Treatment of Fabella syndrome with arthroscopic fabellectomy: a case series and literature review

Abstract Background The fabella is a sesamoid bone in the posterolateral capsule of the human knee joint. In quadrupedal mammals, the fabella is believed to have a role similar to the patella in redirecting extension forces of the knee joint from one point to another. In bipeds, the fabella is not t...

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Main Authors: Shuo-Po Weng, Tsung-Mu Wu, Chi-Sheng Chien, Sheng-Hui Lin
Format: Article
Language:English
Published: BMC 2021-08-01
Series:BMC Musculoskeletal Disorders
Subjects:
Online Access:https://doi.org/10.1186/s12891-021-04630-w
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author Shuo-Po Weng
Tsung-Mu Wu
Chi-Sheng Chien
Sheng-Hui Lin
author_facet Shuo-Po Weng
Tsung-Mu Wu
Chi-Sheng Chien
Sheng-Hui Lin
author_sort Shuo-Po Weng
collection DOAJ
description Abstract Background The fabella is a sesamoid bone in the posterolateral capsule of the human knee joint. In quadrupedal mammals, the fabella is believed to have a role similar to the patella in redirecting extension forces of the knee joint from one point to another. In bipeds, the fabella is not touching the back of the bent knee, and therefore the role in redirecting forces declines. Posterolateral knee pain can be associated with the irritation between the fabella and lateral femoral condyle, a phenomenon also known as fabella syndrome. In cases that are unresponsive to conservative management, surgical fabellectomy can be a successful treatment option. Among the surgical approaches, open resection is most commonly seen. There are also literature reporting arthroscopic-assisted open resection, but seldom mentioned the all-arthroscopic fabellectomy. Case presentation We present 3 patients with a long history (> 12 month) of posterolateral knee pain under suspicion of different pain origins. The diagnosis of fabella impingement was eventually made by ruling out of other causes. All the patients underwent all-arthroscopic fabellectomy for diagnosis and treatment. Investigations of the resected fabella suggested chronic impingement with apparent osteophyte formation and cartilage wearing of the articular side. All patients have been continually followed up at our outpatient department and reported to be pain free after the procedure. Conclusions In the patients presenting posterolateral pain, fabella syndrome cannot be ignored due to its relative higher presence in Asian population. In our experience, the all-arthroscopic fabellectomy offers a smaller wound size, less post-operative pain, fewer days of hospitalization and quicker time to rehabilitation for the patients with chronic posterolateral knee pain caused by fabella syndrome.
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spelling doaj.art-bda7b533dd47487b9ef6fe2d3406303a2022-12-21T18:38:20ZengBMCBMC Musculoskeletal Disorders1471-24742021-08-012211710.1186/s12891-021-04630-wTreatment of Fabella syndrome with arthroscopic fabellectomy: a case series and literature reviewShuo-Po Weng0Tsung-Mu Wu1Chi-Sheng Chien2Sheng-Hui Lin3Orthopedic Department, Kaohsiung Veterans General HospitalOrthopedic Department, Chi-Mei Medical CenterOrthopedic Department, Chi-Mei Medical CenterOrthopedic Department, Chi-Mei Medical CenterAbstract Background The fabella is a sesamoid bone in the posterolateral capsule of the human knee joint. In quadrupedal mammals, the fabella is believed to have a role similar to the patella in redirecting extension forces of the knee joint from one point to another. In bipeds, the fabella is not touching the back of the bent knee, and therefore the role in redirecting forces declines. Posterolateral knee pain can be associated with the irritation between the fabella and lateral femoral condyle, a phenomenon also known as fabella syndrome. In cases that are unresponsive to conservative management, surgical fabellectomy can be a successful treatment option. Among the surgical approaches, open resection is most commonly seen. There are also literature reporting arthroscopic-assisted open resection, but seldom mentioned the all-arthroscopic fabellectomy. Case presentation We present 3 patients with a long history (> 12 month) of posterolateral knee pain under suspicion of different pain origins. The diagnosis of fabella impingement was eventually made by ruling out of other causes. All the patients underwent all-arthroscopic fabellectomy for diagnosis and treatment. Investigations of the resected fabella suggested chronic impingement with apparent osteophyte formation and cartilage wearing of the articular side. All patients have been continually followed up at our outpatient department and reported to be pain free after the procedure. Conclusions In the patients presenting posterolateral pain, fabella syndrome cannot be ignored due to its relative higher presence in Asian population. In our experience, the all-arthroscopic fabellectomy offers a smaller wound size, less post-operative pain, fewer days of hospitalization and quicker time to rehabilitation for the patients with chronic posterolateral knee pain caused by fabella syndrome.https://doi.org/10.1186/s12891-021-04630-wFabella syndromeFabella impingementAll-arthroscopic fabellectomyPosterolateral knee painFabella chondromalaciaFabella osteoarthritis
spellingShingle Shuo-Po Weng
Tsung-Mu Wu
Chi-Sheng Chien
Sheng-Hui Lin
Treatment of Fabella syndrome with arthroscopic fabellectomy: a case series and literature review
BMC Musculoskeletal Disorders
Fabella syndrome
Fabella impingement
All-arthroscopic fabellectomy
Posterolateral knee pain
Fabella chondromalacia
Fabella osteoarthritis
title Treatment of Fabella syndrome with arthroscopic fabellectomy: a case series and literature review
title_full Treatment of Fabella syndrome with arthroscopic fabellectomy: a case series and literature review
title_fullStr Treatment of Fabella syndrome with arthroscopic fabellectomy: a case series and literature review
title_full_unstemmed Treatment of Fabella syndrome with arthroscopic fabellectomy: a case series and literature review
title_short Treatment of Fabella syndrome with arthroscopic fabellectomy: a case series and literature review
title_sort treatment of fabella syndrome with arthroscopic fabellectomy a case series and literature review
topic Fabella syndrome
Fabella impingement
All-arthroscopic fabellectomy
Posterolateral knee pain
Fabella chondromalacia
Fabella osteoarthritis
url https://doi.org/10.1186/s12891-021-04630-w
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