Compression syndromes of the popliteal neurovascular due to Baker cyst: A case report

INTRODUCTION AND IMPORTANCE: Baker's cyst, or popliteal cyst, is typically arising in the popliteal fossa located between the semi-membranous tendon and the medial head of the gastrocnemius. Asymptomatic Baker's cyst does not require treatment. Surgical treatment may be considered after the failure of conservative measures when the cyst causes persistent pain and rarely compresses the adjacent neurovascular structure. CASE PRESENTATION: We report an unusual presentation of Baker's cyst in a 43-year-old patient who complained of knee pain and after several months of conservative treatment. Following a physical and radiological examination, a Baker cyst was confirmed that compresses the tibial nerve. A surgical decompression and excision of the cyst was performed using the posterior approach to allow complete removal of the cyst's stalk and wall. Histopathological report confirms dense collagen without true epithelial lining. The patient was asymptomatic at 6 months of follow-up. CLINICAL DISCUSSION: It is important to recognize that a large Baker's cyst can be symptomatic and present as a compression syndrome of the adjacent neurovascular structure. The current case report described an early surgical management to treat a tibial nerve compression syndrome caused by a Baker cyst. A surgical decompression through a posterior approach may facilitate complete removal of the cyst wall. CONCLUSIONS: Baker's cyst is a common knee pathology that could rarely compress the adjacent neurovascular structures. The surgical decompression through a posterior approach results in favorable outcomes in symptomatic patients with failed conservative measures.