To our knowledge, arthroscopic removal of loose bodies from a
popliteal cyst has never been reported in the medical literature. This article describes our technique for removing loose bodies from a
popliteal cyst and verifies that the procedure can be performed safely and effectively.A 52-year-old man had progressively worsening right knee
pain and swelling of 3 years' duration that had been treated conservatively for 6 months. On physical examination, there was boggy swelling, a palpable
popliteal cyst, crepitus with range of motion, and diffuse discomfort and tenderness about the knee. Magnetic resonance imaging showed
synovitis of unclear etiology. Arthroscopic intervention was performed after conservative measures failed. An accessory posteromedial portal was used to gain access into the
popliteal cyst through the posterior joint capsule. An
electrocautery device was used to penetrate into the
cyst through the posterior
capsule after identifying the correct location of the
cyst by passing a needle percutaneously through the posterior aspect of the
cyst into the joint. Multiple loose bodies along with a large cartilaginous mass were identified in the
popliteal cyst and removed. The patient remained symptom free at 2-year follow-up.As long as the instruments are kept in view and medial to the midline of the knee joint, the neurovascular structures lateral to the
cyst are safe. Keeping the shaver suction on low during
debridement will avoid pulling in any unvisualized tissue. To avoid injury to the superficial saphenous vein and nerve when making the posterior portal, the surgeon should incise through skin only, then use blunt dissection and a blunt obturator to enter into the joint. Simple
decompression of large
popliteal cysts can be accomplished in a similar manner.