Although uncommon, a pes anserinus injury can cause debilitating medial knee pain. In the first of a two-part article, Andrew Hamilton explains the structure of the pes anserinus complex, the risk factors for injury, and how clinicians can differentially diagnose a pes anserinus injury.
Knee injuries are prevalent in athletes due to the loads transmitted through the knee joint during sport. When medial knee pain presents, there are several possible causes, including an injury to the medial ligament, medial cartilage/meniscus, or medial tibial stress fracture. However, in athletes with vigorous and repetitive hamstring use, there is another possibility – pes anserinus injury. Because these injuries are comparatively rare, missed diagnosis is common and can result in unnecessary knee surgery.
The pes anserinus (PA) - also known as pes anserine or the ‘goose’s foot’ – refers to a conjoined insertion of the sartorius, gracilis and semitendinosus muscles along the proximal medial aspect of the tibia (see figure 1). Each of these three muscles is innervated by a different nerve: the femoral, obturator and tibial nerves respectively. Visually, these conjoined tendons form a structure reminiscent of a goose’s webbed foot and were named from the Latin roots, pes for foot and anserinus for goose. Under the conjoined tendons lies the pes anserine bursa, a sac which provides smooth movement of the conjoined hamstring tendons over the medial collateral ligament. The pes anserinus aids knee stability by helping the medial ligament resist valgus forces.
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