Internal Structural Connections in the Popliteus Tendon Complex with Posterior Cruciate Ligament and Clinical Implications / Conexiones Estructurales Internas en el Complejo Tendón Poplíteo con Ligamento Cruzado Posterior e Implicaciones Clínicas

SUMMARY: At present, the anatomical relationship the mid-portion of popliteus tendon complex (PTC) and the surrounding tissues is still unclear, especially its relationship to the posterior cruciate ligament (PCL). It affected the anatomical reconstruction of the posterolateral complex (PLC) injury. A total of 30 cases of the adult human knee joint fixed with formalin were used. Sagittal sections were made in 14 knee joints by the P45 plastination technique and dissection of 16 cases of knee joints. The P45 section revealed that the popliteus muscle fascia ran superiorly over the posterior edge of the tibial intercondylar eminence, and turned forward to be integrated into the PCL. Laterally, near the posterior edge of the lateral tibial plateau, the popliteus tendon penetrates through the articular capsule (AC), where two dense fibrous bundles were given off upwards by the popliteus tendon: one was the ventral fiber bundle, which ran superiorly over the posterior edge of the tibial plateau and then moved forwards to connect with the lateral meniscus; the dorsal fibers bundle ascended directly and participated in the AC. Meanwhile, the popliteus muscle dissection showed that at the posterior edge of the platform of the lateral condyle of the tibia, at the tendon-muscle transition, the PTC and AC were anchored to PCL.

En la actualidad, la relación anatómica entre la porción media del complejo tendinoso poplíteo (CTP) y los tejidos circundantes aún no está clara, especialmente su relación con el ligamento cruzado posterior (LCP). Esto afecta la reconstrucción anatómica de la lesión del complejo posterolateral (LCP). Se utilizaron un total de 30 casos de articulaciones de rodillas humanas de individuos adultos fijadas con formalina. Se realizaron cortes sagitales en 14 articulaciones de rodilla mediante la técnica de plastinación P45 y disección de 16 casos de articulaciones de rodilla. La sección P45 reveló que la fascia del músculo poplíteo discurría superiormente sobre el margen posterior de la eminencia intercondílea tibial y giraba hacia delante para integrarse en el LCP. Lateralmente, cerca del margen posterior de la platillo tibial lateral, el tendón poplíteo penetra a través de la cápsula articular (CA), donde el tendón poplíteo desprendió hacia arriba dos haces fibrosos densos: uno era el haz de fibras ventral, que corría superiormente sobre el margen posterior de la meseta tibial y luego se movió hacia adelante para conectar con el menisco lateral; el haz de fibras dorsales ascendía directamente y participaba en la CA. Por su parte, la disección del músculo poplíteo mostró que en el margen posterior del platillo del cóndilo lateral de la tibia, en la transición tendón-músculo, el CTP y el AC estaban anclados al LCP.

Non-Operative Rehabilitation of Isolated Popliteus Tendon Rupture in a Rugby Player

Isolated rupture of the popliteus tendon is uncommon; instead, it is often seen as part of multi-ligamentous posterolateral corner injuries. In this report, we present a case of a 22-year-old professional rugby player who sustained a lateral blow to his semi-flexed knee in a tackle during a competitive game. A complete popliteus tendon rupture at its musculo-tendinous junction was diagnosed on magnetic resonance imaging despite a relatively unremarkable physical examination. The aims of this report are to highlight the diagnostic challenges with this rare injury as physical signs are often subtle and non-specific. Furthermore, we demonstrate the viability of conservative management in the setting of a direct contact mechanism. Indeed, our patient was successfully treated with a specific rehabilitation protocol via isometric quadriceps contractions, gastrocnemius-soleus and hamstring strengthening exercises and graded activity with successful return to full contact activities at 4 weeks and regular season matches shortly after.

Morphological features of the popliteus tendon, popliteofibular and lateral (fibular) collateral ligaments / Características morfológicas del tendón del músculo poplíteo, y ligamentos popliteofibular y colateral fibular

To reveal the detailed morphological features of the fibular collateral (fibular) ligament, popliteus tendon, popliteofibular ligament and the synovial components regarding to achieve data for surgical and biomechanical utilization. Knees of 10 formalin-fixed male cadavers were dissected bilaterally. Bursae around the lateral collateral ligament and the relation of popliteus tendon with lateral collateral ligament at the femoral attachment site were noted. The positional relation between both ends of popliteofibular ligament was evaluated statistically. The PT exceeded the anterior margin of lateral collateral ligament in 11 sides, the posterior margin of lateral collateral ligament in 3 sides and exceeded both the anterior and posterior margins of lateral collateral ligament in 5 sides. The shape of lateral collateral ligament was narrower at the lower part than the upper in 14 sides. The width of lower part of lateral collateral ligament was found narrower in the cases with sheath-like bursa (vagina synovialis). The relation between both ends of popliteofibular ligament was as followed: the more anteriorly the fibular head attachment was located, the more anteriorly popliteofibular ligament was attached to the popliteus tendon. To resolve the posterolateral corner of the knee with regard to surgical anatomy and biomechanics, individual and concerted morphometric characteristics of lateral collateral ligament, popliteus tendon and PF should be evaluated together with accompanied synovial structures.

El objetivo de este trabajo consistió en descubrir las características morfológicas detalladas del ligamento colateral fibular, del tendón del músculo poplíteo (TMP), del ligamento popliteofibular y de los componentes sinoviales relacionados con la obtención de datos para la aplicación quirúrgica y biomecánica. Se disecaron bilateralmente rodillas de 10 cadáveres de sexo masculino fijados con formalina. Se identificó la bursa alrededor del ligamento colateral fibular y la relación del tendón del músculo poplíteo con el ligamento colateral fibular en el sitio de la inserción femoral. La relación posicional entre ambos extremos del ligamento popliteofibular se evaluó estadísticamente. El TMP excedió el margen anterior del ligamento colateral fibular en 11 casos, el margen posterior del ligamento colateral fibular en 3 casos y superó los márgenes anterior y posterior del ligamento colateral fibular en 5 casos. La forma del ligamento colateral fibular fue más estrecha en la porción inferior que en la porción superior en 14 casos. El ancho de la porción inferior del ligamento colateral fibular fue más estrecha en los casos con bursa del tipo vaina (vagina synovialis). La relación entre ambos extremos del ligamento popliteofibular fue la siguiente: cuanto más anteriormente se localizó la inserción de la cabeza fibular, más anteriormente el ligamento popliteofibular se unió al TMP. Para intervenir el ángulo posterolateral de la rodilla con respecto a la anatomía quirúrgica y la biomecánica, se deben evaluar las características morfométricas individuales y concertadas del ligamento colateral fibular, el TMP y el ligamento popliteofibular, junto con las estructuras sinoviales correspondientes.

Anatomy of the Femoral Attachment Site of the Anterior Cruciate Ligament and the Posterolateral Structures Related to the Stability of the Knee Joint / 대한해부학회지

The anterior cruciate ligament (ACL) and the posterolateral structures are functionally important structures that assist with the stability of the knee joint. Sport-related injuries to these structures and reconstructive surgery are becoming more frequent. However, the anatomic characteristics and the relationship between these structures are not well understood. We measured the morphological characteristics of the posterolateral structures of the knee and the ACL, and we identified the anatomic relationship between the center of the femoral attachment area of the ACL and other femoral structures. We dissected 34 cadaveric knees with no signs of previous surgery, knee abnormality, or disease. The lateral collateral ligament (LCL) and the popliteus tendon (PLT) were present in all knees, although the popliteofibular ligament (PFL) was not present in 20.6% of knees. The mean length of the LCL was 51.99 mm and differed significantly between men and women (P<0.05). The mean length of the PLT was 21.59 mm, and the mean length of the PFL was 18.49 mm. In 67.7% of knees, the PLT was attached to the inferior aspect of the femoral attachment of the LCL, and the femoral attachment of the PLT was covered by the bundle of the LCL. The ACL was distinguished into anteromedial (AM) and posterolateral (PL) bundles in all knees. The mean lengths of the AM and PM bundles were 22.14 mm and 15.98 mm, respectively. The measured lengths in each bundle differed significantly between men and women (P<0.05). The mean distance between the center of the femoral attachment area of the ACL and the intercondylar line was 8.36 mm in the AM bundle, 15.98 mm in the PL bundle, and 10.96 mm in the entire ACL. The mean distance between the center of the femoral attachment area of the ACL and the medial border of the lateral condyle was 8.14 mm in the AM bundle, 7.36 mm in the PL bundle, and 8.45 mm in the entire ACL.