Popliteus tendonitis is an uncommon pathology that which often occurs in athletes and people with a history of other knee ligament injuries. The pathology involves popliteus muscle which is present on the posterolateral aspect of knee region.
Popliteus muscle is key stabilizer the knee, and plays an important role in maintaining proper mechanics at the knee during walking, running, and climbing stairs.
Popliteus muscle orginates from lateral femoral condyle [strongest origin], just anterior and inferior to the lateral collateral ligament origin, from fibula and from the posterior horn of the lateral meniscus.
The muscle inserts on the posterior surface of tibia above soleal or popliteal line occupying about 10 to 12 cms of tibia.
The popliteus tendon runs deep to lateral collateral ligament and passes through a hiatus in the coronary ligament to attach to the femur.
Popliteus is an internal rotator of knee. It assists in initiating knee flexion and early rotational unlocking from tibia. Unlocking is accomplished contour of articulation & retraction of posteriror aspect of lateral meniscus.
It rotates the tibia medially on the femur or femur laterally on the tibia depending on which one is fixed. It also works to withdraw the meniscus during flexion in some persons, and provides rotatory stability to the femur on the tibia
In addition popliteus also acts as secondary restraint in preventing posterior tibial translation on the femur.
It prevents posterior translation of the tibia on the femur.
Apart from these, popliteus prevents excessive external rotation of tibia.
Presentation of Popliteus Tendonitis
Pain is of insidious onset and present along posterolateral portion of the knee. The occurrence of the pain is mainly during weight bearing when knee is between 15-30 degree of flexion [during early swing phase].
History might further reveal a recent activity like downhill running, running on banked surface or backpacking downhill.
The pain is aggravated by running and relieved by rest.
There is tenderness at tendinous insertion at lateral femoral condyle. For palpating the politeus the lower limb is kept in “fig of 4”.
Findings may absent during rest period and having patient run downlhill prior to examination may be helpful.
Joint effusion absent unless concomitant problem.
Lab studies are generally not required in popliteus tendonitis.
Imaging is routinely not required.
Xrays are mostly normal but may show radiodensities in chronic cases.
MRI may be done to rule out intraarticular pathology or tendon avulsion.
Differential Diagnoses of Popliteus Tendonitis
- Lateral mensical pathology e.g cyst
- Osteochondritis dissecans
- Iliotibial band syndrome
- Lateral collateral ligament injury
- Degenerative joint disease
- lateral meniscus
- Proximal tibiofibular instability.
Treatment of Popliteus Tendonitis
During acute symptoms rest, activity restriction, ice application , acompression and elevation of part should be done.
NSAIDs may be used for relieving pain and decreasing inflammation.
The patients with chronic politeus tendonitis need activity restriction for prolonged period. Steroid injections help to alleviate the symtoms.
Acute period is followed by rehabiliatation which consists of flexibility exercises and strengthening exercises.
Retraining the functional movement pattern should be undertaken before return to play is allowed. When patient returns to play, downhill running should be avoided.
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