Popliteus strain: Difference between revisions

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== Introduction  ==
== Introduction  ==


[[Popliteus Muscle|Popliteus]] muscle injuries are rarely  isolated injuries and are mostly associated with other injuries of the posterolateral corner of the knee such as [[Lateral Collateral Ligament Injury of the Knee|lateral collateral ligament injury]][[Anterior Cruciate Ligament (ACL) Reconstruction|, Anterior cruciate ligament injury]] , [[Posterior Cruciate Ligament Injury|posterior cruciate ligament injury]] or [[Meniscal Lesions|meniscal tear]].[1]  
[[Popliteus Muscle|Popliteus]] muscle injuries are rarely  isolated injuries and are mostly associated with other injuries of the posterolateral corner of the knee such as [[Lateral Collateral Ligament Injury of the Knee|lateral collateral ligament injury]][[Anterior Cruciate Ligament (ACL) Reconstruction|, Anterior cruciate ligament injury]] , [[Posterior Cruciate Ligament Injury|posterior cruciate ligament injury]] or [[Meniscal Lesions|meniscal tear]].<ref name=":4">Morrissey CD, Knapik DM. Prevalence, Mechanisms, and Return to Sport After Isolated Popliteus Injuries in Athletes: A Systematic Review. Orthop J Sports Med 2022.10(2): 23259671211073617</ref>  


== Clinically Relevant Anatomy  ==
== Clinically Relevant Anatomy  ==
[[File:Popliteus Muscle.jpg|right|alt=|500x500px]]
[[File:Popliteus Muscle.jpg|right|alt=|500x500px]]
<br>The [[Popliteus Muscle]] tendinous unit is unique in that the distal muscular attachment is designated the insertion and the tendinous proximal (femoral) attachment is designated the origin. The muscle inserts into a triangular area along the posteromedial aspect of the proximal tibial metaphysic above the soleal line. It forms the floor of the popliteus fossa. The tendon of the popliteus passes through the popliteal hiatus, entering the knee joint and inserting into the lateral femoral condyle at the end of the popliteal sulcus. The main tendinous component inserts into the lateral femoral condyle with variable aponeurotic attachments to the posterior horn of the lateral meniscus and the fibular head<ref name=":1">Guha AR, Gorgees KA, Walker DI. Popliteus tendon rupture: a case report and review of the literature. British journal of sports medicine. 2003 Aug 1;37(4):358-60.</ref>.  The insertion into the lateral meniscus retracts and protects the meniscus in flexion, but this function has been disputed. The femoral insertion has a crescent shape, with the superior aspect being concave.<ref>Fox AJ, Bedi A, Rodeo SA. The basic science of human knee menisci: structure, composition, and function. Sports health. 2012 Jul;4(4):340-51.</ref> The main tendon of the popliteus muscle consists of anterior and posterior fibers.<ref>Watanabe Y, Moriya H, Takahashi K, Yamagata M, Sonoda M, Shimada Y, Tamaki T. Functional anatomy of the posterolateral structures of the knee. Arthroscopy. 1993 Feb 1;9(1):57-62.</ref>  The popliteus muscle is innervated by '''[[Tibial Nerve|tibial nerves]] (L4-L5 and S1).'''   
<br>The [[Popliteus Muscle]] tendinous unit is unique in that the distal muscular attachment is designated the insertion and the tendinous proximal (femoral) attachment is designated the origin. The muscle inserts into a triangular area along the posteromedial aspect of the proximal tibial metaphysic above the soleal line. It forms the floor of the popliteus fossa. The tendon of the popliteus passes through the popliteal hiatus, entering the knee joint and inserting into the lateral femoral condyle at the end of the popliteal sulcus. The main tendinous component inserts into the lateral femoral condyle with variable aponeurotic attachments to the posterior horn of the lateral meniscus and the fibular head<ref name=":1">Guha AR, Gorgees KA, Walker DI. Popliteus tendon rupture: a case report and review of the literature. British journal of sports medicine. 2003 Aug 1;37(4):358-60.</ref>.  The insertion into the lateral meniscus retracts and protects the meniscus in flexion, but this function has been disputed. The femoral insertion has a crescent shape, with the superior aspect being concave.<ref>Fox AJ, Bedi A, Rodeo SA. The basic science of human knee menisci: structure, composition, and function. Sports health. 2012 Jul;4(4):340-51.</ref> The main tendon of the popliteus muscle consists of anterior and posterior fibers.<ref>Watanabe Y, Moriya H, Takahashi K, Yamagata M, Sonoda M, Shimada Y, Tamaki T. Functional anatomy of the posterolateral structures of the knee. Arthroscopy. 1993 Feb 1;9(1):57-62.</ref>  The popliteus muscle is innervated by '''[[Tibial Nerve|tibial nerves]] (L4-L5 and S1).'''The popliteus tendon is intra-capsular but extra-articular and extra synovial.<ref name=":5">Siddharth P. Jadhav, Snehal R. More, Roy F. Riascos, Diego F. Lemos, and Leonard E. Swischuk. Comprehensive Review of the Anatomy, Function, and Imaging of the Popliteus and Associated Pathologic Conditions. RadioGraphics 2014 34:2, 496-513
</ref>  


== Functions of the Politeus Muscle at the Knee joint==
== Politeus muscle Function ==
The popliteus muscle has both static and dynamic function at the knee joint.  
The popliteus muscle has both static and dynamic function at the knee joint.  


<u>Dynamic function</u>s : During initial flexion of the knee, it initiates and maintains the internal rotation of the tibia on the femur (unlocking of knee joint) and  prevents forward dislocation of the femur on the tibia.
Dynamic functions : During initial flexion of the knee, it initiates and maintains the internal rotation of the tibia on the femur (unlocking of knee joint) and  prevents forward dislocation of the femur on the tibia.


It acts as a secondary restraint to posterior displacement of the tibia in PCL deficient knees and is an important <u>Static Stabilizer</u> of the posterolateral corner of the knee. (AR gurha popliteus tendon rupture , case report)
It acts as a secondary restraint to posterior displacement of the tibia in PCL deficient knees and is an important Static Stabilizer of the posterolateral corner of the knee. <ref name=":1" />


The popliteus muscle functions as a dynamic internal rotator of the tibia. For this reason rupture of the popliteus muscle is usually associated with acute of the chronic posterolateral instability of the knee.  The isolated rupture of the popliteus tendon musculotendinous unit is an uncommon injury. <ref>Mariani PP, Margheritini F. Partial isolated rupture of the popliteus tendon in a professional soccer player: a case report. BMC Sports Science, Medicine and Rehabilitation. 2009 Dec;1(1):18.</ref> If isolated injury presents without significant instability.<ref>Guha AR, Gorgees KA, Walker DI. Popliteus tendon rupture: a case report and review of the literature. British journal of sports medicine. 2003 Aug 1;37(4):358-60.</ref><br>In some cases the injury is extensive and may include disruption of the arcuate ligament complex, the lateral collateral ligament, both cruciates, and the menisci.<ref>Guha AR, Gorgees KA, Walker DI. Popliteus tendon rupture: a case report and review of the literature. British journal of sports medicine. 2003 Aug 1;37(4):358-60.</ref>  <br><br>
{{#ev:youtube|rsFDUC_dLzM}}


==Mechanism of Injury==
==Mechanism of Injury==


# <u>Contact Injuries / Traumatic Injuries</u>
# Contact/ Traumatic Injuries - Forced external rotation of the tibia on a partially flexed knee, falls onto an extended knee or forced hyperextension.<ref name=":4" />
 
# Non-Contact/Non-Traumatic Injuries - Forced external rotation of the tibia with an associated varus force applied to a fixed tibia<ref name=":4" />
Forced external rotation with application of varus force with a fixed femur
 
2.<u>Non-Contact Injuries/ Non-traumatic Injuries</u>
 
External rotation Mechanism- A sudden external rotation of the partially flexed knee
 
{{#ev:youtube|omBeUCfyXrU}}
 
 
== Characteristics/Clinical Presentation  ==


Lesions have been reported occurring by a non -contact external rotational mechanism: a sudden external rotation to a partially flexed knee<ref>Mariani PP, Margheritini F. Partial isolated rupture of the popliteus tendon in a professional soccer player: a case report. BMC Sports Science, Medicine and Rehabilitation. 2009 Dec;1(1):18.</ref> ,A forced external rotation with a varus force application in some cases, or a forced external rotation with femur fixed have been described. Considering the type of tear, an overuse or degenerative mechanism could be considered as responsible for the partial tear<ref>Popliteus tendon rupture. Case report and review of the literature.
{{#ev:youtube|omBeUCfyXrU}}<ref>Brian Sutterer MD. CJ McCollum INJURY | Popliteus Strain Explained by Doctor. Available from: https://www.youtube.com/watch?v=omBeUCfyXrU </ref>
Rose DJ, Parisien JS
Clin Orthop Relat Res. 1988 Jan; (226):113-7
</ref><ref name=":2">Isolated rupture of the popliteus tendon in a professional athlete.
Burstein DB, Fischer DA
Arthroscopy. 1990; 6(3):238-41.
</ref><ref name=":3">solated avulsion of the popliteus tendon. A case report.
Mirkopulos N, Myer TJ
Am J Sports Med. 1991 Jul-Aug; 19(4):417-9.
</ref>


Clinically the affected patients present with an unnatural outward rotation of the tibia when bending the knee. Additionally ,other general symptoms often occur such as muscle swelling, edema or bleeding<ref name=":0">Kenhub.Popliteus Muscle. https://www.kenhub.com/en/library/anatomy/popliteus-muscle (accessed on 12 June 2018)</ref>
== Clinical Presentation ==


* Pain over the lateral joint line  
* Pain over the lateral joint line  
* Pain at the back of the knee
* Pain at the back of the knee
* Pain on weight-bearing and stair-climbing
* Pain on weight-bearing and stair-climbing
* Incomplete Range of motion for flexion and extension<br><br>
* Incomplete Range of motion  


==Types of Injuries==
==Types of Injuries==
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== Differential Diagnosis  ==
== Differential Diagnosis  ==
# Biceps femoris tendon strain<ref>Study. Biceps Femoris Strain, Tear or Rupture: Symptoms & Treatment. https://study.com/academy/lesson/biceps-femoris-strain-tear-or-rupture-symptoms-treatment.html (accessed on 12 June 2018)
# Biceps femoris tendon strain
</ref>
# [[Meniscal Lesions|Lateral meniscus Injury]]
# [[Meniscal Lesions|Lateral meniscus Injury]]
# [[Lateral Collateral Ligament Injury of the Knee|Lateral collateral ligament injury]]
# [[Lateral Collateral Ligament Injury of the Knee|Lateral collateral ligament injury]]
Line 81: Line 55:


== Diagnostic Procedures  ==
== Diagnostic Procedures  ==
Complete tears of muscle can be clinically identified however the popliteus muscle is an exception. It is difficult to identify which structure of posterolateral complex is injured and therefore MRI is the preferred diagnostic tool.
Complete tears of muscle can be clinically identified however the popliteus muscle is an exception. It is difficult to identify which structure of posterolateral complex is injured and therefore MRI is the preferred diagnostic tool.<ref name=":5" />
 
{{#ev:youtube|5SvXbVETrBk}}
 
<br>An acute haemarthrosis and lateral pain in a stable knee should lead to suspicion of an isolated injury to the popliteus muscle-tendon unit.<ref>9 Nakhostine M, Perko M, Cross M. Isolated avulsion of the popliteus tendon. J Bone Joint Surg [Br] 1995;77:242–4. </ref> The diagnosis should be entertained in any acutely swollen knee with posterolateral tenderness and pain on resisted internal tibial rotation.<ref>Rose DJ, Parisien JS. Popliteus tendon rupture. Case report and review of the literature. Clin Orthop 1988;226:113–17.</ref> <br>MRI of the knee should be performed to evaluate the nature of the injury. The diagnosis may be confirmed by arthroscopic examination of the knee. <br>In some cases, the ruptured popliteus tendon retracts distally through the popliteal hiatus and can no longer be seen in the joint<ref>Naver L, Aalberg JR. Avulsion of the popliteus tendon: a rare cause of chondral fracture and hemarthrosis. Am J Sports Med 1985;13:423–4</ref><ref>Garth WP, Martin MP, Merrill KD. Isolated avulsion of the popliteus tendon: operative repair. J Bone Joint Surg [Am] 1992;74:130–2.</ref><ref>Rose DJ, Parisien JS. Popliteus tendon rupture. Case report and review of the literature. Clin Orthop 1988;226:113–17.</ref>.


{{#ev:youtube|5SvXbVETrBk}}<ref>First Look MRI. Popliteus tendon tear. Available from: https://www.youtube.com/watch?v=5SvXbVETrBk</ref>
=== Diagnostic Test ===
=== Diagnostic Test ===
1. Garrick Test
1. Garrick Test
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This test is where pain is felt when trying to remove the shoe on the other side of the affected knee. This motion requires internal rotation of the affected leg to reach the heel of the other leg and can cause pain during the maneuver when there is injury to the popliteus muscle.
This test is where pain is felt when trying to remove the shoe on the other side of the affected knee. This motion requires internal rotation of the affected leg to reach the heel of the other leg and can cause pain during the maneuver when there is injury to the popliteus muscle.
[[Knee outcome survey]] can be used as an outcome measure


== Examination  ==
== Examination  ==
Clinically the affected patients present with an unnatural outward rotation of the tibia when bending the knee. Additionally, other general symptoms often occur such as muscle swelling, edema or bleeding<ref name=":0" />
Clinically the affected patients present with an unnatural outward rotation of the tibia when bending the knee. Additionally, other general symptoms often occur such as muscle swelling, edema or bleeding<ref name=":0">Kenhub.Popliteus Muscle. https://www.kenhub.com/en/library/anatomy/popliteus-muscle (accessed on 12 June 2018)</ref>


Only a portion of the popliteus can be safely palpated due to the neurovascular structures that overlie it. The attachment on the tibial shaft can usually be reached as well as the tendon at the femoral condyle.
Only a portion of the popliteus can be safely palpated due to the neurovascular structures that overlie it. The attachment on the tibial shaft can usually be reached as well as the tendon at the femoral condyle.
Rest described above in diagnostic tests.
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<div class="row">
<div class="row">
   <div class="col-md-6"> {{#ev:youtube|wDIGll5wzZs}} </div>
   <div class="col-md-6"> {{#ev:youtube|6qvuuyqrpio}} <div class="text-right"><ref>The Knee Resource. Posterior Drawer Test. Available from: http:https://www.youtube.com/watch?v=6qvuuyqrpio</ref></div></div>
 
  <div class="col-md-6"> {{#ev:youtube|ozaqvtXIV2g}} <div class="text-right"><ref>The Knee Resource. Prone Dial Test. Available from: https://www.youtube.com/watch?v=ozaqvtXIV2g</ref></div></div>
<div class="col-md-6"> {{#ev:youtube|3UGffd71KyI}}</div>
</div>
</div>


== Medical Management  ==
== Medical Management  ==
Medical management as line with other muscle injuries as it is mostly associate with other ligament and meniscus injuries guideline is [[RICE]] with anti-inflammatory drugs with analgesic medicines.In case of sever associate injury arthroscopic repair/reconstruction may require.
# [[Popliteus Tendinopathy|Popliteal tendon tenosynovitis Management]]
 
# Popliteal Tendon Avulsion - If an isolated popliteal  is confirmed by MRI imaging , conservative management with a long knee brace , early weight bearing and early range of motion for three months. If conservative management fails , a delayed repair of the popliteal tendon with miniscrews or suture anchors can be performed.<ref name=":6">Anneara P, Arora M. Isolated popliteal tendon avulsions: Current understanding and approach to management. Journal of Arthroscopy and Joint Surgery 2018;5(3):145-148</ref>
# Popliteal tendon tenosynovitis Management  
# Popliteal Tendon Tear -Tears are treated either conservatively or open surgical procedures such as repair or reattachment with screws or anchors or arthroscopic approaches.
# Popliteal Tendon Avulsion - If an isolated popliteal  is confirmed by MRI imaging , conservative management with a long knee brace , early weight bearing and early range of motion for three months. If conservative management fails , a delayed repair of the popliteal tendon with miniscrews or suture anchors can be performed.
# Popliteal Tendon Tear -_ Tears are treated either conservatively or open surgical procedures such as repair or reattachment with screws or anchors or arthroscopic approaches.  


#  
#  


==  Physical Therapy Management    ==
==  Physical Therapy Management    ==
There is no protoccol outined for popliteus rehabilitation. However , certain studies followed non operative treatment with the following protocol. The rehabilitation period included the medial rotation strengthening of the knee in varying degrees of flexion, hamstring exercises, dynamic and static proprioception training and progressive activity involving straight-line, agility and resisted running.
Non-operative Management
 
Isolated popliteal injuries rarely lead to knee instability and usually non-operative management is advocated involving early weight bearing and functional rehabilitation. However, there is no specific protocol outlined for non-operative rehabilitation.<ref name=":4" />


{{#ev:youtube|1UOP7h0eH_8}}
Rehabilitation could include :


Popliteus Strengthening exercises  
* Cryotherapy
* Bracing
* Knee range of motion exercises
* Strengthening exercises of the gastrocnemius , hamstrings , quadriceps and popliteus muscles
* Static and Dynamic proprioceptive training
* Agility<ref name=":4" />
[[File:Popliteus rehab.png|center|458x458px]]


{{#ev:youtube|Z7ejqgNi8u0}}
# The non-weight bearing exercise as depicted in the figure can be performed with or without the resistance band. It enables external rotation of the hip joint and promotes gluteal activity and internal rotation of tibia. It should be performed quickly during the concentric phase and in a slow controlled way in the eccentric phase.
# Open chain prone knee flexion with internal rotation of tibia using a band
# Open chain prone knee isometrics using manual resistance with tibial internal rotation<ref>Joseph J,P H S, Ms K.Role of popliteus muscle retraining in knee rehabilitation 2017;2</ref>


# The non-weight bearing exercise as depicted in figure can be performed with or without the resistance band. It enables external rotation of the hip joint and promotes gluteal activity and internal rotation of tibia. It should be performed quickly during the concentric phase and in a slow controlled way in the eccentric phase.
<div class="row">
# A slightly different exercise performedad bearing position (Figure 4) uses a step of approximately 5-15cm, which is skid proof. The position of the stance leg on the step should be approximately 20-40 degrees knee flexion as a series of stepping tasks are carried out. Figure 4 outlines the different processes the leg steps into: A) With the leg off the step  B) Stepping forwards and off the step into a crossover position  C) Returning to the starting position as in picture A  D) Stepping straight forwards as in a forward lunge  E) A side lunge out to the side
  <div class="col-md-6"> {{#ev:youtube|1UOP7h0eH_8}} <div class="text-right"><ref>Austin Fit Magazine. Agility T Test. Available from:https://www.youtube.com/watch?v=1UOP7h0eH_8 </ref></div></div>
  <div class="col-md-6"> {{#ev:youtube|Z7ejqgNi8u0}} <div class="text-right"><ref>James Chung. Knee Internal Rotation: How to Isolate the Popliteus. Available from: https://www.youtube.com/watch?v=Z7ejqgNi8u0</ref></div></div>
</div>


The treatment of isolated popliteus tendon ruptures has not been very well defined. Review <ref>Ranawat A, Baker III CL, Henry S, Harner CD. Posterolateral corner injury of the knee: evaluation and management. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2008 Aug 1;16(8):506-18.</ref>(Method: MRI, Arthroscopy; Keywords: Popliteus tendon, rupture)of the literature shows 15 cases. Four were treated conservatively, in one case the avulsed chondral fragment was excised without repair of the popliteus tendon. In the remaining 10 cases, there was an osteochondral fracture as a result of avulsion of the tendon from the femoral attachment, and this fragment was reposited and fixed with screws.


Initial protocol is [[POLICE Principle]] (Protection,optimal loading,Rest,EIce,Compression.elevation)<br>Physiotherapy treatment is on a line with other soft tissues and muscle injuries, mobility exercises,  ,,strengthening exercis, eccentricic training and many more rehab protocols depending upon patholo, associatede injuriesandd patients condition.
Operative Management


'''spray-and-stretch techniques''', as described by Travell & Simons (1992),  if trigger point of pain present may be effective<ref>Travell JG, Simons DG. Myofascial pain and dysfunction, vols 1 and 2. Baltimore: Williams and Wilkins. 1992.</ref>  
* Post-operative functional knee bracing for 2 to 4 weeks
* Weight-bearing restrictions
* Knee range of motion exercises
* Quadriceps and hamstring setting exercises
* Progresssion of strengthening exercises , proprioceptive training<ref name=":4" />


== Case Reports    ==


A.R.Guha, K.A. Gorgees, D.I. Walker: Popliteus tendon rupture: a case report and review of the literature. Br. J. Sports Med 2003; 37:358-360<ref name=":1" />
== Resources ==
{{#ev:youtube|rsFDUC_dLzM}}<ref>Kenhub-Learn Human Anatomy. Functions of the popliteus muscle (preview) - 3D Human Anatomy | Kenhub. Available from: https://www.youtube.com/watch?v=rsFDUC_dLzM </ref>


Isolated rupture of the popliteus tendon in a professional athlete. Burstein DB, Fischer DA Arthroscopy. 1990; 6(3):238-41. <ref name=":2" />


Isolated avulsion of the popliteus tendon. A case report. Mirkopulos N, Myer TJ Am J Sports Med. 1991 Jul-Aug; 19(4):417-9<ref name=":3" />.<br>
== References  ==


== References ==
<references />  
<references />  



Latest revision as of 18:43, 17 March 2023



Introduction[edit | edit source]

Popliteus muscle injuries are rarely isolated injuries and are mostly associated with other injuries of the posterolateral corner of the knee such as lateral collateral ligament injury, Anterior cruciate ligament injury , posterior cruciate ligament injury or meniscal tear.[1]

Clinically Relevant Anatomy[edit | edit source]


The Popliteus Muscle tendinous unit is unique in that the distal muscular attachment is designated the insertion and the tendinous proximal (femoral) attachment is designated the origin. The muscle inserts into a triangular area along the posteromedial aspect of the proximal tibial metaphysic above the soleal line. It forms the floor of the popliteus fossa. The tendon of the popliteus passes through the popliteal hiatus, entering the knee joint and inserting into the lateral femoral condyle at the end of the popliteal sulcus. The main tendinous component inserts into the lateral femoral condyle with variable aponeurotic attachments to the posterior horn of the lateral meniscus and the fibular head[2]. The insertion into the lateral meniscus retracts and protects the meniscus in flexion, but this function has been disputed. The femoral insertion has a crescent shape, with the superior aspect being concave.[3] The main tendon of the popliteus muscle consists of anterior and posterior fibers.[4] The popliteus muscle is innervated by tibial nerves (L4-L5 and S1).The popliteus tendon is intra-capsular but extra-articular and extra synovial.[5]

Politeus muscle Function[edit | edit source]

The popliteus muscle has both static and dynamic function at the knee joint.

Dynamic functions : During initial flexion of the knee, it initiates and maintains the internal rotation of the tibia on the femur (unlocking of knee joint) and prevents forward dislocation of the femur on the tibia.

It acts as a secondary restraint to posterior displacement of the tibia in PCL deficient knees and is an important Static Stabilizer of the posterolateral corner of the knee. [2]


Mechanism of Injury[edit | edit source]

  1. Contact/ Traumatic Injuries - Forced external rotation of the tibia on a partially flexed knee, falls onto an extended knee or forced hyperextension.[1]
  2. Non-Contact/Non-Traumatic Injuries - Forced external rotation of the tibia with an associated varus force applied to a fixed tibia[1]

[6]

Clinical Presentation[edit | edit source]

  • Pain over the lateral joint line
  • Pain at the back of the knee
  • Pain on weight-bearing and stair-climbing
  • Incomplete Range of motion

Types of Injuries[edit | edit source]

  • Popliteus Tendon Avulsion
  • Popliteus Tendon Tear (Partial/ Complete)

Differential Diagnosis[edit | edit source]

  1. Biceps femoris tendon strain
  2. Lateral meniscus Injury
  3. Lateral collateral ligament injury
  4. Tibial nerve injury

Diagnostic Procedures[edit | edit source]

Complete tears of muscle can be clinically identified however the popliteus muscle is an exception. It is difficult to identify which structure of posterolateral complex is injured and therefore MRI is the preferred diagnostic tool.[5]

[7]

Diagnostic Test[edit | edit source]

1. Garrick Test

Patient seated, hip and knee are both flexed to 90°. The patient actively externally rotates the lower leg and this is resisted by the examiner. A positive test is pain during the maneuver in the location of the popliteus muscle or tendon.

2. Shoe Removal Maneuver

This test is where pain is felt when trying to remove the shoe on the other side of the affected knee. This motion requires internal rotation of the affected leg to reach the heel of the other leg and can cause pain during the maneuver when there is injury to the popliteus muscle.

Examination[edit | edit source]

Clinically the affected patients present with an unnatural outward rotation of the tibia when bending the knee. Additionally, other general symptoms often occur such as muscle swelling, edema or bleeding[8]

Only a portion of the popliteus can be safely palpated due to the neurovascular structures that overlie it. The attachment on the tibial shaft can usually be reached as well as the tendon at the femoral condyle.

POSTERIOR KNEE JOINT ASSESMENT
Patient should be assessed in supine and prone lying. Pain or ‘a feeling of fullness’ in the posterior knee can be the sign of a joint effusion.
Active and passive range of movement of the knee joint should be assessed in flexion, extension and tibio-femoral rotation.
Manual muscle testing of knee flexion should be performed with the knee joint positioned in both neutral and external rotation.
Palpation of the joint line, the tendons of the hamstrings, gastrocnemius and the popliteus should be carried out.
The posterior draw tests to check the integrity of the Posterior cruciate ligament.
Posterolateral rotational stability of the knee should be checked using either the recurvatum test , reverse pivot shift or dial test. Isolated popliteus injuries do not cause significant posterolateral rotational instability as compared to injuries to the posterolateral corner of the knee.

Medical Management[edit | edit source]

  1. Popliteal tendon tenosynovitis Management
  2. Popliteal Tendon Avulsion - If an isolated popliteal is confirmed by MRI imaging , conservative management with a long knee brace , early weight bearing and early range of motion for three months. If conservative management fails , a delayed repair of the popliteal tendon with miniscrews or suture anchors can be performed.[11]
  3. Popliteal Tendon Tear -Tears are treated either conservatively or open surgical procedures such as repair or reattachment with screws or anchors or arthroscopic approaches.

Physical Therapy Management[edit | edit source]

Non-operative Management

Isolated popliteal injuries rarely lead to knee instability and usually non-operative management is advocated involving early weight bearing and functional rehabilitation. However, there is no specific protocol outlined for non-operative rehabilitation.[1]

Rehabilitation could include :

  • Cryotherapy
  • Bracing
  • Knee range of motion exercises
  • Strengthening exercises of the gastrocnemius , hamstrings , quadriceps and popliteus muscles
  • Static and Dynamic proprioceptive training
  • Agility[1]
Popliteus rehab.png
  1. The non-weight bearing exercise as depicted in the figure can be performed with or without the resistance band. It enables external rotation of the hip joint and promotes gluteal activity and internal rotation of tibia. It should be performed quickly during the concentric phase and in a slow controlled way in the eccentric phase.
  2. Open chain prone knee flexion with internal rotation of tibia using a band
  3. Open chain prone knee isometrics using manual resistance with tibial internal rotation[12]


Operative Management

  • Post-operative functional knee bracing for 2 to 4 weeks
  • Weight-bearing restrictions
  • Knee range of motion exercises
  • Quadriceps and hamstring setting exercises
  • Progresssion of strengthening exercises , proprioceptive training[1]


Resources[edit | edit source]

[15]


References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Morrissey CD, Knapik DM. Prevalence, Mechanisms, and Return to Sport After Isolated Popliteus Injuries in Athletes: A Systematic Review. Orthop J Sports Med 2022.10(2): 23259671211073617
  2. 2.0 2.1 Guha AR, Gorgees KA, Walker DI. Popliteus tendon rupture: a case report and review of the literature. British journal of sports medicine. 2003 Aug 1;37(4):358-60.
  3. Fox AJ, Bedi A, Rodeo SA. The basic science of human knee menisci: structure, composition, and function. Sports health. 2012 Jul;4(4):340-51.
  4. Watanabe Y, Moriya H, Takahashi K, Yamagata M, Sonoda M, Shimada Y, Tamaki T. Functional anatomy of the posterolateral structures of the knee. Arthroscopy. 1993 Feb 1;9(1):57-62.
  5. 5.0 5.1 Siddharth P. Jadhav, Snehal R. More, Roy F. Riascos, Diego F. Lemos, and Leonard E. Swischuk. Comprehensive Review of the Anatomy, Function, and Imaging of the Popliteus and Associated Pathologic Conditions. RadioGraphics 2014 34:2, 496-513
  6. Brian Sutterer MD. CJ McCollum INJURY | Popliteus Strain Explained by Doctor. Available from: https://www.youtube.com/watch?v=omBeUCfyXrU
  7. First Look MRI. Popliteus tendon tear. Available from: https://www.youtube.com/watch?v=5SvXbVETrBk
  8. Kenhub.Popliteus Muscle. https://www.kenhub.com/en/library/anatomy/popliteus-muscle (accessed on 12 June 2018)
  9. The Knee Resource. Posterior Drawer Test. Available from: http:https://www.youtube.com/watch?v=6qvuuyqrpio
  10. The Knee Resource. Prone Dial Test. Available from: https://www.youtube.com/watch?v=ozaqvtXIV2g
  11. Anneara P, Arora M. Isolated popliteal tendon avulsions: Current understanding and approach to management. Journal of Arthroscopy and Joint Surgery 2018;5(3):145-148
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  13. Austin Fit Magazine. Agility T Test. Available from:https://www.youtube.com/watch?v=1UOP7h0eH_8
  14. James Chung. Knee Internal Rotation: How to Isolate the Popliteus. Available from: https://www.youtube.com/watch?v=Z7ejqgNi8u0
  15. Kenhub-Learn Human Anatomy. Functions of the popliteus muscle (preview) - 3D Human Anatomy | Kenhub. Available from: https://www.youtube.com/watch?v=rsFDUC_dLzM