Distal insertions of the semimembranosus tendon: MR imaging with anatomic correlation
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The purpose of this study is to investigate the distal insertions of the semimembranosus tendon with MR imaging, correlated with findings in cadavers.
Materials and methods
Four fresh cadaveric specimens were studied with 3-T MR imaging. Sequences included proton density (PD) sequences (TE, 13; TR, 4957; FOV, 170 × 170; matrix, 424 × 413; NA, 2; slice thickness, 2.5 mm) in the axial, coronal, and sagittal planes and 3D fast field echo (FFE) sequences (TR 9.4; TE 6.9; FOV, 159 × 105; matrix, 200 × 211; NA, 2; slice thickness, 0.57 mm). One specimen was dissected and three specimens were sectioned with a bandsaw in the axial, coronal, and sagittal plane. The sections were photographed and correlated with MR images. To standardize the analysis, the semimembranosus muscle and tendon were assessed at seven levels for the axial sections, and at three levels for the coronal and sagittal sections.
Anatomic dissection revealed six insertions of the distal semimembranosus tendon: direct arm, anterior arm, posterior oblique ligament extension, oblique popliteal ligament extension, distal tibial expansion (popliteus aponeurosis), and meniscal arm. Axial MR images showed five of six insertions: direct arm, anterior arm, oblique popliteal ligament extension, posterior oblique ligament extension, and distal tibial expansion. Sagittal MR images showed four of six insertions: direct arm, anterior arm, oblique popliteal ligament arm, and distal tibial expansion. Sagittal MR images were ideal for showing the direct arm insertion, but were less optimal than the axial images for showing the other insertions. The anterior arm was seen but volume averaging was present with the gracilis tendon. Coronal MR images optimally revealed the anterior arm, although magic angle artifact was present at its posterior aspect. The common semimembranosus tendon and meniscal arm were also well depicted. The division in anterior arm, direct arm, and oblique popliteal ligament arm was poorly seen on coronal images due to volume averaging.
Although the anatomy of the distal semimembranosus tendon is complex, six different semimembranosus insertions can be identified on routine proton density and FFE sequences at 3 T. Analysis of images at defined levels in the three imaging planes simplifies MR interpretation of the anatomy of the distal semimembranosus tendon.
KeywordsKnee, MR imaging Knee, anatomy Knee, posteromedial corner Semimembranosus tendon
- 1.LaPrade RF, Morgan PM, Wentorf FA, Johansen S, Engebretsen L. The anatomy of the posterior aspect of the knee. An anatomic study. J Bone Joint Surg Am. 2007;89:758–64.Google Scholar
- 2.Robinson JR, Sanchez-Ballester J, Bull AM, Thomas Rde W, Amis AA. The posteromedial corner revisited. An anatomical description of the passive restraining structures of the medial aspect of the human knee. J Bone Joint Surg Br. 2004;86:674–81.Google Scholar
- 3.Chahal J, Al-Taki M, Pearce D, Leibenberg A, Whelan DB. Injury patterns to the posteromedial corner of the knee in high-grade multiligament knee injuries: a MRI study. Knee Surg Sports Traumatol Arthrosc. 2010;18:1098–104.Google Scholar
- 4.Lind M, Jakobsen BW, Lund B, Hansen MS, Abdallah O, Christiansen SE. Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability. Am J Sports Med. 2009;37:1116–22.Google Scholar
- 5.Cohen M, Astur DC, Branco RC, de Souza Campos Fernandes R, Kaleka CC, Arliani GG, Jalikjian W, Golano P. An anatomical three-dimensional study of the posteromedial corner of the knee. Knee Surg Sports Traumatol Arthrosc. 2011;19:1614–9.Google Scholar
- 6.Geiger D, Chang E, Pathria M, Chung CB. Posterolateral and posteromedial corner injuries of the knee. Radiol Clin North Am. 2013;51:413–32.Google Scholar
- 7.Beltran J, Matityahu A, Hwang K, Jbara M, Maimon R, Padron M, Mota J, Beltran L, Sundaram M. The distal semimembranosus complex: normal MR anatomy, variants, biomechanics and pathology. Skeletal Radiol. 2003;32:435–45.Google Scholar
- 8.Bonasia DE, Bruzzone M, Dettoni F, Marmotti A, Blonna D, Castoldi F, Gasparetto F, D'Elicio D, Collo G, Rossi R. Treatment of medial and posteromedial knee instability: indications, techniques, and review of the results. Iowa Orthop J 2012;32:173–83.Google Scholar
- 9.De Maeseneer M, Van Roy F, Lenchik L, Barbaix E, De Ridder F, Osteaux M. Three layers of the medial capsular and supporting structures of the knee: MR imaging-anatomic correlation. Radiographics. 2000;20:S83–9.Google Scholar
- 11.House CV, Connell DA, Saifuddin A. Posteromedial corner injuries of the knee. Clin Radiol. 2007;62:539–46.Google Scholar
- 12.Bauer KL, Stannard JP. Surgical approach to the posteromedial corner: indications, technique, outcomes. Curr Rev Musculoskelet Med. 2013;6:124–31.Google Scholar
- 13.Loredo R, Hodler J, Pedowitz R, Yeh LR, Trudell D, Resnick D. Posteromedial corner of the knee: MR imaging with gross anatomic correlation. Skeletal Radiol. 1999;28:305–11.Google Scholar
- 14.Warren LF, Marshall JL. The supporting structures and layers on the medial side of the knee. J Bone Joint Surg (Am). 1979;61:56–62.Google Scholar
- 15.Cardinal E, Moser T. Tendinopathie du semimembraneux et bursopathies de la face postero-mediale du genou. In: Le tendon et son environement. Montpellier:Sauramps Medical 2013;459–476.Google Scholar