Orhan Balta1, Fırat Erpala2, Sezer Astan3, Cihan Uçar4, Harun Altınayak5, Kürşad Aytekin6

1Department of Orthopedics and Traumatology, Tokat Gaziosmanpaşa University Hospital, Tokat, Türkiye
2Department of Orthopedics and Traumatology, Çesme Alper Çizgenakat State Hospital, Izmir, Türkiye
3Department of Orthopedics and Traumatology, Tokat State Hospital, Tokat, Türkiye
4Department of Orthopedics and Traumatology, Trabzon Training and Research Hospital, Trabzon, Türkiye
5Department of Orthopedics and Traumatology, Health Sciences University, Samsun Training and Research Hospital, Samsun, Türkiye
6Department of Orthopedics and Traumatology, Giresun University Faculty of Medicine, Giresun, Türkiye

Keywords: Fabella, posterior condylar offset, posterior tibial slope, sesamoid bones.


Objectives: This study aims to analyze whether the lateral posterior condylar offset (LPCO) and lateral posterior tibial slope (LPTS) values are associated with the presence of fabella by evaluating the frequency of fabella, its location, and whether it is bilateral and the relationship of the fabella with age, sex, and the presence of osteoarthritis.

Patients and methods: Between January 2016 and December 2020, computed tomography (CT) scans including 1,952 knee regions of 1,220 patients (861 males, 359 females; mean age: 54.5±19.7 years; range, 10 to 98 years) were retrospectively analyzed. Age, sex, and the presence of fabella whether unilateral (left or right) or bilateral were recorded. Of the patients with a bilateral knee CT, those with fabella on one side and without on the other were studied further to investigate the effect of fabella on the posterolateral corner (PLC). In these patients, the LPCO and LPTS values, presence of knee osteoarthritis, fabella-femoral distance, and sagittal anterior-posterior diameter of the fabella were evaluated.

Results: While there was no evidence of fabella in 867 (71.1%) patients, it was present in 353 (28.9%) patients. The linear correlation analysis revealed that the correlations between the right LPCO and the right LPTS (r=-0.295; p<0.001) and between the left LPCO and the left LPTS (r=-0.574; p<0.001) were significant. It was observed that LPTS decreased with increasing LPCO. According to the results of the point biserial correlation analysis, there was a significant correlation between the presence of fabella on the right side and the right LPCO value (r=-0.643; p<0.001) and between the presence of fabella on the left side and the left LPCO (r=-0.284; p=0.024). When the two knees were compared, fabella was less present in the knee whose LPCO was higher than that of the other knee, whereas it was more common in the knee whose LPCO was lower than that of the other knee. We found a significant correlation between each side's fabella and LPCO values and between the presence of fabella on the left side and the left LPTS.

Conclusion: The presence of fabella in the knee joint may be associated with LPCO and LPTS values of the knee. The comparison of the two knees of the same patient may reveal that if a fabella is present in a knee, the LPCO value of that knee is lower than that of the other knee. We believe that the reason for this is that the presence of fabella increases the distance to the center of rotation of the knee joint.

Citation: BaltaO, Erpala F, Astan S, Uçar C, Altınayak H, Aytekin K. The prevalence of fabella and its relationship with the lateral posterior condylar offset and lateral posterior tibial slope values. Jt Dis Relat Surg 2022;33(3):588-598.

Ethics Committee Approval

The study protocol was approved by the Tokat Gaziosmanpaşa University Medical Faculty Clinical Research Ethics Committee Ethics Committee (date: 1.4.2021, no: 21-KAEK-095). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

All authors declare that they have all participated in the design, execution, and analysis of the paper, and that they have approved the final version.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.