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Biomechanics of the PCL and related structures: posterolateral, posteromedial and meniscofemoral ligaments

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

This paper reviews and updates our knowledge of the anatomy and biomechanics of the posterior cruciate ligament, and of the posterolateral, posteromedial and meniscofemoral ligaments of the knee. The posterior cruciate ligament is shown to have two functional fibre bundles that are tight at different angles of knee flexion. It is the primary restraint to tibial posterior draw at all angles of knee flexion apart from near full extension. In contrast, the posterolateral and posteromedial structures are shown to tighten as the knee extends, and to be well-aligned to resist tibial posterior draw. These structures also act as primary restraints against other tibial displacements. Tibial internal rotation is restrained by the medial and posteromedial structures, while tibial external rotation is restrained by the lateral and posterolateral structures. They are also the primary restraints against tibial abduction-adduction rotations. The meniscofemoral ligaments are shown, for the first time, to contribute significantly to resisting tibial posterior draw, and to have a strength of approximately 300 N. Taken together, this evidence shows how the posterolateral and posteromedial structures are responsible for posterior knee stability near extension, and this, along with the action of the meniscofemoral ligaments, may explain why an isolated rupture of the posterior cruciate ligament does not often lead to knee instability

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Acknowledgements

This paper includes work done over some years by the authors, and this was supported by the Arthritis Research Campaign, the Wishbone Trust, the Royal College of Surgeons of Edinburgh, the Smith and Nephew Foundation, and the Ealing Hospital knee fellowship.

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Correspondence to A. A. Amis.

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Amis, A.A., Bull, A.M.J., Gupte, C.M. et al. Biomechanics of the PCL and related structures: posterolateral, posteromedial and meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc 11, 271–281 (2003). https://doi.org/10.1007/s00167-003-0410-7

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  • DOI: https://doi.org/10.1007/s00167-003-0410-7

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