Advertisement

Anatomy of the posterior cruciate ligament and the meniscofemoral ligaments

  • A. A. AmisEmail author
  • C. M. Gupte
  • A. M. J. Bull
  • A. Edwards
Knee

Abstract

This paper describes the anatomy of the posterior cruciate ligament (PCL) and the meniscofemoral ligaments (MFLs). The fibres of the PCL may be split into two functional bundles; the anterolateral bundle (ALB) and the posteromedial bundle (PMB), relating to their femoral attachments. The tibial attachment is relatively compact, with the ALB anterior to the PLB. These bundles are not isometric: the ALB is tightest in the mid-arc of knee flexion, the PMB is tight at both extension and deep flexion. At least one MFL is present in 93% of knees. On the femur, the anterior MFL attaches distal to the PCL, close to the articular cartilage; the posterior MFL attaches proximal to the PCL. They both attach distally to the posterior horn of the lateral meniscus. Their slanting orientation allows the MFLs to resist tibial posterior drawer.

Keywords

Posterior cruciate ligament Meniscofemoral ligament Anatomy Fibre bundles Length changes 

Notes

Acknowledgements

The work of C.M.G. was supported by the Royal College of Surgeons of Edinburgh fellowship and the Smith and Nephew Foundation. A.M.J.B. is supported by the Arthritis Research Campaign. A.E. is supported by the West London Board for Postgraduate Medical and Dental Education.

References

  1. 1.
    Amis AA (1999) Anatomy and biomechanics of the posterior cruciate ligament. Sports Med Arthrosc Rev 7:225–234Google Scholar
  2. 2.
    Amis AA (2004) Posterior cruciate ligament: double bundle PCL reconstruction is the most effective method of restoring posterior knee stability following PCL rupture. In: Johnson D, Williams R (eds) Controversies in orthopaedics: sports injuries to the knee. Oxford University Press, OxfordGoogle Scholar
  3. 3.
    Amis AA, Bull AMJ, Gupte CM, Hijazi I, Race A, Robinson JR (2003) Biomechanics of the PCL and related structures: posterolateral, posteromedial and meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc 11:271–281CrossRefPubMedGoogle Scholar
  4. 4.
    Butler DL, Noyes FR, Grood ES (1980) Ligamentous restraints to anterior-posterior drawer in the human knee: a biomechanical study. J Bone Joint Surg Am 62:259–270PubMedGoogle Scholar
  5. 5.
    Girgis FG, Marshall JL, Al Monajem ARS (1975) The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop 106:216–231PubMedGoogle Scholar
  6. 6.
    Gupte CM, Smith A, McDermott ID, Bull AMJ, Thomas RD, Amis AA (2002) Meniscofemoral ligaments revisited: incidence, age correlation and clinical implications. J Bone Joint Surg Br 84:846–851CrossRefPubMedGoogle Scholar
  7. 7.
    Gupte CM, Smith A, Jamieson N, Bull AMJ, Thomas R De W, Amis AA (2002) Meniscofemoral ligaments—structural and material properties. J Biomech 35:1623–1629CrossRefPubMedGoogle Scholar
  8. 8.
    Gupte CM, Bull AMJ, Thomas RD, Amis AA (2003) A review of the function and biomechanics of the meniscofemoral ligaments. Arthroscopy 19(2):161–171Google Scholar
  9. 9.
    Gupte CM, Bull AMJ, Thomas RW, Amis AA (2003) The meniscofemoral ligaments: secondary restraints to posterior drawer. Analysis of anteroposterior and rotatory laxity in the intact and posterior-cruciate-deficient knee. J Bone Joint Surg 85B:765–773Google Scholar
  10. 10.
    Harner CD, Janaushek MA, Kanamori A, Yagi M, Vogrin TM, Woo SLY (2000) Biomechanical analysis of a double-bundle posterior cruciate ligament reconstruction. Am J Sports Med 28:144–151PubMedGoogle Scholar
  11. 11.
    Heller L, Langman J (1964) The meniscofemoral ligaments of the human knee. J Bone Joint Surg Br 46:307–311PubMedGoogle Scholar
  12. 12.
    Hughston JC, Bowden JA, Andrews JR, Norwood LA (1980) Acute tears of the posterior cruciate ligament. Results of operative treatment. J Bone Joint Surg Am 62:438–450PubMedGoogle Scholar
  13. 13.
    Kennedy JC, Hawkins RJ, Willis RB, Danylchuck KD (1976) Tension studies of human knee ligaments. Yield point, ultimate failure, and disruption of the cruciate and tibial collateral ligaments. J Bone Joint Surg Am 58:350–355PubMedGoogle Scholar
  14. 14.
    Kusayama T, Harner CD, Carlin GJ, Xerogeanes JW, Smith BA (1994) Anatomical and biomechanical characteristics of human meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc 2:234–237CrossRefPubMedGoogle Scholar
  15. 15.
    Mannor DA, Shearn JT, Grood ES, Noyes FR, Levy MS (2000) Two-bundle posterior cruciate ligament reconstruction. An in vitro analysis of graft placement and tension. Am J Sports Med 28:833–845PubMedGoogle Scholar
  16. 16.
    Marinozzi G, Pappalardo S, Steindler R (1983) Human knee ligaments: mechanical tests and ultrastructural observations. Ital J Orthop Traumatol 9:231–240PubMedGoogle Scholar
  17. 17.
    Palmer I (1938) On the injuries to the ligaments of the knee joint. Acta Orthop Scand Suppl 5:283Google Scholar
  18. 18.
    Prietto MP, Bain JR, Stonebrook SN, Settlage RA (1988) Tensile strength of the human posterior cruciate ligament (PCL). Transactions of the 34th Annual Meeting of the Orthopaedic Research Society, vol 13, p 195Google Scholar
  19. 19.
    Race A, Amis AA (1994) The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomech 27:13–24CrossRefPubMedGoogle Scholar
  20. 20.
    Race A, Amis AA (1996) Loading of the two bundles of the posterior cruciate ligament: an analysis of bundle function in A–P drawer. J Biomech 29:873–879CrossRefPubMedGoogle Scholar
  21. 21.
    Race A, Amis AA (1998) PCL reconstruction: in vitro biomechanical comparison of ‘isometric’ versus single and double-bundled ‘anatomic’ grafts. J Bone Joint Surg Br 80:173–179CrossRefPubMedGoogle Scholar
  22. 22.
    Trent PS, Walker PS, Wolf B (1976) Ligament length patterns, strength, and rotational axes of the knee joint. Clin Orthop 117:263–270PubMedGoogle Scholar
  23. 23.
    Van Dommelen BA, Fowler PJ (1989) Anatomy of the posterior cruciate ligament. A review. Am J Sports Med 17:24–29PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • A. A. Amis
    • 1
    • 2
    Email author
  • C. M. Gupte
    • 1
    • 2
    • 3
  • A. M. J. Bull
    • 3
  • A. Edwards
    • 1
  1. 1.Biomechanics Section, Department of Mechanical EngineeringImperial College LondonLondonUK
  2. 2.Department of Musculoskeletal SurgeryImperial College LondonLondonUK
  3. 3.Department of BioengineeringImperial College LondonLondonUK

Personalised recommendations