Popliteal cysts in adults: A review

Objective: To review the epidemiology, clinical presentation, pathogenesis, imaging, differential diagnosis, complications, and treatment of popliteal Cysts. Methods: References were taken from MEDLINE from 1985 to 1998 under the sub ject "Popliteal Cyst" with subheadings of Radiography, Ultrasonography, and Radionuclide Imaging. Other pertinent references were used. Childhood cyst s were excluded. Results: Depending on the studied population and the imaging technique, 5% to 32% of knee problems may have these cysts, with 2 age-incidence peaks of 4 to 7 years and 35 to 70 years. In older patients there is usually coexis tent joint pathology. Symptoms may arise in the popliteal fossa from the cy st itself or be dominated by knee pain from coexisting knee pathology. Many cysts are asymptomatic. Physical examination will miss one half of these c ysts. Pathogenesis depends on the connection between the joint and bursa, w ith a valvelike effect allowing passage of fluid from the joint into the bu rsa with subsequent distention producing these cysts. Some bursae have no s uch joint-bursal communication, and the cysts arise primarily as bursitis o f the gastrocnemio-semimembranosus bursa. Imaging is performed by plain x-r ay, ultrasound, arthrography, computerized axial tomography, magnetic reson ance imaging, or nuclear scan; sonography is the method of choice. Complica ted cysts with extension or rupture into the calf mimic phlebitis, an impor tant differential diagnosis. Asymptomatic cysts found incidentally need no treatment; most symptomatic cysts respond to intra-articular corticosteroid injections. Surgical excision is rarely necessary. Conclusions and Relevance: Popliteal cysts are fairly common, may not be fo und on physical examination, require imaging (preferably sonography) to be identified, mimic phlebitis when extending into the calf, and often respond to intra-articular steroid or, rarely, surgical resection.