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

Michael A Finsterwald; Victor Lu; Octavian Andronic; Gareth H Prosser; Piers J Yates; Christopher W Jones

doi:10.1186/s42836-023-00201-7

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

Arthroplasty. 2023 Sep 4;5(1):45. doi: 10.1186/s42836-023-00201-7.

Authors

Michael A Finsterwald^{1

2}, Victor Lu³, Octavian Andronic^{4

5

6}, Gareth H Prosser^{1

2}, Piers J Yates^{1

2}, Christopher W Jones^{1

2

7}

Affiliations

¹ Department of Orthopaedics, Fiona Stanley Hospital, Perth, 6150, Australia.
² The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, 6150, Australia.
³ School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK.
⁴ Department of Orthopaedics, Fiona Stanley Hospital, Perth, 6150, Australia. octavian.andronic@balgrist.ch.
⁵ The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, 6150, Australia. octavian.andronic@balgrist.ch.
⁶ Balgrist University Hospital, University of Zurich, 8008, Zurich, Switzerland. octavian.andronic@balgrist.ch.
⁷ Curtin University, Bentley, Perth, 6120, Australia.

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.

Keywords: Impingement; Popliteal tendon; Popliteus dysfunction; TKA; Total knee arthroplasty.