Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

asymptomatic

1st line – no treatment

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ACUTE
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asymptomatic
1st line – 

no treatment

Asymptomatic patients require no specific treatment.

symptomatic: initial treatment

1st line – conservative treatment

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ACUTE
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symptomatic: initial treatment
1st line – 

conservative treatment

Patients with minor signs and symptoms such as fullness or mild discomfort in the popliteal fossa are managed conservatively with physical therapy and simple analgesics (e.g., aspirin or acetaminophen), or nonsteroidal anti-inflammatory drugs (NSAIDs).

Primary options

aspirin: 325-650 mg orally every 4 hours when required, maximum 4000 mg/day

OR

acetaminophen: 325-1000 mg orally every 4-6 hours when required, maximum 4000 mg/day

OR

ibuprofen: 400 mg orally every 4-6 hours when required, maximum 2400 mg/day

symptomatic: refractory to initial conservative treatment

1st line – correction of any underlying joint pathology

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ACUTE
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symptomatic: refractory to initial conservative treatment
1st line – 

correction of any underlying joint pathology

Patients with underlying knee joint pathology should undergo orthopedic evaluation for treatment of traumatic, infectious, or arthritic pathology.

If a knee effusion is present, aspiration of the knee joint is usually beneficial. Aspiration of the joint space with or without injection of corticosteroids will decrease intra-articular pressure and decrease inflammatory pathology. This should be done only under ultrasound guidance.

Additional direct aspiration of the cyst may be performed in cases of larger fluid collections, although cysts may recur.[23]​

Aspiration should be done with a large-bore needle (i.e., 18 gauge) as the fluid is very viscous.

Consider – intra-articular corticosteroid

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ACUTE
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symptomatic: refractory to initial conservative treatment
Consider – 

intra-articular corticosteroid

Treatment recommended for SOME patients in selected patient group

Intra-articular injection of corticosteroids in patients with underlying knee pathology has been described to produce good symptomatic relief.[9]

Dose may need to be repeated. Adjust doses and frequency according to response. Taper dose gradually after long-term use.

Primary options

betamethasone sodium phosphate/betamethasone acetate: 6-12 mg intra-articularly as a single dose

OR

triamcinolone acetonide: 5-15 mg intra-articularly as a single dose

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OR

methylprednisolone acetate: 4-80 mg intra-articularly as a single dose every 1-5 weeks

Consider – supportive therapies

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ACUTE
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symptomatic: refractory to initial conservative treatment
Consider – 

supportive therapies

Treatment recommended for SOME patients in selected patient group

Physical therapy may be used adjunctively.

Simple analgesics (e.g., aspirin or acetaminophen) may be used adjunctively for pain relief, or NSAIDs.

Primary options

aspirin: 325-650 mg orally every 4 hours when required, maximum 4000 mg/day

OR

acetaminophen: 325-1000 mg orally every 4-6 hours when required, maximum 4000 mg/day

OR

ibuprofen: 400 mg orally every 4-6 hours when required, maximum 2400 mg/day

2nd line – surgery

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ACUTE
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symptomatic: refractory to initial conservative treatment
2nd line – 

surgery

Surgical treatment is rarely performed, and is only indicated in patients with extensive symptoms who fail conservative and percutaneous treatment.

It is the experience of some surgeons that simple excision of a popliteal cyst results in high incidence of recurrence.

Surgical options have been described, including anterior open synovectomy, arthroscopic synovectomy, radiosynovectomy, capsulectomy, capsuloplasty with pedicle graft, and repair of joint capsule.

Arthroscopic resection facilitates management of the cyst, by arthroscopic decompression, and the associated intra-articular disorder. Surgery involves enlarging the interval between the semimembranosus and medial gastrocnemius, allowing the cyst contents to drain into the joint.

Arthroscopic resection is effective, and is associated with reduced morbidity and recurrence compared with excision.[24][25][26][Figure caption and citation for the preceding image starts]: Arthroscopic resection of a popliteal cystFrom the collection of Dr John Kelly IV; used with permission [Citation ends].com.bmj.content.model.Caption@7b8ed9ea[Figure caption and citation for the preceding image starts]: Arthroscopic resection of a popliteal cystFrom the collection of Dr John D. Kelly IV; used with permission [Citation ends].com.bmj.content.model.Caption@4dfb1af5[Figure caption and citation for the preceding image starts]: Septae within a popliteal cystFrom the collection of Dr John D. Kelly IV; used with permission [Citation ends].com.bmj.content.model.Caption@15495bff

Consider – analgesia

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ACUTE
|
symptomatic: refractory to initial conservative treatment
Consider – 

analgesia

Treatment recommended for SOME patients in selected patient group

Simple analgesics (e.g., aspirin or acetaminophen) may be used adjunctively for pain relief, or NSAIDs.

Primary options

aspirin: 325-650 mg orally every 4 hours when required, maximum 4000 mg/day

OR

acetaminophen: 325-1000 mg orally every 4-6 hours when required, maximum 4000 mg/day

OR

ibuprofen: 400 mg orally every 4-6 hours when required, maximum 2400 mg/day

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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