Working Diagnosis:
1. Atypical, recurrent dissecting Baker's cyst's <br>2. Bilateral knee OA with grade 4 chondromalacia <br>3. Degenerative lateral meniscus tear <br>4. Inflamed medial peripatellar plica <br>5.Partial ACL tear.

Treatment:
Patient's posterior swelling improved with compression stockings. No surgical intervention was recommended for Baker's cyst or intra-articular pathology by Orthopedics. Rehabilitation focused on lower extremity strengthening, ice massage, joint protection, edema control, and low-impact exercises. Further imaging was not pursued given interval improvement in symptoms.

Outcome:
Ambulation duration and low-impact fitness gradually improved without significant calf swelling or knee pain. Lower extremity edema and ecchymoses resolved with compression stockings. Pain was controlled with ice and acetaminophen. <br> <br>We transitioned her fitness routine to low-impact swimming, stationary biking, and pool-based Zumba classes. Follow-up was scheduled at one month intervals.

Author's Comments:
-MSK Ultrasound is an accurate, high-yield modality for evaluating location, extent, complexity of Baker's cysts and associated pathology. <br> <br>-MSK Ultrasound guided intra-articular aspiration and corticosteroid injections are viable treatment options for symptomatic Baker's cysts. <br> <br>-Treatment of Baker's cysts should target co-existing knee pathology including chondral, meniscal, and cruciate lesions. <br> <br>-Evaluation for thrombophlebitis/DVT is crucial to proper management of Baker's Cyst's given similar clinical presentations. <br> <br>-No consensus exists on treatment of complex Baker's cysts (dissection/rupture). Conservative, symptom-based therapy is reasonable.

Editor's Comments:
This case displays the value of MSK Ultrasound for the diagnosis and treatment of a Baker's Cyst. For this patient, US allow for serial imaging of the cyst in the outpatient primary care sports medicine clinic.

References:
1. Chen, C.K., H.L. Lew, and R.I.H. Liao, Ultrasound-Guided Diagnosis and Aspiration of Baker's Cyst. American Journal of Physical Medicine & Rehabilitation, 2012. 91(11): p. 1002-1004. <br>2. De Mesa, C. and M.A. Dajoyag-Mejia, Infected ruptured Baker's cyst in a spinal cord injury patient. American journal of physical medicine & rehabilitation / Association of Academic Physiatrists, 2012. 91(11): p. 1005-6. <br>3. Di Sante, L., et al., Ultrasound-guided aspiration and corticosteroid injection of Baker's cysts in knee osteoarthritis: a prospective observational study. American journal of physical medicine & rehabilitation / Association of Academic Physiatrists, 2010. 89(12): p. 970-5. <br>4. Fang, C.S., C.L. McCarthy, and E.G. McNally, Intramuscular dissection of Baker's cysts: report on three cases. Skeletal Radiology, 2004. 33(6): p. 367-71. <br>5. Fritschy, D., et al., The popliteal cyst. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2006. 14(7): p. 623-8. <br>6. Handy, J.R., Popliteal cysts in adults: A review. Seminars in Arthritis and Rheumatism, 2001. 31(2): p. 108-118. <br>7. Handy, J.R., Popliteal cysts in adults: a review. Seminars in Arthritis and Rheumatism, 2001. 31(2): p. 108-18. <br>8. Isenberg, D. and A. Socci, Images in emergency medicine. Woman with leg swelling. Dissecting Baker's cyst. Ann Emerg Med., 2010. 56(5): p. 582, 590. <br>9. Marra, M.D., et al., MRI features of cystic lesions around the knee. Knee, 2008. 15(6): p. 423-438. <br>10. Miller, T.T., et al., MR imaging of baker cysts: Association with internal derangement, effusion, and degenerative arthropathy. Radiology, 1996. 201(1): p. 247-250. <br>11. Wisniewski, S.J., N. Murthy, and J. Smith, Ultrasound Evaluation of Baker Cysts: Diagnosis and Management. Pm&R, 2012. 4(7): p. 533-537. <br>12. Wolfe, R.D. and B. Colloff, Popliteal cysts. An arthrographic study and review of the literature. The Journal of bone and joint surgery. American volume, 1972. 54(5): p. 1057-63. <br>13. Tsang, J.P.K. and Yuen, M.K. Sonography of Baker's Cyst (Popliteal Cyst): the Typical and Atypical Features. Hong Kong J Radiol, 2011(14) p. 200-6.

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