Effect of Radial Extracorporeal Shock Wave Therapy in Patients With Fabella Syndrome

Seol, Pyong-Hwa; Ha, Kang Wook; Kim, Yun Hee; Kwak, Ho-Jun; Park, Seung-Wan; Ryu, Byung-Ju

doi:10.5535/arm.2016.40.6.1124

Cited by 9 publications

(10 citation statements)

References 10 publications

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“…Nevertheless, two of such studies have selected articles published in a specific language [ 46 , 47 ]. In addition, other than patellar tendinopathy, most KSTDs have not been included in previous meta-analyses, such as pes anserine tendinopathy [ 48 ], fabella syndrome [ 49 , 50 ], popliteal cyamella [ 51 ], iliotibial band friction syndrome [ 52 ], infrapatellar fat pad syndrome [ 53 ], and posttraumatic tendon and ligament stiffness, which contribute to joint contracture [ 16 , 17 ]. Restrictions on language in the study inclusion criteria may result in a high risk of bias (i.e., language bias) in research areas such as alternative treatment (e.g., ESWT serves as an alternative to conservative medicine for musculoskeletal conditions) [ 54 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of extracorporeal shock wave therapy for knee tendinopathies and other soft tissue disorders: a meta-analysis of randomized controlled trials

Liao

Xie

Tsauo

et al. 2018

BMC Musculoskelet Disord

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BackgroundExtracorporeal shock-wave therapy (ESWT), which can be divided into radial shock-wave therapy (RaSWT) and focused shock-wave therapy (FoSWT), has been widely used in clinical practice for managing orthopedic conditions. The aim of this study was to determine the clinical efficacy of ESWT for knee soft tissue disorders (KSTDs) and compare the efficacy of different shock-wave types, energy levels, and intervention durations.MethodsWe performed a comprehensive search of online databases and search engines without restrictions on the publication year or language. We selected randomized controlled trials (RCTs) reporting the efficacy of ESWT for KSTDs and included them in a meta-analysis and risk of bias assessment. The pooled effect sizes of ESWT were estimated by computing odds ratios (ORs) with 95% confidence intervals (CIs) for the treatment success rate (TSR) and standardized mean differences (SMDs) with 95% CIs for pain reduction (i.e., the difference in pain relief, which was the change in pain from baseline to the end of RCTs between treatment and control groups) and for restoration of knee range of motion (ROM).ResultsWe included 19 RCTs, all of which were of high or medium methodological quality and had a Physiotherapy Evidence Database score of ≥5/10. In general, ESWT had overall significant effects on the TSR (OR: 3.36, 95% CI: 1.84–6.12, P < 0.0001), pain reduction (SMD: − 1.49, 95% CI: − 2.11 to − 0.87, P < 0.00001), and ROM restoration (SMD: 1.76, 95% CI: 1.43–2.09, P < 0.00001). Subgroup analyses revealed that FoSWT and RaSWT applied for a long period (≥1 month) had significant effects on pain reduction, with the corresponding SMDs being − 3.13 (95% CI: − 5.70 to − 0.56; P = 0.02) and − 1.80 (95% CI: − 2.52 to − 1.08; P < 0.00001), respectively. Low-energy FoSWT may have greater efficacy for the TSR than high-energy FoSWT, whereas the inverse result was observed for RaSWT.ConclusionsThe ESWT exerts an overall effect on the TSR, pain reduction, and ROM restoration in patients with KSTDs. Shock-wave types and application levels have different contributions to treatment efficacy for KSTDs, which must be investigated further for optimizing these treatments in clinical practice.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2204-6) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Efficacy of extracorporeal shock wave therapy for knee tendinopathies and other soft tissue disorders: a meta-analysis of randomized controlled trials

Liao

Xie

Tsauo

et al. 2018

BMC Musculoskelet Disord

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“…Pyong-Hwa Seol et al applied radial extracorporeal shock wave therapy(rESWT) as a new treatment for fabella syndrome [ 18 ]. Four patients of the report received rESWT(3000 shock waves with 12 Hz delivered at the intensity of 3–5 bar) at the fabella under ultrasoundgraphic guidance.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Fabella syndrome with arthroscopic fabellectomy: a case series and literature review

Weng

Chien

et al. 2021

BMC Musculoskelet Disord

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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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“…Dannawi et al 2010, Erichsen (1997), Kim et al (2018), Rankin, Rehman & Ashcroft (2018), Segal, Miller & Krauss (2004), Seol et al (2016), Weiner, Macnab & Turner (1977), Weiner & Macnab (1982) and Zipple, Hammer & Loubert (2003) and most patients (8/10) were able to fully return to pre-operative activity levels (Dekker et al, 2020). Exclusion of this bone has also led to a lack of research investigating the function of this bone.…”

Section: Clinical Issues Condition Sourcementioning

confidence: 99%

Unique myological changes associated with ossified fabellae: a femorofabellar ligament and systematic review of the double-headed popliteus

Berthaume

Barnes

Athwal

et al. 2020

PeerJ

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Introduction The fabella is a sesamoid bone embedded in the tendon of the lateral head of the gastrocnemius. It is the only bone in the human body to increase in prevalence in the last 100 years. As the fabella can serve as an origin/insertion for muscles, tendons, and/or ligaments (e.g., the oblique popliteal and fabellofibular ligaments), temporal changes in fabella prevalence could lead to temporal changes in “standard” knee anatomy. The aim of this study was to investigate unique myological changes to the posterolateral corner knee associated with ossified fabella presence and perform a systematic review to contextualize our results. Methods Thirty-three fresh frozen cadaveric knees were considered. As the knees were all used for previous experimentation, the knees were in variable levels of preservation. Those with adequate preservation were used to determine ossified fabella presence/absence. When ossified fabellae were present, unique myologies associated with the fabella were recorded. A systematic review was performed on the double-headed popliteus to investigate possible correlations between this anatomical variant and the fabella. Results Of the 33 knees, 30 preserved enough soft tissue to determine fabella presence/absence: 16/30 knees had fabellae (five cartilaginous and 11 ossified). Eight of the eleven knees with ossified fabellae retained enough soft tissue to investigate the posterolateral knee anatomy. Of these, 4/8 exhibited unique myological changes. One knee had a double-headed popliteus muscle where one head originated from the medial side of a large, bulbous fabella. A systematic review revealed double-headed popliteus muscles are rare, but individuals are 3.7 times more likely to have a fabella if they have a double-headed popliteus. Another knee had a large, thick ligament stretching from the lateral edge of the fabella to the inferoposterior edge of the lateral femoral epicondyle, deep to the lateral collateral ligament (LCL) and near the popliteal sulcus. We found no mention of such a ligament in the literature and refer to it here as the “femorofabellar ligament”. In all four knees, the plantaris and lateral gastrocnemius appeared to share a common tendinous origin, and the fabella was located at/near the junction of these muscles. In the case of the double-headed popliteus, the fabella clearly served as an origin for the plantaris. Conclusions Despite being found in an average of 36.80% of human knees, most standard anatomical models fail to account for the fabella and/or the unique myological changes associated with fabella presence. Although our sample is small, these data highlight aspects of human biological variability generally not considered when creating generalized anatomical models. Further work is needed to identify additional changes associated with ossified fabellae and the functional consequences of omitting these changes from models.

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Effect of Radial Extracorporeal Shock Wave Therapy in Patients With Fabella Syndrome

Cited by 9 publications

References 10 publications

Efficacy of extracorporeal shock wave therapy for knee tendinopathies and other soft tissue disorders: a meta-analysis of randomized controlled trials

Efficacy of extracorporeal shock wave therapy for knee tendinopathies and other soft tissue disorders: a meta-analysis of randomized controlled trials

Treatment of Fabella syndrome with arthroscopic fabellectomy: a case series and literature review

Unique myological changes associated with ossified fabellae: a femorofabellar ligament and systematic review of the double-headed popliteus

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