From the Guidelines
Recovery from a near full thickness tear of the popliteus tendon near the femoral attachment typically takes 6-12 weeks with appropriate treatment. Initial management includes rest, ice, compression, and elevation (RICE protocol) for the first 48-72 hours to reduce pain and swelling, as relative rest is recommended to decrease repetitive loading of the damaged tendon 1. Pain management can be achieved with over-the-counter medications like ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks as needed.
Key Considerations
- Physical therapy is crucial and should begin after the acute phase, focusing first on gentle range of motion exercises, progressing to strengthening of the surrounding muscles (quadriceps, hamstrings, and calf muscles), and finally sport-specific exercises.
- A hinged knee brace may be recommended for 4-6 weeks to provide stability while allowing controlled movement.
- Most patients can return to daily activities within 6 weeks and sports within 3-4 months, depending on the severity of the tear.
- Surgery is rarely needed for isolated popliteus tears unless they are complete or associated with other knee injuries, as most patients with overuse tendinopathies (about 80 percent) fully recover within three to six months 1.
Diagnostic Considerations
- Plain radiography, ultrasonography, and magnetic resonance imaging can be helpful if the diagnosis remains unclear, with MRI being sensitive and specific for the detection of tendon tears, degeneration, and chronic tendinopathy 1.
- Ultrasonography can be useful for detecting moderate to full thickness tears and showing tendon changes of chronic tendinopathy.
Treatment Approach
- Rest prevents ongoing damage, reduces pain, and may promote tendon healing, although the duration of rest is not well defined 1.
- Eccentric exercise has proved beneficial in Achilles tendinosus and patellar tendinosus and may be helpful in other tendinopathies.
- Cryotherapy, such as icing, is effective for short-term pain relief and may slow the release of blood and proteins from the surrounding vasculature.
From the Research
Recovery from Near Full Thickness Tear of Popliteus Tendon
- The recovery process for a near full thickness tear of the popliteus tendon near the femoral attachment can vary depending on the treatment approach, with options including arthroscopic repair, open repair, and conservative management 2, 3, 4.
- Arthroscopic repair has been described as a viable option, with potential advantages including reduced risk of complications such as postoperative wound drainage, intra-articular sinus formation, infection, and stiffness 2.
- Open repair using suture anchors to restore the popliteus to its anatomic footprint is also a consideration, particularly in young athletic populations with adequate tissue quality 3.
- Fully arthroscopic repair with suture anchors has been reported as an efficient way to treat isolated popliteus tendon avulsion, with successful restoration of knee stability and asymptomatic outcomes at 2-year follow-up 4.
- Conservative management, including strengthening exercises and functional rehabilitation programs, can also be effective in managing symptoms and promoting recovery, as seen in a case report of a partial isolated tear of the popliteus tendon 5.
- The choice of treatment approach should be individualized based on factors such as the severity of the injury, patient age and activity level, and presence of concomitant injuries or conditions 2, 3, 4, 6.