Novel Technique may Address Retained Loose Bodies in Popliteal Cyst During TKA without separate incision: Study

In planning total knee arthroplasty (TKA), preoperative radiographs may show calcific bodies in the posterior soft tissues of the knee. Zachary J. Sirois et al describe a technique in which they can be removed without making a separate skin incision during TKA after femoral and tibial bone resection. This technique involves probing the posteromedial capsule with a clamp to identify the opening to a popliteal cyst. Once identified, the opening is tensioned and incised to allow removal of the loose bodies. If retained, these loose bodies can be a source of patient dissatisfaction, particularly since they are sometimes palpable to the patient. This is the first technique to describe removal of such loose bodies during routine TKA without an additional incision.

Surgical technique

Routine exposure for TKA is performed. The femoral and tibial bone resections are made. The knee is placed in 90deg of flexion and a lamina spreader is placed in the lateral compartment to distract the flexion gap. One visualizes the posteromedial capsule and probes with a Kelly clamp to identify the opening to the popliteal cyst. Once identified, the opening is stretched in a medial lateral direction with the Kelly clamp. This tensions the capsule so the opening can be enlarged by incising proximally and distally with electrocautery or a #15 blade. Once the opening has been enlarged, the Kelly clamp can reach into the cyst and palpate and grasp and remove loose bodies. Sometimes palpating the posterior aspect of the knee can help direct a loose body to the clamp. After removal of the loose bodies, the vertical incision in the posterior capsule does not require closure. No adjustments are made to the normal postoperative protocol.