Diagnosing and Treating Popliteal Tendinopathy After Total Knee Arthroplasty

Abstract

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.

Knee Arthroscopy After Prior Total Knee ArthroplastyType of Study: Narrative Review

“…An examination maneuver to reproduce these symptoms has been described in which the patient is positioned in the decubitus position with the affected leg facing upward and then is asked to abduct the affected thigh into the air with the knee in extension and to then flex the knee to 90° of flexion while maintaining an abducted position with the leg. 30 Ultrasonography-guided cortisone injections can also be used as a diagnostic tool for popliteus tendon dysfunction. 29…”