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Ionescu EV, Stanciu LE, Bujduveanu A, Minea M, Oprea D, Petcu A, Iliescu MG, Ciortea VM, Popa FL, Gheorghe E, Obada B, Oprea C. Clinical Evidence Regarding the Dynamic of Baker Cyst Dimensions after Intermittent Vacuum Therapy as Rehabilitation Treatment in Patients with Knee Osteoarthritis. J Clin Med 2023; 12:6605. [PMID: 37892743 PMCID: PMC10607906 DOI: 10.3390/jcm12206605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/20/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
The Baker cyst (BC), also known as the popliteal cyst or parameniscal cyst, is a fluid-filled sac that normally develops in the back of the knee, between the semimembranosus and medial head of the gastrocnemius. We aimed to evaluate the effectiveness of physiotherapy (10 days of treatment) that associates intermittent vacuum therapy (IVT) on the lower limbs in the treatment of the BC, respectively, in its size reduction. Sixty-five patients with knee osteoarthritis using Kellgren-Lawrence criteria and the presence of BC (ultrasonography evaluation), were divided into the Control and Vacuum groups. We collected the following features: sex, age, level of education, occupation, environment, body mass index, Knee Injury and Osteoarthritis Outcome Score, Western Ontario, and McMaster Universities Osteoarthritis Index, the Functional Independence Measurement, the Fall Risk Score, and the Visual Analog Scale were recorded at baseline and after 10 days. Both groups are similar in terms of demographic features. Regarding the clinical functional parameters, the results elicit a statistically significant change in all parameters between admission and discharge, including the echo volume at BC. Physical medicine and rehabilitation increase the autonomy of patients with BC. Clinical-functional improvement begins in the first 10 days of complex rehabilitation treatment; it is statistically significant and is not different between the two groups, which brings an additional argument for the effectiveness of conservative therapy in the treatment of BC. Although IVT has not demonstrated its superiority over classical balneo-physical therapy, additional research, and long-term monitoring are needed to provide additional arguments regarding this aspect.
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Affiliation(s)
- Elena-Valentina Ionescu
- Balneal and Rehabilitation Sanatorium of Techirghiol, 34-40, Dr. Victor Climescu Street, 906100 Techirghiol, Romania; (E.-V.I.); (L.-E.S.); (A.B.); (M.M.); (D.O.); (C.O.)
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Ovidius” University of Constanta, 1 University Alley, Campus–Corp B, 900470 Constanta, Romania
| | - Liliana-Elena Stanciu
- Balneal and Rehabilitation Sanatorium of Techirghiol, 34-40, Dr. Victor Climescu Street, 906100 Techirghiol, Romania; (E.-V.I.); (L.-E.S.); (A.B.); (M.M.); (D.O.); (C.O.)
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Ovidius” University of Constanta, 1 University Alley, Campus–Corp B, 900470 Constanta, Romania
| | - Andreea Bujduveanu
- Balneal and Rehabilitation Sanatorium of Techirghiol, 34-40, Dr. Victor Climescu Street, 906100 Techirghiol, Romania; (E.-V.I.); (L.-E.S.); (A.B.); (M.M.); (D.O.); (C.O.)
| | - Mihaela Minea
- Balneal and Rehabilitation Sanatorium of Techirghiol, 34-40, Dr. Victor Climescu Street, 906100 Techirghiol, Romania; (E.-V.I.); (L.-E.S.); (A.B.); (M.M.); (D.O.); (C.O.)
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Ovidius” University of Constanta, 1 University Alley, Campus–Corp B, 900470 Constanta, Romania
| | - Doinita Oprea
- Balneal and Rehabilitation Sanatorium of Techirghiol, 34-40, Dr. Victor Climescu Street, 906100 Techirghiol, Romania; (E.-V.I.); (L.-E.S.); (A.B.); (M.M.); (D.O.); (C.O.)
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Ovidius” University of Constanta, 1 University Alley, Campus–Corp B, 900470 Constanta, Romania
| | - Adina Petcu
- Faculty of Pharmacy, Ovidius University of Constanta, 1 University Alley, Campus–Corp C, 900470 Constanta, Romania;
| | - Madalina-Gabriela Iliescu
- Balneal and Rehabilitation Sanatorium of Techirghiol, 34-40, Dr. Victor Climescu Street, 906100 Techirghiol, Romania; (E.-V.I.); (L.-E.S.); (A.B.); (M.M.); (D.O.); (C.O.)
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Ovidius” University of Constanta, 1 University Alley, Campus–Corp B, 900470 Constanta, Romania
| | - Viorela-Mihaela Ciortea
- Department of Rehabilitation Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania;
| | - Florina-Ligia Popa
- Physical Medicine and Rehabilitation Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, Victoriei Blvd., 550024 Sibiu, Romania;
| | - Emma Gheorghe
- Department of Dermathology, Faculty of Medicine, “Ovidius” University of Constanta, 1 University Alley, Campus–Corp B, 900470 Constanta, Romania;
| | - Bogdan Obada
- Department of Orthopedics and Traumathology, Faculty of Medicine, “Ovidius” University of Constanta, 1 University Alley, Campus–Corp B, 900470 Constanta, Romania;
| | - Carmen Oprea
- Balneal and Rehabilitation Sanatorium of Techirghiol, 34-40, Dr. Victor Climescu Street, 906100 Techirghiol, Romania; (E.-V.I.); (L.-E.S.); (A.B.); (M.M.); (D.O.); (C.O.)
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Ovidius” University of Constanta, 1 University Alley, Campus–Corp B, 900470 Constanta, Romania
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Hautmann MG, Dietl B, Wagner L, Zeman F, Kölbl O, Pfister K, Schierling W. Radiotherapy of Lymphatic Fistulas after Vascular Surgery in the Groin. Int J Radiat Oncol Biol Phys 2021; 111:949-958. [PMID: 34324999 DOI: 10.1016/j.ijrobp.2021.07.1696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Lymphatic fistulas are common complications after vascular surgery especially in the groin, which can lead to a prolongation of the inpatient stay, wound infections and follow-up operations. Radiotherapy is one of the non-surgical treatment options. However, there is limited evidence and discussion about the ideal dosage and timing. METHODS AND MATERIALS The analysis was performed on patients from a German university hospital and included 191 patients with 206 lymphatic fistulas from 2005 to 2016. Four different endpoints were analyzed. The patients were irradiated with a fraction dose of 3 Gy up to a cumulative dose of 9 Gy (94/206 cases) or 18 Gy (112/206 cases). The median age of the patients was 70.5 years with 74% male and 26% female patients. Vascular surgery included bypass grafts (52%), thrombendarterectomy/patch angioplasty (26%), and vascular access for aortic endografts (22%). RESULTS The response to radiotherapy for the four different endpoints was 88% (25% decrease in secretion volume), 80% (secretion below 50 ml/24 hours), 81% (removal of the drainage) and 75% (freedom from any intervention), respectively. The overall response for all four endpoints was 63% (129/206) after completion of radiotherapy, and 34% (70/206) after one course with a total dose up to 9 Gy. The median lymphatic secretion was 150 ml/24 hours before radiotherapy and 60 ml/24 hours one day after the end of therapy. The drainage could be removed a median of 3 days after radiotherapy completion. There was no significant difference between patients starting the radiation within 5-9 days or ≥10 days postoperatively (p = .971 OR = 0.99; 95%-CI: 0.56 to 1.74). No relevant factors influencing the response rate could be identified. Re-operation was required in 50/206 cases (25%), in 24/206 cases (12%) due to persistent lymphatic fistula and complications and in 26/206 cases (13%) due to wound and/or vascular complications. CONCLUSION Radiotherapy seems to be an effective, non-surgical treatment option for reducing lymphatic secretion after vascular surgery in the groin. Starting radiation early (≤9 days) or late (≥10 days) postoperatively does not affect the success rate.
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Affiliation(s)
- Matthias G Hautmann
- Department of Radiotherapy, University Hospital Regensburg, Regensburg, Germany.
| | - Barbara Dietl
- Department of Radiotherapy, University Hospital Regensburg, Regensburg, Germany
| | - Laura Wagner
- Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany; Public Health Department, Cologne, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Oliver Kölbl
- Department of Radiotherapy, University Hospital Regensburg, Regensburg, Germany
| | - Karin Pfister
- Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Wilma Schierling
- Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany
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Van Nest DS, Tjoumakaris FP, Smith BJ, Beatty TM, Freedman KB. Popliteal Cysts: A Systematic Review of Nonoperative and Operative Treatment. JBJS Rev 2021; 8:e0139. [PMID: 32149934 DOI: 10.2106/jbjs.rvw.19.00139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Treatment methods for popliteal cysts have varied over the past several decades and have posed challenges to providers as recurrences were frequent. With greater understanding of relevant anatomy, both operative and nonoperative treatment methods have evolved to appropriately target relevant pathology and improve outcomes. The purposes of this review were to outline the evolution of treatment methods and to qualitatively summarize clinical outcomes. METHODS We performed a systematic review on treatments for popliteal cysts to include publications from 1970 to 2019. Other inclusion criteria consisted of studies with ≥10 patients enrolled, studies with a patient age of ≥16 years, studies with an adequate description of the treatment technique, and studies with a Level of Evidence of IV or higher. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and literature quality was assessed using a modified Coleman methodology score. RESULTS Thirty studies met inclusion criteria in this review. Nine studies discussed nonoperative treatment, and 21 studies discussed operative treatment. Eight of the 9 nonoperative treatment studies utilized corticosteroid injections. The most recent studies have advocated for ultrasound-guided intracystic injection with possible cyst fenestration. Most operative studies utilized an arthroscopic approach to enlarge the communication with the joint space. However, alternative treatment techniques are still utilized. CONCLUSIONS The current literature on the treatment of popliteal cysts indicates that intracystic corticosteroid injection with cyst fenestration is an effective nonoperative treatment method. Arthroscopic surgical procedures with enlargement of the communication have been most widely studied, with positive results; however, further studies are needed to confirm superiority over other treatment methods. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Duncan S Van Nest
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Fotios P Tjoumakaris
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Bradley J Smith
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tricia M Beatty
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kevin B Freedman
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Abdus-Salam AA, Olabumuyi AA, Jimoh MA, Folorunso SA, Orekoya AA. The role of radiation treatment in the management of inflammatory musculoskeletal conditions: a revisit. Radiat Oncol J 2020; 38:151-161. [PMID: 33012142 PMCID: PMC7533403 DOI: 10.3857/roj.2020.00178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/03/2020] [Indexed: 01/28/2023] Open
Abstract
Inflammatory musculoskeletal conditions are a common group of diseases among the elderly, worldwide. They are characterized by articular degenerative changes accompanied with often debilitating pain. Treatments often involve life-long analgesic therapy or joint replacement in extreme cases. The aim of this current review is to look at the role of radiation treatment with the hope of further study into the effectiveness of radiation treatment in reducing pain, eliminate or reduce the need for life-long analgesic therapy and thereby avoiding the analgesics’ side effects. Extensive literature search was done on PubMed and other available data base and the findings are presented and discussed. Literature showed that many countries in Europe, especially Germany use radiation routinely for the treatment of many degenerative disorders including osteoarthritis with good results and few side effects. A pilot study is therefore recommended with a view to establish the effectiveness or otherwise of this treatment method in patients.
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Affiliation(s)
| | | | - Mutiu Alani Jimoh
- Department of Radiation Oncology, University of Ibadan, Ibadan, Nigeria
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