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      A Comprehensive Review of the Fabella Bone

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      Author(s): 1 , 1 , , 2 , 3
      Editor(s): ,
      Publication date (Electronic, pub):
      Publication date (Electronic, collection):
      Journal: Cureus
      Publisher: Cureus
      Keywords: sesamoid, knee pain, gastrocnemius, femoral condyle, fabellectomy, shock wave therapy, anatomy, variations

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          Abstract

          The fabella is a sesamoid bone that is embedded in the lateral head of the gastrocnemius muscle and often articulates directly with the lateral femoral condyle. It is present in 10-30% of the general population with a higher incidence in Asians. The fabella can lead to various pathologies such as fabella pain syndrome and common fibular nerve palsy. Conservative treatment involves physical therapy or injecting local anesthetics or steroids around this bone. However, if symptoms persist, then a fabellectomy can be performed. Physicians should be aware of the fabella bone and the multiple pathologies associated with it in order to provide the best treatment and management for patients.

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          Coincident development of sesamoid bones and clues to their evolution.

          Clive Carter, Patricia Erickson, V Sarin … (1999)
          Sesamoid bones form within tendons in regions that wrap around bony prominences. They are common in humans but variable in number. Sesamoid development is mediated epigenetically by local mechanical forces associated with skeletal geometry, posture, and muscular activity. In this article we review the literature on sesamoids and explore the question of genetic control of sesamoid development. Examination of radiographs of 112 people demonstrated that the relatively infrequent appearances of the fabella (in the lateral gastrocnemius tendon of the knee) and os peroneum (in the peroneus longus tendon of the foot) are related within individuals (P < 0.01). This finding suggests that the tendency to form sesamoids may be linked to intrinsic genetic factors. Evolutionary character analyses suggest that the formation of these sesamoids in humans may be a consequence of phylogeny. These observations indicate that variations of intrinsic factors may interact with extrinsic mechanobiological factors to influence sesamoid development and evolution.
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            Anatomical study of the fabella, fabellar complex and its clinical implications.

            Hiroshi Sasaki, Yoichi Ito, Sayaka Yoshitomi … (2007)
            The fabella has been mainly studied using imaging methods but there are less research reports on the gross anatomical studies. We performed this anatomical study of the fabella and its surrounding structures with functional implications using 150 heads of the gastrocnemius muscles of 75 knees from 39 Japanese cadavers. This study is the direct representation of the human fabella and its functional implications. We observed 99 fabellae (66.0%) including 44 complete bony fabellae (29.3%). Of these bony fabellae, 43 (97.7%) were located in the lateral head of the gastrocnemius muscle with its surrounding structures and were positioned only on the lateral condyle of the femur. Moreover, the cartilage and bony fabellae, especially on the lateral side, contributed to the fabella complex with its surrounding muscles and ligaments and formed small articular cavity by cooperating with the femoral condyle. Although the human fabella is considered as appearing in the fabella complex with ageing and it possibly induces clinical symptoms, the fabella may play an important role as a stabilizer between the fabella complex and the femoral condyle.
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              The fabella syndrome - a rare cause of posterolateral knee pain: a review of the literature and two case reports

              Arne Driessen, Maurice Balke, Christoph Offerhaus … (2014)
              Background The purpose of this article was to evaluate the risks and benefits of non-operative treatment versus surgical excision of a fabella causing posterolateral knee pain. We performed a systematic review of literature and also present two case reports. Twelve publications were found in a PubMed literature review searching the word “fabella syndrome”. Non-operative treatment and surgical excision of the fabella has been described. Case presentation Two patients presented to our outpatient clinic with persisting posterolateral knee pain. In both cases the presence of a fabella was identified, located in close proximity to the posterolateral femoral condyle. All other common causes of intra- and extra articular pathologies possibly causing the posterolateral knee pain were excluded. Following failure to respond to physiotherapy both patients underwent arthroscopy which excluded other possible causes for posterolateral knee pain. The decision was made to undertake surgical excision of the fabella in both cases without complication. Both patients were examined 6 month and one year after surgery with the Tegner activity score, the Visual Analogue Scale (VAS), and International Knee Documentation Committee Score (IKDC). Conclusion Consistent posterolateral pain during exercise might indicate the presence of a fabella syndrome. Resecting the fabella can be indicated and is a minor surgical procedure with minimal risk. Despite good results in the literature posterolateral knee pain can persist and prevent return to a high level of sports. Level of evidence: IV, case reports and analysis of literature.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 5 June 2018
                Publication date (Electronic, collection): June 2018
                Volume: 10
                Issue: 6
                Electronic Location Identifier: e2736
                Affiliations
                [1 ] Seattle Science Foundation, Seattle, USA
                [2 ] Swedish Neuroscience Institute, Seattle, USA
                [3 ] Neurosurgery, Seattle Science Foundation, Seattle, USA
                Author notes
                Article
                DOI: 10.7759/cureus.2736
                PMC ID: 6075638
                PubMed ID: 30087812
                SO-VID: 932579e3-3321-419a-a477-453b887719a6
                Copyright © Copyright © 2018, Dalip et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 25 May 2018
                Date accepted : 5 June 2018
                Categories
                Subject: Pathology
                Subject: Orthopedics

                Keywords: sesamoid,knee pain,gastrocnemius,femoral condyle,fabellectomy,shock wave therapy,anatomy,variations
                Data availability:
                Keywords: sesamoid, knee pain, gastrocnemius, femoral condyle, fabellectomy, shock wave therapy, anatomy, variations

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