The Fabella Bone is Connected to the Knee Bone?

What the hell is a Fabella bone? Fabella (from Latin, small bean), is a small sesamoid (floating) bone embedded in the tendon of the gastrocnemius (calf) muscle behind the lateral condyle (outside bump) of the femur (leg bone). The fabella bone is present in 10-30% of humans and is often thought to be formed as a result of muscle stress on a joint. It acts like a pulley allowing the muscle tendon to apply more force to the muscles. Extremely rarely, this fabella bone can cause lateral (outside) knee pain. There are very few published studies on the cases and almost all incidences of fabella syndrome occur in high level (professional) athletes.

As it turns out, my fabella bone had worn a nice little groove in the cartilage of my femur causing pain when running. It took a long time to figure out exactly what was causing my pain, and even once it was figured out, it wasn't a sure solution as it is often a constellation of problems causing the pain.

On January 2, 2016, I was doing a 13 mile run on the snow/ice covered roads in Des Moines, IA. About 8 miles into the run, I jumped from the street to the sidewalk and my right foot slipped on the ice then came to an abrupt stop. It hurt, but I continued the run. I stretched that evening then went to bed with very little pain. The next morning I could hardly get out of bed my right knee was in so much pain. I took it easy for 3 days and my knee was about 90% better and I resumed regular training. I had an MRI, X-Rays, and Ultrasound of my knee and all came back normal with no significant pathology but a possible strain and/or tendonitis in my popliteal tendon. 

 

I went down to Clermont, Florida, in February for the QT2 Pro Camp and put in three really solid weeks of training but left camp with a very sore knee. I had a second read on the MRI and it confirmed what the original read suggested. Strong in-tact knee with no major pathology but some possible tendinitis of my popliteal tendon. I continued through physical therapy and training and was managing the inflammation and pain. I was training, but was not training at the full volume I wanted to race a full ironman, but adequate for 70.3 fitness. 

 

I delayed the start of the season until New Orleans where I was unable to actually finish the race because I was left stranded on the side of the road at mile 46 with a flat tire and a broken valve extender. Next on my list was to race Eagleman and before the race I had stem cell injection in my knee to aid in the inflammation and healing of the tendinitis. I was back to running with little to no pain but just before the race I tweaked my knee again during a training run and decided I need to get in contact with the folks at the Steadman Clinic in Vail, Colorado, where I had two previous hip surgeries (both with great success). I scratched the race at Eagleman to figure out what was wrong. 

 

We did another MRI in Vail, and the same results showed up. No major pathology of the knee but some possible tendinitis of the popliteal tendon. I was fine to keep training and racing, it was really just a matter of pain management and it didn't bother me swimming or cycling and I was able to run on flat surfaces with little to no pain. The popliteal tendon attaches the small popliteus muscle to the femur behind the knee and is used for stability primarily when running on hills. I was careful to keep most of my running flat while letting the tendontiis calm down and managing the inflammation. I was icing regularly and using Voltaren anti inflammatory cream to manage the pain and inflammation. 

 

I was all set to race in Mont Tremblant for the 70.3 and had a front pack swim, came off the bike with a pack of guys in second through sixth place and ready to run. On the first big downhill of the run about 1 mile into the run, I could feel my knee slightly give way then it started causing me a ton of pain. I had not been doing much hill running in training to keep the tendinitis at bay, but what I felt during the race was just too much pain. The pain grew more intense and I finally gave up on the run at mile 3, got some ice at medical and withdrew from the race. I flew back home to Iowa that night disappointed and in a lot of pain. I had a follow-up appointment after the race scheduled for Monday evening in Vail with Dr. Matt Provencher. I flew back out to Vail on Monday and saw him in his clinic that evening. Dr. Provencher did an exam of my knee and I tested positive for fabella syndrome. Dr. Provencher and Dr. Robert LaPrade agreed to add to me to their already full surgery schedule, on Tuesday June 28 at 7 AM to remove the fabella. 

 

These are both world class physicians who have worked with some of the top athletes in all sports. Dr. Provencher was formerly the medical director of the New England Patriots and Dr. LaPrade has done surgery on many of the most famous sports stars around. I arrived at the hospital in Vail at 5:30 AM and the doctors were there early to greet me and we started the surgery at 6:30 AM...ahead of schedule. The operating room was crowded with PA's and fellows eager to see the results of this rare combined super surgery of Dr. LaPrade and Dr. Provencher. What they found during the surgery was  I had a small tear of my meniscus (which was not present on the MRI taken just 3 weeks before). My popliteal tendon had severe tendinitis (from the fabella) which they debrided. They did a small release on my IT band to allow more movement and less friction in the area as a preventative measure. My peroneal nerve was also highly inflamed so they did a neuropathy to move the nerve away from the inflamed tendon. They also removed the fabella bone which was about the size of 3 dimes stacked on top of each other. My fabella bone had rubbed a groove in the cartilidge of my femur and had caused severe peroneal nerve irritation along with popliteal tendonitis. The surgeons extracted the fabella bone and now I have no posterior lateral knee friction. I just had this surgery one week ago on Tuesday morning and I spent last week in Vail doing rehab at the Howard Head Physical Therapy Clinic.

So what now? 

It is early July and I just had knee surgery. I am only 2000 points away from qualifying for Kona and still have 3 more races to score to get there. My hope was to score two 70.3 and race one Ironman and get all the necessary points to put me back on the start line in Kona. The reality is that I must undergo a 6 week rehab after this surgery and then rebuild my fitness. I don't know the rest of my race schedule but I am currently planning on racing the Des Moines Olympic Distance Triathlon on September 4, hopefully one or two 70.3 races, then Ironman Arizona on November 20.

I believe my best racing is still ahead of me and will take on this rehab with all the zeal of vigor of a champion.

Cheers,
TJ