Diagnosing and Treating Popliteal Tendinopathy After Total Knee Arthroplasty
The following office tip describes four patients that underwent primary total knee arthroplasty and developed posterolateral knee pain at a mean follow-up duration of 1.6 months postoperatively. The first patient in this series noted substantial pain lying in bed (in a lateral decubitus position with the operative leg up) while attempting to abduct her leg to adjust her sheet in bed. A thorough clinical and radiographic work-up was performed. This patient’s posturing in bed (and subsequent physical exam maneuver) led to a presumptive diagnosis of popliteal tendinopathy. The diagnosis was confirmed arthroscopically by identifying a frayed and inflamed popliteal tendon. After undergoing arthroscopic popliteal tendon release, the patient noted complete pain relief while retaining coronal stability in both flexion and extension. The following office tip defines a previously undescribed clinical diagnostic examination for popliteal tendinopathy that was identified based on a patient’s symptomatology and subsequently utilized to identify three additional cases of arthroscopically confirmed popliteal tendinopathy.
Gandhi R, Davey JR, Mahomed NN. Predicting patient dissatisfaction following joint replacement surgery. J Rheumatol. 2008;35(12):2415-2418. doi:10.3899/jrheum.080295.
Dennis DA. Evaluation of painful total knee arthroplasty. J Arthroplasty. 2004;19(4 Suppl 1):35-40. http://www.ncbi.nlm.nih.gov/pubmed/15190547. Accessed June 17, 2016.
Potty AGR, Tzeng TH, Sams JD, et al. Diagnosis and Management of Intra-articular Causes of Pain After Total Knee Arthroplasty. Instr Course Lect. 2015;64:389-401. http://www.ncbi.nlm.nih.gov/pubmed/25745923. Accessed June 17, 2016.
Barnes CL, Scott RD. Popliteus tendon dysfunction following total knee arthroplasty. J Arthroplasty. 1995;10(4):543-545. http://www.ncbi.nlm.nih.gov/pubmed/8523017. Accessed May 2, 2016.
Allardyce TJ, Scuderi GR, Insall JN. Arthroscopic treatment of popliteus tendon dysfunction following total knee arthroplasty. J Arthroplasty. 1997;12(3):353-355. http://www.ncbi.nlm.nih.gov/pubmed/9113555. Accessed June 17, 2016.
Nielsen S, Helmig P. The static stabilizing function of the popliteal tendon in the knee. An experimental study. Arch Orthop Trauma surgery Arch für orthopädische und Unfall-Chirurgie. 1986;104(6):357-362. http://www.ncbi.nlm.nih.gov/pubmed/3964042. Accessed June 17, 2016.
Manning BT, Lewis N, Tzeng TH, et al. Diagnosis and Management of Extra-articular Causes of Pain After Total Knee Arthroplasty. Instr Course Lect. 2015;64:381-388. http://www.ncbi.nlm.nih.gov/pubmed/25745922. Accessed June 17, 2016.
Westermann RW, Daniel JW, Callaghan JJ, Amendola A. Arthroscopic Management of Popliteal Tendon Dysfunction in Total Knee Arthroplasty. Arthrosc Tech. 2015;4(5):e565-e568. doi:10.1016/j.eats.2015.06.006.
de Simone V, Demey G, Magnussen RA, Lustig S, Servien E, Neyret P. Iatrogenic popliteus tendon injury during total knee arthroplasty results in decreased knee function two to three years postoperatively. Int Orthop. 2012;36(10):2061-2065. doi:10.1007/s00264-012-1631-5.
Kesman TJ, Kaufman KR, Trousdale RT. Popliteus tendon resection during total knee arthroplasty: an observational report. Clin Orthop Relat Res. 2011;469(1):76-81. doi:10.1007/s11999-010-1525-z.
Copyright (c) 2017 J. Ryan Martin, Allison Fout, Andrew C Stoeckl, Douglas A Dennis
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.