CHAPTER 61 • SOFT TISSUE KNEE INJURIES (TENDON AND BURSAE) 363POPLITEUS TENDINITIS
- Popliteus tendon travels from its origin on the lateral
femoral condyle posterolaterally through the popliteal
hiatus to insert on the posterior aspect of the proximal
tibia (Mann and Hagy, 1977). - Injuries to this area are a cause of posterolateral knee
pain and can occur both acutely (i.e., anterior cruci-
ate ligament(ACL) rupture or posterolateral corner
injuries) or more chronically as an overuse phenome-
non. Chronic injuries most often occur with excessive
downhill running or walking (i.e., backpacking)
(Nauer and Aalberg, 1985; Mayfield, 1977).
CLINICAL PRESENTATION
•Pain to palpation posterolaterally over the popliteus
tendon. This is best appreciated clinically by placing
the leg in a figure-of-four position and palpating at the
origin of the popliteus just anterior to the lateral
femoral epicondyle.
- Differential diagnosis includes iliotibial band syndrome,
lateral meniscal tear, and biceps femoris tendonitis.
TREATMENT
- Includes rest and activity modification in the form of
eliminating downhill activity. Anti-inflammatory
medication as well as physiotherapeutic modalities
are also helpful (Mayfield, 1977).
ILIOTIBIAL BAND SYNDROME
- Most common cause of lateral sided knee pain in long
distance runners. Also seen in cyclists, weightlifters,
football, soccer, and tennis. Often precipitated by
downhill running (Orava, 1978). - Caused by excessive friction between iliotibial band
and lateral epicondyle. Knee flexion angle of 30°
maximizes friction between these two structures
casing an ensuing bursitis. - Anatomic factors predisposing to this condition
include genu varum, tibial varum, varus hindfoot, and
compensatory foot hyperpronation.
CLINICAL PRESENTATION
- Lateral sided knee pain that usually is present after
initial warm-up that often causes cessation of activity.
Pain not present at rest.- Point of maximal tenderness is approximately 3 cm
proximal to lateral joint line over lateral epicondylar
region. - Ober’sand Noble’s testare positive and can confirm
diagnosis: - Ober’s test: Patient is placed in lateral decubitus posi-
tion with the affected extremity upwards. The unaf-
fected knee and hip are flexed. The involved knee is
flexed and hip hyperextended and abducted. Tightness
in the iliotibial tract will prevent the affected extrem-
ity from adducting below the horizontal created by the
patient’s torso (Renee, 1975). - Noble’s test: Patient is in supine position with the
knee flexed 90°. Pain is elicited in lateral epicondylar
region when the patient’s knee is extended between
30 °and 40°. - Radiographs are negative in this condition. MRI can
confirm more chronic cases unresponsive to conserva-
tive treatment.
- Point of maximal tenderness is approximately 3 cm
TREATMENT- Conservative treatment focusing on iliotibial tract,
hamstring, and hip external rotator stretching com-
bined with strengthening of the hip abductors is usu-
ally successful when combined with activity
modification and anti-inflammatory treatment. Foot
orthotics can also be a useful adjunct in conservative
treatment.
•Surgical excision of the posterior aspect of the iliotib-
ial tract overlying the lateral epicondyle at 30°–40°of
knee flexion is effective in chronic cases not respond-
ing to conservative treatment (Martens, Libbrect, and
Burssens, 1989).
PREPATELLAR BURSITIS- Prepatellar bursa is a potential space of synovial tissue
that functions to decrease the friction between the
overlying subcutaneous tissue and patella.
•A bursitis can result from an acute injury, infection,
systemic disease (i.e., gout), or from chronic activity
or overuse (Dawn, 1977). - Commonly seen in the sport of wrestling (Mysnyk et al,
1986).
CLINICAL PRESENTATION•Patients typically present with swelling superficial to
the patella. Knee range of motion may be limited at the
extremes of flexion pending the size of the collection