Semimembranosus tenosynovitis: operative results

Is Dextrose Prolotherapy More Effective Than Steroids in the Treatment of Distal Semimembranous Tendinopathy?

OBJECTIVE

Distal semimembranous (SM) tendinopathy is one of the rare causes of posteromedial knee pain. Steroid injections are included in the treatment of resistant cases. The effectiveness of dextrose prolotherapy is not fully known. This study aimed to investigate the effectiveness of dextrose prolotherapy in distal SM tendinopathy and to compare it with the effectiveness of steroid injections.

METHODOLOGY

 The study included 12 patients who received ultrasound-guided steroid injections and 13 patients who received dextrose prolotherapy treatment with the diagnosis of distal SM tendinopathy. The patient's visual analog scale (VAS) and International Knee Documentation Committee Subjective Knee Assessment (IKDC) scores were analyzed before the procedure, as well as one week and four weeks afterward.

RESULTS

 Pre-procedure VAS scores were similar in the dextrose and steroid groups (4.00 ± 0.70, 4.33 ± 0.88 P = 0.308), while they were significantly lower in the steroid group at week 1 (1.84 ± 0.55, 1.16 ± 0.93, P = 0.036). Fourth-week VAS scores were significantly lower in the dextrose group (0.61 ± 0.65, 1.33 ± 0.65, P = 0.011). IKDC scores were similar in the dextrose and steroid groups before the procedure (48.34 ± 6.01, 46.66 ± 3.34, P = 0.402). In the first week, it was observed to be similar in the dextrose and steroid groups (55.03 ± 8.52, 53.30 ± 1.56, P = 0.496) and higher in the dextrose group in the fourth week (62.50 ± 14.46, 53.13 ± 1.60, P = 0.036).

CONCLUSIONS

It was observed that both dextrose prolotherapy and steroid injections were effective in reducing pain and improving functionality in the treatment of distal SM tendinopathy. Steroid injections showed better results in the first week, while dextrose prolotherapy yielded better outcomes by the fourth week.

Distal semimembranosus tendinopathy: A narrative review

Distal semimembranosus tendinopathy is a relatively uncommon diagnosis that can be responsible for medial knee pain. The semimembranosus tendon inserts on the posteromedial knee and is surrounded by the semimembranosus bursa, with both the bursa and tendon potential sources of pain. Similar to other tendinopathies, semimembranosus tendinopathy often occurs with overuse of the musculotendinous unit and is commonly seen in runners. Diagnosis can be made clinically and may be substantiated with use of ultrasound or magnetic resonance imaging. Scant literature exists evaluating the efficacy of treatments for this condition. Consequently, best practice for treatment is inferred from other similar tendinopathies, clinical expertise, and smaller studies on semimembranosus tendinopathy. Extrapolating from other tendinopathies, rehabilitation should be the cornerstone of initial treatment, with focus on kinetic chain and gait abnormalities, hamstring strength and neuromuscular control, and progressive tendon loading. Recalcitrant cases with a coexisting bursopathy can be treated with an ultrasound-guided bursal corticosteroid injection. Future studies may help delineate the optimal treatment regimen for this relatively uncommon diagnosis.

Semimembranosus tendinopathy: one cause of chronic posteromedial knee pain

Context:

Semimembranosus tendinopathy (SMT) is an uncommon cause of chronic knee pain that is rarely described in the medical literature and may be underdiagnosed or inadequately treated owing to a lack of understanding of the condition.

Evidence Acquisition:

A search of the entire PubMed (MEDLINE) database using the terms knee pain semimembranosus and knee tendinitis semimembranosus, returned only 5 references about SMT—4 case series and 1 case report—and several relevant anatomical or imaging references.

Results:

The incidence of SMT is unknown in the athletic population and is probably more common in older patients. The usual presentation for SMT is aching posteromedial knee pain. Physical examination can usually localize the area of tenderness to the distal semimembranosus tendon or its insertion on the medial proximal tibia. In unclear cases, bone scan, magnetic resonance imaging, or ultrasound may distinguish SMT from other causes of posteromedial knee pain. Treatment should begin with relative rest, ice, nonsteroidal anti-inflammatory drugs, and rehabilitative exercise. In the minority of cases that persist greater than 3 months, a corticosteroid injection at the tendon insertion site may be effective. Surgery to reroute and reattach the tendon is rarely needed but may be effective.

Conclusion:

SMT is an uncommon cause of knee pain, but timely diagnosis can lead to effective treatments.

Semimembranosus tendonitis after total knee arthroplastyGood outcome after surgery in 6 patients

More than 700 total knee arthroplasties were performed in our Department between 1992-2000. 6 patients developed pain on the postero-medial aspect of the knee, within 1 year of surgery. The pain increased during walking and especially on rising from a chair. All patients were women with good knee motion and good alignment of the implanted prosthesis. We found no signs of low-grade infection. Injection of 1% Xylocaine relieved pain for a short time in all patients. They were all treated with excision of the reflected portion of the semimembranosus tendon which was not cut during the arthroplasty. Pain was completely relieved in 5 cases and improvement occurred in 1.

Mineralized fibroma of the tendon sheath presenting as a bursitis

We report on the clinical, imaging-including ultrasound, computed tomography, and magnetic resonance imaging-and histological features of a fibroma of the tendon sheath with mineralized chondroid and osseous metaplasia, presenting as a semimembranosus bursitis. The anatomical characteristics of the semimembranosus bursa are demonstrated by dissection in a cadaveric specimen and correlated with the imaging findings in our patient.

Snapping knee syndrome in an athlete caused by the semitendinosus and gracilis tendons. A case report

We report a case of symptomatic subluxation of the semitendinosus and gracilis over the posteromedial corner of the tibia manifesting with snapping. This is the first such case recorded in non-Asian population and in a high-demand athlete. Snapping was reproduced on active extension of the knee and at initiation of flexion and could be readily palpated over the posteromedial aspect of the tibia. Dynamic ultrasound, a key diagnostic tool in such conditions, revealed abrupt anterior subluxation of the semitendinosus and gracilis tendons during active terminal extension over the insertion of the semimembranosus as well as areas of tendinopathy corresponding with the site of subluxation. Due to failure of conservative treatment, surgery was undertaken, involving tenotomy and resection of a 10-12 cm segment of the semitendinosus and gracilis. The patient returned to the same level of sporting activities within 4 months and remained symptom-free 18 months post-operatively. The role of eccentric loading of the knee joint, as well as the "protective" role of the accessory tendinous bands and aponeurotic expansions of the semitendinosus and gracilis is discussed.

The semimembranosus-tibial collateral ligament bursa. Anatomical study and magnetic resonance imaging

A bursa that was deep to the tibial collateral ligament and adjacent to the semimembranosus tendon was studied in fifty cadaveric knees; a vinyl solution was injected into four of the specimens in order to facilitate a study of the relationship between the bursa and its surrounding structures. The bursa had the shape of an inverted U: the superficial arm was an elliptical pocket that was located between the semimembranosus tendon and the tibial collateral ligament, and the deep arm was a triangular pocket that was located between the semimembranosus tendon and the medial tibial condyle. The bursa measured, on the average, twenty-one millimeters in its greatest anteroposterior dimension and ten millimeters in its greatest superoinferior dimension. Magnetic resonance images were made of two patients, and they showed fluid in the bursa.