A cyst is a fluid filled sac in any location of the body. One of the more common areas where cysts occur is the back of the knee. These cysts are called popliteal cysts or Baker’s cysts. Typically, damage within the knee causes swelling and the fluid is pumped from the knee to this fluid filled sac. This creates swelling and sometimes pain in the back of the knee. This may cause problems achieving full bending or full straightening of the knee.
Typically, draining or cutting out this cyst does not help unless the cause of the fluid accumulation inside the knee is cured. Orthopedic surgeons will recommend that the person get an MRI and subsequent arthroscopy to ‘fix’ the problem. For the person who desires not to have a 24 inch probe stuck in their knee and undergo general anesthesia, there is another option: Prolotherapy.
Let’s think about it. Someone has a trauma to the knee and eventually a baker’s cyst forms. What most likely would be injured to cause instability in the knee so joint fluid accumulates. You got it…ligament damage. In my opinion the best treatment option for a ligament being stretched is Prolotherapy.
Can Arthroscopy fix a ligament that is stretched? No. Prolotherapy to the injured structure will stimulate the body to repair it. Once it is repaired and the joint is stable, no more joint swelling. Once there is no more joint swelling there is no more baker’s cyst.
In summary: For those of you with baker’s cysts, just draining the cyst doesn’t repair anything, it alleviates swelling. Even then the physician will tell you the likelihood is that the cyst will return. Why? Because the damage into and around the knee joint remains. Damage to the following structures could cause a baker’s cyst to form: the menisci, ligaments, cartilage, or joint capsule. All of these structures respond to the repair stimulating effects of Prolotherapy Injections. By a person receiving Prolotherapy treatment to the inside of the knee, the joint structure causing the swelling is often repaired. Once it is repaired, the joint swelling stops. Once the joint swelling stops, the baker’s cyst ceases to exist. We call this “ceasing to exist” a cure.
Baker’s cysts, or popliteal cysts, are typically treated with aspiration and steroid injections. However, Baker’s cysts will often return. In this video, Ross Hauser, MD discusses his experience with Prolotherapy injections to the knee which can help stabilize the surrounding knee structures and prevent recurrence of Baker’s cysts. The knee is the most common body area treated at Dr. Hauser’s office, Caring Medical and Rehabilitation Services. If you have a painful Baker’s cyst or chronic knee pain condition and are looking for an alternative to knee surgery and steroid injections, contact Caring Medical for an appointment.
Gary B. Clark, MD
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.
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)
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.
Christopher J. Centeno, M.D.
403 Summit Blvd Suite 201
Broomfield, CO 80021