A Comprehensive Review of the Fabella Bone

Common fibular nerve palsy due to the Fabella: A review

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.

Fabella Syndrome and Common Peroneal Neuropathy following Total Knee Arthroplasty

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.

Prevalence of the fabella and its general characteristics in Turkish population with magnetic resonance imaging

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.

Fabella and patella variants: radiographic prevalence, distribution and clinical relevance in a population of black african descent

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.

Feeding design in free-living mesostigmatid chelicerae (Acari: Anactinotrichida)

A model based upon mechanics is used in a re-analysis of historical acarine morphological work augmented by an extra seven zoophagous mesostigmatid species. This review shows that predatory mesostigmatids do have cheliceral designs with clear rational purposes. Almost invariably within an overall body size class, the switch in predatory style from a worm-like prey feeding ('crushing/mashing' kill) functional group to a micro-arthropod feeding ('active prey cutting/slicing/slashing' kill) functional group is matched by: an increased cheliceral reach, a bigger chelal gape, a larger morphologically estimated chelal crunch force, and a drop in the adductive lever arm velocity ratio of the chela. Small size matters. Several uropodines (Eviphis ostrinus, the omnivore Trachytes aegrota, Urodiaspis tecta and, Uropoda orbicularis) have more elongate chelicerae (greater reach) than their chelal gape would suggest, even allowing for allometry across mesostigmatids. They may be: plesiosaur-like high-speed strikers of prey, scavenging carrion feeders (like long-necked vultures), probing/burrowing crevice feeders of cryptic nematodes, or small morsel/fragmentary food feeders. Some uropodoids have chelicerae and chelae which probably work like a construction-site mechanical excavator-digger with its small bucket. Possible hoeing/bulldozing, spore-cracking and tiny sabre-tooth cat-like striking actions are discussed for others. Subtle changes lead small mesostigmatids to be predator-scavengers (mesocarnivores) or to be predator-fungivores (hypocarnivores). Some uropodines (e.g., the worm-like prey feeder Alliphis siculus and, Uropoda orbicularis) show chelae similar in design to astigmatids and cryptostigmatids indicating possible facultative saprophagy. Scale matters-obligate predatory designs (hypercarnivory) start for mesostigmatids with chelal gape > 150 μm and cheliceral reach > 350 μm (i.e., about 500-650 μm in body size). Commonality of trophic design in these larger species with solifugids is indicated. Veigaia species with low chelal velocity ratio and other morphological strengthening specialisms, appear specially adapted in a concerted way for predating active soft and fast moving springtails (Collembola). Veigaia cerva shows a markedly bigger chelal gape than its cheliceral reach would proportionately infer suggesting it is a crocodile-like sit-and-wait or ambush predator par excellence. A small chelal gape, low cheliceral reach, moderate velocity ratio variant of the worm-like feeding habit design is supported for phytoseiid pollenophagy. Evidence for a resource partitioning model in the evolution of gnathosomal development is found. A comparison to crustacean claws and vertebrate mandibles is made. Alliphis siculus and Rhodacarus strenzkei are surprisingly powerful mega-cephalics for their small size. Parasitids show a canid-like trophic design. The chelicera of the nematophagous Alliphis halleri shows felid-like features. Glyphtholaspis confusa has hyaena-like cheliceral dentition. The latter species has a markedly smaller chelal gape than its cheliceral reach would suggest proportionately, which together with a high chelal velocity ratio and a high estimated chelal crunch force matches a power specialism of feeding on immobile tough fly eggs/pupae by crushing (durophagy). A consideration of gnathosomal orientation is made. Predatory specialisms appear to often match genera especially in larger mesostigmatids, which may scale quite differently. Comparison to holothyrids and opilioacarids indicates that the cheliceral chelae of the former are cutting-style and those of the latter are crushing-style. A simple validated easy-to-use '2:1 on' predictive algorithm of feeding habit type is included based on a strength-speed tradeoff in chelal velocity ratio for ecologists to test in the field.

Does the Prevalence of Ossified Fabella Vary in Knee Osteoarthritis and Age-Related Degeneration? A Meta-Analysis of About 11,000 Knees

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.

Human biological variation in sesamoid bone prevalence: the curious case of the fabella

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.