Reachout Orthopedics - Issue 2

might cause increased calf pressure (e.g., iatrogenic compartment syndrome of lower leg). The physical status of calf swelling was monitored continuously. In addition, radical synovectomy was performed intra- articularly, especially at the suprapatellar pouch and medial/lateral gutter area. A suction drainage was inserted at the cyst resection site and compressive dressing was applied. This drainage was removed the next day of operation and a full extension splint was applied for 7 days. Immediately after left knee operation, she complained of right knee pain and popliteal area discomfort due to the same complicated popliteal cyst, for which arthroscopic partial cystectomy was performed. Full weight bearing and active– passive motion were permitted from 1 week after surgery. Pain and swelling improved dramatically after surgery and further decreased after hospital discharge. Full range of motion of both knee joints was observed without recurrence of the popliteal cyst at the 12-month follow-up. Case 2 A 75-year-old woman with 11 years of history of seropositive RA presented due to swelling of left popliteal fossa and discomfort when bending the knee. The patient had a low activity of RA (DAS28-ESR 3.1) without any other joint involvement except the left knee joint. She took leflunomide 20 mg daily. Simple X-ray of the knee showed OA change with K–L grade 2. MRI revealed the multiloculated cysts without leakage to the distal limb but combined with meniscal tear and ligament damage. Joint fluid analysis revealed white cell count 400 (PMN 45%). She was treated with the intra-articular glucocorticoid injection, but the symptoms recurred within a few days. Arthroscopic cyst excision and debridement of medial meniscus were performed 3 months after the onset of symptoms. After the operation, the patient is under observation for 12 months without recurrence. Case 3 A 54-year-old-woman with 18 years of history of seropositive RA presented with newly de- veloped swelling of left lower leg. On exami- nation, swelling was observed from the left knee to the ankle and pain was not accom- panied. The patient was taking methotrexate Fig. 3: Popliteal cystic wall consisting of debris and wall septa. The walls were hypervascular and friable, different from the popliteal cyst wall of an osteoarthritic knee joint. The scope was introduced via the posteromedial portal, whereas the arthroscopic shaver was introduced through the standard anterolateral portal ( arrow ). Fig. 1: Radiologic image showing mild joint space narrowing on left knee joint ( arrow ) without a significant valgus or varus deformity. Fig. 2: Magnetic resonance images (fat-suppressed fast spin-echo T2- weighted images) showing 4.1-cm sized multiloculated ganglion cysts at the popliteal fossa and complicated popliteal cyst with leakage to the distal limb through a subcutaneous extension ( arrows ). a Coronal, b sagittal, and c axial images. 26 reachOut Orthopedics