A rare case of isolated traumatic avulsion of the pes anserinus tendon
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CASE REPORT
A rare case of isolated traumatic avulsion of the pes anserinus tendon Sisith P. Ariyaratne 1
&
Richard Clarnette 2 & William K Loftus 3
Received: 29 September 2019 / Revised: 13 May 2020 / Accepted: 17 May 2020 # ISS 2020
Abstract Complete rupture of the conjoint pes anserinus tendon is rare, and isolated rupture without injury to associated structures has not been previously reported in the literature. A case of complete isolated rupture of the pes anserinus tendon is described in a young, healthy male. The non-specific nature of the presentation and rarity of the condition makes diagnosis from history and examination alone challenging. Magnetic resonance imaging was critical in making the correct diagnosis and excluding other potentialassociated injuries with the diagnosis confirmed intraoperatively. The patient underwent surgical repair and rehabilitation and made significant progress. The diagnosis may be overlooked on a routine knee MRI, particularly in the absence of other associated injuries. An untreated injury may result in a poor outcome for the patient, with chronic pain and reduced function. Hence it is important to consider it in traumatic injuries to the region, with a view for an extended scan to visualise the full extent of the pes tendons to their insertion, particularly when there is high fluid signal in the popliteal fossa along the semitendinosus. Keywords Pes anserinus . Avulsion . Rupture . Semitendinosus . Sartorius . Gracilis
Introduction The pes anserinus (PA) (meaning “goose foot” due to the three adjacent tendons resembling the three toes of a goose foot) is a conjoint tendon inserting into the anteromedial aspect of the tibia [1, 2]. It is comprised of tendons from the sartorius, gracilis and semitendinosus muscles, which originate from the anterior superior iliac spine, ischiopubic ramus and ischial tuberosity respectively and become aponeurotic distally. These muscles, in combination, act as knee flexors and tibial rotators and provide rotary and valgus constraints to the knee [9]. Individually, the sartorius acts as a thigh flexor, abductor and external rotator and also flexes and medially rotates the leg; gracilis adducts the hip and also flexes and medially rotates the leg. The semitendinosus acts as a flexor and internal rotator of the leg and a hip extensor [3]. The pes anserinus
* Sisith P. Ariyaratne [email protected] 1
Royal Adelaide Hospital, Adelaide, SA, Australia
2
Wakefield Orthopaedic Clinic, Adelaide, SA, Australia
3
Sound Radiology, Adelaide, SA, Australia
forms a crucial part of the complex stabilising structures on the medial aspect of the knee [3] Injuries to the PA can involve the whole conjoint tendon or one of its constituting tendons [4]. We report a case of complete traumatic avulsion of the PA tendon. Traumatic avulsion of the whole PA tendon is rarely encountered [4, 11] and sparsely described in the literature. A comprehensive literature review using the PubMed and Ovid MEDLINE databases revealed only three case reports: a
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