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Fong S, Wu D, Reed L, Cheng S, Cantave K, Chen H, McGahan P, Chen JL. Biceps femoris accessory tendon tenodesis: A case report. Clin Case Rep 2023; 11:e7984. [PMID: 37822483 PMCID: PMC10562657 DOI: 10.1002/ccr3.7984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023] Open
Abstract
Key Clinical Message We present a case of lateral knee pain from snapping of an accessory tendinous insertion of the biceps femoris. After failure of conservative treatment options, tenodesis of the accessory band to the direct arm insertion at the posterolateral edge of the fibular head effectively resolved symptoms. Abstract There are several distinct causes of lateral knee pain including IT band syndrome, meniscus tears, or other soft tissue pathologies; however, a few case reports have shown the biceps femoris as a cause of lateral knee pain and snapping. Conservative treatment is of modest benefit to the patient in these scenarios, and an MRI is not always able to identify the accessory band, as in our case. Intraoperatively, we discovered an accessory band of the biceps femoris attaching to the anterolateral tibia, causing pain and snapping during knee flexion as the band passed over the fibular head. There have been various surgical attempts to address this pathology; however, we report a successful outcome after tenodesis of the accessory band to the direct insertion at the posterolateral fibular head.
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Affiliation(s)
- Scott Fong
- Advanced Orthopedics and Sports MedicineSan FranciscoCaliforniaUSA
- Case Western Reserve University School of MedicineClevelandOHUSA
| | - Didi Wu
- Advanced Orthopedics and Sports MedicineSan FranciscoCaliforniaUSA
| | - Lena Reed
- Advanced Orthopedics and Sports MedicineSan FranciscoCaliforniaUSA
| | - Samantha Cheng
- Advanced Orthopedics and Sports MedicineSan FranciscoCaliforniaUSA
| | - Kyle Cantave
- Advanced Orthopedics and Sports MedicineSan FranciscoCaliforniaUSA
| | - Hanyu Chen
- Advanced Orthopedics and Sports MedicineSan FranciscoCaliforniaUSA
| | - Patrick McGahan
- Advanced Orthopedics and Sports MedicineSan FranciscoCaliforniaUSA
| | - James L. Chen
- Advanced Orthopedics and Sports MedicineSan FranciscoCaliforniaUSA
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Ryu JH, Lee SW, Lee DH. An all-arthroscopic surgery technique for snapping popliteal tendon syndrome: A case report and literature review. Medicine (Baltimore) 2022; 101:e31347. [PMID: 36343076 PMCID: PMC9646570 DOI: 10.1097/md.0000000000031347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
RATIONALE The incidence of snapping popliteus tendon syndrome, a type of lateral knee snapping, is not high, so making an accurate diagnosis is difficult. A proper treatment following an accurate diagnosis is essential for improvement. Very few cases have been reported of its treatment. PATIENT CONCERNS An 18-year-old male patient had experienced painful popping in the lateral part of the knee during knee flexion for 3 years before his hospital visit. DIAGNOSES Snapping popliteus tendon syndrome. INTERVENTIONS The patient underwent an all-arthroscopic surgery. Tendon debulking and tissue debridement around the popliteus tendon was conducted, but the snapping did not resolve. The enlarged tubercle was excised through an arthroscopic procedure using a burr, and the surgery was finished after confirming that snapping was resolved. OUTCOMES Full range of motion (ROM) was recovered 6 weeks after surgery and the snapping did not recur. LESSONS Snapping popliteus tendon syndrome is a disease that is hardly recognized due to its low prevalence and difficulty in diagnosis, and it requires close observation of the patient before surgery. The location of the tenderness and the snapping occurrence must also be carefully identified. Our procedure is an entirely arthroscopic technique; as it has the prominent advantage of a speedy recovery and easy rehabilitation, it could also be helpful to set treatment standards for this disease in the future.
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Affiliation(s)
- Ji Hyun Ryu
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Se-Won Lee
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Hwan Lee
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * Correspondence: Dong Hwan Lee, Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul 07345, Republic of Korea (e-mail: )
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Okamura H, Ishikawa H, Ohno T, Fujita S, Yamakami S, Inagaki K. Arthroscopic Osteophyte Resection for Osteophyte-Induced Popliteal Impingement. Arthrosc Tech 2022; 11:e1883-e1887. [PMID: 36457389 PMCID: PMC9705398 DOI: 10.1016/j.eats.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
Popliteal tendinitis causes lateral knee pain. A cause is impingement of the popliteal tendon by lateral femoral condylar osteophytes. Conservative and surgical treatments have been reported; however, popliteal impingement is a relatively rare disease, and no treatment has been established. Reduction of mechanical stress is important in the treatment of impingement syndromes. The popliteal tendon is an important tissue that contributes to knee stability and, therefore, usually cannot be transected. On the other hand, osteophyte resection may allow the reduction of mechanical stress. Therefore, we describe an arthroscopic osteophyte resection technique for the treatment of osteophyte-induced popliteal impingement. In brief, this technique involves confirmation of popliteal impingement, osteophyte resection using an osteotome, smoothening of the resected area, and confirmation of the resolution of popliteal impingement.
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Affiliation(s)
- Hiroki Okamura
- Department of Orthopaedic Surgery, Nippon Koukan Hospital, Kanagawa, Japan,Address correspondence to Hiroki Ishikawa, M.D., Ph.D., Department of Orthopaedic Surgery, Nippon Koukan Hospital, 1-2-1 Koukandori, Kawasaki-ku, Kanagawa, 210-0852, Japan.
| | - Hiroki Ishikawa
- Department of Orthopaedic Surgery, Nippon Koukan Hospital, Kanagawa, Japan
| | - Takuya Ohno
- Department of Orthopaedic Surgery, Nippon Koukan Hospital, Kanagawa, Japan
| | - Shogo Fujita
- Department of Orthopaedic Surgery, Nippon Koukan Hospital, Kanagawa, Japan
| | - Shigeo Yamakami
- Department of Orthopaedic Surgery, Nippon Koukan Hospital, Kanagawa, Japan
| | - Katsunori Inagaki
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
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Berthaume MA, Bull AMJ. Cyamella (a popliteal sesamoid bone) prevalence: A systematic review, meta-analysis, and proposed classification system. Clin Anat 2021; 34:810-820. [PMID: 33905585 DOI: 10.1002/ca.23743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/26/2021] [Accepted: 03/01/2021] [Indexed: 01/05/2023]
Abstract
The cyamella is a rare, generally asymptomatic, knee sesamoid bone located in the proximal tendon of the popliteal muscle. Only two studies have investigated cyamella presence/absence in humans, putting ossified prevalence rates at 0.57%-1.8%. We aim to (a) determine cyamella prevalence in a Korean population, (b) examine coincident development of the cyamella and fabella, and (c) perform a systematic review and meta-analysis on the cyamella in humans. Medical computed tomography scans of 106 individuals were reviewed. A systematic review and meta-analysis were performed following PRISMA guidelines. Cyamellae were found in 3/212 knees (1.4%), and presence/absence was uncorrelated to height, age, and sex. The cyamella was not found coincidentally with the fabella, although the statistical power was low. Our systematic review/meta-analysis revealed cyamellae were generally asymptomatic and ossification could occur at 14 years. Cyamellae were equally likely to be found in both sexes, knees, one or both knees, and there appeared to be no global variation in prevalence rates. Cyamellae were found in three distinct locations. There is little support for the role of intrinsic genetic and/or environmental factors in cyamella development in humans. However, the apparent phylogenetic signal in Primates suggests genetics plays a role in cyamella development. We propose a cyamella classification system based on cyamella location (Class I, popliteal sulcus; Class II, tibial condyle; Class III, fibular head) and hypothesize locations may correspond to distinct developmental pathways, and cyamella function may vary with location.
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Affiliation(s)
- Michael A Berthaume
- Department of Bioengineering, Imperial College London, London, UK.,Division of Mechanical Engineering and Design, London South Bank University, London, UK
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, UK
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Su S, Lu Y, Chen Y, Li Z. A symptomatic cyamella in the popliteus tendon causing snapping knee: a case report and literature review. BMC Musculoskelet Disord 2019; 20:495. [PMID: 31656193 PMCID: PMC6815407 DOI: 10.1186/s12891-019-2882-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 10/04/2019] [Indexed: 12/04/2022] Open
Abstract
Background Cyamella,the sesamoid bones of the popliteus muscle, are rare in humans. Snapping knee is an uncommon problem which can be difficult to diagnose. Case presentation In this case, we report a 24-year-old male with snapping knee caused by symptomatic cyamella in the popliteus tendon. A large cyamella was identified upon surgery and was removed. Postoperatively, the patient had immediate relief of preoperative symptoms, and there were no signs of recurrence after 1 years of follow-up. Conclusions Although not previously suggested, symptomatic cyamella in the popliteus tendon should be considered as part of the differential diagnosis of the snapping knee.
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Affiliation(s)
- Shouwen Su
- Department of Orthopedics, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yunxiang Lu
- Department of Orthopedics, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuxian Chen
- Department of Orthopedics, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhiyong Li
- Department of Orthopedics, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Matar HE, Farrar NG. Snapping Biceps Femoris: clinical demonstration and operative technique. Ann R Coll Surg Engl 2018; 100:e59-e61. [PMID: 29364023 PMCID: PMC5930108 DOI: 10.1308/rcsann.2018.0007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2017] [Indexed: 01/13/2023] Open
Abstract
Snapping biceps femoris syndrome has been reported in the literature in a handful of case reports but not yet with a demonstration of clinical examination and intraoperative findings. We present an educational clinical video of snapping biceps femoris with intraoperative demonstration of findings and surgical repair.
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Affiliation(s)
- HE Matar
- Mid Cheshire Hospitals NHS Foundation Trust, UK
| | - NG Farrar
- Mid Cheshire Hospitals NHS Foundation Trust, UK
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Abstract
A 64-year-old man presented with intermittent but progressive lateral-sided knee pain. Symptoms mimicked those of a lateral meniscal tear. Magnetic resonance imaging revealed a cyamella associated with popliteal tendonitis and an intact lateral meniscus.
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Affiliation(s)
- N Rehmatullah
- St Helens and Knowsley Teaching Hospitals NHS Trust, UK.
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Crow SA, Quach T, McAllister DR. Partial tendon release for treatment of a symptomatic snapping biceps femoris tendon: a case report. Sports Health 2012; 1:435-7. [PMID: 23015904 PMCID: PMC3445169 DOI: 10.1177/1941738109338360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Snapping of the biceps femoris tendon over the fibular head is an uncommon condition. Reported causes include an anomalous insertion of the tendon, trauma at the insertion site of the tendon, and an abnormality of the fibular head. This article reports a case of a painful snapping biceps femoris tendon in a patient without an anomalous tendon insertion or an abnormality of the fibular head. Partial release of the superior aspect of the tendon resulted in resolution of symptoms.
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Affiliation(s)
- Scott A Crow
- Department of Orthopaedic Surgery, University of California, Los Angeles, California
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Abstract
OBJECTIVE The purpose of this article is to illustrate the causes of snapping knee. The value of imaging techniques is discussed with an emphasis on dynamic sonography in light of the available surgical and radiologic literature. CONCLUSION Because of its dynamic capabilities, dynamic sonography provides real-time visualization of snapping knee syndrome and may be used as a first-line modality.
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Guillin R, Marchand AJ, Roux A, Niederberger E, Duvauferrier R. Imaging of snapping phenomena. Br J Radiol 2012; 85:1343-53. [PMID: 22744321 DOI: 10.1259/bjr/52009417] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Snapping phenomena result from the sudden impingement between anatomical and/or heterotopical structures with subsequent abrupt movement and noise. Snaps are variously perceived by patients, from mild discomfort to significant pain requiring surgical management. Identifying the precise cause of snaps may be challenging when no abnormality is encountered on routinely performed static examinations. In this regard, dynamic imaging techniques have been developed over time, with various degrees of success. This review encompasses the main features of each imaging technique and proposes an overview of the main snapping phenomena in the musculoskeletal system.
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Affiliation(s)
- R Guillin
- Department of Musculoskeletal Imaging, Rennes University Hospital, CHU de Rennes, Rennes, France.
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Guillin R, Mendoza-Ruiz JJ, Moser T, Ropars M, Duvauferrier R, Cardinal E. Snapping biceps femoris tendon: a dynamic real-time sonographic evaluation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:435-437. [PMID: 20658565 DOI: 10.1002/jcu.20728] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Snapping of the distal arms of the biceps femoris tendon may explain pain and discomfort at the lateral aspect of the knee. We report two cases in which dynamic sonography was able to confirm the diagnosis and document which of the main arms was involved in the process.
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Affiliation(s)
- Raphaël Guillin
- Musculoskeletal Imaging Department, University Hospital of Rennes, France
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