Abstract
BackgroundThe purpose of this article was to evaluate the risks and benefits of non-operative treatment versus surgical excision of a fabella causing posterolateral knee pain. We performed a systematic review of literature and also present two case reports.Twelve publications were found in a PubMed literature review searching the word “fabella syndrome”. Non-operative treatment and surgical excision of the fabella has been described.Case presentationTwo patients presented to our outpatient clinic with persisting posterolateral knee pain. In both cases the presence of a fabella was identified, located in close proximity to the posterolateral femoral condyle. All other common causes of intra- and extra articular pathologies possibly causing the posterolateral knee pain were excluded.Following failure to respond to physiotherapy both patients underwent arthroscopy which excluded other possible causes for posterolateral knee pain. The decision was made to undertake surgical excision of the fabella in both cases without complication.Both patients were examined 6 month and one year after surgery with the Tegner activity score, the Visual Analogue Scale (VAS), and International Knee Documentation Committee Score (IKDC).ConclusionConsistent posterolateral pain during exercise might indicate the presence of a fabella syndrome. Resecting the fabella can be indicated and is a minor surgical procedure with minimal risk. Despite good results in the literature posterolateral knee pain can persist and prevent return to a high level of sports. Level of evidence: IV, case reports and analysis of literature.
Highlights
The purpose of this article was to evaluate the risks and benefits of non-operative treatment versus surgical excision of a fabella causing posterolateral knee pain
Consistent posterolateral pain during exercise might indicate the presence of a fabella syndrome
Case reports We examined two male patients with a long history (> 12 month) of posterolateral knee pain of unknown origin who presented in our outpatient department
Summary
The purpose of this article was to evaluate the risks and benefits of non-operative treatment versus surgical excision of a fabella causing posterolateral knee pain. Case presentation: Two patients presented to our outpatient clinic with persisting posterolateral knee pain In both cases the presence of a fabella was identified, located in close proximity to the posterolateral femoral condyle. The decision was made to undertake surgical excision of the fabella in both cases without complication Both patients were examined 6 month and one year after surgery with the Tegner activity score, the Visual Analogue Scale (VAS), and International Knee Documentation Committee Score (IKDC). The fabella is located in the posterior aspect of the knee where lines of tensile stress intersect It articulates with the posterior part of the articular surface of the lateral femoral condyle and is embedded in the muscular fibres of the gastrocnemius muscle [5]. In addition the fabellofibular ligament (or lig. of Vallois) runs to its distal insertion at the fibular head
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