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The oblique popliteal ligament: an anatomic and MRI investigation

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Abstract

Purpose

Despite being the largest ligament on the posterior aspect of the knee, relatively little is known about the normal morphology of the oblique popliteal ligament (OPL). The aim of this study was to investigate the detailed anatomy of the OPL in cadavers and healthy volunteers.

Methods

The posterior knee was investigated in 25 cadaver lower limbs (mean age 76 ± 9.5 years; 7 men) by dissection, histology, and serial plastination and in 14 healthy individuals (mean age 23 ± 3.2 years; 11 men) using magnetic resonance (MR) imaging. OPL morphology, attachments sites, ligament length and width, relationship to surrounding structures and histological composition were recorded. Intraobserver reliability was assessed using intraclass correlation coefficients.

Results

The OPL is a distinct expansion of the semimembranosus (SM) tendon and sheath, which courses superolaterally to attach to the posterolateral joint capsule or fabella (when present), at the medial margin of the lateral femoral condyle. The ligament blends with the joint capsule medially and laterally, serves as an attachment site for plantaris, and has connections with popliteus. In 70% of dissections, the OPL divided into two bands, separated by small branches of the middle genicular neurovascular bundle that pierced the posterior joint capsule. Differences in mediolateral length were noted between dissection and MR imaging (43.6 ± 6.2 vs. 57.6 ± 4.4 mm; p < 0.001). At its medial and lateral attachments, the OPL was 23.2 ± 6.9 and 17.4 ± 8.7 mm wide (proximodistal), respectively. The OPL was predominantly composed of transverse collagen layers, with little elastin. While visible on axial MR scans, delineation of its most lateral extent was difficult. Repeatability of selected measurements ranged from good to almost perfect.

Conclusions

The OPL is a distinct ligament with identifiable anatomical limits. Based on its morphological characteristics, it appears more tendinous than ligamentous in nature. A better understanding of the OPL may help define its importance in the assessment and treatment of posterior knee injuries.

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Acknowledgements

The authors thank Marlene Black and Shane Soal for their technical expertise with the E12 plastination; the Otago Histology Services Unit; and the Otago School of Medical Sciences Scholarship for support of Liam McRedmond. No external funding was received for this study.

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Corresponding author

Correspondence to Stephanie J. Woodley.

Ethics declarations

All procedures performed in this study that involved human participants (MRI component) were in accordance with the ethical standards of the University of Otago Human Ethics Committee (Reference: 11/079) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all individual participants included in this study.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Hedderwick, M., Stringer, M.D., McRedmond, L. et al. The oblique popliteal ligament: an anatomic and MRI investigation. Surg Radiol Anat 39, 1017–1027 (2017). https://doi.org/10.1007/s00276-017-1838-7

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  • DOI: https://doi.org/10.1007/s00276-017-1838-7

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