Open Popliteal Tendon Repair

Abstract

Popliteal tendon tears without concomitant damage to the cruciate ligaments or other posterolateral corner ligaments are rare entities with few studies reporting on their existence, with rare case reports discussing their treatment. Continued pain, instability, and effusions are typical symptoms, with magnetic resonance imaging being the main tool for diagnosis. Furthermore, monosodium urate crystals that induce gout have been shown to collect in the popliteal groove and thus may lead to degeneration and isolated tearing. Most case reports have reviewed arthroscopic debridement of the tendon in patients with continued pain. However, in the young athletic population, open repair, if the tissue appears to be of adequate quality, should be a consideration. The use of suture anchors to restore the popliteus to its anatomic footprint is desired. This Technical Note describes a safe and reliable technique for open popliteal tendon repair of an isolated avulsion injury.

Fig 1

Arthroscopic view of popliteus showing complete tearing and minimal retraction (white arrow). The patient is positioned supine and the right knee is injured while viewing from the anterolateral portal.

Fig 2

An approximately 6-cm incision is made, starting over the lateral epicondyle and extending distally between the Gerdy tubercle and the fibular head. The patient is positioned supine and the right knee is injured.

Fig 3

The lateral epicondyle is identified, and a ruler is used to mark 18.5 mm anterior to the insertion of the popliteus.

Fig 4

The knee capsule is incised longitudinally.

Fig 5

(A) The popliteus is identified and grasped. (B) Adhesions to the capsule and other surrounding structures are released. Tendon excursion is tested.

Fig 6

The footprint of the popliteus is exposed and prepared to maximize healing.

Fig 7

(A) The tendon is whipstitched with a No. 2 suture, 2 cm in length, along the tendon. (B) Final construct.

Fig 8

The 4.75-mm SwiveLock anchor is drilled (A) and tapped (B).

Fig 9

The 2 G4 Mitek anchors are drilled (A) and placed 8 mm posteriorly and slightly inferior to the previously marked anterior extent of the popliteal footprint (B).

Fig 10

The sutures from the previously whipstitched tendon are loaded into the 4.75-mm SwiveLock anchor and placed into the previously tapped hole while being tensioned appropriately. The knee is then placed in 70° of flexion and neutral rotation without varus or valgus stress during fixation.

Fig 11

The sutures from the G4 Mitek anchors are passed in a horizontal mattress configuration through the tendon (A) and subsequently tied (B). The accessory stitch from the SwiveLock anchor is also passed through the tendon in a horizontal mattress fashion and tied.

Fig 12

The final construct is shown, with the popliteal tendon being repaired to its footprint with 2 anchors. Postoperative range of motion, as well as appropriate tendon isometry, is assessed.

Fig 13

The capsule is closed with an absorbable suture.