From the Guidelines
Conservative management with relative rest, as recommended by the American Family Physician in 2005 1, should be the initial approach for a near full-thickness tear of the popliteus tendon near its femoral attachment. This approach is based on the principle of reducing repetitive loading of the damaged tendon to facilitate healing. The management plan typically includes:
- Relative rest to decrease stress on the tendon
- Pain management with NSAIDs, such as ibuprofen
- Physical therapy focusing on strengthening the surrounding muscles
- Use of a hinged knee brace for stability The goal of this conservative management is to alleviate symptoms and promote tendon healing, thereby improving knee function and reducing the risk of further injury. If symptoms persist after 6 weeks of conservative management, surgical intervention may be considered, particularly for individuals who require high-level knee function, such as athletes. Surgical options may include direct repair of the tendon or augmentation with autograft or allograft tissue, depending on the extent of tissue damage. Proper rehabilitation, either post-conservative management or post-surgery, is crucial for restoring knee function and preventing recurrent injury, with a gradual return to activities over 3-6 months.
From the Research
Suggested Management for Near Full-Thickness Tear of Popliteus Tendon
- The management of a near full-thickness tear of the popliteus tendon near its femoral attachment can be approached through various surgical techniques, including arthroscopic and open repair methods 2, 3, 4.
- Arthroscopic repair with suture anchors is an efficient way of treatment, as it allows for the restoration of knee stability and can be performed with minimal invasion, reducing the risk of complications such as wound drainage, infection, and stiffness 2, 3.
- The use of suture anchors to restore the popliteus to its anatomic footprint is desired, and this technique can be performed through an open or arthroscopic approach 3, 4.
- In cases where the tissue appears to be of adequate quality, open repair should be considered, especially in the young athletic population 4.
- Arthroscopic techniques, such as the use of a suture hook and polydioxanone with an all-inside technique, can also be effective in repairing popliteomeniscal fascicle tears, which may be associated with popliteus tendon injuries 5.
- The choice of surgical technique depends on the specific characteristics of the injury, the quality of the tissue, and the patient's overall condition, and should be determined on a case-by-case basis 2, 6, 3, 4.