Popliteal Fossa Excision (Back of Knee)

It is a procedure that involves removing a tumor (usually malignant or benign aggressive) of the posterior knee compartment (back of knee) while preserving the surrounding bone and soft tissues.

Popliteal Mri

What is a Resection of the Popliteal Fossa (Back of Knee)?

The popliteal fossa compartment (back of knee) is a relatively rare location for musculoskeletal tumors (soft tissue or bone tumors) to arise. The popliteal space is diamond-shaped; on its superior aspect, it is bounded by the semimembranosus, semitendinosus, and biceps femoris muscles (hamstring muscles). It also involves the gastrocnemius muscle (calf muscle). Some of the most common types of soft tissue tumors that arise in this site include lipomas and low-grade liposarcomas. High-grade soft tissue sarcomas may adhere to some of the vascular structures (veins and arteries) and require careful dissection and preservation of the popliteal vessels (arteries and veins). About 90% of soft tissue sarcomas arising in the popliteal fossa (back of knee) can be resected and treated adequately by a limb-sparing surgery. In some instances the extremity cannot be saved and an above-knee amputation is performed. 

Contraindications for saving the limb may include neurovascular invasion, infection, pathological fracture, extensive disease, involvement of the tumor into adjacent bone (nearby bone) contamination from a poorly performed biopsy, recurrent disease.

What’s involved in the technique?

What you can expect afterwards

After your surgery you will spend a few nights in the hospital and then will be recuperating at home. Various pain protocols and nerve blocks are used to minimize pain. Mostly all patients are very comfortable after the surgery. For the first few days you will ice the area and keep it elevated to reduce swelling. You will return to the office 2 weeks after surgery. Once cleared, you will subsequently start physical therapy. We usually prescribe specific physical therapy protocols 3 times a week for 12 weeks after surgery to gradually strengthen muscles. Strengthening with significant resistance after sufficient range of motion is achieved as determined by Dr. Wittig. There may be an ultimate weight limit imposed upon you depending on various factors.  

You will be monitored periodically with MRI imaging over the course of 5 years to ensure there are no signs of recurrence. You will have follow up appointments every 4 months for the first 2 years, then every 6 months for the next 2 years, and then once a year. Since the integrity of the limb has been restored to full or almost full, recovery is anticipated provided the patient adheres to strict physical therapy. 

Types Of Physical Therapy

Popliteal Fossa (Back of Knee) Excision Video

Dr. James Wittig narrates a video illustrating the surgical technique for resection of a tumor of the popliteal fossa. | WATCH VIDEO