A descriptive and morphometric study of the fabellofibular, arcuate popliteal and popliteofibular ligaments

Year 2015, Volume: 9 Issue: 2 , 51 - 59 , 10.09.2015

Zeliha Kurtoğlu , Özlem Elvan Mustafa Aktekin Mehmet Çolak

https://doi.org/10.2399/ana.15.006

https://izlik.org/JA23YA29EH

Abstract

Objectives: The anatomical relationship of the fibrous structures in the posterolateral corner of the knee is highly complex, with many different descriptions of these structures in the literature. Discrepancy in the definitions of FF, AL and PF are a problem for both clinicians and anatomists. This study aimed to examine these structures and describe their features to clarify our understanding of their morphology. Methods: The posterolateral corner of the knee joint was bilaterally dissected in 10 male cadavers. Fibrous structures originating from the fibular head as a common mass were defined in relation to their attachment sites and positions according to the inferior lateral genicular vessels. The fabellofibular ligament (FF) was grouped into two categories, depending on the presence of a dense, fibrous tissue band. The arcuate popliteal ligament components were grouped into superficial (ALs) and deep (ALd) by their position relative to the inferior lateral genicular vessels. The popliteofibular ligament (PF) was identified as the fibrous bundle attached to the inferior border of popliteus tendon (PT). Dimensions of these structures were measured, and statistical analyses undertaken using paired and independent t-tests (p<0.05 significant). Results: FF had a dense fibrous band in 11 out of 20 knees. The fabella thickness was significantly higher in cases which FF had a dense fibrous band (p=0.04). ALs and PF were present in all knees. Absence of ALd was observed in 5 out of 20 knees.  Conclusion: Findings indicate the structural relationship between ALs and FF, variability in the morphology of the ligaments and a positive relationship between fabella thickness and FF morphology. Some structures were consistently present (AL, PF), while ALd was only present intermittently. We suggest descriptions of the posterolateral ligaments of knee that utilize attachment sites, relationships with the inferior lateral genicular vessels, and developmental relationships to the popliteus muscle to clarify terminology for these structures.

Keywords

arcuate popliteal ligament , fabellofibular ligament , popliteofibular ligament , posterolateral corner reconstruction

References

• Covey DC. Injuries of the posterolateral corner of the knee. J Bone
• Joint Surg Am 2001;83-A:106–18.
• Espregueira-Mendes JD, da Silva MV. Anatomy of the lateral collateral
• ligament:a cadaver and histological study. Knee Surg Sports
• Traumatol Arthrosc 2006;14:221–8.
• Brinkman JM, Schwering PJA, Blankevoort L, Koolos JG, Luites
• J, Wymenga AB. The insertion geometry of the posterolateral corner
• of the knee. J Bone Joint Surg Br 2005;87-B:1364–8.
• Camarda L, Condello V, Madonna V, Cortese F. Results of isolated
• posterolateral corner reconstruction. J Orthopaed Traumatol
• ;11:73–79.
• Jung GH, Kim JD, Kim H. Location and classification of popliteus
• tendon’s origin:cadaveric study. Arch Orthop Trauma Surg
• ;130:1027–32.
• Kim JG, Lee YS, Ha JK, Jun SS, Jin YC. Influence of knee flexion
• and femoral cross-pin insertion angle on posterolateral structures
• of the knee and lateral fixation lengths during ACL reconstruction.
• Surg Radiol Anat 2012;34:421–5.
• Wadia FD, Pimple M, Gajjar SM, Narvekar AD. An anatomic
• study of the popliteofibular ligament. International Orthopaedics
• ;27:172–4.
• Minowa T, Murakami G, Suzuki D, Uchiyama E, Kura H,
• Yamashita T. Topographical histology of the posterolateral corner
• of the knee, with special reference to laminar configurations
• around the popliteus tendon: a study of elderly Japanese and latestage
• fetuses. J Orthop Sci 2005;10:48–55.
• Zeng SX, Dong XL, Dang RS, Wu GS, Wang JF, Wang D,
• Huang HL, Guo XD. Anatomic study of fabella and its surrounding
• structures in a Chinese population. Surg Radiol Anat
• ;34:65–71.
• Ishigooka H, Sugihara T, Shimizu K, Aoki H, Hirata K.
• Anatomical study of the popliteofibular ligament and surrounding
• structures. J Orthop Sci 2004;9:51–8.
• LaPrade RF, Ly TV, Wentorf FA, Engebretsen L. 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 2003;3:854–60.
• Seebacher JR, Inglis AE, Marshall JL, Warren RF. The structure
• of the posterolateral aspect of the knee. J Bone Joint Surg Am
• ;64:536–41.
• Standring S, editor. Gray’s anatomy: the anatomical basis of clinical
• practice. 39th ed. Edinburgh (Scotland): Elsevier Churchill
• Livingstone; 2005. p. 1478–80.
• Standring S, editor. Gray’s anatomy: the anatomical basis of clinical
• practice. 40th ed. London: Elsevier Churchill Livingstone;
• p. 1400–8.
• Williams PL, Bannister LH, Collins P, Dyson M, Ferguson MWJ,
• editors. Gray’s anatomy: the anatomical basis of clinical practice.
• th ed. Edinburgh (Scotland): Elsevier Churchill Livingstone;
• p. 702.
• LaPrade RF. Posterolateral knee injuries: anatomy, evaluation, and
• treatment. New York: Thieme Medical Publishers; 2006. p. 33.
• Bolog N, Hodler J. MR imaging of the posterolateral corner of the
• knee. Skeletal Radiol 2007;36:715–28.
• Sudasna S, Harnsiriwattanagit K. The ligamentous structures of
• the posterolateral aspect of the knee. Bull Hosp Jt Dis Orthop Inst
• ;50:35–40.
• Hughston JC, Jacobson KE. Chronic posterolateral rotatory instability
• of the knee. J Bone Joint Surg Am 1985;67:351–9.
• Feipel V, Simonnet ML, Rooze M. The proximal attachments of
• the popliteus muscle: a quantitative study and clinical significance.
• Surg Radiol Anat 2003;25:58–63.
• Oransky M, Canero G, Maiotti M. Embryonic development of the
• posterolateral structures of the knee. Anat Rec 1989;225:347–54.
• Maynard MJ, Deng X, Wickiewicz TL, Warren RF. The popliteofibular
• ligament: rediscovery of a key element in posterolateral
• stability. Am J Sports Med 1996; 24:311–6.
• Kim JG, Ha JG, Lee YS. Posterolateral corner anatomy and its
• anatomical reconstruction with single fibula and double femoral
• sling method: anatomical study and surgical technique. Arch
• Orthop Trauma Surg 2009;129:381–5.
• Stäubli HU, Birrer S. The popliteus tendon and its fascicles at the
• popliteal hiatus: gross anatomy and functional arthroscopic evaluation
• and without anterior cruciate ligament deficiency. J
• Arthroscopy 1990;6:209–20.
• Gilroy AM, MacPherson BR, Ross LM, Schünke M, Schulte E,
• Schumacher U. Atlas of anatomy: 2nd ed. New York: Thieme
• Medical Publishers; 2012. p. 409.
• Moore KL, Dalley AF. Clinically oriented anatomy. 4th ed
• Baltimore: Lippincott Williams and Wilkins; 1999. p. 586.
• Rohen JW, Yokochi C, Lütjen-Dtecoll E. Anatomie des Menschen.
• Fotografischer Atlas der systematischen und topografischen
• Anatomie. Stuttgart: Schattauer; 2006. p. 446.
• Federative Committee of Anatomical Terminology (FCAT).
• Terminologia anatomica. Stuttgart: Thieme; 1998.
• Davies H, Unwin A, Aichroth P. The posterolateral corner of the
• knee. Anatomy, biomechanics and management of injuries. Injury
• ;35:68–75.
• Zhang H, Feng H, Hong L, Wang XS , Zhang J. Popliteofibular
• ligament reconstruction for posterolateral external rotation instability
• of the knee. Knee Surg Sports Traumatol Arthrosc
• ;17:1070–7.
• Sun C, Miao F, Wang X, Wang T, Ma R, Wang D, Liu C. An initial
• qualitative study of dual-energy CT in the knee Ligaments.
• Surg Radiol Anat 2008;30:443–7.
• Kim YC, Chung IH, Yoo WK, Suh JS, Kim SJ, Park CI. Anatomy
• and magnetic resonance imaging of the posterolateral structures of
• the knee. Clin Anat 1997;10:397–404.
• Fox CH, Johnson FB, Whiting J, Roller PP. Formaldehyde fixation.
• J Histochem Cytochem 1985;33:845–53.
• Abe M, Takahashi M, Horiuchi K, Nagano A. The changes in
• crosslink contents in tissuesafter formalin fixation. Analytical
• Biochemistry 2003;318:118–23.