Pain in popliteal fossa

[ramywhite]

Hi everybody, A case of 35 years old male postoperative reconstraction of ACL since about 18 weeks. Now, his quadriceps is normal, hamstring is normal, calf muscles are normal, no effusion, no pain in standing or climping stairs, slight decrease in knee flexion. But he suffers from pain at popliteal fossa at the end of knee flexion specially when he squats. His programme now is closed chain exercise but I give him with that some open chain.

What is this pain? Could open chain exercises be associated with that? And when I can focus on quadriceps only? Anyway this case has now normal quadriceps but I ask for further knowledge.

Thank you for your kind replies.



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[pam formby]

Hi there
I wonder if your patient's problem is a baker's cyst. This is swelling in the semimembranosus bursa caused by fluid leaking out of the knee joint in the presence of articular pathology. The swelling may be more prominent in resisted flexion. If this might be the case, then it is possible that an increased exercise program could have precipitated increased effusion in the knee.
PF

[wutti]

hi

the baker´s cyste is a possibility concerning to the decrease in knee flexion. has the patient a feeling of pressure or "blocking" when he flexes the knee?
But also the popliteus muscle might be a reason for the pain. try to rotate the tibia at 90 deg od fexion (both internal and external) and fully flex the knee with the rotation. If pain increases/decreases it might be a sign of muscular problem. also the posterior horn of the menisci might be affected, the popliteus muscle attaches partly to the post. horn of the lat. menisci and pulls it backwards in full knee flexion. After ACL reconstruction often the small muscles are weak and their function is iritated.
ok good luck

[ramywhite]

Hi pam formby and wutti,
Thank you both for your kind messages. But unfortunatly I am not treating that patient any longer. So, it will be very hard to distingush between that 2 possiblities(baker's cyst or popliteus). But, in fact, I'm facing those manifestations a lot. I read somewhere about popliteus muscle dysfunction and it recommends direct massage as a treatment. Do you know any other modalities or techniques to treat this muscle? Thank you again!

[whalewatcher]

could have a tight graft as well. graft tightness will limit full flexion and full extension, but is usually felt as a generalised knee discomfort and restrictiion as opposed to specific popliteal pain.
Hamstring tendonitis, popliteal tendonitis, and course bakers cyst would all be more likely

whalewatcher