eMedicine Specialties > Orthopedic Surgery > Knee

Cystic Lesions About the Knee: Workup

Author: David M Gonzalez, MD, FACS, Partner, Sports Medicine Surgery and General Orthopaedic Surgery, San Antonio Orthopaedic Group
Contributor Information and Disclosures

Updated: Jan 24, 2010

Workup

Laboratory Studies

  • Laboratory studies are dictated by the patient's general condition.
  • If infection is suggested, record vital signs and obtain a complete blood count (CBC) with differential and an erythrocyte sedimentation rate.
  • Any possible undiagnosed medical condition should be investigated using appropriate laboratory and radiographic studies.

Imaging Studies

  • Obtain plain radiographs, and consider sonograms or any other studies as indicated. MRI is especially useful when evaluating knee cysts.11
  • MRIs may have to include intravenous contrast enhancement because high signal intensity on T2-weighted images does not necessarily mean that a structure is fluid filled.
  • Necrotic tissue, nerve sheath or myxoid tissue, flowing blood, and pus can all resemble cysts on T2-weighted MRIs.12
  • Ultrasonography can also be used to determine if the mass is fluid filled.
  • Computed tomography (CT) scanning, knee arthrography, tomography, and bone scanning have also been used.

Other Tests

  • Aspiration of the cystic mass can be useful in some situations, although recurrence of the cyst is common. Bursal cysts that occur secondary to trauma often respond to aspiration and injection of corticosteroids.

Histologic Findings

The cysts are lined with an epithelium. Bursal sacs are lined with a membrane similar to synovium. A Baker cyst is the most common synovial cyst. Adventitial cysts do not have a true epithelial lining or synovial lining and usually have thickened walls. Many meniscal cysts have been shown to have a clear communication with the joint and appear to be lined with synovium.

More on Cystic Lesions About the Knee

Overview: Cystic Lesions About the Knee
Workup: Cystic Lesions About the Knee
Treatment: Cystic Lesions About the Knee
Follow-up: Cystic Lesions About the Knee
Multimedia: Cystic Lesions About the Knee
References
Further Reading
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References

  1. Goss CM, ed. Gray's Anatomy of the Human Body. 29th ed. Philadelphia, Pa: Lea and Febiger;1974: 353-4.

  2. Crema MD, Roemer FW, Marra MD, Niu J, Lynch JA, Felson DT, et al. Contrast-enhanced MRI of subchondral cysts in patients with or at risk for knee osteoarthritis: The MOST study. Eur J Radiol. Sep 18 2009;[Medline].

  3. Chatzopoulos D, Moralidis E, Markou P, Makris V, Arsos G. Baker's cysts in knees with chronic osteoarthritic pain: a clinical, ultrasonographic, radiographic and scintigraphic evaluation. Rheumatol Int. Dec 2008;29(2):141-6. [Medline].

  4. Shetty GM, Wang JH, Ahn JH, Lee YS, Kim BH, Kim JG. Giant synovial cyst of knee treated arthroscopically through a cystic portal. Knee Surg Sports Traumatol Arthrosc. Feb 2008;16(2):175-8. [Medline].

  5. Newsham KR. Recurrent popliteal cyst in an adult: a case report and review. Orthop Nurs. Jan-Feb 2009;28(1):11-4; quiz 15-6. [Medline].

  6. Sansone V, de Ponti A, Paluello GM, del Maschio A. Popliteal cysts and associated disorders of the knee. Critical review with MR imaging. Int Orthop. 1995;19(5):275-9. [Medline].

  7. Campbell SE, Sanders TG, Morrison WB. MR imaging of meniscal cysts: incidence, location, and clinical significance. AJR Am J Roentgenol. Aug 2001;177(2):409-13. [Medline]. [Full Text].

  8. Ryu RK, Ting AJ. Arthroscopic treatment of meniscal cysts. Arthroscopy. 1993;9(5):591-5. [Medline].

  9. Shetty GM, Nha KW, Patil SP, Chae DJ, Kang KH, Yoon JR, et al. Ganglion cysts of the posterior cruciate ligament. Knee. Aug 2008;15(4):325-9. [Medline].

  10. Weiner SR, Fan P. Popliteal cyst involvement with gonococcal arthritis-dermatitis syndrome. Sex Transm Dis. Jul-Sep 1983;10(3):141-3. [Medline].

  11. Marra MD, Crema MD, Chung M, Roemer FW, Hunter DJ, Zaim S, et al. MRI features of cystic lesions around the knee. Knee. Dec 2008;15(6):423-38. [Medline].

  12. Kosty JW, Moore JG. Juxta-articular myxoma within the suprapatellar pouch masquerading as a ganglion cyst. Orthopedics. Jul 2009;32(7):527. [Medline].

  13. Cone RO III. Imaging sports-related injuries of the knee. In: DeLee JC, Drez D, eds. Orthopaedic Sports Medicine: Principles and Practice. Philadelphia, Pa: WB Saunders;1994: 1568, 1593-8.

  14. Coral A, van Holsbeeck M, Adler RS. Imaging of meniscal cyst of the knee in three cases. Skeletal Radiol. 1989;18(6):451-5. [Medline].

  15. Crenshaw AH. Nontraumatic disorders. In: Canale ST, ed. Campbell's Operative Orthopaedics. 9th ed. St Louis, Mo: Mosby-Year Book;1998: 776-82.

  16. Damron TA, Rock MG. Unusual manifestations of proximal tibiofibular joint synovial cysts. Orthopedics. Mar 1997;20(3):225-30. [Medline].

  17. De Filippo M, Rovani C, Sudberry JJ, et al. Magnetic resonance imaging comparison of intra-articular cavernous synovial hemangioma and cystic synovial hyperplasia of the knee. Acta Radiol. Jul 2006;47(6):581-4. [Medline].

  18. Devereux D, Forrest H, McLeod T, Ahweng A. The nonarterial origin of cystic adventitial disease of the popliteal artery in two patients. Surgery. Nov 1980;88(5):723-7. [Medline].

  19. Insall JN, ed. Surgery of the Knee. 3rd ed. New York, NY: Churchill Livingstone;1984: 739-40.

  20. Jobe CM, Wright M. Anatomy of the knee. In: Fu FH, Harner CD, Vince KG, eds. Knee Surgery. Baltimore, Md: Lippincott Williams and Wilkins;1994: 48-9.

  21. Kuhns JG. Adventitious bursas. Arch Surg. 1943;46:687-96.

  22. Liu YC, Lue KH, Lu KH. Conservative treatment for a symptomatic solitary ganglion cyst of the anterior meniscus invading into the infrapatellar fat pad. Knee Surg Sports Traumatol Arthrosc. Aug 18 [Epub ahead of print] 2006;[Medline].

  23. Masciocchi C, Innacoli M, Cisternino S, et al. Myxoid intraneural cysts of external popliteal ischiadic nerve. Report of 2 cases studied with ultrasound, computed tomography and magnetic resonance imaging. Eur J Radiol. Jan-Feb 1992;14(1):52-5. [Medline].

  24. Miller RH III. Knee injuries. In: Canale ST, ed. Campbell's Operative Orthopaedics. 9th ed. St Louis, Mo: Mosby-Year Book;1998: 1150-4.

  25. Morrison JL, Kaplan PA. Water on the knee: cysts, bursae, and recesses. Magn Reson Imaging Clin N Am. May 2000;8(2):349-70. [Medline].

  26. Niceforo A, Di Giunta AC, Caminiti S, Tirro S. A rare case of a large lateral meniscal cyst of the knee. Arthroscopy. Oct 1998;14(7):759-61. [Medline].

  27. Peetrons P, Allaer D, Jeanmart L. Cysts of the semilunar cartilages of the knee: a new approach by ultrasound imaging. A study of six cases and review of the literature. J Ultrasound Med. Jun 1990;9(6):333-7. [Medline].

  28. Recht MP, Applegate G, Kaplan P, et al. The MR appearance of cruciate ganglion cysts: a report of 16 cases. Skeletal Radiol. Nov 1994;23(8):597-600. [Medline].

  29. Roidis N, Zachos V, Basdekis G, et al. Tumor-like meniscal cyst. Arthroscopy. Jan 2007;23(1):111.e1-6. [Medline].

  30. Surendran S, Park SE, Lee HK, et al. Haemorrhagic synovial cyst of the posterior cruciate ligament: a case report. Knee. Jan 2007;14(1):55-8. [Medline].

  31. Thompson TL, Simpson BM, Burgess D, Wilson RH. Massive prepatellar bursa. J Natl Med Assoc. Jan 2006;98(1):90-2. [Medline].

  32. Turek SL. Orthopaedics: Principles and Their Application. 4th ed. Philadelphia, Pa: JB Lippincott;1984: 1400-1.

  33. Tyson LL, Daughters TC, Ryu RK, Crues JV 3rd. MRI appearance of meniscal cysts. Skeletal Radiol. Aug 1995;24(6):421-4. [Medline].

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Further Reading

Related eMedicine topics

Baker Cyst

Ganglion Cyst

Prepatellar Bursitis

Osteoarthritis

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Keywords

cystic lesions of the knee, benign soft tissue cysts about the knee, knee cysts, meniscal cysts, popliteal cysts, bursae, bursitis, housemaid's knee, carpet layer's knee, fluid cyst, semisolid cyst, ganglion cysts, intraneural cysts, popliteal artery cysts, rheumatoid arthritis, osteoarthritis, blood-filled bursae, pus-filled bursae, myxoid intraneural cysts

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Contributor Information and Disclosures

Author

David M Gonzalez, MD, FACS, Partner, Sports Medicine Surgery and General Orthopaedic Surgery, San Antonio Orthopaedic Group
David M Gonzalez, MD, FACS is a member of the following medical societies: American Medical Association, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Society of Military Orthopaedic Surgeons, Texas Medical Association, Texas Orthopaedic Association, and Western Orthopaedic Association
Disclosure: Contributor Honoraria Other

Medical Editor

Robert D Bronstein, MD, Associate Professor, Department of Orthopedic Surgery, University of Rochester School of Medicine
Robert D Bronstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Thomas M DeBerardino, MD, Associate Professor of Orthopaedic Surgery, University of Connecticut Health Center
Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine
Disclosure: Arthrex, Inc. Grant/research funds Other; Arthrex, Inc. Honoraria Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None; Arthrex, Inc. Consulting fee Speaking and teaching

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS, Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital
Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society
Disclosure: Zimmer Stock Implant Designer

 
 
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