Popliteal tendon impingement as a cause of pain following total knee arthroplasty: a systematic review

Abstract

Introduction Popliteal tendon impingement (PTI) is an under-recognized cause of persistent pain following total knee arthroplasty (TKA). The purpose of the systematic review was to summarize and outline successful strategies in the diagnosis and management of PTI. Methods A systematic review following the PRISMA guidelines was performed for four databases: MEDLINE (Pubmed), Ovid EMBASE, Web of Science, and Cochrane Database. It was registered in the International Prospective Register for Systematic Reviews and Meta-analysis (PROSPERO) under the registration number: CRD42023398723. The risk of bias assessment was performed using the criteria of the methodological index for non-randomized studies (MINORS). Results A total of 8 studies were included. There were 2 retrospective case series and 6 case reports. The follow-up ranged from 6 to 30 months. Two studies described PTI as an intraoperative phenomenon during TKA with “snapping”; whilst 6 studies described indications and outcomes for arthroscopic tenotomy for PTI following TKA. In making the diagnosis, there was concurrence that the posterolateral pain should be focal and that dynamic ultrasonography and diagnostic injection play an important role. Two specific clinical tests have been described. There was no consistency regarding the need for imaging. There were no reports of instability following popliteal tendon tenotomy or other complications. Conclusion PTI should be suspected as a cause for persistent focal pain at the posterolateral knee following TKA. The diagnosis can be suspected on imaging and should be confirmed with dynamic ultrasonography and an ultrasound-guided diagnostic injection. An arthroscopic complete tenotomy of the tendon can reliably alleviate pain and relies on correct diagnosis. There is no evidence for clinically relevant negative biomechanical consequences following tenotomy. Level of evidence Systematic Review of Level IV and V studies.

Asymmetric Implant Design for Posterolateral Overhang of the Femoral Component in Total Knee Arthroplasty: A Retrospective Computed Tomography-Based Study

“…The popliteus tendon is considered particularly prone to impingement owing to its intra-articular location and close contact with the lateral femoral condylar margin [ 24 ]. Popliteus tendon impingement (PTI) is a soft tissue impingement after TKA (Figure 4 ), and PTI has been described as secondary to friction with the femoral osteophyte [ 13 , 25 ] or overhang of the prosthesis [ 14 , 15 ], which is successfully treated by surgical release. The presence of localized posterolateral pain has been reported as a diagnostic of PTI.…”

Automatic measurement of lower limb alignment in portable devices based on deep learning for knee osteoarthritis

“…In clinical practice, measurement accuracy can be influenced by factors such as body position [11][12][13] (like loading, flexion, or rotation of lower limbs), image quality [7], and reader experience [14][15][16]. Even with software assistance, deviations caused by hardware facilities and use can also affect the measurement, which leads to inter-and intra-reader variability and unsatisfied reliability [17][18][19]. In actual use, landmarks selection manually can also be time-consuming.…”