Abstract
Background
In posterolateral insufficiency, many investigators have proposed a lateral tunnel for PT reconstruction. Although they were usually located at the anterior and proximal to the lateral femoral epicondyle, there are still controversies regarding the exact location of PT tunnel. The aim of the present study was to describe our novel findings of femoral attachment of popliteus tendon (PT) and lateral collateral ligament (LCL) and to present an adequate femoral tunnel site, based on the cadaver dissection.
Methods
Nine embalmed cadavers (18 knees), which were fully extended, were dissected to determine a precise anatomic description of the PT attachment compared to the femoral epicondyle and the LCL. The anatomic variations and attachment of the LCL and PT around the epicondyle were described.
Results
The LCL (mean length: 53 mm, mean width 9 mm) was attached uniformly at the lateral epicondyle of the femur, which was slightly inferior and posterior to the top of the lateral epicondyle, but the PT (mean length: 36 mm, mean width: 8 mm) had the multiform attachments around the epicondyle and our dissection identified three different locations of the PT’s attachment; postero-inferior attachment (13 knees), just inferior attachment (2 knees), and double attachment by bifurcate bundles (3 knees). These results demonstrate that the attachment for the PT is mostly located at the postero-inferior site of the epicondyle in the fully extended position and can be seen only when the knee is fully extended because the attachment of the PT shifts anteriorly with regard to the LCL in higher flexion angles.
Conclusion
If the original site of the PT’s attachment cannot be seen, the recommendation of the femoral tunnel for the PT reconstruction should be located at the postero-inferior site as compared with the LCL attachment in the fully extended position.
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References
Diamantopoulos A, Tokis A, Tzurbakis M, Patsopoulos I, Georgoulis A (2005) The posterolateral corner of the knee: evaluation under microsurgical dissection. Arthroscopy 21:826–833
LaPrade RF, Ly TV, Wentorf FA, Engebretsen L (2003) The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med 31:854–860
LaPrade RF, Gilbert TJ, Bollom TS, Wentorf F, Chaljub G (2000) The magnetic resonance imaging appearance of individual structures of the posterolateral knee. A prospective study of normal knees and knees with surgically verified grade III injuries. Am J Sports Med 28:191–199
Veltri DM, Deng XH, Torzilli PA, Maynard MJ, Warren RF (1996) The role of the popliteofibular ligament in stability of the human knee. A biomechanical study. Am J Sports Med 24:19–27
Kim JG, Kim JH, Ha JG (2005) The anatomy of the posterior and posterolateral corner of the knee. J Korean Orthop Assoc 40:70–75
Fanelli GC, Edson CJ, Reinheimer KN, Garofalo R (2007) Posterior cruciate ligament and posterolateral corner reconstruction. Sports Med Arthrosc 15:168–175
Fanelli GC, Orcutt DR, Edson CJ (2005) The multiple-ligament injured knee: evaluation, treatment, and results. Arthroscopy 21:471–486
LaPrade RF, Wentorf FA, Crum JA (2004) Assessment of healing of grade III posterolateral corner injuries: an in vivo model. J Orthop Res 22:970–975
Nielsen S, Ovesen J, Rasmussen O (1985) The posterior cruciate ligament and rotatory knee instability. An experimental study. Arch Orthop Trauma Surg 104:53–56
Veltri DM, Deng XH, Torzilli PA, Warren RF, Maynard MJ (1995) The role of the cruciate and posterolateral ligaments in stability of the knee. A biomechanical study. Am J Sports Med 23:436–443
Vogrin TM, Hoher J, Aroen A, Woo SL, Harner CD (2000) Effects of sectioning the posterolateral structures on knee kinematics and in situ forces in the posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 8:93–98
Cooper JM, McAndrews PT, LaPrade RF (2006) Posterolateral corner injuries of the knee: anatomy, diagnosis, and treatment. Sports Med Arthrosc 14:213–220
Grood ES, Stowers SF, Noyes FR (1988) Limits of movement in the human knee. Effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg Am 70:88–97
Gollehon DL, Torzilli PA, Warren RF (1987) The role of the posterolateral and cruciate ligaments in the stability of the human knee. A biomechanical study. J Bone Joint Surg Am 69:233–242
LaPrade RF, Resig S, Wentorf F, Lewis JL (1999) The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft force. A biomechanical analysis. Am J Sports Med 27:469–475
Wang CJ, Chen CY, Chen LM, Yeh WL (2000) Posterior cruciate ligament and coupled posterolateral instability of the knee. Arch Orthop Trauma Surg 120:525–528
Fanelli GC (2005) Surgical reconstruction for acute posterolateral injury of the knee. J Knee Surg 18:157–162
LaPrade RF (2005) Anatomic reconstruction of the posterolateral aspect of the knee. J Knee Surg 18:167–171
Lee MC, Park YK, Lee SH, Jo H, Seong SC (2003) Posterolateral reconstruction using split Achilles tendon allograft. Arthroscopy 19:1043–1049
Yoon KH, Bae DK, Ha JH, Park SW (2006) Anatomic reconstructive surgery for posterolateral instability of the knee. Arthroscopy 22:159–165
Kim SJ, Park IS, Cheon YM, Ryu SW (2004) New technique for chronic posterolateral instability of the knee: posterolateral reconstruction using the tibialis posterior tendon allograft. Arthroscopy 20(Suppl 2):195–200
Wang CJ, Chen HS, Huang TW, Yuan LJ (2002) Outcome of surgical reconstruction for posterior cruciate and posterolateral instabilities of the knee. Injury 33:815–821
Zantop T, Schumacher T, Diermann N, Schanz S, Raschke MJ, Petersen W (2007) Anterolateral rotational knee instability: role of posterolateral structures. Winner of the AGA-DonJoy Award 2006. Arch Orthop Trauma Surg 127:743–752
Perez CL, Sumillera GM, Sunye GC (1999) Bifurcate popliteus tendon. Arthroscopy 15:638–639
Doral MN, Atay AO, Bozkurt M, Ayvaz M, Tetik O, Leblebicioglu G (2006) Three-bundle popliteus tendon: a nonsymptomatic anatomical variation. Knee 13:342–343
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Jung, G.H., Kim, J.D. & Kim, H. Location and classification of popliteus tendon’s origin: cadaveric study. Arch Orthop Trauma Surg 130, 1027–1032 (2010). https://doi.org/10.1007/s00402-010-1123-2
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DOI: https://doi.org/10.1007/s00402-010-1123-2