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Background: The presentation of patients with knee injuries which can have a significant impact on their ability to work and perform activities of daily living is constantly rising. The posterolateral corner of the knee has a complex anatomy of muscles, tendons, and ligaments, with huge variation in the population. The fabella is one such structure, found in the posterolateral corner of the knee, which can serve as a common origin point of various ligaments., Case Report: We present a case report of a 53-year-old white man who presented with atraumatic, posterior knee pain and was found to have a congenital, anomalous band originating from the fabella, causing semimembranosus impingement. This was diagnosed with magnetic resonance imaging; he underwent division of the anomalous band, which resulted in complete resolution of his symptoms., Conclusion: We propose that patients who present with posterior knee pain, without any history of trauma, and have no abnormalities on plain radiographs, should undergo magnetic resonance imaging of their knees. This will help in assessing the ligament complex in the posterior compartment of the knee, and exclude impingement of the semimembranosus as an, albeit rare, cause of posteromedial knee pain.

Pain at the first metatarsophalangeal (MTP) joint can result from inflammation, chondromalacia, flexor hallucis brevis tendinitis, osteochondritis dessecans, fracture of a sesamoid bone, avascular necrosis of sesamoids, inflamed bursae, intractable keratoses, infection, sesamoiditis, gout arthropathy, and rheumatoid arthritis. Congenital absence of a sesamoid bone is extremely rare. We present a 17-year-old male patient with pain at the plantar aspect of the right MTP joint associated with congenital absence of the medial sesamoid. There was tenderness and the range of motion was minimally restricted. He described the pain as necessitating changes in his social life. On radiographs, the medial hallucial sesamoid was absent on the right side. The MTP joint was also evaluated using magnetic resonance imaging (MRI). A metatarsal pad was prescribed and the patient was satisfied with the treatment at the 2 months follow-up period. MRI revealed no pathological tissue at the medial sesamoid site. Hallucial sesamoids absorb pressure, reduce friction, protect the tendons, act like a fulcrum to increase the mechanical force of the tendons, and provide a dynamic function to the great toe by elevating first metatarsal head. Congenital absence of these bones is very rare but we must consider it in a patient with MTP joint pain., (Copyright 2006 Wiley-Liss, Inc.)

Sesamoid bones and secondary centers of ossification account for the accessory bones of the foot, and there is a wide range of frequency with which these different ossicles appear. They are usually incidental asymptomatic findings on imaging studies, and their clinical importance lies in not mistaking them for fractures. Occasionally these ossicles can become painful due to fracture, degenerative changes, avascular necrosis, and irritation or impingement of adjacent soft tissue.

The sesamoid bones of the first metatarsal exhibit a special anatomic configuration, enveloped by the tendons of the flexor hallucis brevis and lying within the capsule of the first metatarsophalangeal joint. Painful conditions of the hallux sesamoid bones are many and include congenital, traumatic, arthritic, infectious, and ischemic conditions. Because of the complex anatomy and the numerous pain-sensitive structures in the region of the first metatarsophalangeal joint, a differential diagnosis can be challenging. The imaging examination should always begin with conventional radiography, including special axial and lateromedial views of the sesamoid bones. In cases in which results of routine radiography are inconclusive, scintigraphy, conventional or computed tomography, xeroradiography, or magnetic resonance imaging can be used. A thorough understanding of the anatomy; pathophysiology; and clinical, laboratory, and imaging findings is often helpful in the establishment of a diagnosis and management plan for painful conditions of the hallux sesamoid bones.