Popliteus tendon tenosynovitis.

This series of case suggests that the entity of tenosynovitis of the popliteus tendon is more common than once recognized. A high index of sucpicion and accurate palpation of the lateral aspect of the knee lead one to the diagnosis. Knowledge of this entity may prevent future misdiagnosis of tear of the lateral meniscus and unnecessary meniscectomy as experienced by Helfet, Holden, and myself. There is a definite correlation with activities requiring downhill walking or running. The runners invariably complained of the oneset of symptoms during downhill running rather than uphill running. Back packing enthusiastscomplained of no symptoms for several days after ascending into the mountains, only to experience the symptoms at the end of a long, rapid descent out of the mountains. The pathomechanics of this inflammation of the popliteus tendon is not fully understood. Preliminary analysis of gait movies suggests that in downhill running there is an increased vector to displace the weight-bearing femur forward on the relatively fixed tibia as the knee is increasingly flexed (Fig. 5). Previously mentioned EMG functional studies indicate that the popliteus muscle is active during this weight-bearing phase of gait and may act to retard the femur from forward displacement on the tibia in conjunction with the quadriceps. More specifically, it may help to retard the lateral femoral condyle from rotating forward off the lateral tibial plateau. Downhill running or walking therefore may cause increased stress on the popliteus muscle-tendon unit in an effort to decelerate the body weight against the altered angle of gravitational pull, with resultant tenosynovitis and symptoms. In this series there were no top flight competitive runners. The typical patient was a 31-year-old physician who was jogging 1 to 5 miles and decided to increase his pace and distance, particularly while jogging downhill. The average age of this series of patients (31 years) at the time of onset, coupled with the fact many of these persons were relatively sedentary until stressing the knee by increased activity, suggests that there will be an increasing number of these patients in the future as jogging and running are prescribed for cardiovascular system conditioning.