Use of Sclerosant-Acting Antibiotic versus Corticosteroids to Treat Symptomatic Baker Cysts: A Prospective Study

Purpose: A prospective study about the efficiency and safety of a sclerosant antibiotic (minocycline chlorohydrate) versus steroids (triamcinolone acetonide) to treat patients with symptomatic Baker cysts.

Methods and Materials: We prospectively enrolled 66 patients randomized into two cohorts: cyst drainage followed by antibiotic injection and cyst drainage followed by injection of steroids. A total of 58 patients underwent 6-month clinical and radiologic follow-up. The primary end point was a volume reduction > 40% with respect to the native volume of the cyst. Secondary end points were duration, pain reduction (visual analog scale [VAS]), and cyst permanence (volume reduction < 40%).

Results: The primary end point was reached in the 66.7% of patients treated with antibiotics (mean volume reduction: 54%) and in the 35.7% of patients treated with steroids (mean volume reduction: 69%). Cyst permanence was seen in 65% of the patients treated with steroids and in 34% of those treated with antibiotics. We achieved a mean pain reduction (VAS) of 3.2 points. The procedural duration was higher in patients treated with antibiotics (15.5 minutes) compared with corticosteroids (8.6 minutes).

Conclusion: Both treatments are safe (no major or minor adverse events), but an antibiotic injection is more efficient considering the primary end point. Despite an increased procedural time, patients with antibiotic treatment have a lower rate of cyst permanence.

Fig. 1 Baker cyst, pre-drainage view.

Fig. 2 Baker cyst during drainage, needle follow-up.

Fig. 3 Sclerosing agent (antibiotic) in the cyst at the end of the procedure.

Fig. 4 Three-month follow-up: no evidence of cyst.

Publication History

Article published online:
17 December 2020