How to treat a Baker's cyst?

The symptoms of a Baker's cyst (Baker's cyst)

The Baker's cyst is an outpouching of the posterior joint capsule, which is filled with synovial fluid. The Baker's cyst becomes larger over time (up to the size of a fist) and can be easily felt and palpated in the hollow of the knee. It presses on the nearby vessels, nerves and muscles and leads to a restriction of movement in the knee joint. Patients report a feeling of tension of varying intensity, dependent on movement or recurring, as well as pressure pain, particularly on the inside of the popliteal fossa, which increases during the course of the day. Some sufferers describe pain that radiates into the calf muscles, a feeling of numbness and tingling. In rare cases, the Baker's cyst can burst, causing the cyst fluid to leak into the surrounding tissue of the popliteal fossa. Those affected then complain of acute pain radiating into the calf muscles, leading to swelling of the lower leg and restricted movement.

The causes

The Baker's cyst is a sign that something is defective in the knee joint. This damage to the knee joint leads to irritation of the synovial membrane, which produces more synovial fluid as a result. The joint pressure increases and the knee joint capsule expands. At the weakest point of the joint capsule, in the area of the popliteal fossa, it gives way and a bulge forms, the so-called Baker's cyst.

The cause of the Baker's cyst is usually wear-related and chronic damage to the knee joint. This can be a torn meniscus, osteoarthritis, instability (increased mobility of the knee joint due to a torn cruciate ligament) or a rheumatic disease.

The right treatment for a Baker's cyst

The diagnosis is made through a thorough examination of the affected knee joint. This is followed by normal X-ray images of the knee and an MRI scan, which describes the extent and localisation of the Baker's cyst and identifies damage to the knee joint. The results are discussed in detail with the patient and the appropriate treatment is recommended.

The following conservative therapies are prioritised at the start of treatment:

• Anti-inflammatory medication
• Physiotherapy
• A puncture of the cyst with possible administration of cortisone

The puncture has a short-term effect and the Baker's cyst refills with fluid. Cortisone also has corresponding side effects and should be injected with caution.

If the symptoms do not improve with conservative treatment, the cyst must be surgically removed.

The irritating causes (e.g. meniscus tear) in the knee joint can be treated by means of arthroscopy. This reduces the overproduction of joint fluid caused by irritation and the painful Baker's cyst becomes smaller or disappears. In the case of a large Baker's cyst (e.g. the size of a fist), the cyst should be removed together with the connection to the knee joint (pedicle).

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