Treating Baker’s cysts

If you have a Baker’s cyst, symptoms like pain and pressure will tend to get worse when you put weight on your knee. So it helps to take enough breaks and put your leg up. You can also get shoe insoles and knee bandages to give your knee extra support.

But that doesn’t mean you should go easy on your knee all the time. If your Baker’s cyst was caused by osteoarthritis of the knee, for instance, exercise will strengthen the muscles that stabilize and protect the joint. It also ensures that the cartilage in the joint gets the nutrients it needs to recover. There are special exercises and stretches you can do to help strengthen your knee muscles if you have osteoarthritis of the knee. You can try out stretching exercises and fascia training to see if they ease any symptoms your Baker’s cyst is causing.

You can also try applying heat or cold to the back of your knee. People with inflammatory diseases in their knees (like rheumatoid arthritis) tend to find cooling more soothing. Heat can relieve the symptoms in people with damaged cartilage. One thing you can do to either cool the knee or keep it warm is wrap it in towels. You put a damp towel on your knee first, and then wrap dry towels around it. You can also put things like quark (or thick yogurt) or mustard powder between the different layers of towels.

Anti-inflammatory and painkilling medications like diclofenac gel can be applied to the skin for temporary pain relief. Taking anti-inflammatory painkillers like diclofenac or ibuprofen for a few days can help, but you should discuss this with your doctor first.

If a Baker’s cyst causes problems, it’s important to identify the cause and treat it. If it’s caused by something like rheumatoid arthritis or osteoarthritis, conservative treatments such as physical therapy can help. If things like making sure you have enough breaks, using medical aids or doing suitable exercise don’t help enough, the cyst can be drained.

• Known as needle aspiration, this involves inserting a needle into your knee to remove fluid from the cyst.
• The doctor usually injects an inflammation-reducing drug (typically a steroid medication) into the cyst or the knee joint straight after the procedure.

This combination can relieve the swelling and pain for a while. But it’s not used very often because the effect sometimes only lasts a few days or weeks – if the Baker’s cyst was caused by osteoarthritis of the knee, for example. You can have this done as an outpatient at an orthopedic practice.

Some of the other possible treatment options for Baker’s cysts are still being researched so too little is known about their pros and cons at the moment. These treatments include radiotherapy and radiosynoviorthesis (RSO). In radiotherapy, the knee joint is exposed to low amounts of radiation for a few seconds; RSO involves injecting a radioactive liquid into the joint. There hasn’t been enough research into the use of electrical stimulation for pain relief either.

Surgery is only considered if non-surgical (“conservative”) treatment doesn’t provide enough relief. But it’s usually only an option if the underlying cause can be treated effectively with surgery. Baker’s cysts can be caused by many different things, and surgery won't help for all of them.

If the cyst has developed due to a knee injury, the injured part of the knee (cartilage or a ligament, for instance) can be treated. If your meniscus is damaged or torn, a surgeon can smooth the surfaces or stitch it back together.

If you’ve got a Baker’s cyst and a torn anterior cruciate ligament, and you’re having problems despite conservative treatment, you can have surgery to replace the ligament.

People with rheumatoid arthritis sometimes have the inflamed membranes removed if physical therapy and medication haven’t helped enough. The technical term for this surgery is synovectomy.

In people who have a Baker’s cyst and advanced osteoarthritis of the knee, surgery is rarely effective. It cannot remove the cause and the cyst tends to come back.

Before the procedure, you’ll have an MRI scan to see exactly where the cyst is and what it looks like. This can also give the medical team a detailed picture of the underlying cause, which could be something like a torn meniscus.

Surgery on the knee joint is usually done using an endoscope in a procedure called “arthroscopy.” The surgeon makes small cuts in your knee, and can then insert a camera and instruments to examine and treat the problem. For instance, they might flush out the joint or smooth the cartilage, replace a ligament or remove loose tissue.

They don’t usually remove the actual cyst. But they might change the connection between the cyst and the knee joint cavity. This can be done in two ways:

• Enlargement: The connection is enlarged to allow the synovial fluid to drain off.
• Closing: The connection is closed off to stop fluid from building up.

It is not yet clear whether one of these techniques is better than the other.

In arthroscopy, the inner wall of the cyst can be removed or left in place. There are no clear research findings about which approach is better. They both usually stop the cyst coming back. Side effects like swelling, bruising or infection are rare and don’t last long.

Knee arthroscopy is done with an anesthetic, typically a short-acting general anesthetic. Small arthroscopic procedures like meniscus surgery tend to be done as outpatient treatment (with no overnight stay in hospital). If you’re having a larger procedure, like surgery on a cruciate ligament, you might have to spend a few days in hospital.