1
|
Woliński F, Bryliński Ł, Kostelecka K, Teresiński G, Buszewicz G, Baj J. Common fibular nerve palsy due to the Fabella: A review. Clin Anat 2024; 37:73-80. [PMID: 37377050 DOI: 10.1002/ca.24089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/30/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023]
Abstract
One of the most common nerve palsies - common fibular nerve palsy - can be caused by the variant small sesamoid bone in the posterolateral compartment of the knee joint known as the fabella. We compared and reviewed all reported cases of common fibular nerve palsy due to fabellae in the English literature. Compression can develop spontaneously or post-surgically (total knee arthroplasty). Symptoms progress rapidly to complete foot drop. Among all the cases reviewed, 68.42% were males with a median age of 39.39 years. Fabella compression was more common in the left common fibular nerve (CFN) (63.16%). Both big (23 × 20 × 16 mm) and small (5 × 5 mm) fabellae can be responsible for compression. While diagnosis can be problematic, the treatment (either surgical fabellectomy or conservative) is relatively easy and brings quick improvement.
Collapse
Affiliation(s)
- Filip Woliński
- Student Scientific Group, Department of Forensic Medicine, Medical University of Lublin, Lublin, Poland
| | - Łukasz Bryliński
- Student Scientific Group, Department of Forensic Medicine, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Kostelecka
- Student Scientific Group, Department of Forensic Medicine, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Teresiński
- Chair and Department of Forensic Medicine, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Buszewicz
- Chair and Department of Forensic Medicine, Medical University of Lublin, Lublin, Poland
| | - Jacek Baj
- Department of Anatomy, Medical University of Lublin, Lublin, Poland
| |
Collapse
|
2
|
Lin JC, Tsai MH, Lin WP, Kuan TS, Lien WC. Entrapment neuropathy of common peroneal nerve by fabella: A case report. World J Clin Cases 2023; 11:6857-6863. [PMID: 37901021 PMCID: PMC10600867 DOI: 10.12998/wjcc.v11.i28.6857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/12/2023] [Accepted: 09/04/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Neuropathy of the common peroneal nerve caused by compression by a fabella is an extremely rare form of compression neuropathy. Involving both the superficial and deep peroneal nerves, it usually manifests as either impaired sensation from the lower lateral leg to the top of the foot or drop foot, or as a combination of both. CASE SUMMARY We report the case of a 58-year-old Asian female who presented with inversion of the right foot during the stance phase of gait without sensory complaints related to the lower leg. Electrodiagnostic testing revealed the neuropathy of the common peroneal nerve at the level of the knee, exclusively affecting the muscular branch of the superficial peroneal nerve. A neuromuscular ultrasound disclosed swelling of the right common peroneal nerve just before it crossed over a large fabella as well as atrophy and fatty infiltration of the right peroneus longus and peroneus brevis muscles. Surgical excision of the fabella and neurolysis were performed. Subsequently, the strength of the right foot evertors improved, but the unsteady gait with occasional falls persisted for nine months after the surgery. Therefore, another procedure was performed to transfer the split posterior tibialis tendon to the peroneus brevis in order to correct the gait. CONCLUSION This is the first case of neuropathy of the common peroneal nerve caused by compression by a fabella affecting exclusively the muscular branch of the superficial peroneal nerve. Clinicians should be aware of this unusual peripheral neuropathy while evaluating and treating patients with gait disturbance.
Collapse
Affiliation(s)
- Jing-Chun Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Mu-Hung Tsai
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Wei-Pin Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Ta-Shen Kuan
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Wei-Chih Lien
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| |
Collapse
|
3
|
Özbay H, Mraja HM, Can A, Erdoğan F. Prevalence and Radiological Characteristics of the Fabella in Turkish Population. Cureus 2022; 14:e31534. [DOI: 10.7759/cureus.31534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 11/16/2022] Open
|
4
|
Zhong J, Zhang G, Si L, Hu Y, Xing Y, He Y, Yao W. The prevalence and parameters of fabella and its association with medial meniscal tear in China: a retrospective study of 1011 knees. BMC Musculoskelet Disord 2022; 23:188. [PMID: 35232412 PMCID: PMC8886965 DOI: 10.1186/s12891-022-05092-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background Fabella is a sesamoid bone of knee that has potential biomechanical function. We aimed to examine the fabellar prevalence and parameters in Chinese population and test the hypothesis that fabellar presence and morphology were associated with meniscus tear or ligament injury. Methods A total of 1011 knee magnetic resonance imaging scans from 979 patients with knee pain were analyzed retrospectively. The exclusion criteria are postsurgical scans, difficulty in fabella discrimination, conditions not suitable for measurement, and unsatisfied image. The fabellar presence and its parameters (length, width and thickness) were documented. The association between fabellar presence and meniscus tear or ligament injury were assessed by chi-square test, in all knees and subgroups (age, gender, side, lesion part). The correlation of fabellar presence and parameters with advancing age was assessed by Spearman correlation analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to investigate whether factors related with meniscus tear or ligament injury. Diagnostic performance of risk factors was assessed by receiver operating characteristic (ROC) analysis. Results The overall prevalence of fabellae was 39.8% (402/1011 knees) and increased with the increasing age (r = 0.237, P < 0.001). The size of the fabellae differed according to genders, age, and presence of articulating grooves. Fabella presented more often in knees with medial meniscus (MM) tears (66.7% vs 33.8%; P < 0.001) with a multivariate OR of 2.960 (95% CI, 1.853–3.903). The association remained in all tear parts (anterior, middle, and posterior), and in younger (age < 50 years) and older patients (age ≥ 50 years). Age, fabellar length, width, length/thickness ratio and width/thickness ratio yielded an area under the ROC curve (AUC) of 0.604–0.766 to predict an MM tear. In combination with age, fabellar width and length/thickness ratio, the AUC was improved 0.791 (95% CI, 0.744–0.837), with a sensitivity of 73.0% and a specificity of 74.6%. Conclusion The presence of fabellae, increased fabellar length and width as well as flatter fabellar morphology, are significantly associated with an increased risk for MM tear. These findings might aid clinicians in identifying patients at risk for a MM tear and informing them. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05092-4.
Collapse
Affiliation(s)
- Jingyu Zhong
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, 200336, Shanghai, China
| | - Guangcheng Zhang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, 200233, Shanghai, China
| | - Liping Si
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, 200336, Shanghai, China
| | - Yangfan Hu
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, 200336, Shanghai, China
| | - Yue Xing
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, 200336, Shanghai, China
| | - Yaohua He
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, 200233, Shanghai, China. .,Department of Orthopedics, Shanghai Sixth People's Hospital, Jinshan Branch, No. 147 Jiankang Road, 201500, Shanghai, China.
| | - Weiwu Yao
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111, Xianxia Road, 200336, Shanghai, China.
| |
Collapse
|
5
|
Zhang L, Wen YL, He CY, Zeng Y, Wang JQ, Wang GY. Relationship between Classification of Fabellae and the Severity of Knee Osteoarthritis: A Relevant Study in the Chinese Population. Orthop Surg 2021; 14:274-279. [PMID: 34913250 PMCID: PMC8867427 DOI: 10.1111/os.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/18/2021] [Accepted: 03/11/2021] [Indexed: 12/05/2022] Open
Abstract
Objective To classify the fabellae and discuss the relationship between the classification of fabellae and the severity of knee osteoarthritis (KOA) in Chinese. Methods From February 2019 to February 2020, 136 patients were measured and classified using three‐dimensional computed tomography (CT) reconstruction. According to the CT imaging characteristics, the fabellae were divided into five types: type I, a fabella on the lateral femoral condyle; type II, a fabella on the medial femoral condyle; type III, a fabella on the lateral femoral condyle and a fabella on the medial femoral condyle; type IV, two fabellae on the medial femoral condyle; and type V, two fabellae on the lateral femoral condyle. The severity of KOA was assessed on the Recht grade by magnetic resonance imaging (MRI). The data were analyzed with SPSS 24.0. Results The classification of fabellae were correlated with KOA grades (χ2 = 35.026, P < 0.05). In terms of KOA grades, grade I and grade II were occupied most by fabellar type II (32, 72.8%); type II and other types showed significant statistical difference (P < 0.05). Grade I and grade II were also mainly fabellar type IV (four, 100%). Fabellar type V's biggest component was grade III and grade IV (six, 75%). Type IV and type V showed significant statistical difference (P < 0.05). Conclusion The classification of fabellae were correlated with KOA grades. The type II may mean the lower KOA grades while type V may mean the higher KOA grades.
Collapse
Affiliation(s)
- Lei Zhang
- Department of Orthopaedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopaedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Luzhou, China.,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, China
| | - You-Liang Wen
- School of Rehabilitation Medicine GanNan Medical University, Ganzhou, China
| | - Chun-Ying He
- School of Clinical Medicine of Integrated Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou, China
| | - Yan Zeng
- Department of Nephrology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Jun-Qiu Wang
- School of Clinical Medicine of Integrated Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou, China
| | - Guo-You Wang
- Department of Orthopaedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopaedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Expert Workstation in Luzhou, Luzhou, China
| |
Collapse
|
6
|
Fabella Syndrome and Common Peroneal Neuropathy following Total Knee Arthroplasty. Case Rep Orthop 2021; 2021:7621844. [PMID: 34513102 PMCID: PMC8429020 DOI: 10.1155/2021/7621844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Case A 62-year-old man presented with persistent lateral knee pain 15 months following an uncomplicated total knee arthroplasty. There was a tendinous snapping structure over the lateral aspect of the knee in deep flexion with positive Tinel's sign over the fibular head. The patient underwent an uncomplicated flabella excision. The patient was cleared to return to work and full duty at two months postoperatively. Conclusion Flabella syndrome is a rare but increasingly common mechanism of persistent lateral knee pain following total knee arthroplasty. Surgeons should be aware of this etiology of persistent lateral knee pain and offer treatment modalities to address this pathology.
Collapse
|
7
|
Weng SP, Wu TM, Chien CS, Lin SH. Treatment of Fabella syndrome with arthroscopic fabellectomy: a case series and literature review. BMC Musculoskelet Disord 2021; 22:748. [PMID: 34461874 PMCID: PMC8406563 DOI: 10.1186/s12891-021-04630-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Shuo-Po Weng
- Orthopedic Department, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, Taiwan (Republic of China)
| | - Tsung-Mu Wu
- Orthopedic Department, Chi-Mei Medical Center, No.901, Zhonghua Rd., Yongkang Dist., Tainan City, Taiwan (Republic of China)
| | - Chi-Sheng Chien
- Orthopedic Department, Chi-Mei Medical Center, No.901, Zhonghua Rd., Yongkang Dist., Tainan City, Taiwan (Republic of China)
| | - Sheng-Hui Lin
- Orthopedic Department, Chi-Mei Medical Center, No.901, Zhonghua Rd., Yongkang Dist., Tainan City, Taiwan (Republic of China).
| |
Collapse
|
8
|
Unluturk O, Duran S, Yasar Teke H. Prevalence of the fabella and its general characteristics in Turkish population with magnetic resonance imaging. Surg Radiol Anat 2021; 43:2047-2054. [PMID: 34398300 DOI: 10.1007/s00276-021-02817-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/06/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The fabella is a fibrocartilaginous or ossified sesamoid bone in the knee, largely located in the lateral tendon of the head of the gastrocnemius muscle. In this study, the prevalence, gender differences, localization and size of the fabella were determined in a Turkish population to make a comparison with other population studies in the literature. MATERIALS AND METHODS Thousand patients (500 females, 500 males) who underwent knee magnetic resonance imaging (MRI) with fabella in all three planes, including axial, sagittal and coronal evaluated, retrospectively. All MRI examinations were performed using a 1.5 T unit. Patients with a history of trauma or operation, motion artifacts and patients who could not be evaluated due to image quality were excluded. Anteroposterior diameter in sagittal plan (sAP) of the fabella and the fabella-femur distance was measured. Measurements were evaluated with Pearson's Chi-squared and Mann-Whitney U test for non-homogeneous data in SPSS program, and ANOVA test for homogeneous data. A p value of < 0.05 was considered significant in all analyses. RESULTS The overall prevalence of fabella was found to be 155 cases. Unilateral fabella was detected in 72.9% of the cases, of which 56.6% were on the right side and 43.4% were on the left side. The median value of AP diameter in sagittal plan was calculated as 4.40 ± 1.31 mm. Concerning the gender-related examination the sAP diameter of the fabella was larger in men than in women (p < 0.05). The median value of FFD was calculated as 2.50 ± 0.50 mm. The distribution of FFD between genders was not statistically significant (p = 0.492). CONCLUSION The fabella is usually a sesamoid bone that can be detected incidentally by imaging techniques. The incidence in the Turkish population is 15.5%, and no gender difference was detected. It is clear that further studies on the basis of populations are needed, especially considering that pathological problems remain in question and there is a lack of scientific data (variations, developmental characteristics, etc.) on sesamoid bones.
Collapse
Affiliation(s)
- Ozge Unluturk
- Ministry of Justice, Council of Forensic Medicine, İstanbul, Turkey
| | - Semra Duran
- Department of Radiology, University of Health Sciences, Ankara Bilkent City Hospital, Bilkent Bulvarı No.1, Ankara, Turkey.
| | | |
Collapse
|
9
|
Adedigba JA, Idowu BM, Hermans SP, Okwori OF, Onigbinde SO, Oluwadiya KS, Amoako AA, Weidenhaft MC. Fabella and patella variants: radiographic prevalence, distribution and clinical relevance in a population of black african descent. Anat Cell Biol 2021; 54:184-192. [PMID: 33594010 PMCID: PMC8225475 DOI: 10.5115/acb.20.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 11/27/2022] Open
Abstract
To evaluate the radiographic characteristics and prevalence of fabella and patella variants in an indigenous African population. This retrospective observational study of orthogonal knee radiographs of 377 consecutive subjects was conducted in Lagos, Nigeria, from February 2017 to November 2017. The presence of bipartite/multipartite patella, as well as the presence of fabella were noted. The craniocaudal diameter, anteroposterior diameter, fabello-femoral distance and fabello-tibial distance of the fabella were measured. P≤0.05 represented a statistically significant result. Three hundred and seventy-seven subjects were enrolled. The average age was 41.22±21.37 years with a range of 3-100 years old. There were 158 male (41.9%) and 219 female (58.1%) subjects. The prevalence of fabella was 11.94%. There was a positive correlation between age <47 and ≥47 and occurrence of fabella, P<0.015. There was no statistically significant difference between the mean male and female measured fabella diameters. The overall prevalence of bipartite and multipartite patella in this study was 2.12%. Among male and female subjects, the difference in prevalence of bi and multipartite patella was statistically significantly, P=0.03. The prevalence of fabella and patella variants was lower in this study compared to the findings in other populations and ethnicities. Sex and age were significantly correlated with fabella prevalence. The results reported in this study will facilitate future studies examining the correlations between fabella and patella variants and various knee pathologies in a population of Black African descent.
Collapse
Affiliation(s)
| | | | - Sarah Perou Hermans
- Department of Radiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Onoja Frederick Okwori
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | | | - Angela Ameyaa Amoako
- Department of Microbiology, University of Wisconsin-La Crosse, La Crosse, WI, USA
| | - Mandy C Weidenhaft
- Department of Radiology, Tulane University School of Medicine, New Orleans, LA, USA
| |
Collapse
|
10
|
Matroushi ODA, Sirasanagandla SR, Shabibi AA, Obaidani AA, Dhuhli HA, Jaju S, Mushaiqri MA. Radiological study of fabella in Omani subjects at a tertiary care center. Anat Cell Biol 2021; 54:315-320. [PMID: 33967029 PMCID: PMC8493026 DOI: 10.5115/acb.20.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/27/2022] Open
Abstract
Ethnic diversity is associated with variability in the prevalence rates of fabella. We aimed to evaluate the prevalence and the radiological features of fabella in Omani patients. This is a retrospective analysis of hospital electronic database of patients referred for radiological investigations (radiographs and magnetic resonance imaging) of the knee, at a tertiary care referral center. Descriptive statistics were performed to determine the prevalence of fabella. Chi-square test was used to determine the association between sex or age with respect to the presence of fabella. A total of 813 knee radiographs were reviewed for the presence of fabella. Fabella was found in 24.1% of total cases. A statistically significant sex difference was observed with respect to the presence of fabella in left knees in males (P<0.01). The presence of fabella was significantly associated with age groups for the right (P<0.05) and left knees (P<0.01). In magnetic resonance imaging film reviews, all the identified fabellae (20.2%) were bony structures and were located within the lateral head of the gastrocnemius muscle. There were no cartilaginous fabellae detected. The current study revealed a prevalence of 24.1% of fabella in Omani subjects which is almost similar to the results as seen in Caucasian ethnic populations.
Collapse
Affiliation(s)
| | - Srinivasa Rao Sirasanagandla
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ammar Al Shabibi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Humoud Al Dhuhli
- Department of Radiology and Molecular Imaging, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Sanjay Jaju
- Department of Family Medicine & Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mohamed Al Mushaiqri
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| |
Collapse
|
11
|
Asghar A, Naaz S, Chaudhary B. The Ethnic and Geographical Distribution of Fabella: A Systematic Review and Meta-Analysis of 34,733 Knees. Cureus 2021; 13:e14743. [PMID: 34084671 PMCID: PMC8164001 DOI: 10.7759/cureus.14743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The primary studies demonstrated that fabellar prevalence (FP) varied with ethnic and geographical distribution. Osteoarthritis (OA) and age-related degeneration have a significant association with FP. The prevalence of OA worldwide was doubled with life expectancy. Increased life expectancy has increased exposure to OA and age-related degeneration which could be a possible reason for the rise of FP. The analysis was conducted to provide insight about FP in respect to geographical, ethnic, sex, and laterality distribution. Methodology: Eighty-six studies were included which have data from 34,733 knee joints. Fifty radiological studies were consisting of 27,293 knees and 36 cadaveric studies had the data of 7,440 knees of dissected specimens, respectively. The prevalence, Odds, and rate ratios were calculated for aging, osteoarthritis, and ethnic variation. Results: The worldwide FP was 25% (95% CI, 0.22, 0.28). The prevalence of fabella was found to be higher in cadaveric studies (32%) than radiological studies (19%) with significant heterogeneity. The FP was 16-18% till 1950 which was doubled by 2020 (35%). The FP in OA knee was 51% which was thrice of baseline.
Collapse
Affiliation(s)
- Adil Asghar
- Anatomy, All India Institute of Medical Sciences Patna, Patna, IND
| | - Shagufta Naaz
- Anaesthesiology, All India Institute of Medical Sciences Patna, Patna, IND
| | - Binita Chaudhary
- Anatomy, All India Institute of Medical Sciences Patna, Patna, IND
| |
Collapse
|
12
|
Asghar A, Naaz S, Narayan RK, Kumar A. Does the Prevalence of Ossified Fabella Vary in Knee Osteoarthritis and Age-Related Degeneration? A Meta-Analysis of About 11,000 Knees. Cureus 2021; 13:e12535. [PMID: 33564533 PMCID: PMC7863029 DOI: 10.7759/cureus.12535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Osteoarthritis (OA) and age-related degeneration (ARD) are stimulants for the development of the fabella in the knee joint. This meta-analysis updates previous studies and reviews on the prevalence of the fabella in OA or ARD knee joints. In addition, it provides a quantitative estimation of the fabellar prevalence in knees having OA and ARD. METHODOLOGY Twenty studies containing data from 11,056 knee joints were utilized in the investigation, consisting of 6,819 knees of individuals with OA (including those with age greater than 40 years) and 4,237 knees of individuals without OA (including less than 40 years of age), respectively. Totally, 2,434 knees of the OA subjects had fabellae (including more than 40 years), while in the non-OA subjects, 844 had fabellae (including less than 40years). The odds ratio (OR) and relative risk (RR) were calculated. RESULTS The fabellar prevalence was observed to be higher in OA knees, where the risk ratio of developing fabella was 2.55 (2.15-3.02). Compared with this, the risk ratio for the incidence of fabella in ARD knee was 1.71 (1.59-1.85). The bilateral occurrence of fabella was more common than unilateral. The risk of developing fabella in individuals aged less than 40-year was 0.59 which was 41% less than individuals aged more than 40 years. The risk ratio of developing fabella in co-exposure of ARD and OA was 1.84 [1.66, 2.04, 95% CI]. CONCLUSION OA and ARD would increase the prevalence of ossified fabella by 84%, thus acting as stimulants or associations and risk factors for ossified fabella.
Collapse
Affiliation(s)
- Adil Asghar
- Anatomy, All India Institute of Medical Sciences Patna, Patna, IND
| | - Shagufta Naaz
- Anesthesiology, All India Institute of Medical Sciences Patna, Patna, IND
| | - Ravi K Narayan
- Anatomy, All India Institute of Medical Sciences Patna, Patna, IND
| | - Anup Kumar
- Orthopaedics, All India Institute of Medical Sciences Patna, Patna, IND
| |
Collapse
|
13
|
Berthaume MA, Barnes S, Athwal KK, Willinger L. Unique myological changes associated with ossified fabellae: a femorofabellar ligament and systematic review of the double-headed popliteus. PeerJ 2020; 8:e10028. [PMID: 33088615 PMCID: PMC7571414 DOI: 10.7717/peerj.10028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/02/2020] [Indexed: 11/20/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Michael A Berthaume
- Division of Mechanical Engineering and Design, London South Bank University, London, UK.,Department of Bioengineering, Imperial College London, London, UK
| | - Spencer Barnes
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - Kiron K Athwal
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - Lukas Willinger
- Department of Mechanical Engineering, Imperial College London, London, UK.,Department of Orthopaedic Sports Medicine, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany
| |
Collapse
|
14
|
Dekker TJ, Crawford MD, DePhillipo NN, Kennedy MI, Grantham WJ, Schairer WW, LaPrade RF. Clinical Presentation and Outcomes Associated With Fabellectomy in the Setting of Fabella Syndrome. Orthop J Sports Med 2020; 8:2325967120903722. [PMID: 32133386 PMCID: PMC7042559 DOI: 10.1177/2325967120903722] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 11/11/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Clinical outcomes pertaining to isolated lateral fabellectomy in the setting
of fabella syndrome are limited to small case reports at this time. Purpose: To assess the most common presenting symptoms, clinical outcomes, and
satisfaction after fabella excision in the setting of fabella syndrome. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients with a minimum of 21-month follow-up after isolated
fabellectomy for fabella syndrome were reviewed retrospectively. Clinical
outcome scores of the following domains were collected: Western Ontario and
McMaster Universities Osteoarthritis Index (WOMAC) score and Lysholm knee
survey, along with a simple numeric patient satisfaction score (range, 1-10;
10 = “very satisfied”). Statistical analysis was performed using paired
t tests for all clinical outcome data. Results: A total of 11 isolated fabella excisions were included in 10 patients with
isolated lateral-sided knee pain in the setting of fabella syndrome (8
males, 2 females), with a mean age of 36.9 years (range, 23-58 years) and a
mean follow-up of 2.4 years (range, 21-47 months). A total of 8 patients
(80%) were able to return to full desired activities, including sports. Only
5 of 11 (45%) excisions had concomitant lateral femoral condyle cartilage
pathology. There were significant improvements across multiple WOMAC
domains, and the WOMAC total score improved from 28.5 ± 17.6 preoperatively
to 11.6 ± 10.2 postoperatively (P < .05). Lysholm scores
significantly improved from 66.6 ± 23.1 preoperatively to 80.2 ± 13.9
postoperatively (P = .044). Overall patient-reported
satisfaction was 8.8 ± 1.6. Conclusion: Fabella excision in the setting of fabella syndrome demonstrated improvements
in clinical outcome scores, high rate of returning to preinjury level of
activities, and low risk of complications or need for additional surgical
procedures.
Collapse
Affiliation(s)
| | | | - Nicholas N DePhillipo
- The Steadman Clinic, Vail, Colorado, USA.,Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Mitchell I Kennedy
- Department of Orthopaedics, Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | | |
Collapse
|
15
|
Berthaume MA, Bull AMJ. Human biological variation in sesamoid bone prevalence: the curious case of the fabella. J Anat 2019; 236:228-242. [PMID: 31623020 PMCID: PMC6956444 DOI: 10.1111/joa.13091] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2019] [Indexed: 01/23/2023] Open
Abstract
The fabella is a sesamoid bone located in the gastrocnemius behind the lateral femoral condyle. In humans, fabellae are 3.5 times more common today than they were 100 years ago, with prevalence rates varying between and within populations. In particular, fabellae have been assumed to be more common in Asians than non‐Asians, equally common in men and women, potentially more common in older individuals, and bilateral cases (one per knee) appear to be more common than unilateral ones. The roles of genetic and environmental factors in this phenotypic variation have been hypothesized, but not rigorously investigated. Given its clinical and evolutionary significance (i.e. being associated with several knee ailments, causing medical issues on its own, interfering with medical devices, and being less common in humans than in other mammals), it is important comprehensively to understand prevalence rate variation, and the roles of genetics and environmental factors in that variation. To address these questions, we performed a meta‐analysis on data from studies published from 1875 to 2018 to investigate possible variation in sexual dimorphic (n = 22 studies, 7911 knees), ontogenetic (n = 10 studies, 4391 knees), and global (n = 65 studies, 21 626 knees) fabella prevalence rates. In addition, we investigated what proportion of cases are bilateral (n = 37 studies, 900 individuals), and among unilateral cases (n = 20 studies, 204 individuals), if fabellae are more common in the left or right knee. Our results show that, today, fabellae are 2.47–2.60% more common in men than women, and prevalence rates increase ontogenetically in old age (i.e. 70 years old), implying that fabellae can ossify early (i.e. 12 years old) or late in life. Approximately 72.94% of cases are bilateral, and among unilateral ones, fabellae are equally common in right and left knees. There is marked regional variation in fabella prevalence rates, with rates being highest in Asia, followed by Oceania, South America, Europe, Middle East, and North America, and lowest in Africa. Worldwide, an average of 36.80% of knees has ossified fabellae detectable by dissection. These results imply that, while the ability to form a fabella may be genetically controlled, the mechanisms that trigger fabella ossification may be environmentally controlled. What these environmental factors are, can only be speculated.
Collapse
Affiliation(s)
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, UK
| |
Collapse
|
16
|
Hou W, Xu L, Wang J, Wang B, Liu L, Xu K, Cai Y, Guo H, Xu P. Fabellar prevalence, degeneration and association with knee osteoarthritis in the Chinese population. Sci Rep 2019; 9:13046. [PMID: 31506455 PMCID: PMC6736872 DOI: 10.1038/s41598-019-49174-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 08/20/2019] [Indexed: 01/13/2023] Open
Abstract
The fabella is a sesamoid bone of the knee that can degenerate in some patients with osteoarthritis. The purpose of this study was to examine the prevalence and degeneration grades of fabellae in the Chinese population and to analyse their relationships with subject ages and knee osteoarthritis grades. The anteroposterior and lateral knee roentgenograms of 1150 subjects were recruited from the institutional database. The Kellgren-Lawrence scoring system was used to evaluate knee osteoarthritis. The degeneration grades of fabellae were scored in lateral roentgenograms by screening their shapes, sizes, subchondral sclerosis and osteophyte formation. The prevalence and degeneration of fabellae among ages, genders and knee sides were analysed by the Pearson Chi-Square test, and their relationships with knee osteoarthritis were analysed by the Spearman nonparametric correlation test. The overall prevalence of fabellae was 48.6% in 1359 knees. There was no significant difference in fabellar prevalence between the two sides (χ² = 0.025, P = 0.87437) and genders (χ² = 3.647, P = 0.05617), while the prevalence increased with the increasing ages of the subjects (χ² = 213.868, P < 0.001). The fabellar degeneration grades were correlated with age (r = 0.5288, P < 0.001) and knee osteoarthritis scores (r = 0.6892, P < 0.001). These results suggested that the fabellar prevalence and degeneration grades were correlated with age and knee osteoarthritis scores.
Collapse
Affiliation(s)
- Weikun Hou
- Osteonecrosis and Joint Reconstruction Ward, Department of Joint Surgery, HongHui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710054, China
| | - Lin Xu
- Osteonecrosis and Joint Reconstruction Ward, Department of Joint Surgery, HongHui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710054, China.,Department of Orthopaedics, Hanzhong 3201 Hospital, Hanzhong, Shaanxi, 723000, China
| | - Jingbo Wang
- Department of Radiology, HongHui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710054, China
| | - Bo Wang
- Center for Translational Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Lin Liu
- Osteonecrosis and Joint Reconstruction Ward, Department of Joint Surgery, HongHui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710054, China
| | - Ke Xu
- Osteonecrosis and Joint Reconstruction Ward, Department of Joint Surgery, HongHui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710054, China
| | - Yuanzhen Cai
- Osteonecrosis and Joint Reconstruction Ward, Department of Joint Surgery, HongHui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710054, China
| | - Hao Guo
- Osteonecrosis and Joint Reconstruction Ward, Department of Joint Surgery, HongHui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710054, China
| | - Peng Xu
- Osteonecrosis and Joint Reconstruction Ward, Department of Joint Surgery, HongHui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710054, China.
| |
Collapse
|
17
|
Berthaume MA, Di Federico E, Bull AMJ. Fabella prevalence rate increases over 150 years, and rates of other sesamoid bones remain constant: a systematic review. J Anat 2019; 235:67-79. [PMID: 30994938 PMCID: PMC6579948 DOI: 10.1111/joa.12994] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 01/13/2023] Open
Abstract
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.
Collapse
Affiliation(s)
| | | | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, UK
| |
Collapse
|
18
|
Ultrasound Evaluation and Surgical Excision of a Fabella Causing Peroneal Neuropathy in a Track Athlete. Case Rep Orthop 2019; 2018:2371947. [PMID: 30693123 PMCID: PMC6332997 DOI: 10.1155/2018/2371947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/14/2018] [Indexed: 11/18/2022] Open
Abstract
Background There are multiple causes of posterior knee pain and radicular symptoms. A symptomatic fabella is a rare cause but should be considered in the differential diagnosis. Purpose Physicians should consider a symptomatic fabella as a diagnosis when common treatments for posterior knee pain have not alleviated the symptoms. Study Design Case report. Methods Review of clinical documentations of an orthopedist, physiatrist, physical therapist, 2 primary care sports medicine physicians, and the surgical report of an orthopedist. Results It took time and resources including several referrals and imaging modalities to make a final diagnosis. Conclusion Symptomatic fabellae are an uncommon finding but should be considered in the differential diagnosis with an athlete with posterior knee pain. Clinical Relevance Considerable time and resources were used to ultimately diagnose and treat a NCAA Division 1 athlete. Surgical excision was required of a sesamoid bone that is present in 30% of individuals.
Collapse
|
19
|
Adukia V, Ricks M, Colquhoun K, Flynn N. An anomalous band originating from the fabella causing semimembranosus impingement presenting as knee pain: a case report. J Med Case Rep 2019; 13:6. [PMID: 30621758 PMCID: PMC6325678 DOI: 10.1186/s13256-018-1946-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 12/07/2018] [Indexed: 11/27/2022] Open
Abstract
Background The presentation of patients with knee injuries which can have a significant impact on their ability to work and perform activities of daily living is constantly rising. The posterolateral corner of the knee has a complex anatomy of muscles, tendons, and ligaments, with huge variation in the population. The fabella is one such structure, found in the posterolateral corner of the knee, which can serve as a common origin point of various ligaments. Case report We present a case report of a 53-year-old white man who presented with atraumatic, posterior knee pain and was found to have a congenital, anomalous band originating from the fabella, causing semimembranosus impingement. This was diagnosed with magnetic resonance imaging; he underwent division of the anomalous band, which resulted in complete resolution of his symptoms. Conclusion We propose that patients who present with posterior knee pain, without any history of trauma, and have no abnormalities on plain radiographs, should undergo magnetic resonance imaging of their knees. This will help in assessing the ligament complex in the posterior compartment of the knee, and exclude impingement of the semimembranosus as an, albeit rare, cause of posteromedial knee pain.
Collapse
Affiliation(s)
- V Adukia
- Trauma and Orthopaedic Department, Queen Alexandra Hospital, Portsmouth, UK
| | - M Ricks
- Trauma and Orthopaedic Department, University Hospital Southampton, Southampton, UK.
| | - K Colquhoun
- Trauma and Orthopaedic Department, Queen Alexandra Hospital, Portsmouth, UK
| | - N Flynn
- Trauma and Orthopaedic Department, Queen Alexandra Hospital, Portsmouth, UK
| |
Collapse
|
20
|
Pop TS, Pop AM, Olah P, Trâmbiţaş C. Prevalence of the fabella and its association with pain in the posterolateral corner of the knee: A cross-sectional study in a Romanian population. Medicine (Baltimore) 2018; 97:e13333. [PMID: 30461651 PMCID: PMC6392660 DOI: 10.1097/md.0000000000013333] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The functions and clinical consequences of the fabella, a sesamoid bone found in the posterolateral aspect of the knee joint, are still a reason of intense debate in the scientific literature. Its incidence was reported to range between 20% and 87% and its presence was usually associated with the persistent pain in the posterolateral region of the knee. The aim of our study was to measure the prevalence, anatomic and clinical features of the fabella within a cross-sectional study, conducted in a Romanian orthopaedic center. Between 2015 and 2017, a consecutive series of 562 patients with knee injuries or persistent knee pain has been examined by radiographs and Magnetic Resonance Imaging and a set of anatomical and clinical parameters have been recorded. Collected data was evaluated with RadiANT DICOM Viewer and statistically analyzed with GraphPad Prism 7. The level of significance was set at P <.05. The incidence of the fabella in our study group was 16.93%, lower than previously reported for Caucasian populations. We found statistically significant differences regarding the possible association of the fabella with pain in the posterolateral corner of the knee (P = .04) and the 2 dimensions of the bone according to gender (P = .03 respectively P = .01), but the prevalence was not influenced by gender (P = .6). The anatomic characteristics could be important in differentiating this sesamoid bone from calcifications or loose bodies located in the knee joint region. Due to the high association with the posterolateral knee pain, the fabella should be recorded during knee examination as a differential diagnosis, before any surgical procedure.
Collapse
Affiliation(s)
| | | | - Peter Olah
- Department of Informatics and Biostatistics
| | - Cristian Trâmbiţaş
- Department of Anatomy and Embryology, University of Medicine and Pharmacy of Tîrgu Mureş, Romania
| |
Collapse
|
21
|
Rankin I, Rehman H, Ashcroft GP. Fabella Syndrome Following De-Rotation Surgery to Correct a Femoral Malunion. Open Orthop J 2018; 12:346-352. [PMID: 30197717 PMCID: PMC6118036 DOI: 10.2174/1874325001812010346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 06/16/2018] [Accepted: 06/24/2018] [Indexed: 11/24/2022] Open
Abstract
Background: The fabella is a sesamoid bone situated within the lateral head of the gastrocnemius tendon, close to the lateral femoral condyle, and adjoined to the fabellofibular ligament. It is a normal variant, found in up to 87% of patients. Fabella Syndrome describes traditionally posterolateral knee pain, occurring due to biomechanical pressure of the fabella against the lateral femoral condyle. Given its rarity, its diagnosis is often overlooked. We present a case of Fabella Syndrome with a modified surgical excision technique and review of the literature. Methods and Results: A thirty-four-year-old man presented with posterolateral knee pain following de-rotation surgery to correct a femoral malunion, from a previous femoral shaft fracture. Due to the patient’s complex orthopaedic history, Fabella Syndrome was not initially diagnosed. Fabellectomy eliminated all symptoms of knee pain, with no limitations in knee function. Conclusion: Review of the literature identified ten publications (evidence level IV) describing Fabella Syndrome. This is the first reported case of Fabella Syndrome secondary to femoral de-rotation surgery. The authors recommend fabellectomy as a definitive treatment for Fabella Syndrome, in keeping with published literature.
Collapse
Affiliation(s)
- Iain Rankin
- NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Haroon Rehman
- NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
| | | |
Collapse
|
22
|
Abstract
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.
Collapse
Affiliation(s)
| | | | | | - R Shane Tubbs
- Neurosurgery, Seattle Science Foundation, Seattle, USA
| |
Collapse
|
23
|
The oblique popliteal ligament: an anatomic and MRI investigation. Surg Radiol Anat 2017; 39:1017-1027. [PMID: 28324130 DOI: 10.1007/s00276-017-1838-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/23/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Despite being the largest ligament on the posterior aspect of the knee, relatively little is known about the normal morphology of the oblique popliteal ligament (OPL). The aim of this study was to investigate the detailed anatomy of the OPL in cadavers and healthy volunteers. METHODS The posterior knee was investigated in 25 cadaver lower limbs (mean age 76 ± 9.5 years; 7 men) by dissection, histology, and serial plastination and in 14 healthy individuals (mean age 23 ± 3.2 years; 11 men) using magnetic resonance (MR) imaging. OPL morphology, attachments sites, ligament length and width, relationship to surrounding structures and histological composition were recorded. Intraobserver reliability was assessed using intraclass correlation coefficients. RESULTS The OPL is a distinct expansion of the semimembranosus (SM) tendon and sheath, which courses superolaterally to attach to the posterolateral joint capsule or fabella (when present), at the medial margin of the lateral femoral condyle. The ligament blends with the joint capsule medially and laterally, serves as an attachment site for plantaris, and has connections with popliteus. In 70% of dissections, the OPL divided into two bands, separated by small branches of the middle genicular neurovascular bundle that pierced the posterior joint capsule. Differences in mediolateral length were noted between dissection and MR imaging (43.6 ± 6.2 vs. 57.6 ± 4.4 mm; p < 0.001). At its medial and lateral attachments, the OPL was 23.2 ± 6.9 and 17.4 ± 8.7 mm wide (proximodistal), respectively. The OPL was predominantly composed of transverse collagen layers, with little elastin. While visible on axial MR scans, delineation of its most lateral extent was difficult. Repeatability of selected measurements ranged from good to almost perfect. CONCLUSIONS The OPL is a distinct ligament with identifiable anatomical limits. Based on its morphological characteristics, it appears more tendinous than ligamentous in nature. A better understanding of the OPL may help define its importance in the assessment and treatment of posterior knee injuries.
Collapse
|
24
|
Hauser NH, Hoechel S, Toranelli M, Klaws J, Müller-Gerbl M. Functional and Structural Details about the Fabella: What the Important Stabilizer Looks Like in the Central European Population. BIOMED RESEARCH INTERNATIONAL 2015; 2015:343728. [PMID: 26413516 PMCID: PMC4564579 DOI: 10.1155/2015/343728] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 03/05/2015] [Indexed: 01/13/2023]
Abstract
The posterolateral corner of the knee accommodating the fabella complex is of importance in orthopaedic surgery. Unfortunately, there is a lack of data in literature for clinical routine. Therefore, we investigated the fabella's characteristics, biomechanical nature, and present histologic details. Of special interest were the fabella's occurrence and position, calcium concentration as long-term load intake indicator, and the histology. Within our analysis, fabellae were found in 30.0% of all datasets, located on the upper part of the posterolateral femoral condyle. The region of fabella contact on this condyle showed a significantly lower calcium concentration than its surroundings. Histologically, the fabella showed no articular cartilage but a clearly distinguishable fabellofibular ligament that consisted of two bundles: one, as already described in literature inserted at the fibular tip, and another part newly described on the top of the lateral meniscus. In its role of stabilizing the soft tissue structures of the posterolateral knee, the fabella seems to serve as suspension for the ligaments evolving from its base. Even though a joint formation of any kind is unlikely, the presence of a fabella needs to be kept in mind during knee examination and any surgical procedures.
Collapse
Affiliation(s)
- Nicole Helene Hauser
- Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, 4056 Basel, Switzerland
| | - Sebastian Hoechel
- Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, 4056 Basel, Switzerland
| | - Mireille Toranelli
- Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, 4056 Basel, Switzerland
| | - Joerg Klaws
- Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, 4056 Basel, Switzerland
| | - Magdalena Müller-Gerbl
- Department of Biomedicine, Musculoskeletal Research, University of Basel, Pestalozzistrasse 20, 4056 Basel, Switzerland
| |
Collapse
|
25
|
Chen TW, Lin CW, Lee CL, Chen CH, Chen YJ, Lin TY, Huang MH. The efficacy of shock wave therapy in patients with knee osteoarthritis and popliteal cyamella. Kaohsiung J Med Sci 2014; 30:362-70. [PMID: 24924842 DOI: 10.1016/j.kjms.2014.03.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 11/22/2013] [Indexed: 10/25/2022] Open
Abstract
This randomized, controlled study was performed to compare the effects of extracorporeal shockwave therapy (ESWT) and ultrasound on the rehabilitation of knee osteoarthritis with popliteal cyamella. One hundred and twenty patients with bilateral moderate knee osteoarthritis (Altman III) and popliteal cyamella were selected and randomly assigned to four groups (GI-GIV). Patients in Groups I-III received isokinetic muscular strengthening exercises three times weekly for 8 weeks. Group II received pulse ultrasound treatment for popliteal cyamella three times weekly for 8 weeks, Group III received weekly shock wave therapy for popliteal cyamella for the first 6 weeks, and Group IV acted as controls. The therapeutic effects were evaluated by changes in the arthritic knees range of motion (ROM), visual analogue scale, Lequesne's index, and muscle peak torques after treatment and at follow-up 6 months later. Each treated group exhibited increased muscle peak torques and significantly reduced pain and disability after treatment and at follow-ups. However, only patients in Groups II and III showed significant improvements in ROM after treatment, and only participants in Group III showed immediate improvement in ROM after each treatment. Patients in Group III also showed the greatest increase in muscular strength and the greatest decrease in disability after treatment and at the follow-ups. ESWT is better than pulse ultrasound in rehabilitation of patients with knee osteoarthritis and popliteal cyamella results in more functional improvements.
Collapse
Affiliation(s)
- Tien-Wen Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Cheng-Wei Lin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chia-Ling Lee
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Hsin Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Jen Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tz-Yan Lin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Mao-Hsiung Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Neuroscience, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| |
Collapse
|
26
|
Driessen A, Balke M, Offerhaus C, White WJ, Shafizadeh S, Becher C, Bouillon B, Höher J. The fabella syndrome - a rare cause of posterolateral knee pain: a review of the literature and two case reports. BMC Musculoskelet Disord 2014; 15:100. [PMID: 24666711 PMCID: PMC3987160 DOI: 10.1186/1471-2474-15-100] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/19/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The purpose of this article was to evaluate the risks and benefits of non-operative treatment versus surgical excision of a fabella causing posterolateral knee pain. We performed a systematic review of literature and also present two case reports.Twelve publications were found in a PubMed literature review searching the word "fabella syndrome". Non-operative treatment and surgical excision of the fabella has been described. CASE PRESENTATION Two patients presented to our outpatient clinic with persisting posterolateral knee pain. In both cases the presence of a fabella was identified, located in close proximity to the posterolateral femoral condyle. All other common causes of intra- and extra articular pathologies possibly causing the posterolateral knee pain were excluded.Following failure to respond to physiotherapy both patients underwent arthroscopy which excluded other possible causes for posterolateral knee pain. The decision was made to undertake surgical excision of the fabella in both cases without complication.Both patients were examined 6 month and one year after surgery with the Tegner activity score, the Visual Analogue Scale (VAS), and International Knee Documentation Committee Score (IKDC). CONCLUSION Consistent posterolateral pain during exercise might indicate the presence of a fabella syndrome. Resecting the fabella can be indicated and is a minor surgical procedure with minimal risk. Despite good results in the literature posterolateral knee pain can persist and prevent return to a high level of sports. LEVEL OF EVIDENCE IV, case reports and analysis of literature.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Jürgen Höher
- Department of Traumatology, Clinic for Sports Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), University of Witten/Herdecke (Campus Cologne-Merheim), Ostmerheimerstrasse 200, 51109 Köln, Germany.
| |
Collapse
|
27
|
Ehara S. Potentially symptomatic fabella: MR imaging review. Jpn J Radiol 2013; 32:1-5. [PMID: 24158650 DOI: 10.1007/s11604-013-0253-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/24/2013] [Indexed: 11/24/2022]
Abstract
Fabella, a small ossicle at the posterolateral aspect of the knee, is potentially a source of knee pain. Although fabella syndrome is a rare cause of knee symptoms in young adults, osteocartilaginous degeneration prominent in the fabellofemoral joint on magnetic resonance imaging may be commonly seen in elderly patients.
Collapse
Affiliation(s)
- Shigeru Ehara
- Iwate Medical University, School of Medicine, Morioka, 020-8505, Japan,
| |
Collapse
|