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.

Characterastics of muscle architectural parameters for early knee osteoarthritis in middle-aged and elderly women / 中国康复理论与实践

ObjectiveTo observe the architectural parameter changes of the muscles around the knee in middle-aged and elderly women with early knee osteoarthritis (KOA) by musculoskeletal ultrasound, and to clarify the indicators of muscles that affect early KOA. MethodsFrom January to August, 2022, 20 healthy middle-aged and elderly healthy women (controls) and 20 middle-aged and elderly women with unilateral early KOA (KOA group) were recruited through Beijing Bo'ai Hospital, to measure muscle thickness of the popliteus muscle, the muscle thickness and the pennation angle of the quadriceps, as rectus femoris, vastus intermedius, vastus lateralis, vastus medialis longus and vastus medialis oblique. ResultsCompared with the healthy limb of KOA group, and the controls, the muscle thickness of vastus medialis longus, vastus medialis oblique and popliteus muscle of the affected limb of KOA group became thinner (t > 2.133, P < 0.05); the proportion of thickness of vastus medialis oblique to thickness of vastus lateralis became smaller (t > 3.660, P < 0.05). The pennation angle was smaller in the affected limb of KOA group than in the matched dominant side of the controls (t = 3.101, P < 0.05). Logistic regression analysis showed that the muscle thickness of vastus medialis oblique (OR = 0.235, 95%CI 0.068 to 0.805, P = 0.021) and popliteus muscle (OR = 0.387, 95%CI 0.152 to 0.980, P = 0.045) were related to the onset of early KOA. ConclusionThe thickness of vastus medialis longus, vastus medialis oblique and popliteus muscle decrease, and the balance of the strength of vastus medialis oblique and vastus lateralis weakens in the affected limbs of the middle-aged and elderly women with early KOA. The thickness of vastus medialis oblique and popliteus muscle are protective factors for onset of KOA.

Cadaveric study on anatomical variations of popliteal artery and its terminal branches: a clinical perspective

Introduction: Anatomical knowledge is very important for accurate diagnosis and proper treatment of the patient.The popliteal region presents a wide range of vascular anomalies. The correct diagnosis of these anatomicalvariations plays a key role in success of diverse procedures performed by orthopaedicians, vascular surgeonsand radiologists. In this context, the aim of our study was to gain knowledge on the origin, level and mode oftermination, course and relations of popliteal artery with surrounding structures, mainly the muscles, in poplitealfossa. The results obtained were compared with previous studies.Materials and methods: The study was carried out in 50 lower limbs of 25 well-embalmed cadavers. There wasno evidence of previous knee surgeries in any of the limbs. The specimens were collected from the department ofAnatomy, KVG Medical College, Sullia.Results: The femoral artery continued as popliteal artery, which terminated at the lower border of popliteusmuscle. Trifurcation pattern was observed in one specimen. 10% of specimens had hypoplastic/aplasticposteriortibial artery, distally replaced by peroneal artery. Another 4% of specimens had smaller posterior tibialand larger peroneal artery. Length of tibio peroneal trunk from the lower border of popliteus muscle was shorterthan normal (2.5 cm) in one specimen and longer in another specimen. The observation on course and relationsshowed that the popliteal artery passed beneath a bony tunnel of fibula before terminating in one specimen andin another specimen, popliteal artery was superficial to popliteal vein in the middle of popliteal fossa. In othertwo specimens, it coursed more medially towards medial head of gastrocnemius and another specimen presentedwith popliteal artery crossed by muscle belly of plantaris.Conclusion: This study adds up to the knowledge on vascular variations in the popliteal region, the awareness ofwhich is important to vascular surgeons while performing arterial reconstructions in femoro distal bypass graftprocedures and also to orthopaedicians during surgical clubfoot release.

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.

Reconstrucción mínimamente invasiva de la esquina posterolateral con sustitución simultánea del ligamento cruzado anterior para lesiones ligamentarias complejas de rodilla / Minimally invasive reconstruction of the posterolateral corner with simultaneous replacement of the anterior cruciate ligament for complex knee ligament injuries

Resumen: Introducción: Es importante conocer la efectividad del uso de técnicas combinadas para el tratamiento de las lesiones ligamentarias complejas de la rodilla, su evolución y las estrategias utilizadas para su desarrollo. Objetivo: Evaluar y describir los resultados de reconstruir de manera simultánea con una técnica mínimamente invasiva el complejo posterolateral (CPL) y el ligamento cruzado anterior (LCA). Material y métodos: Se realizó la reconstrucción del LCA y el CPL en siete pacientes, mediante la técnica descrita, en el período de Marzo a Noviembre de 2012. Todos los pacientes se evaluaron a los seis meses del procedimiento a través del uso de pruebas subjetivas IKDC, IKSS. Se valoró su retorno a actividades laborales y su índice de satisfacción. Resultados: Seis pacientes fueron del sexo masculino y solo uno del femenino, con rangos de edad entre los 26 y 46 años. La mayoría de las lesiones fueron causadas por accidentes asociados al deporte. Todos los participantes eran personas en la etapa productiva de la vida que requirieron un período promedio de tres meses de incapacidad. A los seis meses, conforme a la escala de IKDC, obtuvimos un paciente con IKDC de A, cuatro con un IKDC de B, uno de C y uno de D. En la escala subjetiva de IKSS, 80% promedió estabilidad de la rodilla por arriba de los 90 puntos, un paciente tuvo escala de 100 puntos y otro de 70 puntos.

Abstract: Objective: To evaluate and describe the results of a simultaneous reconstruction with minimally invasive technique of the posterolateral complex (PLC) and the anterior cruciate ligament (ACL). Material and methods: ACL and PLC reconstruction was performed in seven patients using the technique described, in the period from March to November 2012. All patients were evaluated at six months after the procedure using IKDC and IKSS subjective tests. Their return to work activities and their level of satisfaction were assessed. Results: Six male and one female patients ranging in age between 26 and 46 years were evaluated. The injuries were mostly caused by sports related accidents. All patients were economically active and required an average period of three months of disability. The assessment and outcomes at six months, according to the IKDC scale, were: one patient with IKDC A, four with IKDC B, one patient with C, and one with D. In the subjective scale IKSS, 80% averaged a knee stability of over 90 points, a patient had a 100-point scale and another, of 70 points.

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.

Neurovascular Compression Caused by Popliteus Muscle Enlargement Without Discrete Trauma

Popliteal entrapment syndrome caused by isolated popliteus muscle enlargement is very rare, although its occurrence has been reported after discrete trauma. However, popliteal artery stenosis with combined peroneal and proximal tibial neuropathy caused by popliteus muscle enlargement without preceding trauma has not been reported. A 57-year-old man presented with a tingling sensation and pain in his left calf. He had no previous history of an injury. The symptoms were similar to those of lumbosacral radiculopathy. Calf pain became worse despite treatment, and the inability to flex his toes progressed. Computed tomography angiography and magnetic resonance imaging of the lower extremity showed popliteal artery stenosis caused by popliteus muscle enlargement and surrounding edema. An electrodiagnostic study confirmed combined peroneal and proximal tibial neuropathy at the popliteal fossa. Urgent surgical decompression was performed because of the progressive neurologic deficit and increasing neuropathic pain. The calf pain disappeared immediately after surgery, and he was discharged after the neurologic functions improved.

Neurovascular Compression Caused by Popliteus Muscle Enlargement Without Discrete Trauma

Popliteal entrapment syndrome caused by isolated popliteus muscle enlargement is very rare, although its occurrence has been reported after discrete trauma. However, popliteal artery stenosis with combined peroneal and proximal tibial neuropathy caused by popliteus muscle enlargement without preceding trauma has not been reported. A 57-year-old man presented with a tingling sensation and pain in his left calf. He had no previous history of an injury. The symptoms were similar to those of lumbosacral radiculopathy. Calf pain became worse despite treatment, and the inability to flex his toes progressed. Computed tomography angiography and magnetic resonance imaging of the lower extremity showed popliteal artery stenosis caused by popliteus muscle enlargement and surrounding edema. An electrodiagnostic study confirmed combined peroneal and proximal tibial neuropathy at the popliteal fossa. Urgent surgical decompression was performed because of the progressive neurologic deficit and increasing neuropathic pain. The calf pain disappeared immediately after surgery, and he was discharged after the neurologic functions improved.

Shape and innervation of popliteus muscle / 대한해부학회지

The aim of this study was to delineate the shape of the popliteus muscle and determine the correct motor point site for treating spasticity. A total of 22 legs from 13 fresh Korean cadavers were evaluated. The x-axis was set as a transverse line across the lateral and medial epicondyle of the femur and the y-axis as a vertical line at the midpoint of the medial malleolus of the tibia and lateral malleolus of the fibula. The popliteus muscle is an obtuse triangle in shape. Superior, medial, and inferior angles were 27.2+/-4.3degrees, 114.8+/-19.8degrees, and 38.0+/-18.8degrees respectively. The lengths of the superior, medial, and lateral sides of the triangle were 7.6+/-1.0 cm, 6.2+/-1.0 cm, and 11.9+/-1.5 cm respectively. Nerve branches ran superficially on the periosteum of the tibia and entered the popliteus on its superficial surface. The diverging point of the nerve branch entered the popliteus from the tibial nerve located at the midline of the popliteal fossa and 17% of the leg length above the intercondylar line. Most nerve entry points (83.3%) were within a 2.0x3.0 cm rectangle with the center located at -1.0 cm (-7%) on the x-axis and -3.3 cm (-9%) on the y-axis.

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.

MR imaging study of the posterolateral structures of the normal knee / 中华放射学杂志

Objective To provide a practicable method for the complete display and localization of the posterolateral structures (PLS) of the normal knee through MRI study. Methods 30 tibial bone specimens were observed to establish the bony landmark for localizing the knee. In 50 cadaver knees, the angles between lateral tibial plateau and the long axis of the individual structure of PLS were measured. Then the scan methods of the oblique MR images were determined based on above results. The routine and oblique scans of T 1WI were performed in 40 normal knees. The display effect and appearance of the PLS were observed on MRI. Results The lateral tibial plateau was a stable bony landmark for measuring and localizing of the knee. In the 40 normal knees, The fibular collateral ligament could be intactly displayed on 70? posterior coronal oblique images in 34 cases (85%). The popliteus could be better seen on either 45? medial sagittal oblique in 34 cases (85%) or 60? posterior coronal oblique planes in 36 cases (90%). The popliteofibular ligament could be intactly appreciated on both 60? posterior coronal oblique in 32 cases (80%) and 70? lateral sagittal oblique images in 34 cases (85%). Although the arcuate ligament and the fabellofibular ligament could occasionally be seen on routine and oblique images, but the display rate was lower. Conclusion The oblique MR imaging can intactly display the main structures of PLS, and can be useful in diagnosing the injuries in those structures.