Os cistos de padeiro localizam-se na área posteromedial do joelho, adentraram o ventre medial dá músculo gastrocnêmio e ministérios tendão semimembranoso. No decorrer adulto, esses cistos ser estar relacionados a lesões intra-articulares, o que sejam, prejuízo meniscais alternativa artrose. Fazendo crianças, geralmente são resultado de teste físico ou de exames de imagem, presente pouca relação clínica. O exame de ultrassonografia é correto para são definidos e mensurar ministérios cisto poplíteo. Para o tratamento, a abordado principal ele deve ser relacionada aos tratamento da lesão articular. Na maioria no casos que há cobrar de se endereço diretamente ministérios cisto. Os cistos no decorrer joelho são, majoritariamente na deles totalidade, benignos (cistos de baker e cistos parameniscais). Porém, a presença de algum sinais exigem que ministérios ortopedista suspeite da probabilidade de malignidade: sintomas desproporcionais aos tamanho do cisto, ausência de prejuízo articular (ex.: meniscal) o que justifique der existência a partir de cisto, topografia atípica, erode óssea associada, dimensões superior der 5cm e invasão tecidual (cápsula articular).

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Joelho; Cisto Popliteal; Adulto; Criança


Baker"s cysts estão located in a posteromedial region of ns knee between a medial ship of the gastrocnemius muscle and semimembranosus tendon. In adults, this cysts are related come intra-articular lesions, which may consist that meniscal lesions or arthrosis. In children, these cysts estão usually uncovered on physical examination or imaging studies, and they generally dá not have any type of clinical relevance. Ultrasound examination is appropriate for identifying and measuring a popliteal cyst. The main treatment method should emphasis on a joint lesions, and in most situations there is no need come address the cyst directly. Back almost tudo de knee cysts ~ ~ benign (Baker"s cysts and parameniscal cysts), existence of some indicators makes it crucial to suspect malignancy: symptom disproportionate to ns size of a cyst, absence of joint damage (e.g. Meniscal tears) that could explain a existence of a cyst, unexplained cyst topography, bone erosion, cyst size better than 5 cm and tissue intrusion (joint capsule).

Knee; Popliteal Cyst; Adult; Child


UPDATING ARTICLE

Master"s degree e Doctor"s degree a partir de Universidade de são Paulo; Assistant doctor of a Knee coporação, grupo of the Institute that Orthopedics and Traumatology of HC/FMUSP

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ABSTRACT

Baker"s cysts ~ ~ located in ns posteromedial region of the knee between ns medial ship of ns gastrocnemius muscle e semimembranosus tendon. In adults, this cysts ~ ~ related to intra-articular lesions, which might consist of meniscal lesions or arthrosis. In children, this cysts are usually uncovered on physical examination or imaging studies, and they generally do not have any clinical relevance. Ultrasound examination is appropriate porque o identifying e measuring the popliteal cyst. Ns main treatment method should emphasis on the joint lesions, and in most situations there is durante need to address a cyst directly. Although almost all knee cysts are benign (Baker"s cysts e parameniscal cysts), existence of some indicators makes it necessary to suspect malignancy: symptoms disproportionate to a size of a cyst, absence of joint damage (e.g. Meniscal tears) that could explain the existence of a cyst, inexplicable cyst topography, bone erosion, cyst size higher than 5 cm and tissue invasion (joint capsule).

Keywords: Knee; Popliteal Cyst; Adult; Child

INTRODUCTION

The Baker"s cyst, or popliteal cyst, manifests chin as an increase of volume in the depois de region of the knee. These cysts to be described ao the primeiro time by Adams in 1840, but were popularized through Baker"s summary in 1877. In his description, padeiro postulated that the formation that this cyst results from a buildup of fluid in a bursa of the semimembranosus tendon, com communication in between here and the joint, yet with der one-way flow of liquid in ns direction of the cyst, restricted by naquela valve(1). ~ Baker"s description, several papers explained popliteal cysts and noted the Baker"s cyst corresponds to der cyst situated between ns medial head of the gastrocnemius muscle e semimembranosus tendon.

Baker"s cyst gift bimodal epidemiologic distribution, with peaks in childhood and in adulthood(2). Baker"s cyst in childhood is rare and generally found by chance. Over there is usually no precedent trauma for the figure of popliteal cysts in children. In ns case of adults, in turn, there is typically an association between these cysts and intra-articular lesions. The most frequent linked pathologies ser estar meniscal lesions (lesions of the medial meniscus in 82% of ns cases e of lesions that the lateral meniscus in 38%) and osteoarthritis(3). Studies with magnetic resonance describe that the prevalence the popliteal cysts is 5% of ns adult population, e higher in enlarge patients(4). Patients com rheumatoid arthritis e patients com gout commonly present popliteal cysts(5).

From ns anatomopathological allude of view, the is der ganglion cyst extended by mesothelial cells and fibroblasts. Ns fluid in its doméstica is viscous e with naquela high concentration of fibrin. The interior of the cyst may present lobulations com walls ranging são de 2 come 8 mm. In a 1950s, Bickel et al(6) actually classified Baker"s cysts in three types, em ~ the anatomopathological allude of view, segue to wall thickness e cyst content. A clinical relevance of this classification is limited.

The pathogenesis that Baker"s cyst is defined by a presence of der connection between ns knee joint and a bursa between the gastrocnemius muscle e the semitendinosus tendon, allowing ns flow of fluid. Over there is a valve effect between ns cyst e the joint, early out to the action of the semitendinosus and gastrocnemius muscles. Throughout flexion a "valve" opens e during extension the "valve" close the door due to the tension of these muscles. Moreover, ns intra-articular push of the knee interferes in ns formation e in ns filling of the popliteal cysts. Ns intra-articular pressure during partial knee flexion is an adverse (-6 mmHg), coming to be positive with knee extension (16 mmHg). Hence, these three components - presence of communication between joint and bursa, "valve" effect and variation that intra-articular press in the knee - exchange mail to ns pathophysiologic explanation of ns formation that Baker"s cysts(2).

CLINICAL PICTURE

Patients com Baker"s cyst might refer to a presence of der mass or development in the traseira region of a knee. In children, these cysts estão asymptomatic, e are mostly discovered in physical examinations.

In adults, this cysts can cause pain and a emotion of push in the traseira region of a knee. Ns symptoms estão more intense once extending ns joint or during physical activities.

Most of the time, the clinical complaints are not connected to ns cyst, yet refer to ns problem connected with a condition. Therefore, complaints relating to osteoarthritis or to meniscal lesion ~ ~ more frequent(2).

When a Baker"s cyst ruptures, a clinical snapshot consists of abrupt e intense ache in the traseira region of ns knee e of the calf. This photo is often confused with a diagnosis that deep vein thrombosis. In both clinical cases there have the right to be an increase of volume e clubbing of the calf(7).

In Baker"s cysts of significant intervalo there can be compression of associated structures and clinical symptom arising em ~ the latter. This file is rare, yet need to be suspected once there is correlation between compressive symptoms and the place of ns cyst(8-11).

For ns physical examination, we have to assess a patient in prone position e perform knee palpation in extension and in flexion that 90 degrees. We palpate naquela rounded, mobile mass, with sensation of fluid content and of well-defined edges. Ns cyst often tends to disappear or come decrease com 45 levels of knee flexion (Foucher"s sign). This check is helpful to differentiate Baker"s cysts from fixed, hard masses that são de not mudança position.

IMAGING DIAGNOSIS

Ultrasonography permits us to definir the size and location of ns Baker"s cyst. Additional subsidiary check is not commonly necessary. Ultrasonography permits us to evaluate ns tumor content, and to differentiate cysts com liquid contents são de solid masses.

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Complementarily, we can perform magnetic resonance imaging, i m sorry is especially useful in case of uncertainty of lesions linked with ns popliteal cyst. In a MR imaging exam, the popliteal cyst gift low-signal intensity in ns T1-weighted images e high-signal strongness in ns T2-weighted images, because of its fluid contente (Figures 1, 2 e 3). Baker"s cyst is composed of an ovular, well-defined picture of liquid content. Magnetic resonance imaging permits us to differentiate popliteal cysts em ~ parameniscal cysts, since the latter are generally situated on the lado de fora edges of the meniscuses (medial or lateral) and present interaction with a meniscal lesion(12).