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Arthroscopy-Assisted Fabella Excision: Surgical Technique.

ABSTRACT: The fabella is an anatomic variant not seen in all individuals and can potentially be a source of chronic knee pain due to chondromalacia, osteoarthritis, fractures, or biomechanical pressure against the lateral femoral condyle. It is situated intra-articular, close to the lateral femoral condyle, the lateral gastrocnemius head tendon, and the fabellofibular ligament. Given its rarity, the diagnosis of a symptomatic fabella is often overlooked when evaluating patients with persistent posterolateral knee pain. However, this diagnosis should always be considered, especially in high-performance runners, bikers, and triathletes. Although nonoperative management can potentially resolve symptoms associated with this condition, fabella excision via arthroscopically assisted surgery is a reliable and safe alternative to treat patients who do not benefit from nonsurgical treatment. We present our technique detailing fabella excision for treatment of posterolateral knee pain, which includes an arthroscopic evaluation of the fabella to assess damage to the femoral condyle and minimize over-resection and potential damage to surrounding structures.

SUBMITTER: Provencher MT

PROVIDER: S-EPMC5442983 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Arthroscopy-Assisted Fabella Excision: Surgical Technique.

Provencher Matthew T MT Sanchez George G Ferrari Márcio B MB Moatshe Gilbert G Chahla Jorge J Akamefula Ramesses R LaPrade Robert F RF

Arthroscopy techniques 20170327 2

The fabella is an anatomic variant not seen in all individuals and can potentially be a source of chronic knee pain due to chondromalacia, osteoarthritis, fractures, or biomechanical pressure against the lateral femoral condyle. It is situated intra-articular, close to the lateral femoral condyle, the lateral gastrocnemius head tendon, and the fabellofibular ligament. Given its rarity, the diagnosis of a symptomatic fabella is often overlooked when evaluating patients with persistent posterolate ...[more]

PMID: 28580255

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Project description:Thoracic outlet syndrome (TOS) is a rare condition resulting from the compression of the brachial plexus and/or the subclavian vessels in the thoracic outlet (TO). Neurogenic TOS (NTOS) is the most common form in up to 95% of the cases, while venous TOS (VTOS) occurs in 3-5% and arterial TOS (ATOS) in 1-2% of the cases. Patients may suffer from the pathologic coexistence of arterio-venous compression in the TO called arterio-venous TOS (AVTOS) with an overlap of clinical symptoms. While imaging studies such as computed tomography (CT)-angiography, magnetic resonance imaging (MRI)-angiography and duplex sonography are helpful to detect the underlying condition in vascular pathologies, electrodiagnostic testing is necessary to distinguish NTOS from other peripheral neuropathies. Subclavian vein (SV)-compression in the TO can result in venous thrombosis, called Paget-Schroetter syndrome (PSS), named after the discoverers of the disease. Besides oral anticoagulation in cases with venous upper extremity thrombosis and multimodal conservative treatment in the management of NTOS, surgical decompression is the current standard of care for TOS. Surgical decompression aims to remove structures compressing the brachial plexus or the subclavian vasculature in the TO. In NTOS, when conservative management has failed, surgical resection of the 1st or a cervical rib is often combined with scalenectomy and brachial plexus neurolysis. Minimally invasive techniques have replaced traditionally open supra-, infraclavicular or transaxillary approaches with excellent results and minimal morbidity. Video-assisted thoracoscopic surgery (VATS) was described to offer better visualization, shorter length of stay (LOS) and less neurovascular injuries attributable to less traction applied. Robotic-assisted thoracoscopic surgery (RATS) moreover, further improved magnification, angulation of the surgical instruments in narrow anatomical spaces and the comfort for the operating surgeon. Uniportal RATS (uRATS) has lately been applied for 1st rib resection. The aim of this surgical technique manual is to describe and illustrate a RATS 1st rib resection with its advantages over traditionally open approaches step by step.

Dataset Information

Arthroscopy-Assisted Fabella Excision: Surgical Technique.

Publications

Arthroscopy-Assisted Fabella Excision: Surgical Technique.

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