Abstract
Background:
The popliteus tendon helps provide dynamic external rotation stability to the posterolateral corner of the knee joint. Popliteus Insufficiency Syndrome (PIS) is a novel diagnosis characterized by symptomatic external rotation instability of the knee; however, diagnosis is rare and often unrecognized since symptoms are subtle, and imaging is largely unremarkable. We present a case series of pediatric athletes thought to have PIS successfully treated with popliteus reconstruction with hamstring autograft.
Objectives:
In pediatric athletes with Popliteus Insufficiency Syndrome, popliteus reconstruction with hamstring autograft restores rotational stability and enables safe return to sport.
Methods:
After IRB approval, all patients ≤ 18 years with PIS who underwent open popliteus reconstruction with hamstring autograft by a single surgeon between 2020–2024 were retrospectively reviewed. Demographics, sport, imaging, and intra-operative findings were collected. Outcome measures included return-to-sport status, Patient-Reported Outcomes Measurement Information System (PROMIS) scores, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation, surgical satisfaction, and improvement.
Results:
Three pediatric athletes were included in this study. Patient 1 was an 18-year-old female soccer player who sustained a hyperextention injury to her right knee during a game. Her MRI was normal and she was subsequently released to return to play; however, she had persistent pain and subjective looseness in her knee and was ultimately diagnosed with PIS. Patient 2 was a 16-year-old male football player who presented for a second opinion regarding an injury to his right knee a year prior despite multiple arthroscopic partial meniscectomies. Patient 3 was a 14-year-old female soccer player with a right knee injury and negative MRI treated conservatively with extensive physical therapy for two years. These three pediatric athletes had external rotation laxity on exam, and ultimately were diagnosed with PIS and treated with popliteus reconstruction. Postoperatively, average PROMIS Physical Function, Pain Interference, Depression, and IKDC were 69, 42, 34, and 92 at an average follow-up of 16 months. All three patients reported they were “Very Satisfied” and two reported they were “Completely Better” postoperatively.
Conclusion:
In this small pediatric series, popliteus reconstruction reliably restored rotational stability, enabling these athletes to return to sport. Postoperative outcomes, including satisfaction, and surgical improvement, were excellent. Although limited by sample size, these findings suggest that athletes with PIS who have failed extensive nonoperative management may be successfully treated with popliteus reconstruction.