Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2014 Mar 26:15:100.
doi: 10.1186/1471-2474-15-100.

The fabella syndrome - a rare cause of posterolateral knee pain: a review of the literature and two case reports

Arne Driessen, Maurice Balke, Christoph Offerhaus, William James White, Sven Shafizadeh, Christoph Becher, Bertil Bouillon, Jürgen Höher  1
Affiliations
Case Reports

The fabella syndrome - a rare cause of posterolateral knee pain: a review of the literature and two case reports

Arne Driessen et al. BMC Musculoskelet Disord. .

Abstract

Background: 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. 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 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. 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).

Conclusion: Consistent 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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Sagittal view of lateral right knee showing the fabella in close topographical relation to the posterior lateral femoral condyle embedded in the lateral head of gastrocnemius muscle.
Figure 2
Figure 2
Axial view of the same knee showing the relation of the fabella to the cartilage of the posterior lateral femoral condyle.
Figure 3
Figure 3
Resected fabella with cartilaginous surface.
Figure 4
Figure 4
Resecting the fabella through a lateral incision between M. biceps femoris, iliotibial band and posterolateral femoral condyle.
Figure 5
Figure 5
Sagittal view after 3 month after resection of the fabella; intact posterolateral capsule & gastrocnemius muscle with little scar tissue.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Tabira Y, Saga T, Takahashi N, Watanabe K, Nakamura M, Yamaki K-I. Influence of a fabella in the gastrocnemius muscle on the common fibular nerve in Japanese subjects. Clin Anat (New York, N.Y.) 2012;26(7):893–902. doi:10.1002/ca.22153. - PubMed
    1. Pritchett JW. The incidence of fabellae in osteoarthrosis of the knee. J Bone Jt Surg. 1984;66:1379–1380. - PubMed
    1. Minowa T, Murakami G, Kura H, Suzuki D, Han S-H, Yamashita T. Does the fabella contribute to the reinforcement of the posterolateral corner of the knee by inducing the development of associated ligaments? J Orthop Sci Off J Japanese Orthop Assoc. 2004;9:59–65. - PubMed
    1. Kawashima T, Takeishi H, Yoshitomi S, Ito M, Sasaki H. Anatomical study of the fabella, fabellar complex and its clinical implications. Surg Radiol Anat SRA. 2007;29:611–616. doi: 10.1007/s00276-007-0259-4. - DOI - PubMed
    1. Müller W. Knee - Form, Funct Ligament Reconstr. New York: Springer Verlag Berlin Heidelberg; 1982. The knee - form, function and ligament reconstruction. 40, 96, 98, 192, 249, 252.

MeSH terms

LinkOut - more resources