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 From
the Journal of Prolotherapy
Literature Review:
Popliteal (Baker’s) Cysts of the Knee
Gary B. Clark, MD, MPA
Treatment of Baker’s Cyst
Sclerotherapy (Prolotherapy) of Baker’s cyst with
imaging confirmation of resolution.
Centeno CJ, et al. Pain Physician. 2008
Mar-Apr;11(2):257-61.
ABSTRACT SUMMARY
Centeno, et. al. (2008), presented an “isolated case report” of
treating a 52-year-old male patient for Baker’s cyst—the
patient’s general history being classic, as previously
described. The main objective of this single-case management
report was to observe whether the already recognized curative
effect of Sclerotherapy on a Baker’s cyst could be verified by
MRI imaging changes.
Initial conservative treatment of the patient’s right popliteal
cyst consisted of NSAID medication; drainage of the swelling,
once a month, for three months; along with physical therapy.
Each drainage was performed posteriorly and produced about 40cc
of clear serous fluid, causing 1-2 weeks of symptomatic relief
of pain and stiffness. Then the swelling, pain, and disability
would resume.
Because of persistent recurrence of the cyst and its symptoms,
the authors began three monthly combined treatment sessions,
consisting of complete drainage and proliferant-sclerosant
injections.
• After draining the Baker’s cyst
from the posterior aspect of the knee, the authors injected 3 to
5cc of their proliferant solution into the joint space. This
solution consisted of approximately 15% dextrose, 10% sodium
morrhuate, diluted in .6% lidocaine (JOP discussant’s
estimations). The solution was injected into the joint space
anteriorly, i.e., “intraarticular through the medial
infrapatellar approach.” (sic)
• According to a telephone conversation with the author, sodium
morrhuate diluted in lidocaine was also injected directly into
the cyst, posteriorly, following each drainage—although this is
not clearly delineated in the article.9
• Within four months of initiating this combined treatment, the
patient reported decreased cystic swelling, pain, and range of
motion disability—albeit he continued to experience medial knee
pain attributed to residual meniscal injury.
Of key importance to the main objective of management of this
patient, pre-treatment and follow-up MRI studies were obtained.
The 12-month post-injection MRI study revealed complete
resolution of the cyst. Thus, the authors suggested there being
a positive value of MRI as a follow-up of treatment of Baker’s
cyst Sclerotherapy. Wisely, they recommended more large scale,
prospective case studies to confirm their isolated observation.
(Study design: Uncontrolled, single-case report: Minimal level 4
evidence)
JOP Commentary
This article definitely presents descriptive MRI evidence,
including radiophotographs, showing cyst resolution following
treatment. Perhaps a source of confusion, however, is the
interspersion of the two terms, “Sclerotherapy” and “Prolotherapy.”
The term “Sclerotherapy” is in the leading title. Then,
“Prolotherapy” is used seven times and “Sclerotherapy” or
“sclerosing” are used a total of eight times. “Prolotherapy” is
used in the abstract conclusions and the major heading,
“Utilization of Prolotherapy Agent.” Then, “Sclerotherapy”
appears in the main article conclusion.
It is still arguable between the two camps of Prolotherapists
and Sclerotherapists as how the healing of the subject patient’s
popliteal cyst might be explained.
• Prolotherapists might look at
the glass as half-full and say that the healing occurred
subsequent to the sodium morrhuate’s causing an inflammatory
reaction that congregated growth factors, which stimulated
fibroblasts to lay down new collagen, “regenerating” a unified
fibrous closure, thus, eliminating the cystic space—ergo, a
“healing” cascade reminiscent of a “House that Jack Built.”
• Sclerotherapists might look at the glass as half-empty and say
that the scarring occurred subsequent to the sodium morrhuate’s
causing an inflammatory reaction that stimulated fibroblasts to
lay down new collagen, creating a fibrous scar, adhering the
cyst walls, thus, closing down the cystic space—ergo, a
“scarring” phenomenon reminiscent of the scarring of a skin
wound.
More information
Christopher J. Centeno, M.D.
Centeno-Schultz Clinic
403 Summit Blvd Suite 201
Broomfield, CO 80021
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