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Diagnostic accuracy of ultrasound for the assessment of Baker’s cysts: a meta-analysis

Journal of Orthopaedic Surgery and Research volume 17, Article number: 535 (2022) Cite this article

Abstract

Background

Baker’s cyst is the most common cystic disease of the knee, and a fast and accurate diagnosis of Baker’s cyst is essential for a better management. Ultrasound is a rapid, portable, widely available, inexpensive and noninvasive imaging modality. However, the diagnostic accuracy of ultrasound on Baker’s cyst still remains undetermined. We conducted the first meta-analysis to comprehensively assess the accuracy of ultrasound for the detection of Baker’s cyst.

Methods

PubMed, Embase and Web of Science were searched from inception to July 14, 2022, without language restrictions. Studies providing cross-tabulations of ultrasound versus pathology (gold standard) or MRI (standard imaging technique) for diagnosis of Baker’s cyst were included. Indicators for the diagnostic accuracy of ultrasound, including sensitivity, specificity and area under the curve, were calculated using a bivariate model. Sensitivity analysis was conducted to evaluate the heterogeneity and robustness of the results.

Results

A total of 13 studies with 1,011 subjects (mean age 32.2 years; men 53.5%) met the inclusion criteria. The pooled sensitivity, specificity and area under the curve of ultrasound for diagnosis of Baker’s cyst, compared with pathology, were 0.97 (95% confidence intervals: 0.73–1.00), 1.00 (0.98–1.00) and 1.00 (0.99–1.00), respectively. The pooled estimates of ultrasound versus MRI were 0.94 (0.87–0.98) for sensitivity, 1.00 (0.83–1.00) for specificity and 0.97 (0.95–0.98) for area under the curve. Sensitivity analysis did not change the results materially.

Conclusion

Ultrasound shows excellent diagnostic accuracy for the assessment of Baker’s cyst and provides similar diagnostic information (absent or present) compared to MRI. Because of its advantages of low cost, portability and accessibility, ultrasound is likely to be a choice of imaging technique for screening Baker’s cyst in clinical and population settings as well as in follow-ups.

Background

Baker’s cyst (BC), also known as popliteal cyst, is the most common cystic disease of the knee, which affects approximately 11.7% of the middle-aged and elderly population [1,2,3]. The clinical manifestations of BC include knee pain, localized swelling or mass, limited range of motion and even peripheral neuropathy and ischemia [4,5,6,7]. BC has demonstrated a longitudinal association with the radiological and clinical progression of osteoarthritis [8] and may therefore be considered a predictor of osteoarthritis [9] and a modifiable treatment target [10]. Early diagnosis of BC may prevent further complications connected with the direct compression or ruptures to the surrounding tissues [11]. However, it may be a challenging task for physicians to differentiate BC from other musculoskeletal disorders in or near the popliteal fossa, such as synovial and bone tumor, meniscal cyst and ganglion cyst, which share similar symptoms and signs [12]. Therefore, a tool for fast and accurate diagnosis of BC is needed and could contribute to better management among patients with BC.

Pathological diagnosis is the gold standard for the diagnosis of BC. However, it requires an invasive procedure, such as biopsy or surgical excision. In clinical practice, diagnosis of BC is commonly confirmed by noninvasive imaging, e.g., magnetic resonance imaging (MRI), especially for small and asymptomatic BC [12, 13]. MRI has also been considered the reference standard of imaging in diagnosis of BC [1, 14, 15]. Nevertheless, owing to its limited availability and long examination time, MRI is rarely used as the initial evaluation method for patients with BC and is generally applied as a diagnostic option when a patient experiences persistent symptom despite adequate conservative treatment or when surgery is considered [16, 17]. Otherwise, BC is, for the most part, asymptomatic and necessitates no treatment.

Ultrasonography is a rapid, portable, widely available, inexpensive and noninvasive imaging modality that has been proposed as a promising imaging tool for the assessment of BC [15, 18, 19]. However, a general view is that ultrasound is not as accurate as MRI in diagnosing BC (absent or present) [19, 20]. Currently, there are no published systematic investigations regarding the diagnostic accuracy of ultrasound for BC. To fill this knowledge gap, we conducted the first ever meta-analysis to determine the diagnostic accuracy of ultrasound for BC compared to both surgical pathology and MRI.

Methods

Protocol

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines [21]. A predefined protocol of this study was registered with PROSPERO (ID = CRD42022343307).

Literature search

PubMed, Embase and Web of Science databases were systematically searched from inception up to July 14, 2022. Keywords or Medical Subject Headings terms were properly defined with necessary adaptions to all the search terms for the purpose of satisfying the specific search and syntax rules of three databases (see Additional file 1: Data 1 for the complete electronic search strategy). The reference lists of included studies were searched manually to identify additional studies. Two reviewers (KL and XL) screened the data sources independently, and disagreement, if any, between them was resolved by consulting a third reviewer (TJ).

Inclusion/exclusion criteria

Articles meeting the following criteria were included: (1) studies using both ultrasound and pathology or both ultrasound and MRI to assess BC with any diagnostic criteria; (2) studies providing a table of true-positive, false-positive, true-negative and false-negative counts, which can be used to evaluate the diagnostic accuracy of ultrasound based on pathology and MRI, respectively, as the reference standard; and (3) no language and study design restrictions.

The exclusion criteria were as follows: (1) studies involving cadaver subjects or non-human research; (2) duplicate publications (if multiple published studies were retrieved from the same database, the largest or the most complete one was included); (3) reviews; or (4) abstract or title publication only.

Quality assessment

The risk of bias was evaluated by two reviewers (KL and XL) with the tool of quality assessment for diagnostic accuracy studies-2 (QUADAS-2) [22]. In the case of disagreement, consensus would be reached by consultation. The QUADAS-2 tool mainly concerns the bias and applicability of the study results, including patient selection, index test, reference standard and study flow and timing.

Data extraction

Two investigators (KL and XL) performed data extraction independently using a standardized form. Any disagreements would be resolved by consulting an authoritative third reviewer (TJ). Data were collected on the study characteristics (year of publication, country and type of study), patient characteristics, features of ultrasound, MRI and pathology, pathological findings and a cutoff value of BC and the 2 × 2 diagnostic table. Ultrasound was considered for the index test by taking pathology and MRI as the reference standard, respectively. The diagnostic table was extracted at the joint level.

Statistical analysis

To assess the diagnostic efficacy of ultrasound, a bivariate model was used to calculate the diagnostic odds ratio (DOR), the summary receiver operating characteristic (SROC), area under the curve (AUC), as well as the pooled sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR), along with their 95% confidence intervals (95% CI) [23]. P values less than 0.05 were considered statistically significant. Heterogeneity was assessed using the I2 test (0–40%: low; 30–60%: moderate; 50–90%: substantial; and 75–100%: considerable) [24]. The sensitivity analysis was performed by excluding small-sample studies or studies involving a high risk of bias to evaluate the heterogeneity and robustness.

All statistical analyses were performed with STATA (V.15.0, Stata, College Station, Texas, USA) and/or Review Manager 5.4 (RevMan 5.4, The Cochrane Collaboration, Oxford, UK).

Results

Study characteristics

The results of database search are summarized in the PRISMA flowchart as shown in Fig. 1. Of the 1715 reports screened, 13 studies (four studies reporting ultrasound versus pathology and nine studies reporting ultrasound versus MRI) met the selection criteria and were included in this meta-analysis, covering a total of 1011 patients with 1033 knees [15, 18,19,20, 25,26,27,28,29,30,31,32,33]. The mean age of patients was 32.2 years, and 53.5% were men. The details of the study characteristics are presented in Table 1. Of the included studies, seven were conducted in developed countries and six in developing countries. All the BCs were recorded using a dichotomous scale (either present or absent) based on information retrieved from the original studies. Additional file 1: Figs. 1 and 2 demonstrate the methodological quality of each study.

Fig. 1
figure 1

Summary of database search and study selection according to PRISMA flow diagram

Full size image
Table 1 Characteristics of included studies
Full size table
Fig. 2
figure 2

The paired forest plots for the diagnostic accuracy of ultrasound. A The reference test was pathology; B the reference test was MRI. TP, true positive; FP, false positive; FN, false negative; TN, true negative; and CI, confidence intervals

Full size image

Diagnostic value of ultrasound compared with pathology

Four studies with a total of 616 patients reported the diagnostic accuracy of ultrasound versus pathology for BCs and yielded an AUC of 1.00 (95% CI 0.99–1.00, I2 = 0) and a DOR of 12,335 (95% CI 546–278,517, I2 = 99.97) (Table 2; Figs. 2, 3). The overall sensitivity, specificity, PLR and NLR were 0.97 (95% CI 0.73–1.00, I2 = 29.68), 1.00 (95% CI 0.98–1.00, I2 = 0), 335.47 (95% CI 42.60–2641.68, I2 = 34.67) and 0.03 (95% CI 0.00–0.34, I2 = 62.01), respectively (Table 2; Fig. 2). Because the diagnostic accuracy of ultrasound versus pathology was only reported by four studies and a low degree of heterogeneity was observed, the sensitivity analysis was not performed.

Table 2 Summary of diagnostic accuracy results of ultrasound versus reference test
Full size table
Fig. 3
figure 3

Summary receiver operating characteristic (SROC) curves of ultrasound. A The reference test was pathology; B the reference test was MRI. SENS, sensitivity; SPEC, specificity; and AUC, area under the curve

Full size image

Diagnostic value of ultrasound compared with MRI

Nine studies with a total of 395 patients reported the diagnosis accuracy of ultrasound versus MRI for BCs and yielded an AUC of 0.97 (95% CI 0.95–0.98, I2 = 87) and a DOR of 8,318 (95% CI 80–866,026, I2 = 100) (Table 2; Figs. 2, 3). The overall sensitivity was 0.94 (95% CI 0.87–0.98, I2 = 86.66), specificity was 1.00 (95% CI 0.83–1.00, I2 = 91.23), PLR was 483.38 (95% CI 4.55–51,407.24, I2 = 84.31) and NLR was 0.06 (95% CI 0.03–0.13, I2 = 89.48), respectively (Table 2; Fig. 2). In sensitivity analysis, the pooled results of diagnostic accuracy were found to be robust (AUC 0.97 95% CI 0.83–0.97) after removing two small-sample studies (number of patients < 30) [18, 26], but the level of heterogeneity remained high. After removing four studies involving a high risk of bias [19, 20, 25, 31], the pooled results of diagnostic accuracy were still robust (AUC 0.98 95% CI 0.76–1.00) and the heterogeneity of AUC was significantly reduced, with the I2 index decreasing from 87 to 22%. The study quality assessed by QUADAS-2 may influence the degree of heterogeneity among the included studies.

Discussion

This meta-analysis comprehensively assessed the diagnostic performance of ultrasound versus reference standard (i.e., pathology and MRI) for BC. Our results suggest that ultrasound shows excellent diagnostic accuracy for BC as compared with pathology. Moreover, the use of ultrasound provides similar diagnostic information (absent or present) compared to MRI for the evaluation of BC.

Multiple imaging approaches have been used in the diagnosis and assessment of BC, among which MRI is considered to be the reference standard. However, the limited availability and high cost of MRI decrease its application value for diagnosing BC in clinical practice, especially for quickly assessing potential BC or screening asymptomatic patients [16, 17]. In contrast, ultrasound is widely available and low cost and has shown excellent diagnostic accuracy. Anechoic or hypoechoic fluid between the semimembranosus and the medial head of the gastrocnemius could be accurately detected even when the transverse diameter is less than 4 mm [34]. However, ultrasound has its shortcomings. It is deemed an operator-dependent technique and does require consideration of appropriate training and quality assessment. However, Oo et al. showed that the pooled kappa of a binary score was almost perfect for BCs (inter-rater reliability, 0.92 [0.83–1.00]) [35]. Moreover, ultrasound is not sensitive to intra-articular lesions, and therefore, further imaging is needed to confirm the presence of an associated internal derangement [15]. For instance, MRI can provide additional information during the development of surgical plans when detailed evaluation of deep knee structures and the overall profile of the joint are required.

In addition to the dichotomous diagnosis of BC, other additional features of BC, e.g., the opening (the communication between the gastrocnemio-semimembranosus bursa and the knee joint capsule) and volume of BC, have been accurately detected by ultrasound as reported in previous studies. Assessment of the opening of BC was often carried out by MRI preoperatively, and the results could guide the formulation of clinical surgical plans [14, 36]. Two previous studies suggested that ultrasound was able to diagnose the opening of BC [15, 18], but no detailed investigation has been reported yet on the diagnostic accuracy of ultrasound versus MRI on this topic. In addition, ultrasound was also thought to be able to estimate the volume of BC [18], which was closely related to the development of symptoms among patients with BC [37,38,39]. However, owing to the lack of published data, this additional information about BCs could not be included in our meta-analysis. Further studies with a focus on the diagnostic accuracy of ultrasound on features of BC are therefore needed.

Since ultrasound could provide highly efficient and accurate information in diagnosing BC, the use of ultrasound may facilitate clinical management and decision-making with reduced cost and time consumption. In view of advantages and disadvantages of each imaging modality, the choice of which one to assess BC depends on the requirement of the referring clinicians and researchers. If they want to know whether a BC exists in a patient with a well-defined intra-articular disorder, such as osteoarthritis or rheumatoid arthritis, or in participants of population screening and cohort follow-ups, ultrasound is the technique of choice. If they already know that a BC is present, ultrasound can be used to assess complications, such as rupture and compression. In addition, ultrasound can also be performed as a real-time guide for biopsies, fluid aspiration and injection of medication, which may contribute to individualized treatment [40].

As a major strength, our study provided novel evidence that ultrasound could present similar diagnostic information (absent or present) for BC compared to MRI, with accumulation of evidence from an enlarged sample. Moreover, we conducted a systematic literature search regardless of language or reporting types across three different databases in order to identify available published studies as comprehensively as possible. Lastly, the results of sensitivity analysis supported the robustness of most findings.

However, this meta-analysis has several limitations that should be acknowledged. First, a high degree of heterogeneity was detected among the included studies, so that a bivariate model was adopted in our meta-analysis to incorporate the uncertainties arising from between study variations. Second, this meta-analysis included a limited number of studies, with only three studies involving 100 participants or more [19, 28, 30]. Given the limited number of larger studies included, more primary research is needed. Third, this meta-analysis was unable to derive an optimal cutoff, as none of the included studies proposed a cutoff value.

Conclusions

Ultrasound shows excellent diagnostic accuracy for BC as compared with pathology and provides similar diagnostic information (absent or present) compared to MRI. It is therefore recommended as a candidate in the diagnostic examination of patients with BC, especially when MRI is not available or contraindicated.

Availability of data and materials

The datasets analyzed during the current study are available from the corresponding authors on reasonable request.

Abbreviations

BC:

Baker’s cyst

AUC:

Area under the curve

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analyses

QUADAS-2:

Quality assessment for diagnostic accuracy studies-2

DOR:

Diagnostic odds ratio

SROC:

Summary receiver operating characteristic

PLR:

Positive likelihood ratio

NLR:

Negative likelihood ratio

CI:

Confidence intervals

References

  1. Miller TT, Staron RB, Koenigsberg T, Levin TL, Feldman F. MR imaging of Baker cysts: association with internal derangement, effusion, and degenerative arthropathy. Radiology. 1996;201(1):247–50. https://doi.org/10.1148/radiology.201.1.8816552.

    Article  CAS  Google Scholar 

  2. Hayashi D, Roemer FW, Dhina Z, Kwoh CK, Hannon MJ, Moore C, et al. Longitudinal assessment of cyst-like lesions of the knee and their relation to radiographic osteoarthritis and MRI-detected effusion and synovitis in patients with knee pain. Arthritis Res Ther. 2010;12(5):R172. https://doi.org/10.1186/ar3132.

    Article  Google Scholar 

  3. Cao Y, Jones G, Han W, Antony B, Wang X, Cicuttini F, et al. Popliteal cysts and subgastrocnemius bursitis are associated with knee symptoms and structural abnormalities in older adults: a cross-sectional study. Arthritis Res Ther. 2014;16(2):R59. https://doi.org/10.1186/ar4496.

    Article  Google Scholar 

  4. Rauschning W, Lindgren PG. Popliteal cysts (Baker’s cysts) in adults, I: clinical and roentgenological results of operative excision. Acta Orthop Scand. 1979;50(5):583–91. https://doi.org/10.3109/17453677908989808.

    Article  CAS  Google Scholar 

  5. Fritschy D, Fasel J, Imbert J-C, Bianchi S, Verdonk R, Wirth CJ. The popliteal cyst. Knee Surg Sports Traumatol Arthrosc. 2006;14(7):623–8. https://doi.org/10.1007/s00167-005-0028-z.

    Article  Google Scholar 

  6. Simpson FG, Robinson PJ, Bark M, Losowsky MS. Prospective study of thrombophlebitis and “pseudothrombophlebitis.” Lancet. 1980;1(8164):331–3. https://doi.org/10.1016/s0140-6736(80)90883-1.

    Article  CAS  Google Scholar 

  7. Katz RS, Zizic TM, Arnold WP, Stevens MB. The pseudothrombophlebitis syndrome. Medicine (Baltimore). 1977;56(2):151–64. https://doi.org/10.1097/00005792-197703000-00005.

    Article  CAS  Google Scholar 

  8. Bevers K, Vriezekolk JE, Bijlsma JWJ, van den Ende CHM, den Broeder AA. Ultrasonographic predictors for clinical and radiological progression in knee osteoarthritis after 2 years of follow-up. Rheumatology (Oxford). 2015;54(11):2000–3. https://doi.org/10.1093/rheumatology/kev224.

    Article  Google Scholar 

  9. Bevers K, Bijlsma JWJ, Vriezekolk JE, van den Ende CHM, den Broeder AA. The course of ultrasonographic abnormalities in knee osteoarthritis: 1 year follow up. Osteoarthritis Cartilage. 2014;22(10):1651–6. https://doi.org/10.1016/j.joca.2014.06.012.

    Article  CAS  Google Scholar 

  10. Visser AW, Mertens B, Reijnierse M, Bloem JL, de Mutsert R, le Cessie S, et al. Bakers’ cyst and tibiofemoral abnormalities are more distinctive MRI features of symptomatic osteoarthritis than patellofemoral abnormalities. RMD Open. 2016;2(1):e000234. https://doi.org/10.1136/rmdopen-2015-000234.

    Article  CAS  Google Scholar 

  11. Akgul O, Guldeste Z, Ozgocmen S. The reliability of the clinical examination for detecting Baker’s cyst in asymptomatic fossa. Int J Rheum Dis. 2014;17(2):204–9. https://doi.org/10.1111/1756-185X.12095.

    Article  Google Scholar 

  12. Herman AM, Marzo JM. Popliteal cysts: a current review. Orthopedics. 2014;37(8):e678–84. https://doi.org/10.3928/01477447-20140728-52.

    Article  Google Scholar 

  13. Handy JR. Popliteal cysts in adults: a review. Semin Arthritis Rheum. 2001;31(2):108–18. https://doi.org/10.1053/sarh.2001.27659.

    Article  CAS  Google Scholar 

  14. Frush TJ, Noyes FR. Baker’s cyst: diagnostic and surgical considerations. Sports Health. 2015;7(4):359–65. https://doi.org/10.1177/1941738113520130.

    Article  Google Scholar 

  15. Ward EE, Jacobson JA, Fessell DP, Hayes CW, van Holsbeeck M. Sonographic detection of Baker’s cysts: comparison with MR imaging. AJR Am J Roentgenol. 2001;176(2):373–80. https://doi.org/10.2214/ajr.176.2.1760373.

    Article  CAS  Google Scholar 

  16. Torreggiani WC, Al-Ismail K, Munk PL, Roche C, Keogh C, Nicolaou S, et al. The imaging spectrum of Baker’s (Popliteal) cysts. Clin Radiol. 2002;57(8):681–91. https://doi.org/10.1053/crad.2001.0917.

    Article  CAS  Google Scholar 

  17. Bunt CW, Jonas CE, Chang JG. Knee pain in adults and adolescents: the initial evaluation. Am Fam Phys. 2018;98(9):576–85.

    Google Scholar 

  18. Neubauer H, Morbach H, Schwarz T, Wirth C, Girschick H, Beer M. Popliteal cysts in paediatric patients: clinical characteristics and imaging features on ultrasound and MRI. Arthritis. 2011;2011:751593. https://doi.org/10.1155/2011/751593.

    Article  Google Scholar 

  19. Singh AP, Chandak S, Agarwal A, Malhotra A, Jain A, Khan AA. Utility of high-resolution sonography for evaluation of knee joint pathologies as a screening tool. J Diagn Med Sonog. 2021;37(6):556–67. https://doi.org/10.1177/87564793211035773.

    Article  Google Scholar 

  20. El-Miedany YM, Housny IH, Mansour HM, Mourad HG, Mehanna AM, Megeed MA. Ultrasound versus MRI in the evaluation of juvenile idiopathic arthritis of the knee. Joint Bone Spine. 2001;68(3):222–30. https://doi.org/10.1016/s1297-319x(01)00269-x.

    Article  CAS  Google Scholar 

  21. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151(4):W65–94. https://doi.org/10.7326/0003-4819-151-4-200908180-00136.

    Article  Google Scholar 

  22. Whiting PF, Rutjes AWS, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–36. https://doi.org/10.7326/0003-4819-155-8-201110180-00009.

    Article  Google Scholar 

  23. Reitsma JB, Glas AS, Rutjes AWS, Scholten RJPM, Bossuyt PM, Zwinderman AH. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol. 2005;58(10):982–90. https://doi.org/10.1016/j.jclinepi.2005.02.022.

    Article  Google Scholar 

  24. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, et al. Updated guidance for trusted systematic reviews: a new edition of the cochrane handbook for systematic reviews of interventions. Cochrane Database Syst Rev. 2019;10:ED000142. https://doi.org/10.1002/14651858.ED000142.

  25. Sadeghian H, Shekarchi B, Zahedi Niya M, Bagheri H. Ultrasound findings in knee osteoarthritis and rheumatoid arthritis compared to MRI. Bali Med J. 2018. https://doi.org/10.15562/bmj.v7i2.1059.

    Article  Google Scholar 

  26. Makarova MV, Valkov MY. Comparison of the diagnostic accuracy of magnetic resonance imaging and ultrasound examination for X-ray negative stage of knee joints osteoarthritis. Res Practical Med J. 2018;5(1):10–9. https://doi.org/10.17709/2409-2231-2018-5-1-1.

    Article  Google Scholar 

  27. Singh B, Pawar KN, Kachewar S, Ghule SS, Lakhkar DL. Evaluation of knee joint by ultrasound and MRI. IOSR J Dental Med Sci. 2016;15(10):122–31.

    Google Scholar 

  28. Wu S, Tu R, Liu G, Shi Y. Role of ultrasound in the diagnosis of common soft tissue lesions of the limbs. Ultrasound Q. 2013;29(1):67–71. https://doi.org/10.1097/RUQ.0b013e3182823617.

    Article  CAS  Google Scholar 

  29. Yücesoy C, Gülden G, Ajda B, Keyik B, Öztürk E, Tüzün M, et al. Ultrasonographic assessment of knee in patients with rheumatoid arthritis: Is it an effective imaging method for initial evaluation? Turk J Rheumatol. 2011;26(2):120–6. https://doi.org/10.5606/tjr.2011.018.

    Article  Google Scholar 

  30. An J, Park S, Park J, Jin W, Ryu K. Soft tissue masses in the extremities: the accuracy of an ultrasonographic diagnosis. J Korean Soc Ultrasound Med. 2011;30(3):167–72.

    Google Scholar 

  31. Ostergaard M, Court-Payen M, Gideon P, Wieslander S, Cortsen M, Lorenzen I, et al. Ultrasonography in arthritis of the knee: a comparison with MR imaging. Acta Radiol. 1995;36(1):19–26. https://doi.org/10.1080/02841859509173342.

    Article  CAS  Google Scholar 

  32. AbiEzzi SS, Miller LS. The use of ultrasound for the diagnosis of soft-tissue masses in children. J Pediatr Orthop. 1995;15(5):566–73. https://doi.org/10.1097/01241398-199509000-00003.

    Article  CAS  Google Scholar 

  33. Toolanen G, Lorentzon R, Friberg S, Dahlström H, Oberg L. Sonography of popliteal masses. Acta Orthop Scand. 1988;59(3):294–6. https://doi.org/10.3109/17453678809149366.

    Article  CAS  Google Scholar 

  34. de Miguel ME, Cobo Ibáñez T, Usón Jaeger J, Bonilla Hernán G, Martín ME. Clinical and ultrasonographic findings related to knee pain in osteoarthritis. Osteoarthr Cartil. 2006;14(6):540–4. https://doi.org/10.1016/j.joca.2005.12.012.

    Article  Google Scholar 

  35. Oo WM, Linklater JM, Daniel M, Saarakkala S, Samuels J, Conaghan PG, et al. Clinimetrics of ultrasound pathologies in osteoarthritis: systematic literature review and meta-analysis. Osteoarthr Cartil. 2018;26(5):601–11. https://doi.org/10.1016/j.joca.2018.01.021.

    Article  CAS  Google Scholar 

  36. Trăistaru R, Popescu R, Gruia C, Rogoveanu O. A complex assessment of patients with knee osteoarthritis and Baker’s cyst: observational study. Rom J Morphol Embryol. 2013;54(3):593–601.

    Google Scholar 

  37. Martí-Bonmatí L, Mollá E, Dosdá R, Casillas C, Ferrer P. MR imaging of Baker cysts–prevalence and relation to internal derangements of the knee. MAGMA. 2000;10(3):205–10. https://doi.org/10.1007/BF02590647.

    Article  Google Scholar 

  38. Balik MS, Turan A, Celik FB. Is there a relationship between three-dimensionally measured Baker’s cyst volume and knee pathologies? Eurasian J Med. 2019;51(1):64–9. https://doi.org/10.5152/eurasianjmed.2019.18385.

    Article  Google Scholar 

  39. Köroğlu M, Callıoğlu M, Eriş HN, Kayan M, Cetin M, Yener M, et al. Ultrasound guided percutaneous treatment and follow-up of Baker’s cyst in knee osteoarthritis. Eur J Radiol. 2012;81(11):3466–71. https://doi.org/10.1016/j.ejrad.2012.05.015.

    Article  Google Scholar 

  40. Çağlayan G, Özçakar L, Kaymak SU, Kaymak B, Tan AA. Effects of Sono-feedback during aspiration of Baker’s cysts: a controlled clinical trial. J Rehabil Med. 2016;48(4):386–9. https://doi.org/10.2340/16501977-2049.

    Article  Google Scholar 

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Acknowledgements

We thank Chao Zeng, Jie Wei and Yilun Wang for their constructive and valuable suggestions on the research and manuscript revision.

Patient and public involvement

Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

Transparency

The lead author affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

Funding

This work was supported by the National Natural Science Foundation of China (81930071 and U21A20352) and the Key Research and Development Program of Hunan Province of China (2021SK2017).

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Author notes

  1. Ke Liu and Xiaoxiao Li contributed equally to this work

Authors and Affiliations

  1. Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China

    Ke Liu, Qianlin Weng, Guanghua Lei & Ting Jiang

  2. Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China

    Xiaoxiao Li & Guanghua Lei

  3. National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China

    Guanghua Lei

  4. Department of Ultrasonography, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China

    Ting Jiang

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Contributions

TJ is the corresponding author. GL and TJ conceived and designed the study and revised the manuscript. KL and XL developed the search strategies, extracted the data, carried out the evaluation of the risk of bias and wrote the first draft of the manuscript. TJ, KL and XL performed the analyses and the interpretation of data. QW assisted with data interpretation and performed critical revisions on the manuscript. All authors provided feedback on early and advanced drafts of the manuscript and approved the final version. All authors read and approved the final manuscript.

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Correspondence to Ting Jiang.

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Supplementary Information

Additional file 1.

The complete search strategy and the results of quality assessments.

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Liu, K., Li, X., Weng, Q. et al. Diagnostic accuracy of ultrasound for the assessment of Baker’s cysts: a meta-analysis. J Orthop Surg Res 17, 535 (2022). https://doi.org/10.1186/s13018-022-03430-9

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Journal of Orthopaedic Surgery and Research

ISSN: 1749-799X