Michael A Finsterwald, Victor Lu, Octavian Andronic, Gareth H Prosser, Piers J Yates, Christopher W Jones
{"title":"腘肌腱撞击是全膝关节置换术后疼痛的原因:系统回顾。","authors":"Michael A Finsterwald, Victor Lu, Octavian Andronic, Gareth H Prosser, Piers J Yates, Christopher W Jones","doi":"10.1186/s42836-023-00201-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Popliteal tendon impingement (PTI) is an under-recognized cause of persistent pain following total knee arthroplasty (TKA). The purpose of the systematic review was to summarize and outline successful strategies in the diagnosis and management of PTI.</p><p><strong>Methods: </strong>A systematic review following the PRISMA guidelines was performed for four databases: MEDLINE (Pubmed), Ovid EMBASE, Web of Science, and Cochrane Database. It was registered in the International Prospective Register for Systematic Reviews and Meta-analysis (PROSPERO) under the registration number: CRD42023398723. The risk of bias assessment was performed using the criteria of the methodological index for non-randomized studies (MINORS).</p><p><strong>Results: </strong>A total of 8 studies were included. There were 2 retrospective case series and 6 case reports. The follow-up ranged from 6 to 30 months. Two studies described PTI as an intraoperative phenomenon during TKA with \"snapping\"; whilst 6 studies described indications and outcomes for arthroscopic tenotomy for PTI following TKA. In making the diagnosis, there was concurrence that the posterolateral pain should be focal and that dynamic ultrasonography and diagnostic injection play an important role. Two specific clinical tests have been described. There was no consistency regarding the need for imaging. There were no reports of instability following popliteal tendon tenotomy or other complications.</p><p><strong>Conclusion: </strong>PTI should be suspected as a cause for persistent focal pain at the posterolateral knee following TKA. The diagnosis can be suspected on imaging and should be confirmed with dynamic ultrasonography and an ultrasound-guided diagnostic injection. An arthroscopic complete tenotomy of the tendon can reliably alleviate pain and relies on correct diagnosis. There is no evidence for clinically relevant negative biomechanical consequences following tenotomy.</p><p><strong>Level of evidence: </strong>Systematic Review of Level IV and V studies.</p>","PeriodicalId":2,"journal":{"name":"ACS Applied Bio Materials","volume":null,"pages":null},"PeriodicalIF":4.6000,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10476413/pdf/","citationCount":"0","resultStr":"{\"title\":\"Popliteal tendon impingement as a cause of pain following total knee arthroplasty: a systematic review.\",\"authors\":\"Michael A Finsterwald, Victor Lu, Octavian Andronic, Gareth H Prosser, Piers J Yates, Christopher W Jones\",\"doi\":\"10.1186/s42836-023-00201-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Popliteal tendon impingement (PTI) is an under-recognized cause of persistent pain following total knee arthroplasty (TKA). The purpose of the systematic review was to summarize and outline successful strategies in the diagnosis and management of PTI.</p><p><strong>Methods: </strong>A systematic review following the PRISMA guidelines was performed for four databases: MEDLINE (Pubmed), Ovid EMBASE, Web of Science, and Cochrane Database. It was registered in the International Prospective Register for Systematic Reviews and Meta-analysis (PROSPERO) under the registration number: CRD42023398723. The risk of bias assessment was performed using the criteria of the methodological index for non-randomized studies (MINORS).</p><p><strong>Results: </strong>A total of 8 studies were included. There were 2 retrospective case series and 6 case reports. The follow-up ranged from 6 to 30 months. Two studies described PTI as an intraoperative phenomenon during TKA with \\\"snapping\\\"; whilst 6 studies described indications and outcomes for arthroscopic tenotomy for PTI following TKA. In making the diagnosis, there was concurrence that the posterolateral pain should be focal and that dynamic ultrasonography and diagnostic injection play an important role. Two specific clinical tests have been described. There was no consistency regarding the need for imaging. There were no reports of instability following popliteal tendon tenotomy or other complications.</p><p><strong>Conclusion: </strong>PTI should be suspected as a cause for persistent focal pain at the posterolateral knee following TKA. The diagnosis can be suspected on imaging and should be confirmed with dynamic ultrasonography and an ultrasound-guided diagnostic injection. An arthroscopic complete tenotomy of the tendon can reliably alleviate pain and relies on correct diagnosis. 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引用次数: 0
摘要
引言:腘肌腱撞击(PTI)是全膝关节置换术(TKA)后持续疼痛的一个未被充分认识的原因。系统回顾的目的是总结和概述PTI诊断和管理的成功策略。方法:按照PRISMA指南对MEDLINE (Pubmed)、Ovid EMBASE、Web of Science和Cochrane Database四个数据库进行系统评价。该药物已在国际前瞻性系统评价和荟萃分析注册库(PROSPERO)注册，注册号为CRD42023398723。偏倚风险评估采用非随机研究(未成年人)的方法学指标标准。结果:共纳入8项研究。有2个回顾性病例系列和6个病例报告。随访6 ~ 30个月。两项研究将PTI描述为TKA术中出现的“咔嗒”现象;而6项研究描述了关节镜下肌腱切断术治疗TKA后PTI的适应症和结果。在诊断时，一致认为后外侧疼痛应是局灶性的，动态超声检查和诊断注射发挥重要作用。描述了两种具体的临床试验。关于成像的需要没有一致性。没有腘肌腱肌腱切开术后不稳定或其他并发症的报道。结论:应怀疑PTI是TKA后膝关节后外侧持续局灶性疼痛的原因。在影像学上可以怀疑诊断，应通过动态超声检查和超声引导下的诊断注射来确诊。关节镜下完全肌腱切断术可以可靠地减轻疼痛，并依赖于正确的诊断。肌腱切断术后没有临床相关的负生物力学后果的证据。证据水平:IV级和V级研究的系统评价。
Popliteal tendon impingement as a cause of pain following total knee arthroplasty: a systematic review.
Introduction: Popliteal tendon impingement (PTI) is an under-recognized cause of persistent pain following total knee arthroplasty (TKA). The purpose of the systematic review was to summarize and outline successful strategies in the diagnosis and management of PTI.
Methods: A systematic review following the PRISMA guidelines was performed for four databases: MEDLINE (Pubmed), Ovid EMBASE, Web of Science, and Cochrane Database. It was registered in the International Prospective Register for Systematic Reviews and Meta-analysis (PROSPERO) under the registration number: CRD42023398723. The risk of bias assessment was performed using the criteria of the methodological index for non-randomized studies (MINORS).
Results: A total of 8 studies were included. There were 2 retrospective case series and 6 case reports. The follow-up ranged from 6 to 30 months. Two studies described PTI as an intraoperative phenomenon during TKA with "snapping"; whilst 6 studies described indications and outcomes for arthroscopic tenotomy for PTI following TKA. In making the diagnosis, there was concurrence that the posterolateral pain should be focal and that dynamic ultrasonography and diagnostic injection play an important role. Two specific clinical tests have been described. There was no consistency regarding the need for imaging. There were no reports of instability following popliteal tendon tenotomy or other complications.
Conclusion: PTI should be suspected as a cause for persistent focal pain at the posterolateral knee following TKA. The diagnosis can be suspected on imaging and should be confirmed with dynamic ultrasonography and an ultrasound-guided diagnostic injection. An arthroscopic complete tenotomy of the tendon can reliably alleviate pain and relies on correct diagnosis. There is no evidence for clinically relevant negative biomechanical consequences following tenotomy.
Level of evidence: Systematic Review of Level IV and V studies.
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