Arthroscopic Management of Popliteal Tendon Dysfunction in Total Knee Arthroplasty

Abstract

Unexplainable knee pain may follow knee replacement surgery. The popliteal tendon should be evaluated as a possible cause of lateral knee pain and dysfunction after knee arthroplasty. The tendon can snap over or impinge on lateral osteophytes or prominent femoral components and produce mechanical symptoms and pain. Ultrasound-guided injections may confirm the diagnosis and provide symptomatic relief in some patients. Those who respond well to injections and in whom conservative management ultimately fails may be offered arthroscopic release of the popliteal tendon. We present the arthroscopic technique for popliteal tendon release in a symptomatic patient whose pain resolved immediately postoperatively. We recommend the use of an anterolateral viewing portal and an accessory lateral working portal to access the posterolateral knee. There can be extensive scar tissue overlying the popliteal tendon after arthroplasty. Arthroscopic tendon transection and excision comprise a reliable procedure for popliteal tendon impingement after knee arthroplasty without compromising knee stability.

Ultrasound Diagnosis of Osteophytic Impingement of the Popliteus Tendon After Total Knee Replacement

“…Whether the osteophyte is preexisting or develops is not clear. The catching of the tendon on the osteophyte leads to reproduction of pain, a snapping sensation, or both on physical examination when the knee is passively flexed with application of varus stress . It is an important diagnosis to make, as it is a potentially reversible cause of pain in this patient population.…”

“…Eighty‐three percent (5 of 6) of the patients reported decreased pain immediately after the injection, implicating tendon impingement as the cause. Westermann et al were the first group to describe the use of US‐guided injections to confirm clinically suspected popliteus tendon impingement but did not mention the number of patients in their series. Their patients who responded favorably to popliteus tendon sheath injection underwent arthroscopic debridement of the popliteus tendon and scar tissue in the lateral joint, with resolution of symptoms .…”

“…There are a variety of pathologic entities that cause knee pain after total knee arthroplasty (TKA). Posterolateral knee pain, with or without mechanical symptoms such as snapping, is commonly attributed to impingement of the popliteus tendon on the lateral condylar component or an osteophyte in the popliteal sulcus . The diagnosis may be suspected clinically, but ultrasound (US)‐guided injection may be requested for confirmation.…”

Diagnosing and Treating Popliteal Tendinopathy After Total Knee Arthroplasty

“…Both of these conditions can increase tension on the traversing popliteal tendon resulting in irritation. Additionally, arthroscopic release of the popliteal tendon was proposed as a standard treatment for patients diagnosed with popliteal tendinopathy [8]. The release of the tendon in this patient population was not associated with an increase in instability and had reliable pain relief.…”

Arthroscopic treatment of total knee arthroplasty complications

“…Westermann et al have described a technique of arthroscopic release of the popliteus tendon after TKA using an anterolateral portal and an accessory lateral vision portal created under direct visualization, approximately 4 cm posterior to the anterolateral portal. 15 With this technique, the arthroscopic release immediately alleviated pain.…”