Is my back-of-knee pain the popliteus or a meniscus tear?

Why they are confused

The popliteus tendon and the back of the lateral meniscus are close neighbours; the tendon even has attachments to the meniscus. Pain from either is felt in a similar spot, and some people have both. That is why a careful history and examination come before any conclusion.

Clues that point one way or the other

• Gradual onset with more running or hiking points towards the tendon
• A specific twisting moment, such as a turn in football or padel, points towards the meniscus
• Pain mainly on descents and stairs fits the tendon
• Catching, locking or the knee getting stuck fits the meniscus
• Swelling after activity is more typical of a meniscus tear
• Pain on deep squatting or kneeling with a twist suggests the meniscus

How the diagnosis is confirmed

Examination tests include pressing along the joint line and over the tendon, specific twisting tests for the meniscus, resisted rotation for the popliteus, and ligament tests for the posterolateral corner. When the picture is unclear, or symptoms are not improving, an MRI is the most useful scan. It shows the meniscus, the popliteus tendon and the ligaments in one study.

What it means for treatment

Popliteus tendinopathy is treated with load management and progressive strengthening. A lateral meniscus tear may also settle with physiotherapy, but tears that lock the knee or keep catching may need arthroscopic repair or trimming.

At Aman Hospital in Doha, Dr. Gelber explains which structure is responsible and what that means for your sport. Seek prompt review if your knee locks and will not straighten.