What are the recommended management strategies for a Baker's cyst that is causing significant pain or functional impairment?

Recommended management strategies for a Baker's cyst causing significant pain or functional impairment include:

• Initial conservative treatment with simple analgesia such as paracetamol or ibuprofen and physiotherapy to manage symptoms and improve function.
• Referral to secondary care (rheumatologist or orthopaedic surgeon) if symptoms are troublesome despite conservative measures, the cyst is very large, or the diagnosis is unclear.
• In secondary care, treatments may include aspiration of the knee effusion with or without intra-articular corticosteroid injection, cyst aspiration with intra-cystic corticosteroid injection, and arthroscopy to identify and treat any underlying joint pathology such as meniscal tears.
• Surgical intervention is generally reserved for cases where underlying joint pathology requires correction; excision of the cyst alone is not recommended due to a high rate of recurrence.
• Management should also focus on identifying and optimizing treatment of any underlying joint disease (e.g., osteoarthritis, rheumatoid arthritis) to facilitate cyst resolution.

Direct aspiration of a Baker's cyst in primary care is not recommended.

Urgent assessment is required if red flags or suspicion of serious alternative diagnoses such as deep vein thrombosis are present.

Patient education and reassurance are important, as Baker's cysts may resolve with treatment of the underlying condition.

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