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Arthroscopic popliteal tenotomy grants satisfactory outcomes in total knee arthroplasty with persistent localised posterolateral pain and popliteus tendon impingement

Knee Surgery, Sports Traumatology, Arthroscopy (2023)Cite this article

Abstract

Purpose

The purpose was to estimate the prevalence of popliteus tendon impingement following TKA, and to describe the characteristics and the differential diagnosis protocol for this rare condition. The hypothesis was that arthroscopic popliteal tenotomy in TKA patients with suspected popliteus tendon impingement would relieve pain and improve satisfaction.

Methods

Of 741 TKAs performed over three years, eight (1.1%, all women) had suspected popliteus tendon impingement, of which seven had severe localised posterolateral knee pain and one global knee pain. Upon confirmation of popliteus tendon impingement, arthroscopic popliteal tenotomy was performed, and outcomes (Pain on visual analogue scale (pVAS; best, 0; worst, 10), Oxford Knee Score (OKS; best, 48; worst, 0) and satisfaction (best, 100%; worst, 0%) assessed at mean 18-month follow-up.

Results

At four to 30 months after TKA, arthroscopic exploration revealed popliteus tendon impingement in all eight knees. Six reported complete pain relief (pVAS, 0) the day following arthroscopic popliteal tenotomy, whilst one reported some residual pain (pVAS, 2). The remaining patient with global pain reported no pain relief, and required revision TKA at 12 months. Excluding the revised TKA, OKS was between 19 and 43, and satisfaction was rated ≥ 80% in five of the remaining seven patients.

Conclusions

Arthroscopic popliteal tenotomy relieved symptoms in TKA patients with persistent localised posterolateral pain and a positive popliteus test. These findings suggest that the popliteus test is reliable to diagnose popliteus tendon impingement following TKA, which could be treated by arthroscopic popliteal tenotomy.

Level of evidence

Level IV, Small case series.

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Data availability

The authors can upon reasonable request provide access to the anonymised raw data.

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Acknowledgements

Jacobus H. Müller2 (2ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland), Orcid: 0000-0002-0855-3852, Mo Saffarini2,* (2ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland).

Funding

This work was supported by ‘GCS Ramsay Santé pour l’Enseignement et la Recherche’, which provided funding for data collection and manuscript preparation.

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Authors and Affiliations

  1. Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France

    Michel P. Bonnin, Lampros Gousopoulos, Alexandre Cech, Louka Bondoux & Tarik Aït-Si-Selmi

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  1. Michel P. Bonnin
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  2. Lampros Gousopoulos
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  3. Alexandre Cech
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  4. Louka Bondoux
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  5. Tarik Aït-Si-Selmi
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ReSurg

  • Jacobus H. Müller
  •  & Mo Saffarini

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Conflict of interest

LG, AC, LB, JHM and MS declare no conflicts of ineterest. MPB: reports personal fees from Symbios, Wright Medical, Integra, and DePuy Synthesis outside the submitted work. TASS: reports personal fees from Symbios and DePuy-Synthes outside the submitted work.

Ethical approval

All patients had provided written informed consent for the use of their data and images for research and publishing purposes and the institutional review board of Ramsay Santé pour l’Enseignement et la Recherche approved the study in advance (IRB reference number: COS-RGDS-2022-06-004-BONNIN-M).

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Bonnin, M.P., Gousopoulos, L., Cech, A. et al. Arthroscopic popliteal tenotomy grants satisfactory outcomes in total knee arthroplasty with persistent localised posterolateral pain and popliteus tendon impingement. Knee Surg Sports Traumatol Arthrosc (2023). https://doi.org/10.1007/s00167-023-07376-1

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  • DOI: https://doi.org/10.1007/s00167-023-07376-1

Keywords

  • Total knee arthroplasty
  • Popliteus tendon impingement
  • Arthroscopy
  • Pain
  • Tenotomy