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Wu WT, Onishi K, Mezian K, Naňka O, Wang B, Su DCJ, Ricci V, Chang KV, Özçakar L. Ultrasound imaging of the posterior lateral corner of the knee: a pictorial review of anatomy and pathologies. Insights Imaging 2024; 15:39. [PMID: 38334861 PMCID: PMC10857999 DOI: 10.1186/s13244-024-01606-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/02/2024] [Indexed: 02/10/2024] Open
Abstract
Assessment of the posterior lateral knee pain poses diagnostic challenges, requiring accurate evaluation of various structures in light of the medical history and physical examination. Despite substantial progress in the ultrasonographic diagnosis of musculoskeletal disorders, the current protocol (EURO-MUSCULUS/USPRM. Basic scanning protocols for knee) fails to conduct a comprehensive investigation into the intricate, tendons, and ligaments of the posterior lateral knee. This pictorial review aims to bridge this gap by offering a systematic approach to utilize ultrasound examination of the less-discussed structures in this specific region. Providing cadaveric and magnetic resonance images, this essay demonstrates the efficacy of ultrasound in diagnosing posterior lateral knee pain. Notably, pathologies such as ligamentous sprains and tears are clearly discernible. Moreover, the integration of ultrasound guidance plays a vital role in reducing the risk of inadvertent neurovascular injury during injection, such as the common peroneal nerve and lateral genicular artery. This comprehensive approach will enhance clinicians' understanding and equip them with effective management strategies for posterior lateral knee pain.Critical relevance statement In this visual exposition, we delve into the intricacies of the posterior lateral corner of the knee. Offering a methodical approach to employ ultrasound for visualization of the less-explored structures within this region, the authors aim to enhance the diagnosis in posterior lateral knee pain.Key points1. Ultrasound excels at revealing intricate structures in the posterior lateral knee.2. Due to proximity of vital structures, extreme caution is crucial during injections.3. Employing dynamic scan and understanding ligaments enables a comprehensive exploration of pathologies.
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Affiliation(s)
- Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, No. 87, Nei-Jiang Rd., Wan-Hwa District, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kentaro Onishi
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Ondřej Naňka
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Bow Wang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Daniel Chiung-Jui Su
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan, Taiwan
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, No. 87, Nei-Jiang Rd., Wan-Hwa District, Taipei, Taiwan.
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan.
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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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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Samra D, Cross T, Feller J, Gultekin S. Outcome of Fabellar Excision on Return to Sport and Performance for an Elite Athlete With Established Lateral Compartment Chondropathy. Orthop J Sports Med 2021; 9:23259671211034157. [PMID: 34568507 PMCID: PMC8461132 DOI: 10.1177/23259671211034157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- David Samra
- Sydney Swans Football Club, Sydney, New South Wales, Australia.,Stadium Sports Medicine Clinic, Sydney, New South Wales, Australia
| | - Tom Cross
- Sydney Swans Football Club, Sydney, New South Wales, Australia.,Stadium Sports Medicine Clinic, Sydney, New South Wales, Australia
| | | | - Sinem Gultekin
- University of Sydney, Sydney, New South Wales, Australia.,Western Health, Melbourne, Victoria, Australia
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Fabella Syndrome and Common Peroneal Neuropathy following Total Knee Arthroplasty. Case Rep Orthop 2021; 2021:7621844. [PMID: 34513102 PMCID: PMC8429020 DOI: 10.1155/2021/7621844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Case A 62-year-old man presented with persistent lateral knee pain 15 months following an uncomplicated total knee arthroplasty. There was a tendinous snapping structure over the lateral aspect of the knee in deep flexion with positive Tinel's sign over the fibular head. The patient underwent an uncomplicated flabella excision. The patient was cleared to return to work and full duty at two months postoperatively. Conclusion Flabella syndrome is a rare but increasingly common mechanism of persistent lateral knee pain following total knee arthroplasty. Surgeons should be aware of this etiology of persistent lateral knee pain and offer treatment modalities to address this pathology.
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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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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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Matroushi ODA, Sirasanagandla SR, Shabibi AA, Obaidani AA, Dhuhli HA, Jaju S, Mushaiqri MA. Radiological study of fabella in Omani subjects at a tertiary care center. Anat Cell Biol 2021; 54:315-320. [PMID: 33967029 PMCID: PMC8493026 DOI: 10.5115/acb.20.194] [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] [Received: 07/24/2020] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/27/2022] Open
Abstract
Ethnic diversity is associated with variability in the prevalence rates of fabella. We aimed to evaluate the prevalence and the radiological features of fabella in Omani patients. This is a retrospective analysis of hospital electronic database of patients referred for radiological investigations (radiographs and magnetic resonance imaging) of the knee, at a tertiary care referral center. Descriptive statistics were performed to determine the prevalence of fabella. Chi-square test was used to determine the association between sex or age with respect to the presence of fabella. A total of 813 knee radiographs were reviewed for the presence of fabella. Fabella was found in 24.1% of total cases. A statistically significant sex difference was observed with respect to the presence of fabella in left knees in males (P<0.01). The presence of fabella was significantly associated with age groups for the right (P<0.05) and left knees (P<0.01). In magnetic resonance imaging film reviews, all the identified fabellae (20.2%) were bony structures and were located within the lateral head of the gastrocnemius muscle. There were no cartilaginous fabellae detected. The current study revealed a prevalence of 24.1% of fabella in Omani subjects which is almost similar to the results as seen in Caucasian ethnic populations.
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Affiliation(s)
| | - Srinivasa Rao Sirasanagandla
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ammar Al Shabibi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Humoud Al Dhuhli
- Department of Radiology and Molecular Imaging, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Sanjay Jaju
- Department of Family Medicine & Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mohamed Al Mushaiqri
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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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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12
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Berthaume MA, Bull AMJ. Human biological variation in sesamoid bone prevalence: the curious case of the fabella. J Anat 2019; 236:228-242. [PMID: 31623020 PMCID: PMC6956444 DOI: 10.1111/joa.13091] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2019] [Indexed: 01/23/2023] Open
Abstract
The fabella is a sesamoid bone located in the gastrocnemius behind the lateral femoral condyle. In humans, fabellae are 3.5 times more common today than they were 100 years ago, with prevalence rates varying between and within populations. In particular, fabellae have been assumed to be more common in Asians than non‐Asians, equally common in men and women, potentially more common in older individuals, and bilateral cases (one per knee) appear to be more common than unilateral ones. The roles of genetic and environmental factors in this phenotypic variation have been hypothesized, but not rigorously investigated. Given its clinical and evolutionary significance (i.e. being associated with several knee ailments, causing medical issues on its own, interfering with medical devices, and being less common in humans than in other mammals), it is important comprehensively to understand prevalence rate variation, and the roles of genetics and environmental factors in that variation. To address these questions, we performed a meta‐analysis on data from studies published from 1875 to 2018 to investigate possible variation in sexual dimorphic (n = 22 studies, 7911 knees), ontogenetic (n = 10 studies, 4391 knees), and global (n = 65 studies, 21 626 knees) fabella prevalence rates. In addition, we investigated what proportion of cases are bilateral (n = 37 studies, 900 individuals), and among unilateral cases (n = 20 studies, 204 individuals), if fabellae are more common in the left or right knee. Our results show that, today, fabellae are 2.47–2.60% more common in men than women, and prevalence rates increase ontogenetically in old age (i.e. 70 years old), implying that fabellae can ossify early (i.e. 12 years old) or late in life. Approximately 72.94% of cases are bilateral, and among unilateral ones, fabellae are equally common in right and left knees. There is marked regional variation in fabella prevalence rates, with rates being highest in Asia, followed by Oceania, South America, Europe, Middle East, and North America, and lowest in Africa. Worldwide, an average of 36.80% of knees has ossified fabellae detectable by dissection. These results imply that, while the ability to form a fabella may be genetically controlled, the mechanisms that trigger fabella ossification may be environmentally controlled. What these environmental factors are, can only be speculated.
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Affiliation(s)
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, UK
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Kenanidis E, Athanasiadis DI, Geropoulos G, Kakoulidis P, Potoupnis M, Tsiridis E. Does the sternum play a role in the aetiopathogenesis of adolescent idiopathic scoliosis? Preliminary data of a new theory. Hippokratia 2018; 22:173-177. [PMID: 31695304 PMCID: PMC6825423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The role of the sternum, if any, in the aetiopathogenesis of adolescent idiopathic scoliosis (AIS) remains unexplored. We evaluated morphological features of the sternum for the first time in individuals with AIS. METHODS Medical records of a tertiary hospital were reviewed from 2010 to 2018 to identify adolescents with thoracic or thoracolumbar AIS. We included scoliotic patients between 14 and 18 years of age on radiologic evaluation without previous treatment for the disease. A complete history and 3D computed tomography (CT) scan were also prerequisites for study inclusion. We compared the shape and position of the sternum between adolescents with AIS and age-matched individuals as control. The control group was recruited with a random selection from patients attending hospital for extraskeletal reasons during the same period. Using CT, we evaluated the part of the sternum found in the right front quadrant of the axial plane at the level of the middle of the manubrium of the sternum and apical vertebra. We also provided an evidence-based theory of the sternum involvement in AIS aetiopathogenesis. RESULTS Twelve scoliotic patients with mean age 16.6 and mean Cobb angle 39.7 degrees were included in the study. No difference was found between groups at the level of the manubrium of the sternum (p =0.486). At the level of the apical vertebra, there was a significant difference of the part of sternum found in the right front quadrant of the axial plane between groups (95 % vs 56 %, p <0.001). CONCLUSIONS These are preliminary data demonstrating for the first-time morphological differences of the sternum, between AIS and age-matched non-scoliotic individuals. The sternum of adolescents with AIS was more inclined than non-scoliotic controls that could raise the hypothesis of sternum involvement in AIS pathogenesis. HIPPOKRATIA 2018, 22(4): 173-177.
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Affiliation(s)
- E Kenanidis
- Academic Orthopedic Department, Papageorgiou General Hospital, Aristotle University Thessaloniki, Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.)- Center of Interdisciplinary Research and Innovation (C.I.R.I.), Aristotle University Thessaloniki, Thessaloniki, Greece
| | - D I Athanasiadis
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.)- Center of Interdisciplinary Research and Innovation (C.I.R.I.), Aristotle University Thessaloniki, Thessaloniki, Greece
| | - G Geropoulos
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.)- Center of Interdisciplinary Research and Innovation (C.I.R.I.), Aristotle University Thessaloniki, Thessaloniki, Greece
| | - P Kakoulidis
- Academic Orthopedic Department, Papageorgiou General Hospital, Aristotle University Thessaloniki, Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.)- Center of Interdisciplinary Research and Innovation (C.I.R.I.), Aristotle University Thessaloniki, Thessaloniki, Greece
| | - M Potoupnis
- Academic Orthopedic Department, Papageorgiou General Hospital, Aristotle University Thessaloniki, Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.)- Center of Interdisciplinary Research and Innovation (C.I.R.I.), Aristotle University Thessaloniki, Thessaloniki, Greece
| | - E Tsiridis
- Academic Orthopedic Department, Papageorgiou General Hospital, Aristotle University Thessaloniki, Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.)- Center of Interdisciplinary Research and Innovation (C.I.R.I.), Aristotle University Thessaloniki, Thessaloniki, Greece
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