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Buruian A, Pinheiro V, Fonseca F, Matos P. Fracture of the fabella with radiologic and MRI. BMJ Case Rep 2023; 16:e251811. [PMID: 38035674 PMCID: PMC10689351 DOI: 10.1136/bcr-2022-251811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/02/2023] Open
Abstract
The fabella is an inconstant sesamoid bone. A handful of cases have been reported so far describing fabella fracture, usually involving high energy mechanism or stress fractures after total knee arthroplasty. This paper presents a fabella fracture in a man in his 40s after suffering a car crash, the clinical and radiographic presentation, treatment and complete recovery at 4-months follow-up.
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Affiliation(s)
- Alexei Buruian
- Orthopaedics department, Hospital Distrital da Figueira da Foz, EPE, Figueira da Foz, Portugal
| | - Vitor Pinheiro
- Orthopaedics department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Fernando Fonseca
- Orthopaedics department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Pedro Matos
- Orthopaedics department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
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Özbay H, Mraja HM, Can A, Erdoğan F. Prevalence and Radiological Characteristics of the Fabella in Turkish Population. Cureus 2022; 14:e31534. [DOI: 10.7759/cureus.31534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 11/16/2022] Open
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Zhong J, Zhang G, Si L, Hu Y, Xing Y, He Y, Yao W. The prevalence and parameters of fabella and its association with medial meniscal tear in China: a retrospective study of 1011 knees. BMC Musculoskelet Disord 2022; 23:188. [PMID: 35232412 PMCID: PMC8886965 DOI: 10.1186/s12891-022-05092-4] [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: 05/17/2021] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background Fabella is a sesamoid bone of knee that has potential biomechanical function. We aimed to examine the fabellar prevalence and parameters in Chinese population and test the hypothesis that fabellar presence and morphology were associated with meniscus tear or ligament injury. Methods A total of 1011 knee magnetic resonance imaging scans from 979 patients with knee pain were analyzed retrospectively. The exclusion criteria are postsurgical scans, difficulty in fabella discrimination, conditions not suitable for measurement, and unsatisfied image. The fabellar presence and its parameters (length, width and thickness) were documented. The association between fabellar presence and meniscus tear or ligament injury were assessed by chi-square test, in all knees and subgroups (age, gender, side, lesion part). The correlation of fabellar presence and parameters with advancing age was assessed by Spearman correlation analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to investigate whether factors related with meniscus tear or ligament injury. Diagnostic performance of risk factors was assessed by receiver operating characteristic (ROC) analysis. Results The overall prevalence of fabellae was 39.8% (402/1011 knees) and increased with the increasing age (r = 0.237, P < 0.001). The size of the fabellae differed according to genders, age, and presence of articulating grooves. Fabella presented more often in knees with medial meniscus (MM) tears (66.7% vs 33.8%; P < 0.001) with a multivariate OR of 2.960 (95% CI, 1.853–3.903). The association remained in all tear parts (anterior, middle, and posterior), and in younger (age < 50 years) and older patients (age ≥ 50 years). Age, fabellar length, width, length/thickness ratio and width/thickness ratio yielded an area under the ROC curve (AUC) of 0.604–0.766 to predict an MM tear. In combination with age, fabellar width and length/thickness ratio, the AUC was improved 0.791 (95% CI, 0.744–0.837), with a sensitivity of 73.0% and a specificity of 74.6%. Conclusion The presence of fabellae, increased fabellar length and width as well as flatter fabellar morphology, are significantly associated with an increased risk for MM tear. These findings might aid clinicians in identifying patients at risk for a MM tear and informing them. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05092-4.
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Affiliation(s)
- Jingyu Zhong
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, 200336, Shanghai, China
| | - Guangcheng Zhang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, 200233, Shanghai, China
| | - Liping Si
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, 200336, Shanghai, China
| | - Yangfan Hu
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, 200336, Shanghai, China
| | - Yue Xing
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, 200336, Shanghai, China
| | - Yaohua He
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, 200233, Shanghai, China. .,Department of Orthopedics, Shanghai Sixth People's Hospital, Jinshan Branch, No. 147 Jiankang Road, 201500, Shanghai, China.
| | - Weiwu Yao
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, 200336, Shanghai, China.
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Zhang L, Wen YL, He CY, Zeng Y, Wang JQ, Wang GY. Relationship between Classification of Fabellae and the Severity of Knee Osteoarthritis: A Relevant Study in the Chinese Population. Orthop Surg 2021; 14:274-279. [PMID: 34913250 PMCID: PMC8867427 DOI: 10.1111/os.13006] [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: 01/01/2021] [Revised: 02/18/2021] [Accepted: 03/11/2021] [Indexed: 12/05/2022] Open
Abstract
Objective To classify the fabellae and discuss the relationship between the classification of fabellae and the severity of knee osteoarthritis (KOA) in Chinese. Methods From February 2019 to February 2020, 136 patients were measured and classified using three‐dimensional computed tomography (CT) reconstruction. According to the CT imaging characteristics, the fabellae were divided into five types: type I, a fabella on the lateral femoral condyle; type II, a fabella on the medial femoral condyle; type III, a fabella on the lateral femoral condyle and a fabella on the medial femoral condyle; type IV, two fabellae on the medial femoral condyle; and type V, two fabellae on the lateral femoral condyle. The severity of KOA was assessed on the Recht grade by magnetic resonance imaging (MRI). The data were analyzed with SPSS 24.0. Results The classification of fabellae were correlated with KOA grades (χ2 = 35.026, P < 0.05). In terms of KOA grades, grade I and grade II were occupied most by fabellar type II (32, 72.8%); type II and other types showed significant statistical difference (P < 0.05). Grade I and grade II were also mainly fabellar type IV (four, 100%). Fabellar type V's biggest component was grade III and grade IV (six, 75%). Type IV and type V showed significant statistical difference (P < 0.05). Conclusion The classification of fabellae were correlated with KOA grades. The type II may mean the lower KOA grades while type V may mean the higher KOA grades.
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Affiliation(s)
- Lei Zhang
- Department of Orthopaedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopaedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Luzhou, China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, China
| | - You-Liang Wen
- School of Rehabilitation Medicine GanNan Medical University, Ganzhou, China
| | - Chun-Ying He
- School of Clinical Medicine of Integrated Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou, China
| | - Yan Zeng
- Department of Nephrology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Jun-Qiu Wang
- School of Clinical Medicine of Integrated Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou, China
| | - Guo-You Wang
- Department of Orthopaedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopaedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Luzhou, China
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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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Unluturk O, Duran S, Yasar Teke H. Prevalence of the fabella and its general characteristics in Turkish population with magnetic resonance imaging. Surg Radiol Anat 2021; 43:2047-2054. [PMID: 34398300 DOI: 10.1007/s00276-021-02817-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/06/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The fabella is a fibrocartilaginous or ossified sesamoid bone in the knee, largely located in the lateral tendon of the head of the gastrocnemius muscle. In this study, the prevalence, gender differences, localization and size of the fabella were determined in a Turkish population to make a comparison with other population studies in the literature. MATERIALS AND METHODS Thousand patients (500 females, 500 males) who underwent knee magnetic resonance imaging (MRI) with fabella in all three planes, including axial, sagittal and coronal evaluated, retrospectively. All MRI examinations were performed using a 1.5 T unit. Patients with a history of trauma or operation, motion artifacts and patients who could not be evaluated due to image quality were excluded. Anteroposterior diameter in sagittal plan (sAP) of the fabella and the fabella-femur distance was measured. Measurements were evaluated with Pearson's Chi-squared and Mann-Whitney U test for non-homogeneous data in SPSS program, and ANOVA test for homogeneous data. A p value of < 0.05 was considered significant in all analyses. RESULTS The overall prevalence of fabella was found to be 155 cases. Unilateral fabella was detected in 72.9% of the cases, of which 56.6% were on the right side and 43.4% were on the left side. The median value of AP diameter in sagittal plan was calculated as 4.40 ± 1.31 mm. Concerning the gender-related examination the sAP diameter of the fabella was larger in men than in women (p < 0.05). The median value of FFD was calculated as 2.50 ± 0.50 mm. The distribution of FFD between genders was not statistically significant (p = 0.492). CONCLUSION The fabella is usually a sesamoid bone that can be detected incidentally by imaging techniques. The incidence in the Turkish population is 15.5%, and no gender difference was detected. It is clear that further studies on the basis of populations are needed, especially considering that pathological problems remain in question and there is a lack of scientific data (variations, developmental characteristics, etc.) on sesamoid bones.
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Affiliation(s)
- Ozge Unluturk
- Ministry of Justice, Council of Forensic Medicine, İstanbul, Turkey
| | - Semra Duran
- Department of Radiology, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent Bulvarı No.1, Ankara, Turkey.
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Adedigba JA, Idowu BM, Hermans SP, Okwori OF, Onigbinde SO, Oluwadiya KS, Amoako AA, Weidenhaft MC. Fabella and patella variants: radiographic prevalence, distribution and clinical relevance in a population of black african descent. Anat Cell Biol 2021; 54:184-192. [PMID: 33594010 PMCID: PMC8225475 DOI: 10.5115/acb.20.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 11/27/2022] Open
Abstract
To evaluate the radiographic characteristics and prevalence of fabella and patella variants in an indigenous African population. This retrospective observational study of orthogonal knee radiographs of 377 consecutive subjects was conducted in Lagos, Nigeria, from February 2017 to November 2017. The presence of bipartite/multipartite patella, as well as the presence of fabella were noted. The craniocaudal diameter, anteroposterior diameter, fabello-femoral distance and fabello-tibial distance of the fabella were measured. P≤0.05 represented a statistically significant result. Three hundred and seventy-seven subjects were enrolled. The average age was 41.22±21.37 years with a range of 3-100 years old. There were 158 male (41.9%) and 219 female (58.1%) subjects. The prevalence of fabella was 11.94%. There was a positive correlation between age <47 and ≥47 and occurrence of fabella, P<0.015. There was no statistically significant difference between the mean male and female measured fabella diameters. The overall prevalence of bipartite and multipartite patella in this study was 2.12%. Among male and female subjects, the difference in prevalence of bi and multipartite patella was statistically significantly, P=0.03. The prevalence of fabella and patella variants was lower in this study compared to the findings in other populations and ethnicities. Sex and age were significantly correlated with fabella prevalence. The results reported in this study will facilitate future studies examining the correlations between fabella and patella variants and various knee pathologies in a population of Black African descent.
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Affiliation(s)
| | | | - Sarah Perou Hermans
- Department of Radiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Onoja Frederick Okwori
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | | | - Angela Ameyaa Amoako
- Department of Microbiology, University of Wisconsin-La Crosse, La Crosse, WI, USA
| | - Mandy C Weidenhaft
- Department of Radiology, Tulane University School of Medicine, New Orleans, LA, USA
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Asghar A, Naaz S, Chaudhary B. The Ethnic and Geographical Distribution of Fabella: A Systematic Review and Meta-Analysis of 34,733 Knees. Cureus 2021; 13:e14743. [PMID: 34084671 PMCID: PMC8164001 DOI: 10.7759/cureus.14743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The primary studies demonstrated that fabellar prevalence (FP) varied with ethnic and geographical distribution. Osteoarthritis (OA) and age-related degeneration have a significant association with FP. The prevalence of OA worldwide was doubled with life expectancy. Increased life expectancy has increased exposure to OA and age-related degeneration which could be a possible reason for the rise of FP. The analysis was conducted to provide insight about FP in respect to geographical, ethnic, sex, and laterality distribution. Methodology: Eighty-six studies were included which have data from 34,733 knee joints. Fifty radiological studies were consisting of 27,293 knees and 36 cadaveric studies had the data of 7,440 knees of dissected specimens, respectively. The prevalence, Odds, and rate ratios were calculated for aging, osteoarthritis, and ethnic variation. Results: The worldwide FP was 25% (95% CI, 0.22, 0.28). The prevalence of fabella was found to be higher in cadaveric studies (32%) than radiological studies (19%) with significant heterogeneity. The FP was 16-18% till 1950 which was doubled by 2020 (35%). The FP in OA knee was 51% which was thrice of baseline.
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Affiliation(s)
- Adil Asghar
- Anatomy, All India Institute of Medical Sciences Patna, Patna, IND
| | - Shagufta Naaz
- Anaesthesiology, All India Institute of Medical Sciences Patna, Patna, IND
| | - Binita Chaudhary
- Anatomy, All India Institute of Medical Sciences Patna, Patna, IND
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Asghar A, Naaz S, Narayan RK, Kumar A. Does the Prevalence of Ossified Fabella Vary in Knee Osteoarthritis and Age-Related Degeneration? A Meta-Analysis of About 11,000 Knees. Cureus 2021; 13:e12535. [PMID: 33564533 PMCID: PMC7863029 DOI: 10.7759/cureus.12535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Osteoarthritis (OA) and age-related degeneration (ARD) are stimulants for the development of the fabella in the knee joint. This meta-analysis updates previous studies and reviews on the prevalence of the fabella in OA or ARD knee joints. In addition, it provides a quantitative estimation of the fabellar prevalence in knees having OA and ARD. METHODOLOGY Twenty studies containing data from 11,056 knee joints were utilized in the investigation, consisting of 6,819 knees of individuals with OA (including those with age greater than 40 years) and 4,237 knees of individuals without OA (including less than 40 years of age), respectively. Totally, 2,434 knees of the OA subjects had fabellae (including more than 40 years), while in the non-OA subjects, 844 had fabellae (including less than 40years). The odds ratio (OR) and relative risk (RR) were calculated. RESULTS The fabellar prevalence was observed to be higher in OA knees, where the risk ratio of developing fabella was 2.55 (2.15-3.02). Compared with this, the risk ratio for the incidence of fabella in ARD knee was 1.71 (1.59-1.85). The bilateral occurrence of fabella was more common than unilateral. The risk of developing fabella in individuals aged less than 40-year was 0.59 which was 41% less than individuals aged more than 40 years. The risk ratio of developing fabella in co-exposure of ARD and OA was 1.84 [1.66, 2.04, 95% CI]. CONCLUSION OA and ARD would increase the prevalence of ossified fabella by 84%, thus acting as stimulants or associations and risk factors for ossified fabella.
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Affiliation(s)
- Adil Asghar
- Anatomy, All India Institute of Medical Sciences Patna, Patna, IND
| | - Shagufta Naaz
- Anesthesiology, All India Institute of Medical Sciences Patna, Patna, IND
| | - Ravi K Narayan
- Anatomy, All India Institute of Medical Sciences Patna, Patna, IND
| | - Anup Kumar
- Orthopaedics, All India Institute of Medical Sciences Patna, Patna, IND
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The prevalence of fabella and its association with the osteoarthritic severity of the knee in Korea. Clin Rheumatol 2020; 39:3625-3629. [DOI: 10.1007/s10067-020-05078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/23/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
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