AB1121 EFFICACY AND SAFETY OF ULTRASOUND GUIDED ASPIRATION AND INTRA_LESIONAL CORTICOSTEROIDS INJECTION OF RUPTURED BAKER’SCYST
Authors: Mohammed A. Mortada, Youmna A. Amer
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Baker's cyst is the most common mass in the popliteal fossa and results from fluid distension of the gastrocnemio-semimembranosus bursa. The most common complication of Baker's cyst is the rupture or dissection of fluid into the adjacent proximal gastrocnemius muscle belly, which results in a pseudothrombophlebitis syndrome mimicking symptoms of DVT. Treatment of ruptured Baker cysts ranged from conservative management to surgical resection. Ultrasonographic guided aspiration and corticosteroids injection may be an effective and easy method of management of these cases. Up to the best of our knowledge, this is the first study to detect the efficacy and safety of ultrasonographic guided aspiration and injections of ruptured Baker cysts. <h3>Objectives</h3> To evaluate the efficacy and safety of ultrasonographic guided aspiration and local corticosteroids of ruptured Baker cysts based on follow-up clinical and sonographic results. <h3>Methods</h3> A retrospective study was conducted on 42 patients (12 males and 30 females, mean age 36 +/- 10 SD years) affected by a ruptured Baker cysts associated to knee joint disorders in the period between January 2013 to January 2019.The diagnosis was done by clinical presentation of acute calf pain, swelling, tenderness at the calf muscles and ultrasonographic evidences of ruptured backer cysts in the form of free fluid collection in the calf connected to a well defined cyst at the back of knee. All cases were treated by ultrasonographic guided aspiration and intra_lesional injection of corticosteroids once or twice one week a part. Follow up were done on a weekly basis until complete resolution of symptoms then 3 months later. Visual analogue scale (VAS) for calf pain and Rauschning-Lindgren and Lysholm Knee Scoring Scales were used to assess pre/post-injection knee functions. <h3>Results</h3> The primary diagnoses to patients presented with ruptured Baker cyst in this study were as follow: 18 (42.8%) cases with rheumatoid arthritis, 15 (37.5%) cases with osteoarthritis and 9 (21.4%) cases with psoriatic arthritis. Clinical parameters (VAS for calf pain and Rauschning-Lindgren score) improved significantly in all patients at both post injection evaluation visits. Rauschning-Lindgren score was significantly lower after US guided injections (mean, 0; range, 0-1) than at baseline (mean, 2; range, 1–2); <i>p</i> &lt; 0.001 (table1). VAS for calf pain also significantly lower after US guided injections (mean,0.5; range, 0-1) than at baseline (mean, 9.5; range, 0-10); <i>p</i> &lt; 0.001. Ultrasonographic features improved significantly with complete disappearance of free fluid at the calf in 35 (83.3%) cases one week after the injection. As regards Baker cyst only 5 (11%) cases showed complete disappearance of the backer cyst and in the majority of cases 37 (88%) there were persistent Baker cysts. No side effects were reported in all cases. VAS; visual analogue scale <h3>Conclusion</h3> Ultrasonographic guided aspiration and intra_lesional corticosteroids injection is an effective and safe method in management of ruptured Baker cysts. <h3>References</h3> [1] Nigerian Journal of Orthopaedics and Trauma June 2009: 8 (1): 31-32 <h3>Disclosure of Interests</h3> None declared