Treatment of Baker's Cyst
Most Baker's cysts should be managed conservatively by addressing the underlying knee pathology (typically osteoarthritis), with ultrasound-guided aspiration and corticosteroid injection reserved for symptomatic cases requiring more immediate relief. 1, 2
Initial Management Approach
Conservative treatment is first-line for most Baker's cysts:
- Address underlying knee pathology (most commonly osteoarthritis) through self-management education programs and activity modifications 2
- Weight management for overweight patients with osteoarthritis-related cysts 2
- Physical therapy to strengthen surrounding muscles 2
- NSAIDs and proper exercises with close observation can lead to complete symptom resolution, as demonstrated in cases where cyst size decreased significantly over 12 months 3
Interventional Treatment
For symptomatic cysts requiring more aggressive management:
- Ultrasound-guided aspiration provides temporary relief and can be performed at bedside 1, 4
- Corticosteroid injection into the knee joint is beneficial when associated synovitis is present 1, 4
- This procedure represents a safe, non-surgical, non-narcotic treatment option that may be definitive in some cases 4
- Immediate symptom relief (pain, dysesthesia, gait abnormalities) can occur following aspiration 5
Diagnostic Workup Before Treatment
Essential imaging to guide treatment decisions:
- Plain radiographs of the knee (AP, lateral, sunrise/Merchant, tunnel views) should be obtained first to evaluate underlying joint pathology 1
- Ultrasound is the preferred initial diagnostic tool to confirm the cyst, assess for rupture, and guide aspiration procedures 1, 2
- MRI without IV contrast is indicated when concomitant internal knee pathology is suspected or additional evaluation is needed after ultrasound 1
Critical Differential Diagnosis
Before initiating treatment, exclude these conditions:
- Ruptured Baker's cyst can mimic deep vein thrombosis with calf pain and swelling—imaging is essential to differentiate 1, 6, 7
- Popliteal artery aneurysm must be excluded, especially in patients with history of other arterial aneurysms—do not assume all popliteal masses are benign 1
Complications Requiring Urgent Management
Watch for these scenarios:
- Cyst rupture causes sudden calf pain, swelling, and fluid dissemination into the calf 1, 8
- Infection (rare but serious)—requires arthroscopic irrigation and open debridement 8
- Nerve compression (common peroneal neuropathy)—may require urgent aspiration if causing neurologic symptoms 5
- Severe limb ischemia (extremely rare)—historically managed surgically, though conservative management may succeed in selected cases 3
Follow-up and Monitoring
Post-treatment surveillance: