A case series of post-tuberculous Baker's cyst

Introduction: The gastrocnemius-semimembranous bursa of the knee, which connects to the posterior region of the joint capsule, becomes distended in a Baker's (popliteal) cyst. In adults, it is nearly always secondary to pathological changes in the knee joint that cause an effusion. Baker cysts are mostly asymptomatic, but they may have presentations ranging from mild swelling, a picture similar to infective arthritis, to massive swelling leading to rupture and causing lower limb ischemia. We have presented these cases of post-tubercular baker cysts and evaluated their post-treatment outcomes.

Material and methods: Between September 2018 and September 2021, 12 patients with post-tuberculous baker cysts who presented to the outpatient department or emergency department of our institute were treated with conservative or open excision and followed up for 12 months at regular intervals. The functional assessment was done by VAS pain scoring and Lysholm knee scoring at the start of treatment, 1, 6 and 12 months after the surgery or conservative treatment.

Results: 8 patients with post-tubercular Baker cysts were managed conservatively with aspirations and medications. Four patients with large multiloculated post-tubercular baker cysts were managed operatively. The mean age of patients with complicated post-tuberculosis Baker cyst was 44.92 ± 5.07 years. VAS The scoring of all the patients improved with each visit and 1-year follow-up. The Lysholm Knee score of patients also improved with each visit. All patients had excellent scores, with 3 patients having a score of 100 at 1-year follow-up.

Conclusion: Complicated Baker's cysts with multiloculated post-tubercular cysts need surgical management in most cases. Excellent to good functional outcomes can be achieved in these unusual cases with prompt intervention, detailed work-up, and medications.