A Case Series on Arthroscopic Valvulectomy of Symptomatic Popliteal Cysts in Elderly Patients Using a Modified Gillquist Maneuveropic Valvulectomy of Symptomatic Popliteal Cysts in Elderly Patients Using a Modified Gillquist Maneuver
Main Article Content
Abstract
The primary objective of this study was to assess the outcomes of arthroscopic management of popliteal cysts using the modified Gillquist maneuver for visualization. The original Gillquist maneuver was originally developed to gain access to the posterior knee compartment. However, there were drawbacks, including blind arthroscope insertion, which could potentially lead to unnecessary trauma to the knee and the risk of arthroscope damage. The modified Gillquist maneuver was introduced to overcome these limitations, offering the advantage of direct visualization during arthroscope insertion into the posterior compartment through either the anterolateral or anteromedial portals. This single-institution case series focused on a cohort of five patients aged over 60 diagnosed with unilateral popliteal cysts. These individuals underwent arthroscopic valvulectomy using the modified Gillquist maneuver. The results of the procedure were highly encouraging, providing symptomatic relief for all five patients. Significant improvements were observed in clinical metrics, including the Numeric Rating Scale (NRS), Rauschning and Lindgren Criteria, Lysholm Score, and Knee Range of Motion during a follow-up period of up to 24 months. These promising outcomes highlight the potential efficacy of the modified Gillquist maneuver as a viable surgical approach for managing popliteal cysts in the elderly population.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
<a rel="license" href="http://creativecommons.org/licenses/by/4.0/"><img alt="Creative Commons License" style="border-width:0" src="https://i.creativecommons.org/l/by/4.0/88x31.png" /></a><br />This work is licensed under a <a rel="license" href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution 4.0 International License</a>.
References
Adams R. Chronic rheumatic arthritis of the knee joint. Dublin J Med Sci. 1840;17:520–2.
Baker WM. On the formation of synovial cysts in the leg in connection with disease of the knee-joint. 1877. Clin Orthop Relat Res. 1994;(299):2-10. https://pubmed.ncbi.nlm.nih.gov/8119018.
Lindgren PG, Willén R. Gastrocnemio-semimembranosus bursa and its relation to the knee joint. I. Anatomy and histology. Acta Radiol Diagn (Stockh). 1977;18(5):497–512. https://pubmed.ncbi.nlm.nih.gov/930627. https://doi.org/10.1177/028418517701800501.
Demange MK. Baker's Cyst. Revista brasileira de ortopedia. 2015;46(6):630–3. https://pubmed.ncbi.nlm.nih.gov/27027065. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4799332. https://doi.org/10.1016/S2255-4971(15)30317-7.
Leib AD, Roshan A, Foris LA, Varacallo M. Baker's Cyst. Treasure Island (FL): StatPearls Publishing. 2023.
Picerno V, Filippou G, Bertoldi I, et al. Prevalence of Baker's cyst in patients with knee pain: an ultrasonographic study. Reumatismo. 2014;65(6):264–70. https://pubmed.ncbi.nlm.nih.gov/24705029. https://doi.org/10.4081/reumatismo.2013.715.
Fielding JR, Franklin PD, Kustan J. Popliteal cysts: a reassessment using magnetic resonance imaging. Skeletal Radiol. 1991;20(6):433–5. https://pubmed.ncbi.nlm.nih.gov/1925676. https://doi.org/10.1007/BF00191086
Torreggiani WC, Al-Ismail K, Munk PL, et al. The imaging spectrum of Baker's (popliteal) cysts. Clin Radiol. 2002;57(8):681–91. https://pubmed.ncbi.nlm.nih.gov/12169279. https://doi.org/10.1053/crad.2001.0917.
Frush TJ, Noyes FR. Baker's cyst: diagnostic and surgical considerations. Sports Health. 2015;7(4):359–65. https://pubmed.ncbi.nlm.nih.gov/26137182. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4481672. https://doi.org/10.1177/1941738113520130.
Han JH, Bae JH, Nha KW, et al. Arthroscopic treatment of popliteal cysts with and without cystectomy: a systematic review and meta-analysis. Knee Surg Relat Res. 2019;31(2):103–12. https://pubmed.ncbi.nlm.nih.gov/30893988. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561675. https://doi.org/ 10.5792/ksrr.18.068
Rauschning W, Lindgren PG. Popliteal cysts (Baker's cysts) in adults. I. Clinical and roentgenological results of operative excision. Acta Orthop Scand. 1979;50(5):583–91. https://pubmed.ncbi.nlm.nih.gov/525326. https://doi.org/10.3109/17453677908989808.
Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982;10(3):150–4. https://pubmed.ncbi.nlm.nih.gov/6896798. https://doi.org/10.1177/036354658201000306.
Malinowski K, Mostowy M, Ebisz M, et al. Arthroscopic cystectomy and valve excision of popliteal cysts complemented with management of intra-articular pathologies: a low recurrence rate and good functional outcomes in a series of ninety-seven cases. Int Orthop. 2023;47(6):1433–40. https://pubmed.ncbi.nlm.nih.gov/6912920. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10199846. https://doi.org/10.1007/s00264-023-05745-6.
Gillquist J, Hagberg G, Oretorp N. Arthroscopic examination of the posteromedial compartment of the knee joint. Int Orthop. 1979;3(1):13–8. https://pubmed.ncbi.nlm.nih.gov/549861. https://doi.org/10.1007/BF00266321.
Lee JY, Chia ZY, Jiang L, Ang B, Chang P. A review of the Gillquist maneuver: modifications for a safer and easily reproducible approach for knee transintercondylar notch posterior compartment arthroscopy. Arthroscopy Tech. 2020;9(4):e435–8. https://pubmed.ncbi.nlm.nih.gov/32368461. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188957. https://doi.org/10.1016/j.eats.2019.11.014.
Brazier BG, Sudekum SA, DeVito PM, Dodds JA. Arthroscopic treatment of popliteal cysts. Arthroscopy Tech. 2018;7(11):e1109–4. https://pubmed.ncbi.nlm.nih.gov/30533356. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262067. https://doi.org/10.1016/j.eats.2018.07.006.
Lanham NS, Tompkins M, Milewiski M, Hart J, Miller M. Knee arthroscopic posteromedial portal placement using the medial epicondyle. Orthopedics. 2015;38(6):366–8. https://pubmed.ncbi.nlm.nih.gov/26091211. https://doi.org/10.3928/01477447-20150603-03.
Zhou XN, Li B, Wang JS, Bai LH. Surgical treatment of popliteal cyst: a systematic review and meta-analysis. J Orthop Surg Res. 2016;11:22. https://pubmed.ncbi.nlm.nih.gov/26879283. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754995. https://doi.org/10.1186/s13018-016-0356-3.
Pankaj A, Chahar D, Pathrot D. Arthroscopic management of popliteal cysts. Indian J Orthop. 2016;50(2):154–8. https://pubmed.ncbi.nlm.nih.gov/27053804. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800957. https://doi.org/10.4103/0019-5413.177568.
Sansone V, De Ponti A. Arthroscopic treatment of popliteal cyst and associated intra-articular knee disorders in adults. Arthroscopy. 1999;15(4):368–72. https://pubmed.ncbi.nlm.nih.gov/10355711. https://doi.org/10.1016/s0749-8063(99)70053-8.
Ahn JH, Yoo JC, Lee SH, Lee YS. Arthroscopic cystectomy for popliteal cysts through the posteromedial cystic portal. Arthroscopy. 2007;23(5):559.e1–4. https://pubmed.ncbi.nlm.nih.gov/17478291. https://doi.org/10.1016/j.arthro.2006.07.050.