Treating the symptoms and not the cause.

In our chronic pain center we see many cases of baker’s cyst. Worse, we see many recurring cases of baker’s cysts referred to us by other clinics.

The typical treatment for a Baker’s cyst can range from rest to aspiration. In cases where the cyst is causing pressure on the nerves of the knee or general discomfort. aspiration is performed to drain the fluid. This is usually followed by an anti-inflammatory to bring down swelling. Ironically, it is this very treatment that causes the Cyst to return.

As pointed out, the Baker’s cyst formed as a response to damage in the knee. Aspiration, antin-inflammatories, even arthroscopy to remove portions of damaged cartilage or menisus does not fix the problem causing the cyst, it accelerates the problem with knee replacement being the logical conclusion.

Knee surgery causing knee replacement? But it is just a cyst!
When a Baker’s cyst is recurring, that means the knee is trying, through inflammation (swelling) to stabilize the knee. When the swelling is removed, the body’s attempt at fixing the problem is removed. The very cause of the swelling – damage to the soft tissue, a bone on bone situation – is allowed to continue unimpeded. It then becomes only a matter of time before the knee is in advanced osteoarthritic distress and a total knee replacement is called for.

Inflammation to the rescue?
Inflammation is the body’s response to healing injury. Some physicians have not forgotten this basic fact of medicine. In our practice we use inflammation as a weapon to heal. Utilizing two techniques, Prolotherapy and Platelet Rich Plasma Therapy (PRP), we can, through the use of “controlled inflammation,” heal the cause of the Baker’s cyst – joint deterioration. In the knee, instability occurs because the ligaments of the knee have become loose. This allows for excessive movement causing the grinding and inflammation indentified with a “wobbly joint.” Both Prolotherapy and Platelet Rich Plasma therapy are injection techniques that target the weak ligaments, strengthening and restoring them to their natural strong, thick, and elastic state. Recent medical studies on both treatments support that articular cartilage and meniscal tissue can regrow with these treatment.

Ultrasound Guidance
A Baker’s Cyst is usually caused by excess fluid from the anterior portion of the knee. When there is no more room for that fluid, it will commonly be pressured to the back of the knee causing the Baker’s Cyst. Dr. Darrow easily remove this fluid under ultrasound guided aspiration. After aspiration of the cyst or fluid from the anterior portion of the knee, there is typically immediate relief and increase in range of motion of the knee joint.

If your doctor plans to aspirate your knee or other part of the body, be sure to have him do it under ultrasound guidance so that the procedure is basically painless, and the exact areas of fluid can be removed (the fluid can be seen as dark areas under ultrasound). Doing this blindly (without ultrasound guidance) will not remove all the fluid, and your doctor will needlessly be poking you all over to try to collect fluid because he can not see where he is going.

If you are interested in finding out more about Prolotherapy and Platelet Rich Plasma Therapy as a means to preventing and treating the problems associated with Baker’s cyst, please contact us