Isolated Popliteus Tendon Avulsion: Fully Arthroscopic Repair with Suture Anchor: A Case Report

Most Publications Regarding Arthroscopic Treatment of Posterolateral Corner Injuries of the Knee Have a Low Level of Evidence and Provide Limited Information to Determine the Most Effective Treatment

Purpose

To examine the Level of Evidence and overall quality of studies addressing arthroscopic posterolateral corner reconstructions of the knee.

Methods

A search was performed using the PubMed/Medline, Web of Science, and Google Scholar databases for all studies investigating arthroscopic treatment of posterolateral corner injuries of the knee. Studies reporting outcomes or describing arthroscopic techniques for treatment of posterolateral corner injuries of the knee were the focus of this analysis. Clinical as well as biomechanical and cadaveric studies were included. Studies only investigating open techniques were excluded. Two independent reviewers determined the level of evidence for each included study using the criteria established by the Journal of Bone and Joint Surgery and scored each clinical study from 0 to 100 based on 10 criteria from the modified Coleman Methodology Score.

Results

Twenty-four studies matched the inclusion criteria. There were 6 cadaveric technique descriptions, 6 clinical technique descriptions, 3 biomechanical studies, 4 technical repair descriptions, and 5 clinical outcome studies. Thirty-eight percent of all studies were of Level V evidence. Fifty percent of studies were of Level IV evidence, and 12% of studies were of Level III evidence. The mean modified Coleman Methodology Score for the clinical studies was 43 ± 11.4, which is regarded as poor, mainly due to the limited number of patients and the retrospective nature of the studies.

Conclusions

Most studies addressing arthroscopic posterolateral corner reconstruction of the knee are of low level of evidence and provide limited information about the best treatment options.

Clinical Relevance

The number of publications on arthroscopic posterolateral corner reconstruction techniques continues to rise. This systematic review evaluates the level of evidence of these studies.

Isolated femoral avulsion of the popliteus tendon: a systematic review of the literature

The popliteus tendon is an important part of the posterolateral corner of the knee. Isolated injuries to the posterolateral corner are very rare, as most injuries occur in multiligamentous knee trauma. Purely isolated popliteus tendon injuries are even more rare. There is very little evidence for treatment of isolated popliteus tendon avulsion injuries. The aim of this systematic review is to report on all publications regarding isolated popliteus tendon avulsion injuries and hopefully provide some guidance for future treatment algorithms. A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies were included if they documented isolated popliteus tendon avulsion injuries. Exclusion criteria were studies with popliteus injuries in combination with other knee ligamentous injuries and popliteus tendon injuries other than femoral avulsion injuries. Twenty-eight studies were included which mentioned in total 38 patients with isolated popliteus tendon avulsion injuries. 24 patients (63%) were treated operatively. 3 (8%) patients were diagnosed arthroscopically but did not receive any surgical treatment. 9 patients (24%) were treated conservatively. In two publications, there was no mention of treatment. We found no clear recommendations in the literature for treatment of this rare injury.

Open Popliteus Tendon Reconstruction Using a Hamstring Tendon Autograft

The popliteus tendon plays a critical role in restraining the tibia against external rotation. It is often injured in the setting of posterolateral corner injuries. However, it is rarely injured in isolation from other structures of the posterolateral corner. This Technical Note describes an open anatomic reconstruction of the popliteus tendon. Although several techniques exist, this technique has been biomechanically validated and shown to have good outcomes. An early rehabilitation protocol focused on protected range of motion, edema control, quadriceps strengthening, and pain control is essential for maximizing patient outcomes.

Prevalence, Mechanisms, and Return to Sport After Isolated Popliteus Injuries in Athletes: A Systematic Review

Background:

Injuries to the posterolateral corner of the knee are commonly reported in athletes, although the prevalence of isolated injuries to the popliteus in athletes is largely unknown.

Purpose:

To systematically review the literature to better understand the prevalence, mechanisms, sporting activities, tear characteristics, management, outcomes, and return-to-sport rate and timing in athletes who have sustained isolated popliteus injuries.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors searched the PubMed, OVID, MEDLINE, Biosis Previews, SPORTDiscus, PEDRO, and EMBASE databases for studies from January 1988 to August 2021 on athletes who sustained isolated popliteus injuries during sporting activities.

Results:

A total of 19 studies consisting of 27 athletes with isolated popliteus injuries sustained during sport were identified. The mean athlete age was 19.9 ± 10.5 years, while 89% (n = 24/27) were male. Traumatic/contact mechanisms were reported in 67% (n = 18/27) of injuries, with American football and soccer being the most common sports. Lateral-sided knee pain was the most frequent complaint, with 85% (n = 23/27) of athletes reporting swelling. Avulsion injuries off the lateral condyle were present in 67% (n = 18/27) of cases. Nonoperative management was performed in 52% (n = 14/27) of athletes. Operative treatment consisted primarily of arthroscopic or open fixation of the osseous fragment. When reported, all athletes successfully returned to sport at a mean of 10.8 ± 8.2 weeks after injury.

Conclusion:

Isolated injuries to the popliteus remain rarely reported in athletes, and athletes are typically evaluated after they experience forced external rotation of the tibia relative to the femur, present with lateral-sided knee pain and effusion, and undergo a stable ligamentous examination. Injuries occurred primarily in male athletes and were the result of traumatic/contact mechanisms, most commonly involving avulsion injuries off the lateral femoral condyle.