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Choi GS, Chang MC. Partial isolated tear of the popliteus tendon following an in-car traffic accident: A rare cause of knee pain: A CARE-compliant case report. Medicine (Baltimore) 2023; 102:e35270. [PMID: 37713891 PMCID: PMC10508435 DOI: 10.1097/md.0000000000035270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023] Open
Abstract
RATIONALE Lesions caused by traffic accidents are often microscopic and minimal; therefore, their diagnosis can be easily overlooked. Moreover, when it is a rarely reported type of lesion, it can be even more easily undiagnosed. Isolated popliteal injuries are uncommon and have rarely been reported. PATIENT CONCERNS In this case study, we describe a right partially isolated popliteus tendon rupture that was undiagnosed for 2 years in a patient with posterior knee pain after an in-car traffic accident. A 49-year-old female patient presented with right knee pain that had persisted for 2 years and was initiated after an in-car traffic accident. The patient's right knee pain aggravated while standing and walking. Six months after the accident, her pain was confined to the posterolateral aspect of the knee and subsequently spread throughout her right knee. The pain score was 4 on a numerical rating scale. Physical examination revealed tenderness in the posterolateral corner of the right knee. Additionally, right knee pain was reported in the terminal range of knee flexion during the passive range of motion test. Radiographs of the right knee showed normal findings. DIAGNOSES A T2-weighted proton density sagittal and coronal knee magnetic resonance imaging revealed a partial-thickness tear with intrasubstance ganglion cysts at the musculotendinous junction of the popliteus tendon. No other abnormalities were observed in the patient. INTERVENTION Conservative treatment involved strengthening exercises and functional rehabilitation programs. OUTCOMES Six months later, the knee pain almost completely subsided. LESSONS Musculoskeletal injuries caused by traffic accidents are frequently overlooked. Therefore, a detailed examination should be conducted for an accurate diagnosis. Clinicians should consider the possibility of popliteal tendon injuries in patients with posterior knee pain.
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Affiliation(s)
- Gyu-Sik Choi
- Cheokbareun Rehabilitation Clinic, Pohang-si, Gyeonsangbuk-do, Republic of Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Weng SP, Wu TM, Chien CS, Lin SH. Treatment of Fabella syndrome with arthroscopic fabellectomy: a case series and literature review. BMC Musculoskelet Disord 2021; 22:748. [PMID: 34461874 PMCID: PMC8406563 DOI: 10.1186/s12891-021-04630-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background The fabella is a sesamoid bone in the posterolateral capsule of the human knee joint. In quadrupedal mammals, the fabella is believed to have a role similar to the patella in redirecting extension forces of the knee joint from one point to another. In bipeds, the fabella is not touching the back of the bent knee, and therefore the role in redirecting forces declines. Posterolateral knee pain can be associated with the irritation between the fabella and lateral femoral condyle, a phenomenon also known as fabella syndrome. In cases that are unresponsive to conservative management, surgical fabellectomy can be a successful treatment option. Among the surgical approaches, open resection is most commonly seen. There are also literature reporting arthroscopic-assisted open resection, but seldom mentioned the all-arthroscopic fabellectomy. Case presentation We present 3 patients with a long history (> 12 month) of posterolateral knee pain under suspicion of different pain origins. The diagnosis of fabella impingement was eventually made by ruling out of other causes. All the patients underwent all-arthroscopic fabellectomy for diagnosis and treatment. Investigations of the resected fabella suggested chronic impingement with apparent osteophyte formation and cartilage wearing of the articular side. All patients have been continually followed up at our outpatient department and reported to be pain free after the procedure. Conclusions In the patients presenting posterolateral pain, fabella syndrome cannot be ignored due to its relative higher presence in Asian population. In our experience, the all-arthroscopic fabellectomy offers a smaller wound size, less post-operative pain, fewer days of hospitalization and quicker time to rehabilitation for the patients with chronic posterolateral knee pain caused by fabella syndrome.
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Affiliation(s)
- Shuo-Po Weng
- Orthopedic Department, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, Taiwan (Republic of China)
| | - Tsung-Mu Wu
- Orthopedic Department, Chi-Mei Medical Center, No.901, Zhonghua Rd., Yongkang Dist., Tainan City, Taiwan (Republic of China)
| | - Chi-Sheng Chien
- Orthopedic Department, Chi-Mei Medical Center, No.901, Zhonghua Rd., Yongkang Dist., Tainan City, Taiwan (Republic of China)
| | - Sheng-Hui Lin
- Orthopedic Department, Chi-Mei Medical Center, No.901, Zhonghua Rd., Yongkang Dist., Tainan City, Taiwan (Republic of China).
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Swinford ST, LaPrade R, Engebretsen L, Cohen M, Safran M. Biomechanics and physical examination of the posteromedial and posterolateral knee: state of the art. J ISAKOS 2020. [DOI: 10.1136/jisakos-2018-000221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Case Report of a Complex Lateral Femorotibial Joint Injury With Popliteal Tendonitis in a Foal. J Equine Vet Sci 2020; 91:103144. [PMID: 32684272 DOI: 10.1016/j.jevs.2020.103144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/09/2020] [Accepted: 05/15/2020] [Indexed: 11/23/2022]
Abstract
A two-month-old, Spanish breed, foal was referred with right hind limb lameness of two weeks duration. Clinical examinations confirmed a complex combination of lesions within the lateral femorotibial joint, including a subchondral bone cyst in the lateral femoral condyle, a severe popliteal tendonitis, and a delayed cartilage detachment of the lateral femoral condyle. Because of the complex association of these lesions, poor prognosis for an athletic career was given to the owner. Four years later, the filly is pasture sound. Lesions of the popliteal tendon in the horse are uncommon. The popliteal tendon should also be investigated in cases of trauma to the lateral femorotibial joint, as it could be associated with other affected structures.
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Cuevas-Ramos G, Cova M, Arguelles D, Prades M. Anatomical variations of the equine popliteal tendon. J Vet Sci 2019; 20:e36. [PMID: 31364321 PMCID: PMC6669204 DOI: 10.4142/jvs.2019.20.e36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/15/2019] [Accepted: 05/13/2019] [Indexed: 11/20/2022] Open
Abstract
The function of the popliteal muscle and tendon in horses remains undescribed. In humans, it is considered a stabilizer of the posterior-lateral region of the knee; its function is closely related to that of the lateral collateral ligament (LCL) and meniscus. The popliteal tendon (PopT) constitutes the main proximal attachment of the popliteus muscle to the femur, and in humans, insertional variations have been described. Knowledge of anatomical variations is needed for the correct interpretation of diagnostic images and arthroscopic findings. To elucidate further the anatomy of the equine PopT, both hind limbs of 30 horses were dissected. Similar to humans, the equine PopT has 3 variants (types I, II, and III) depending on the number of components forming the tendon. Additionally, the area of insertion varies; the location can be either cranial, underneath, or caudal to the proximal insertion of the LCL. Furthermore, the PopT has a constant attachment to the lateral meniscus. The results of the present study are useful for clinicians working with equine orthopedics, as the tendon and insertional variants could affect the interpretation of diagnostic images and arthroscopic examinations.
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Affiliation(s)
- Gabriel Cuevas-Ramos
- Université de Toulouse, Equine Surgery Department, École Nationale Vétérinaire de Toulouse, Toulouse 31076, France.,Universitat Autònoma de Barcelona, Equine Clinic, Cerdanyola del Vallès, Barcelona 08193, Spain.
| | - Melanie Cova
- Université de Toulouse, Equine Surgery Department, École Nationale Vétérinaire de Toulouse, Toulouse 31076, France
| | - David Arguelles
- Universitat Autònoma de Barcelona, Equine Clinic, Cerdanyola del Vallès, Barcelona 08193, Spain
| | - Marta Prades
- Universitat Autònoma de Barcelona, Equine Clinic, Cerdanyola del Vallès, Barcelona 08193, Spain
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Ali AA, Abdelwahab MB. Short-Term Outcome of Multi-Ligament Knee Injury among Sudanese Patients. Open Access Maced J Med Sci 2019; 7:1486-1493. [PMID: 31198460 PMCID: PMC6542394 DOI: 10.3889/oamjms.2019.282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND: Multi-ligament knee injury is the state of having two or more of the major knee ligaments, namely: the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), the lateral collateral ligament (LCL), the posteromedial corner (PMC), and the posterolateral corner (PLC). The knee is a hinge joint; this dictates two direction movements on the y-axis plane. The knee joints carry the weight load of the body uniquely. The role of the knee ligaments is not conserved only to maintain knee in a rigid position while standing, but also orchestrates the biomechanics of knee motion in harmony. Multi-ligament knee injury is very rare (incidence < 10:10,000 of trauma cases). Patients with multiple ligaments injuries of the knee become disabled for a long period. This disability rises from the pain and stiffness of the knee joint. A disability that might be associated with increased frequencies of sick leave from work, or much more dire consequences, such as quitting a job or being relieved of duty. AIM: To assess the functional outcome of the knee of patients with a multi-ligament knee injury after treatment using a standard scoring system and to determine the recovery rates of each treatment option to a multi-ligament knee injury. METHODS: it is a cross-sectional study conducted from January 2018 to January 2019. All patients with multi-ligament knee injuries that were diagnosed by MRI, and underwent reconstruction surgeries or on the waiting list, at Ribat University Hospital and Alyaa Specialized Hospital, Alkuwiti specialised hospital, and Haj Alsafi Hospital for the past 2 years were included. Lyshlome knee scoring scale was used to assess the functional outcome of each patient. RESULTS: 24 patients were enrolled in this study (16 had reconstruction surgery, 8 did not). 3 had excellent outcome (LKSS = 95 – 100), 8 of them had good score (LKSS = 84-94), 5 had fair outcome (LKSS = 65-83). All those who did not have reconstruction had a poor score (LKSS < 64). CONCLUSION: Reconstruction of multi-ligament knee injury shows a good outcome than it was left alone. Post-operative physiotherapy increases the potential of reconstruction. While our data is limited because of the rare condition, we plan to expand our study area to include a larger sample size. We also recommend extending the post-operative physiotherapy to improve the outcome of a multi-ligament knee injury.
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Villafañe F, Holloway N, Kettner N. A Case Report of Osteochondritis Dissecans in a Rare Location: The Lateral Femoral Trochlea. J Chiropr Med 2017; 16:324-330. [DOI: 10.1016/j.jcm.2017.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/17/2017] [Accepted: 07/28/2017] [Indexed: 10/18/2022] Open
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Van Ginckel A, Bennell KL, Campbell PK, Wrigley TV, Hunter DJ, Hinman RS. Location of knee pain in medial knee osteoarthritis: patterns and associations with self-reported clinical symptoms. Osteoarthritis Cartilage 2016; 24:1135-42. [PMID: 26836285 DOI: 10.1016/j.joca.2016.01.986] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 01/18/2016] [Accepted: 01/24/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To (1) document pain location in medial tibiofemoral osteoarthritis (OA) using the patient-administered Photographic Knee Pain Map (PKPM); (2) compare pain severity, nature and likelihood of neuropathic-like symptoms, physical dysfunction and presence of symptoms at other sites across the most common pain patterns. DESIGN Baseline data were analysed from 164 participants with medial tibiofemoral OA (TFJOA) participating in a randomised controlled trial (RCT). Participants completed the PKPM indicating all relevant pain zones of their most painful knee. Pain zones were collapsed into regions to determine patterns of pain. Symptoms were quantified using numeric rating scales (NRSs) of pain severity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Intermittent and Constant Osteoarthritis Pain (ICOAP) and painDETECT questionnaires. Symptoms at other joints were categorised as present/absent. RESULTS The medial joint line (n = 123, 75%), patellar tendon (n = 62, 38%) and posterior knee (n = 61, 37%) were the most frequently reported pain zones. The most frequent patterns were diffuse (41%), isolated medial (16%), anterior-medial (12%) and medial-posterior (11%) pain. WOMAC and ICOAP scores were higher in the diffuse compared to anterior-medial patterns. Mean PainDETECT scores were higher with both diffuse and medial-posterior pain relative to anterior-medial pain. CONCLUSION Only 16% of the cohort indicated isolated medial knee pain, whilst a diffuse pain pattern was most common. People with diffuse knee pain reported more severe pain and physical dysfunction than those with anterior-medial pain. Prevalence of possible/likely neuropathic-like symptoms tended to be more frequent in diffuse and posterior-medial patterns compared to anterior-medial pain.
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Affiliation(s)
- A Van Ginckel
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Victoria, Australia.
| | - K L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Victoria, Australia.
| | - P K Campbell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Victoria, Australia.
| | - T V Wrigley
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Victoria, Australia.
| | - D J Hunter
- Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney, New South Wales, Australia.
| | - R S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Victoria, Australia.
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Mridha AR, Ranjan R, Kinra P, Ray R, Khan SA, Shivanand G. Angiomyomatous hamartoma of popliteal lymph node: an unusual entity. J Pathol Transl Med 2015; 49:156-8. [PMID: 25812737 PMCID: PMC4367112 DOI: 10.4132/jptm.2013.08.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 08/06/2013] [Accepted: 08/08/2013] [Indexed: 11/17/2022] Open
Affiliation(s)
- Asit Ranjan Mridha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Ranjan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Prateek Kinra
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ruma Ray
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Shah Alam Khan
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Gamanagatti Shivanand
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Sheikh K, Siau K. A Baker's dozen. CASE REPORTS 2015; 2015:bcr-2015-209756. [DOI: 10.1136/bcr-2015-209756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mason JS, Tansey KA, Westrick RB. Treatment of subacute posterior knee pain in an adolescent ballet dancer utilizing trigger point dry needling: a case report. Int J Sports Phys Ther 2014; 9:116-24. [PMID: 24567862 PMCID: PMC3924615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
STUDY DESIGN Case Report. BACKGROUND AND PURPOSE Dry needling (DN) is an increasingly popular intervention used by clinicians as a treatment of regional neuromusculoskeletal pain. DN is an invasive procedure that involves insertion of a thin monofilament needle directly into a muscle trigger point (MTP) with the intent of stimulating a local twitch response. Current evidence is somewhat limited, but recent literature supports the use of this intervention in specific neuromusculoskeletal conditions. The purpose of this case report is to present the outcomes of DN as a primary treatment intervention in an adolescent subject with subacute posterior knee pain. CASE DESCRIPTION The subject was a 16-year-old female competitive ballet dancer referred to physical therapy with a two month history of right posterior knee pain. Palpation identified MTPs which reproduced the patient's primary symptoms. In addition to an exercise program promoting lower extremity flexibility and hip stability, the subject was treated with DN to the right gastrocnemius, soleus, and popliteus muscles. OUTCOMES The subject reported being pain free on the Numerical Pain Scale and a +7 improvement in perceived change in recovery on the Global Rating of Change at final follow-up. Physical examination demonstrated no observed impairments or functional limitations, including normal mobility, full strength, and unrestricted execution of dance maneuvers. DISCUSSION The patient was able to return to high level dance training and competition without physical limitations and resumed pre-injury dynamic movement activities including dancing, running, jumping, and pivoting without pain. DN can be an effective and efficient intervention to assist patients in decreasing pain and returning to high intensity physical activity. Additional research is needed to determine if DN is effective for other body regions and has long-term positive outcomes. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- John S. Mason
- Physical Therapy Department, McDonald Army Health Center, Fort Eustis, VA
| | - Kimberly A. Tansey
- Physical Therapy Department, McDonald Army Health Center, Fort Eustis, VA
| | - Richard B. Westrick
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA
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