Popliteal Tendonitis

Ovid: 5-Minute Sports Medicine Consult, The

Popliteal Tendonitis
Michael A. Krafczyk
Seth M. Burkey
  • The popliteus muscle originates from the popliteal saddle on the lateral femoral condyle. It then runs deep to the lateral collateral ligament (LCL) and then goes intraarticular. It courses through the popliteal hiatus of the coronary ligament and inserts on the posterior tibia under the tibial condyles (1).
  • There are also attachments to the fibula (popliteofibular ligament) as well as the lateral meniscus, posterior cruciate ligament (PCL), and posterior capsule.
  • The femoral origin of the popliteus is consistently anterior and distal to the femoral attachment of the LCL.
  • Its primary function is that of internal rotation of the tibia on the femur.
  • Also an important structure in preventing external tibial rotation
  • Also may help the PCL prevent forward displacement of the femur during deceleration and downhill running
  • Popliteal tendinitis involves irritation, swelling, and pain along the length of the tendon that courses lateral around the femoral condyle.
  • It is often seen with downhill running. It presents as posterolateral knee pain that is worse with downhill running and sitting cross-legged.
Risk Factors
  • May occur as overuse injuries or acutely such as in trauma.
  • Commonly seen in downhill running (cross-country), walking (backpacking)
  • Poor conditioning
  • Pes planus foot (hyperpronation)
  • Quadriceps weakness
General Prevention
  • Appropriate warm-up and stretching
  • Adequate rest and recovery during sports participation
  • Proper training technique
  • Foot orthoses for pes planus
  • Maintain good quadriceps strength.
  • Usually due to repetitive stress, such as seen in runners
  • Almost always a result of quadriceps overuse
  • Also may be due to a blow to the anteromedial border of the knee, a hyperextension injury, or a varus noncontact injury
  • The patient will complain of insidious lateral or posterolateral knee pain.
  • May elicit a history of walking, backpacking, and running, such as downhill or cross-country
  • Can be intermittent or constant
  • Worse with weight bearing when the knee is between 15 and 30 degrees of flexion
  • The patient also may describe trauma directed to the anteromedial border of the knee, hyperextension, or a varus injury.
Physical Exam
  • Palpation of the tendon insertion along the lateral femoral condyle will reveal pain. Tendon is best palpated with the patient in a figure-of-4 (cross-legged) position and palpating just posterior and just anterior to the LCL (2).
  • The Garrick test involves testing the popliteus with the patient supine and the hips and knees flexed to 90 degrees, in which resisted internal rotation of the knee provokes pain. Passive external rotation with the knee in the same position also can provoke pain (3)[C].
  • Shoe-removal maneuver, in which the sitting patient internally rotates the injured lower leg and foot to push the contralateral shoe off, also may produce pain.
Diagnostic Tests & Interpretation
  • Plain films may reveal calcific deposits of the tendon in cases of calcific tendonitis or signs of possible avulsion fracture as in trauma.
  • MRI will reveal fluid and inflammation of the popliteus sheath and tendon.
Diagnostic Procedures/Surgery
Arthroscopic examination of the knee can reveal synovitis of the sheath or hydroxyapatite deposits (4).
Differential Diagnosis
  • Iliotibial tract tendinitis
  • Biceps femoris tendinitis
  • Lateral meniscal tear
  • Lateral collateral ligament injury


Ongoing Care
726.69 Other enthesopathy of knee

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