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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References
Amis AA (1985) The biomechanics of ligaments. In: Jenkins DHR (ed) Ligament injuries and their treatment. Chapman and Hall, London, pp 3–28
Amis AA (1999) The kinematics of knee stability. In: Jakob RP, Fulford P, Horan F (eds) EFORT European Instructional Course Lectures, vol 4. J Bone Joint Surg Br, London, pp 96–104
Amis AA, Scammell BE (1993) Biomechanics of intraarticular and extraarticular reconstructions of the anterior cruciate ligament. J Bone Joint Surg Br 75:812–817
Brantigan OC, Voshell AF (1941) The mechanics of the ligaments and menisci of the knee joint. J Bone Joint Surg Am 23:44–66
Brantigan OC, Voshell AF (1943) The tibial collateral ligament: its function, its bursae, and its relation to the medial meniscus. J Bone Joint Surg Am 25:121–131
Butler DL, Kay MD, Stouffer DC (1986) Comparison of material properties in fascicle-bone units from human patellar tendon and knee ligaments. J Biomech 19:425–432
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 62:259–270
Clancy WG J, Shelbourne KD, Zoellner GB, Keene JS, Reider B, Rosenberg TD (1983) Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament. Report of a new procedure. J Bone Joint Surg Am 65:310–322
Covey DC (2001) Injuries of the posterolateral corner of the knee. J Bone Joint Surg Am 83:106–118
Friederich N F, O'Brien WR (1990) Functional anatomy of the meniscofemoral ligaments. Proc Fourth Congress of the European Society of Sports Traumatology Knee Surgery and Arthroscopy (ESSKA)
Fukubayashi T, Torzilli PA, Sherman MF, Warren RF (1982) An in vitro biomechanical evaluation of anterior-posterior motion of the knee. Tibial displacement, rotation, and torque. J Bone Joint Surg Am 64:258–264
Girgis FG, Marshall JL, Al Monajem ARS (1975) The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop 106:216–231
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
Grood ES, Noyes FR, Butler DL, Suntay WJ (1981) Ligamentous and capsular restraints preventing straight medial and lateral laxity in intact human cadaver knees. J Bone Joint Surg Am 63:1257–1269
Grood ES, Stowers SF, Noyes FR (1988) Limits of movement in the human knee. Effects of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg Am 70:88–97
Gupte CM, Bull AMJ, Thomas RD, Amis AA (2003) A Review of the function and biomechanics of the meniscofemoral ligaments. Arthroscopy 19:161-171
Gupte CM, Bull AMJ, Thomas RD, Amis AA (2003) The meniscofemoral ligaments: secondary restraints to the posterior drawer. Analysis of anteroposterior and rotatory laxity in the intact and posterior-cruciate-deficient knee. J Bone Joint Surg Br 85:765-773
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 84:846–851
Gupte CM, Smith A, Jamieson N, Bull AMJ, Amis AA (2002) Meniscofemoral ligaments—structural and material properties. J Biomech 35:1623-1629
Harner CD, Janaushek MA, Kanamori A, Yagi M, Vogrin TM, Woo SL-Y (2000) Biomechanical analysis of a double-bundle posterior cruciate ligament reconstruction. Am J Sports Med 28:144–151
Heller L, Langman J (1964) The meniscofemoral ligaments of the human knee. J Bone Joint Surg Br 46:307–311
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 62:438–450
Hughston J C, Eilers AF (1994) The role of the posteror oblique ligament in repairs of acute medial (collateral) ligament tears of the knee. J Bone Joint Surg Am 76:1328–1344
Kaneda Y, Moriya H, Takahashi K, Shimada Y, Tamaki T (1997) Experimental study on external tibial rotation of the knee. Am J Sports Med 25:796–800
Kennedy JC, Fowler PJ (1971) Medial and anterior instability of the knee. J Bone Joint Surg Am 53:1257–1270
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 58:350–355
Kusayama T, Harner CD, Carlin GJ, Xerogeanes JW, Smith BA (1994) Anatomical and biomechanical characteristics of human meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc 2:234–237
Last RJ (1950) The popliteus muscle and the lateral meniscus. J Bone Joint Surg Br 32:93–99
Mains DB, Andrews JG, Stonecipher T (1977) Medial and anterior-posterior ligament stability of the human knee, measured with a stress apparatus. Am J Sports Med 5:144–153
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 28:833–845
Marinozzi G, Pappalardo S, Steindler R (1983) Human knee ligaments: mechanical tests and ultrastructural observations. Ital J Orthop Traumatol 9:231–240
Maynard MJ, Deng X, Wickiewicz TL, Warren RF (1996) The popliteofibular ligament. Rediscovery of a key element in posterolateral stability. Am J Sports Med 24:311–316
Nielsen S, Kromann-Andersen C, Rasmussen O, Andersen K (1984) Instability of cadaver knees after transection of capsule and ligaments. Acta Orthop Scand. 55:30–34
Noyes FR, Grood ES (1976) The strength of the anterior cruciate ligament in humans and rhesus monkeys: age-related and species-related changes. J Bone Joint Surg Am 58:1074–1082
Palmer I (1938) On the injuries to the ligaments of the knee joint. Acta Orthop Scand Suppl 5:283
Piziali RL, Seering WP, Nagel DA, Schurman DJ (1980) The function of the primary ligaments of the knee in anterior-posterior and medial-lateral motions. J Biomech 13:777–784
Prietto MP, Bain JR, Stonebrook SN, Settlage RA (1988) Tensile strength of the human posterior cruciate ligament (PCL). Trans 34th Ann ORS 13:195
Race A, Amis AA (1994) The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomech 27:13–24
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 29:873–879
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 80:173–179
Radoïévitch S (1931) Les ligaments des ménisques interarticulaires du genou. Ann Anat Pathol 8:400–413
Ritchie JR, Bergfeld JA, Kambic H, Manning T (1998) Isolated sectioning of the medial and posteromedial capsular ligaments in the posterior cruciate ligament-deficient knee. Influence on posterior tibial translation. Am J Sports Med 26:389–394
Seebacher JR, Inglis AE, Marshall JL, Warren RF (1982) The structure of the posteolateral aspect of the knee. J Bone Joint Surg Am 64:536–541
Slocum DB, Larson RL (1968) Rotatory instability of the knee. J Bone Joint Surg Am 50:211–225
Smillie IS (1970) Injuries of the ligaments. In: Injuries of the knee joint, 2nd edn. Livingstone, London, pp 189–253
Strobel M, Stedtfeld HW (1990) Diagnostic evaluation of the knee. Springer, Berlin Heidelberg New York
Sugita T, Amis AA (2001) Anatomy and biomechanics of the lateral collateral and popliteofibular ligaments. Am J Sports Med 29:466–472
Terry GC, LaPrade RF (1996) The posterolateral aspect of the knee. Anatomy and surgical approach. Am J Sports Med 24:732–739
Trent PS, Walker PS, Wolf B (1976) Ligament length patterns, strength, and rotational axes of the knee joint. Clin Orthop 117:263–270
Ulrich K, Krudwig WK, Witzel U (2002) Posterolateral aspect and stability of the knee joint. I. Anatomy and function of the popliteus muscle-tendon unit: an anatomical and biomechanical study. Knee Surg Sports Traumatol Arthrosc 10:86–90
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
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
Warren LF, Marshall JL, Girgis F (1974) The prime static stabiliser of the medial side of the knee. J Bone Joint Surg Am 56:665–674
Warren LF, Marshall JL (1979) The supporting structures and layers on the medial side of the knee. An anatomical analysis. J Bone Joint Surg Am 61:56–62
Watanabe Y, Moriya H, Takahashi K, Yamagata M, Sonoda M, Shimada Y, Tamaki T (1993) Functional anatomy of the posterolateral structures of the knee. Arthoscopy 9:57–62
Woo SL-Y, Hollis JM, Adams DJ, Lyon RM, Takai S (1991) Tensile properties of the human femur-anterior cruciate ligament-tibia complex: the effects of specimen age and orientation. Am J Sports Med 19:217–225
Yamamoto M, Hirohata K (1994) Anatomical study of the meniscofemoral ligaments of the knee. Kobe J Med Sci 37:209–226
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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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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