Symptomatic enlarged fabella

Agathangelidis, Filon; Vampertzis, Themistoklis; Gkouliopoulou, Erato; Papastergiou, Stergios

doi:10.1136/bcr-2016-218085

Cited by 10 publications

(10 citation statements)

References 4 publications

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“…Most studies reporting on prevalence rates in humans have determined the presence of the fabella through surgeries/dissections (Agathangelidis et al. ), X‐rays (Pancoast, ), computed tomography (CT) scans (Hauser et al. ), and magnetic resonance imaging (MRI) scans (Hedderwick et al.…”

Section: Introductionmentioning

confidence: 99%

Fabella prevalence rate increases over 150 years, and rates of other sesamoid bones remain constant: a systematic review

2019

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The fabella is a sesamoid bone located behind the lateral femoral condyle. It is common in non‐human mammals, but the prevalence rates in humans vary from 3 to 87%. Here, we calculate the prevalence of the fabella in a Korean population and investigate possible temporal shifts in prevalence rate. A total of 52.83% of our individuals and 44.34% of our knees had fabellae detectable by computed tomography scanning. Men and women were equally likely to have a fabella, and bilateral cases (67.86%) were more common than unilateral ones (32.14%). Fabella presence was not correlated with height or age, although our sample did not include skeletally immature individuals. Our systematic review yielded 58 studies on fabella prevalence rate from 1875–2018 which met our inclusion criteria, one of which was an outlier. Intriguingly, a Bayesian mixed effects generalized linear model revealed a temporal shift in prevalence rates, with the median prevalence rate in 2000 (31.00%) being ~ 3.5 times higher than that in 1900 (7.64%). In all four countries with studies before and after 1960, higher rates were always found after 1960. Using data from two other systematic reviews, we found no increase in prevalence rates of 10 other sesamoid bones in the human body, indicating that the increase in fabella prevalence rate is unique. Fabella presence/absence is due to a combination of genetic and environmental factors: as the prevalence rates of other sesamoid bones have not changed in the last 100 years, we postulate the increase in fabella prevalence rate is due to an environmental factor. Namely, the global increase in human height and weight (due to improved nutrition) may have increased human tibial length and muscle mass. Increases in tibial length could lead to a larger moment arm acting on the knee and on the tendons crossing it. Coupled with the increased force from a larger gastrocnemius, this could produce the mechanical stimuli necessary to initiate fabella formation and/or ossification.

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Section: Introductionmentioning

confidence: 99%

Fabella prevalence rate increases over 150 years, and rates of other sesamoid bones remain constant: a systematic review

2019

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“…However, most ossified fabellae are 1-2 cm in diameter (Kojima, 1958;Chung, 1934), and diminutive size does not imply a bone is insignificant or should be overlooked. For example, the smallest of the 206 bones in the human skeleton-the stapes, malleus, and incus-are smaller than fabellae (Agathangelidis et al, 2016), but still counted as they are responsible for our ability to hear. Finally, with regards to location, while the position of some sesamoid bones may vary within the skeleton (Berthaume & Bull, in press;Corvalan, Tang & Robinson, 2018), the fabella is consistently located in the posterolateral corner of the knee (Tabira et al, 2012;Kawashima et al, 2007;Samuels, Regnault & Hutchinson, 2017), meaning variable location is not a reason to exclude the fabella from the standard anatomical model.…”

Section: Exclusion Of the Fabella From The Standard Anatomical Modelsmentioning

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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“…PAES is a term that was first introduced by Love and Whelan in 1965 [ 24 ]. This syndrome occurs when the popliteal artery is compressed by musculotendinous structures in the popliteal fossa.…”

Section: Reviewmentioning

confidence: 99%

“…Recurrent compression of the popliteal artery can lead to intimal damage, distal embolization, thrombosis, post-stenotic dilation and true aneurysms. The first known case of fabella pain syndrome with PAES was in a patient presented with intermittent claudication and severe knee osteoarthritis due to the fabella compressing the popliteal artery [ 24 ]. This was diagnosed using CT angiography which showed left popliteal artery occlusion without development of a collateral circulation.…”

Section: Reviewmentioning

confidence: 99%

A Comprehensive Review of the Fabella Bone

Dalip

Iwanaga

Oskouian³

et al. 2018

Cureus

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The fabella is a sesamoid bone that is embedded in the lateral head of the gastrocnemius muscle and often articulates directly with the lateral femoral condyle. It is present in 10-30% of the general population with a higher incidence in Asians. The fabella can lead to various pathologies such as fabella pain syndrome and common fibular nerve palsy. Conservative treatment involves physical therapy or injecting local anesthetics or steroids around this bone. However, if symptoms persist, then a fabellectomy can be performed. Physicians should be aware of the fabella bone and the multiple pathologies associated with it in order to provide the best treatment and management for patients.

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Symptomatic enlarged fabella

Cited by 10 publications

References 4 publications

Fabella prevalence rate increases over 150 years, and rates of other sesamoid bones remain constant: a systematic review

Fabella prevalence rate increases over 150 years, and rates of other sesamoid bones remain constant: a systematic review

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

A Comprehensive Review of the Fabella Bone

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