popliteus muscle mri anatomy

Injuries to PMFs or other structures around the popliteal hiatus have been described and have been reported to be responsible for clinical symptoms such as pain, snapping and popping.16,29,30 However, their occurrence as isolated injuries is considered extremely rare9 and is considered more frequent in the case of Anterior Cruciate Ligament (ACL) injury6 or postero-lateral corner injuries with popliteal tendon involvement.9 Thus, PMFs tears in the context of ACL or Postero-Lateral Corner (PLC) injuries could often be misunderstood, since their biomechanical and clinical effects could be masked by the preponderant consequences of ligaments rupture. The website cannot function properly without these cookies, which is why they are not subject to your consent. CONCLUSION. Heavy worker, non-athletic except for recreational cycling. 2021;80(3):505-13. The average length of its attachment to the lateral meniscus is 6.5 1.5 mm.1 With the postero-inferior PMF it creates a small pouch, or recess, behind the meniscal wall and in communication with the popliteal space. Cross sectional anatomy of the knee based on MRI : articular surface of patella and femur, condyle, epicondyle and muscles (popliteus, sartorius, gastrocnemius, semimembranous with tendos.) The tendon is intra-capsular but extra-synovial and extra-articular. This tool is at the same time useful for the training and teaching of the anatomy, but also for experts to illustrate a course or an explanation of a pathology to a patient, in particular in the context of the ruptures of the cross ligaments or the lesions of the meniscuses. The PS-PMF was torn medially to the popliteus tendon (e) while inspecting the inferior surface of the lateral meniscus, the PI-PMF was found intact (f). The Posterolateral Corner Anatomy: Popliteus Muscle on MRI. 10a, b). The .gov means its official. MRI of the knee is often performed for presumed musculoskeletal conditions. Posterolateral Corner Injury. 6d). Differently, due to its more posterior and medial position, the PMTL is difficult to access through standard arthroscopic portals. Attachments: Originates from the lateral condyle of the femur and the lateral meniscus of the knee joint. 4 min. Folia Morphol. In fact, when the proximal fibula moves distally from its original articulation with the distal femur to its current articulation at the proximal tibiofibular joint, the lateral capsule is pulled down, forming a new capsular layer between the distal femur and the proximal popliteus muscle.2,3 The many anatomical dissection studies that have tried to describe this complex anatomy have identified three distinct structures, the popliteomeniscal fascicles (PMFs), as the principal connections between the lateral meniscus and the popliteus tendon, where capsular connections are interrupted.1,2,47 However, this complexity generated great inconsistencies in terminology among authors during the last century,1,4,6,811 and the reported variability of the connections between the lateral meniscus and the popliteal tendon8,9 further increased the confusion. It is in close relationship to the other posterolateral corner structures of the knee including lateral collateral ligament, arcuate and fabellofibular ligaments as well as the popliteofibular ligament for which the myotendinous junction of the popliteus muscle serves as a site of origin 1. A structure originating from the posterior part of the fibular head near the tibiofibular joint and inserting both on the popliteus tendon and the meniscus (through the popliteomeniscal fascicle) was described in 1990 by Stubli and Birrer, which named it the posterior limb of popliteofibular fascicle.6. {"url":"/signup-modal-props.json?lang=us"}, Oh G, Yu Y, Hacking C, et al. Current Concepts on the Morphology of Popliteus Tendon and Its Clinical Implications. Lippincott Williams & Wilkins. The latter has been referred also as the coronary ligament, even if the acronym LMTL has been identified as being more appropriate to describe its anatomical characteristics.21 The hiatus is completed by two structures that provide a distal connection with the tip of the fibula: the popliteofibular ligament and the meniscofibular fascicle. Here, the posterior free margin of the meniscofibular fascicle can be palpated as well. MFF, meniscofibular fascicle; PS-PMF, postero-superior popliteomeniscal fascicle; A-PMF, anterior popliteomeniscal fascicle; PI-PMF, postero-inferior popliteomeniscal fascicle. It should also be acknowledged that low-quality MRI with thick slices could easily miss some of these structures and that, considering the oblique course of PMFs, a proton-density weighting oblique-coronal images and 4550 slice angle with the posterior tibial condyle is recommended for their assessment.18 Nevertheless, standard MRI could be helpful to detect gross static abnormalities, especially examining the sagittal plane (Table 1). This webpage presents the anatomical structures found on shoulder MRI. 8600 Rockville Pike The axial view showed an abnormal shape of the lateral meniscus (white dotted line) with no peripheral rim at the level of the popliteus tendon (yellow-dotted line) (f). Considering the oblique course and the intimate connection with the popliteus tendon, it can hardly be discerned if no hyperintense fluid fills the popliteal space. The magnetic resonance imaging (MRI) showed rupture of the ACL and a displaced bucket-handle tear of the lateral meniscus. National Library of Medicine 16f). Coronal slice passing at the level of the popliteal hiatus; the popliteofibular ligament (red arrow) is seen originating from the inferior portion of the popliteus tendon (white asterisk) (b). The lateral meniscotibial ligament was intact (yellow arrow) on coronal slices (c). It has 3 origins: the lateral femoral condyle, the fibular head, and the lateral meniscus. A second MRI performed after two months due to symptom persistence without any traumas revealed the complete anterior displacement of the lateral meniscus posterior horn (white asterisk) (d) without any peripheral rim on both sagittal and coronal slices (red asterisk) (e). The axial view was normal, with a C-shaped lateral meniscus (white dotted line) and correct relationship with the popliteus tendon (yellow dotted line) (c). Inconsistencies and controversies in anatomical origins, shape and names of these structures are generated by their complex anatomy and interconnections between each other, which could inevitably lead to selective and partial isolation according to the dissection technique. While the postero-superior and the postero-inferior are named consistently among authors, inconsistencies exist regarding the definition of the most anterior PMF, which has been named either antero-inferior6,8 and antero-superior;1 therefore, considering its oblique course, in the present manuscript it is named neutrally the anterior PMF (A-PMF), since no distinctions are needed among a superior and inferior structure such as for the posterior fascicles. The MFF direction is distal and posterior, towards the tip of the fibula, with an oblique course which crosses the route of the popliteal tendon; it thus represents a layer interposed between the popliteus tendon and the convex tibial plateau, to which it adheres. Among the three PMFs, the postero-superior is the one that is most clearly visible and identified, since it originates from the posterior surface of the popliteus tendon and terminates mainly on the superior part of the posterior horn of the meniscus. Some of them require your consent. Unable to process the form. Before In most cases22 it could be seen as a distinct structure, between the LMTL anteriorly and the orifice of the postero-inferior PMF posteriorly; lifting up the meniscus with the probe, the meniscofibular fascicle, the postero-inferior PMF and the LMTL are put in tension, easing their visualization and exposing the orifice (Fig. Stephen J Pomeranz, MD. Anatomy and function of the popliteus muscle-tendon unit: an anatomical and biomechanical study. The popliteal hiatus is a complex region, formed by the confluence of various structures connecting the meniscus, popliteal tendon, tibia and fibula. 12, Popliteus muscle. In the axial MRI slice passing at the level of the fibular tip (red F) resembling the specimen in (b), it is possible to appreciate the inferior aperture and the popliteal recess as an hyperintense crescent-shape image (yellow asterisks), indicating the interruption of the meniscotibial connections at the level of the popliteal hiatus (d). Go to: 2. This software is open and free to anyone curious about anatomy, but it was particularly created for radiologists, rheumatologists, orthopedic surgeons, general practitioners, and medical students (support for the preparation of medical boards), and radiology technicians. The first magnetic resonance imaging (MRI) was reported as inconclusive with an apparently normal posterior horn of the lateral meniscus (white asterisk); a retrospective review allowed to note abnormalities at the level of PS-PMF (red arrow) on sagittal slices (a) and absent lateral meniscotibial ligament (white arrow) substituted with an hyperintense signal on coronal slices (b). There is a wide variety of variant vascular anatomy and vascular pathology that can occur around the knee, including an aberrant anterior tibial artery, vascular trauma that occurs with knee dislocation, popliteal artery entrapment syndrome, popliteal artery aneurysm, popliteal vein thrombosis, cystic adventitial . Injuries or abnormalities of the popliteal hiatus and its structures have been described, resulting in meniscal hypermobility and subluxation.16 Hypermobile lateral meniscus has been described as a condition characterized by an excessive mobility of the posterior horn of the lateral meniscus leading to knee pain and/or locking symptoms mostly with kneeling or squatting; however, no precise definition is provided. However, when the lateral meniscus is in situ, the diagnosis could be difficult35 (Fig. Jadhav SP, More SR, Riascos RF, Lemos DF, Swischuk LE. Anatomy As described in a three-layer approach, the popliteus musclotendinous complex is considered to be a layer three structure forming one of the main deep posterolateral stabilizers. In this retrospective study we will review the anatomy of the popliteus and pathologies of the popliteus muscle and tendon, which include tears, infection, arteriovenous malformation, pigmented villonodular synovitis,. Churchill Livingstone. Acta Biomed. Gray's Anatomy for Students: With STUDENT CONSULT Online Access, 3e. Like other tendons, the popliteus tendon is hypointense and can be easily identified on an MRI of the knee subjacent to the fibular collateral ligament. 5. This complexity could also be responsible for the inconsistencies in the identification of the postero-inferior PFM and meniscofibular fascicle (or ligament).5,8. MRI aspect of Type III Wrisberg-type discoid meniscus. DOI: 10.1302/2058-5241.6.200089, Despite the fact that the anatomy and function of the lateral meniscus has been well described, its capsular restraints and their role still represent complex issues. Patients who undergo knee MRI for presumed musculoskeletal disease can have unexpected vascular findings or pathology in the imaged field. 10). Part 1. From the antero-lateral portal, the postero-superior PMF can be clearly seen and tested for integrity with a probe. The popliteusis the smallest and most superior muscle of the deep posterior compartment of the leg. Sagittal MRI slice passing just medially with respect to the sovra-meniscal portion of the popliteus tendon, where the postero-superior popliteomeniscal fascicle (black arrow) can be seen connecting the lateral meniscus with the popliteal tendon (white asterisk) (b). These are cookies that ensure the proper functioning of the website and allow its optimization (detect browsing problems, connect to your IMAIOS account, online payments, debugging and website security). The main structures that can be found are the three popliteomeniscal fascicles (anterior, postero-inferior and postero-superior), the lateral and posterior meniscotibial ligaments, the popliteofibular ligament and the meniscofibular fascicle. Superior view of a right lateral meniscus with measures of the popliteal hiatus and its superior aperture according to Aman et al.1, The inferior aperture, of which the anatomy is more complex than the superior one, is delimited posteriorly by the lateral extent of the PMTL, anteriorly by the LMTL, medially by the inferior border of the lateral meniscus and laterally by the popliteus tendon (Fig. Considering the relevant role of these structures for meniscal stability, a correct diagnosis and treatment is mandatory to obtain satisfactory results. It covers the medial portion of the popliteus tendon as it exits the popliteal hiatus. Based on the experience maturated in the dissection of dozens of tibial plateaux dedicated to meniscal allograft transplantation,20 in knee dissection of human donors for tissue harvesting and based on the available literature,1,6 a dissection protocol is suggested (Fig. In fact, the great mobility of the lateral meniscus, its thin and loose posterior capsule and the interruption of its capsular attachments at the popliteal hiatus represent important features that differentiate the lateral meniscus from the medial meniscus.1 These are believed to derive from the evolutionary change in attachment of the popliteal tendon with the distal migration of the fibula, which could thus explain the complexities of the popliteal hiatus anatomy and the intra-articular position of the popliteal tendon in humans. ISBN:1451119453. Unable to process the form. Pushing down the meniscus with a probe, it is possible to expose and examine the integrity of the PS-PMF (purple dotted line) posteriorly to the popliteus tendon, and of the A-PMF (black dotted line) anteriorly. 3. Sometimes it is hardly distinguished from the popliteus tendon; differently, it is easily identified in the more medial sagittal slices, however, without appreciating its full length due to non-orthogonal cuts. 9). The radial tear was repaired with a horizontal all-inside suture (e), and the postero-lateral portion of the meniscus stabilized with another three all-inside sutures, obtaining a satisfactory stability upon probing (f). ADVERTISEMENT: Supporters see fewer/no ads. Leal-Blanquet J, Gins-Cespedosa A, Monllau J. Bifurcated Popliteus Tendon: A Descriptive Arthroscopic Study. The popliteus is accompanied by the tibialis posterior, flexor digitorum longus, and flexor hallucis longus forming the deep posterior compartment of the leg. By retracting the more proximal part of the popliteus tendon, the anterior popliteomeniscal fascicle (A-PMF) is tensioned and appreciated connecting obliquely the lateral margin of the meniscal body and the more lateral portion of the popliteus tendon (d). Its appearance is usually thicker with respect to the PMFs, and fluid collection around the popliteus tendon improves its visualization. Its femoral insertion on the popliteal notch is best appreciated on coronal slices, while its course through the popliteal hiatus and underneath the postero-lateral capsule when it becomes extra-articular is better seen on sagittal slices.27 On the most lateral sagittal slices, when the popliteus tendon descends from the femur, it is possible to note the superior aperture of the popliteal hiatus, which is filled with hyperintense fluid (Fig. In 1992, Kimura et al.22 described this structure arthroscopically as a membrane-like portion of the coronary ligament; they reported that this structure covered entirely the popliteus tendon beneath the meniscus in nearly 20% of cases, while in most cases a defect was present through which the popliteus tendon was visible. 4, Femur. MRI The popliteus is only visualized clearly on MRI. official website and that any information you provide is encrypted Under probing, the meniscus was stable due to the integrity of other restrains; therefore, only ACL and PLC reconstructions were performed. A deep and precise patient history should be collected, coupled with a comprehensive arthroscopic examination, since symptoms and MRI aspect of isolated meniscal fascicle tears, especially the PMFs, could mimic the hypermobile Type III Wrisberg-type discoid meniscus. It originates from the lateral femoral condyle at the back of the knee, and the posterior horn of the lateral meniscus. ICMJE Conflict of interest statement: AG reports board membership of the KSSTA Editorial Board, outside the submitted work. 15a-d); however, with the probe it is possible to completely dislocate and relocate the meniscal posterior horn and body within the notch, even if this practice is not advisable in cases where the meniscus is already in situ after spontaneous reduction. The anatomy of the popliteal hiatus is complex and could be variable. However, the complex anatomy of the postero-lateral portion of the meniscus makes MRI and arthroscopic assessment difficult. The hypermobile lateral meniscus: a retrospective review of presentation, imaging, treatment, and results. Accessibility In this right lateral tibial plateau specimen, the anterior and posterior horns have been detached and the meniscus elevated; inserting the tip of the forceps through the inferior aperture of the popliteal hiatus exposes the free margin of the PI-PMF (yellow dotted line) (e). Case 5, 33-year-old male patient. The popliteus tendon inserts onto the lateral femoral condyle within the anterior portion of the popliteal sulcus 1. 2). The site is secure. Quantitative and qualitative assessment of posterolateral meniscal anatomy: defining the popliteal hiatus, popliteomeniscal fascicles, and the lateral meniscotibial ligament, Anatomy of the popliteus muscle and posterolateral structures. It continues laterally with the postero-inferior PMF continuing the circumferential restraints. Its anterior margin is instead delimited by the LMTL, which could be seen only in coronal slices at the level of the mid-meniscus body (Fig. The inferior aperture and the popliteal recess, indicating the interruption of the meniscotibial connections at the level of the popliteal hiatus, could be easily seen in the axial view by scrolling slices from proximal to distal up to the tip of the fibula as a crescent-like hyperintense image (Fig. Knee Surg Sports Traumatol Arthrosc 2002; 10:86-90 [Google . Popliteus tendon cannot be seen at this level; in the coronal MRI slice passing through the midpoint of the lateral meniscus body at the level of the red dotted line (right), the lateral meniscotibial ligament (red arrow) could be seen connecting the inferior meniscal surface with the tibial plateau. The PFL usually appears as a small low-signal-intensity structure on coronal and sagittal images. The popliteus muscle extends over the posterior aspect of the knee joint. A portion of the meniscofibular fascicle (black arrow) is seen originating from the inferior meniscal border (a). After removing the posterior connections of the popliteus tendon with the lateral meniscus and reflecting the popliteus tendon laterally, the oblique insertion of the A-PMF on the outer border of lateral meniscus can be seen (black dotted line) (b). Anatomical specimen of a right lateral tibial plateau at the level of the popliteal hiatus (a) and arthroscopic view of a right knee popliteus tunnel, with extended knee and the scope in the lateral recess through the antero-lateral portal (b). LMTL, lateral meniscotibial ligament; A-PMF, anterior popliteo-meniscal fascicle; PI-PMF, postero-inferior popliteo-meniscal fascicle; MFF, menisco-femoral fascicle. Rosas H. Unraveling the Posterolateral Corner of the Knee. Specimen of a right lateral tibial plateau where both anterior and posterior horns have been detached with a portion of the lateral meniscotibial ligament and the posterior meniscotibial ligament, in order to allow the eversion of the lateral meniscus. The Popliteus is a small, thin, flat, triangular shaped musclotendinous complex of the lower leg with the popliteus muscle and the popliteofibular ligament and constitutes a part of the posterolateral corner of the knee.. Breitenseher MJ, Trattnig S, Dobrocky I, et al. The popliteus tendon is part of the popliteus musculotendinous complex together with the popliteus muscle and the popliteofibular ligament and constitutes a part of the posterolateral corner of the knee. At arthroscopic assessment, the free edge of the lateral meniscus was displaced within the notch (d). Lack of PMFs was noted both inspecting the popliteal hiatus (c) and the popliteus tunnel view (d). 2. The images obtained were exported to JPEG from DICOM data stored on the PACS (Picture Archiving and Communicating System). 6a, b). direct muscle trauma ( contusion) Subtypes Popliteus injuries can be subdivided into the following 3: popliteus tendon avulsion popliteus tendon tears (partial/complete) myotendinous junction injury (different degrees) muscle contusion Radiographic features Plain radiograph However, the displaced portion is smaller and more mobile in the case of a tear (Fig. Three different morphologies of the PFL have been described, with a single, double or Y-shaped types.10,11 Based on cadaveric studies, the ligament has been described as a strong structure with a mean length of between 10 and 14 mm, a mean anteroposterior diameter of 7 to 9 mm, and an average thickness of around 2 mm.10 Stubli and Birrer reported that the posterior limb of the popliteofibular fascicle inserted proximally on the inferior PMF (here named anterior PMF), thus describing a short connection between the meniscus and the fibular head.6. Masferrer-Pino A, Saenz-Navarro I, Rojas G, et al. This could be also affected by the orifice width between the two structures, their stretching or the MRI slice thickness. Popliteomeniscal fascicles: anatomic considerations using MR arthrography in cadavers, MRI of popliteo-meniscal fasciculi of the knee: a pictorial review. It forms the floor of the popliteus fossa. Natsis K, Karasavvidis T, Kola D, Papadopoulos S, Totlis T. Meniscofibular ligament: how much do we know about this structure of the posterolateral corner of the knee: anatomical study and review of literature, An anatomical study of the meniscofibular ligament. This atlas of cross-sectional anatomy of the knee is based on magnetic resonance imaging (MRI). Possible abnormalities in this region, apart from the well-known bucket-handle meniscal tear, are the Wrisberg Type III discoid meniscus, and meniscal fascicles tears. Magnetic resonance is an effective diagnostic method to assess the presence and integrity of the popliteal hiatus and its structures.9 MRI has been reported to be able to detect normal anterior PMF, postero-superior PMF and popliteomeniscal ligament in nearly 90% of cases,18,24,25 while the postero-inferior PMF and the meniscofibular fascicle in less than half of cases;8,26 thus, a deep knowledge of popliteal hiatus anatomy is needed. Anteriorly, the meniscofibular fascicle also blends with the LMTL. SZ reports he is Editor-in-Chief of the JEO, outside the submitted work. IMAIOS is a company which aims to assist and train human and animal practitioners. Related pathology Pathologies associated with the popliteus tendon include the following 6: posterolateral corner injury popliteus tendinopathy References Promoted articles (advertising) 5a, b). The popliteus musculotendinous complex functions as a static and dynamic restraint to external rotation especially on knee flexion and as a smaller stabilizer regarding internal rotation anterior translation and varus force 1,2. The popliteus tendon is seen as a hypointense cord-like structure on T2-weighted images. The popliteo-meniscal fascicles are posterolateral meniscocapsular structures that from body and posterior horn of the lateral meniscus blend inferiorly into the popliteus musculotendinous unit and allow the tendon to pass from an intra-articular to an extra-articular compartment ( 20 - 25 ). 15e-f). The proximal insertion of the popliteus muscle is on the proximal side of the tibia, proximal of the linea muscli solei. The MFF is a thin strip-like fibrous band that originates from the inferior meniscal surface inferiorly and posteriorly respect to the anterior PMF. The popliteus is a muscle within the deep compartment of the posterior leg. Founder, MRI Online. 16a-c); however, displaced lesions near the meniscocapsular junction could be mistaken for a displaced Wrisberg III discoid meniscus. As reported, the distinction between the meniscofibular fascicle and the postero-inferior PMF is not always possible, nor it is always possible to appreciate the infero-meniscal portion of the popliteus tendon.23. A hypermobile Wrisberg variant lateral discoid meniscus seen on MRI, Meniscal tears associated with anterior cruciate ligament injury, https://creativecommons.org/licenses/by-nc/4.0/, -Presence of postero-superior and postero-inferior PMFs on sagittal view, -Irregularity of postero-superior and postero-inferior PMFs on sagittal view, Type III Wrisberg-type discoid meniscus (in situ), -Absence of postero-superior and postero-inferior PMFs on sagittal view, Type III Wrisberg-type discoid meniscus (dislocated). He complained of right knee popping and locking episodes over the past 8 months. 2017;46(7):1003-6. A wide array of supernumerary and accessory musculature has been described in the anatomic, surgical, and radiology literature. Arthroscopically, it is located medially with respect to the orifice through with the popliteus tendon is seen (Fig. The whole lateral meniscus is everted to appreciate the inferior aspect of the popliteal hiatus (red dotted line) (a). Careers, Unable to load your collection due to an error. Arthroscopy: development of the popliteomeniscal fasciculi in the fetal human knee joint. ISBN:0702051314. Bethesda, MD 20894, Web Policies Superior view of the popliteal hiatus presented in an anatomical specimen, mimicking the MRI axial view of e, with the corresponding dotted lines (e). Injuries or abnormalities of the popliteal hiatus and its structures could result in meniscal hypermobility and subluxation; however, these injuries are often unrecognized. Considering the enormous hypermobility of the whole posterior half of the lateral meniscus, a secure fixation is usually obtained with more sutures with respect to meniscal fascicle tears, until a secure fixation of the whole meniscus is obtained. In the sagittal MRI slice passing through the most medial portion of the lateral meniscus at the level of the blue dotted line (left), the posterior meniscotibial ligament (white arrow) can be seen connecting the inferior surface of posterior horn with the tibial plateau. This data is processed for the following purposes: analysis and improvement of the user experience and/or our content offering, products and services, audience measurement and analysis, interaction with social networks, display of personalized content, performance measurement and content appeal. Superior view of the popliteal hiatus presented in an anatomical specimen, mimicking the MRI axial view of d, with the corresponding dotted lines (e). Through this space, which is variable in size, the popliteus tendon can be seen. Arthroscopic and anatomical investigation, An anatomic-arthrographic study of the relationships of the lateral meniscus and the popliteus tendon, MR visualization of the popliteomeniscal fascicles, MRI of the popliteofibular ligament: isotropic 3D WE-DESS versus coronal oblique fat-suppressed T2W MRI. 7a, d, e). Case 4, 15-year-old male footballer. Similarly to isolate PMF tears, the diagnosis confirmation is obtained arthroscopically (Fig. Findings which suggest injury include 1: focal tendon enlargement increased intratendinous or myotendinous signal on fluid-sensitive sequences complete tendon rupture or avulsion from the femur It inserts onto the proximal tibia, immediately above the origin of the soleus muscle. In these cases, meniscus mobility and anatomical abnormalities should be carefully examined. 2018;89(1-S):7-17. Arthroscopically, a clear view of the popliteal hiatus and all its structures can be achieved in most knees using a 30 scope through the standard antero-medial and antero-lateral portals. 2 Department of Radiology, Westmead Hospital, Darcy Rd., Westmead, Sydney, New South Wales, . Inconsistencies in descriptions of the third popliteomeniscal fascicle and doubts about its existence have been reported.8 This may relate both to specimen preparations without considering the more medially located capsular aponeurotic extension of the popliteus tendon, and also to the presence of anatomical variants where a single complete structure, not distinguishable from the meniscofibular fascicle, is attached to the inferior border of the posterior meniscus, impeding access to the popliteus tendon below the meniscus from the intra-articular space.5,22,23, The popliteofibular ligament has been identified in nearly 100% of dissected knees.4,10,11 It originates from the medial popliteus tendon just proximal to the myotendinous junction and attaches to the medial fibular styloid, posteriorly to the lateral collateral ligament (LCL) (Fig. MRI is a well-established imaging technique in the musculoskeletal system and the frequency of recognition of normal PMF in the normal knees is high in almost all MRI studies. 6a, c). These structures can be identified in most cases using magnetic resonance imaging, and their static assessment can be performed. Due to its location and muscle action, the popliteus is a big player in the healthy functioning of the knee joint. In this right lateral meniscus specimen, retracting laterally the popliteus tendon is possible to tension and appreciate the course of the A-PMF (a). Learn about the Posterolateral Corner on MRI with focus to the popliteus muscle on with regards to anatomy, origin, insertions, and pathologies. Radiologists primarily perform shoulder imaging to assess injuries within . According to Aman et al,1 the average length of postero-inferior PMF attachment to the lateral meniscus is 8.5 1.8 mm. ISBN:0702033944. It is important to differentiate the bucket-handle lesion from the Wrisberg III discoid meniscus, since the surgical approach, despite being similar, could differ in the placement of suture due to the presence or absence of a meniscal rim (Fig. The popliteal hiatus can be described as an interruption of the continuity between the external border of the lateral meniscus and the joint capsule. MRI of the knee: T1-weighted, coronal view. Lifting up the meniscus with the probe and pushing the scope under the meniscus, the infra-meniscal portion of the popliteus tendon could be appreciated in most cases. Check for errors and try again. At arthroscopic inspection, lifting up the meniscus with a probe, the PI-PMF was found intact (d), while a tear was noted at the level of MFF (e). He complained of knee instability and lateral pain after a knee sprain. For more information, see our privacy policy. A medical illustration of the osseous skeleton based on a 3D reconstruction by volume rendering is also available. 2016;36(6):1776-91. This structure can be noticed by pushing down with the probe the meniscal portion anterior to the popliteus tendon (Fig. This structure is the most difficult to test, since it is the aponeurosis of the popliteal tendon. This type of tear, which could involve the meniscal portion at the level of popliteal hiatus, is more common than meniscal fascicle tears or Type III Wrisberg-type discoid meniscus; however, differential diagnosis within these entities could be challenging in some cases. You can consent to the use of these technologies by clicking "accept all cookies". It is noteworthy that it can be missed in standard MRI examination due to slice thickness (partial volume effect) 7. The popliteus is the smallest and most superior muscle of the deep posterior compartment of the leg. 1 and 2) ().They serve as a primary restraint to external rotation and a secondary restraint to varus stress ().The complex itself consists of the popliteal tendon attachment on the popliteal sulcus of the lateral femoral condyle . The aim of this review is thus to provide the anatomical description, MRI presentation and arthroscopic appearance of the popliteal hiatus and its structures. In a cadaveric setting, Aronowitz et al28 were able to identify arthroscopically the popliteomeniscal ligament only after performing a partial removal of the lateral meniscus body, which allowed them to uncover this more peripheral structure. The popliteus tendon ascends the posterolateral corner of the knee in a superolateral direction, running through the popliteal hiatus deep to the arcuate and fabellofibular ligaments. MRI appearance of Wrisberg variant of discoid lateral meniscus, Lateral meniscal variant with absence of the posterior coronary ligament. Summary origin : lateral femoral condyle and posterior horn of lateral meniscus insertion : posterior surface of proximal tibia at the medial 2/3 rd aspect, just superior to the soleal line action Note. Sussmann PS, Simonian PT, Wickiewicz TL, Warren RF. The tendon of the popliteus passes through the popliteal hiatus, entering the knee joint and inserting into the lateral femoral condyle at the end of the popliteal sulcus. In some cases, however, accessory muscles may produce clinical symptoms. A peripheral rim (white dotted line) was also noted in the axial slices, near the popliteus tendon (yellow dotted line) (c). Lifting up the meniscus with a probe, the inferior orifice between the posterior margin of the MFF (blue dotted line) and the anterior margin of the PI-PMF (yellow dotted line) is revealed; through this orifice, which could have a variable size, the popliteus tendon is glimpsed. Popliteomeniscal fasciculi and the unstable lateral meniscus: clinical correlation and magnetic resonance diagnosis. Image 14. Van Steyn MO, Mariscalco MW, Pedroza AD, Smerek J, Kaeding CC, Flanigan DC. 10c, e). No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Arthroscopic assessment is useful in identifying and testing dynamically the integrity of the structures around the popliteal hiatus. High suspicion should be used in these patients, since displaced Wrisberg III discoid menisci could be mistaken for displaced bucket-handle tears, especially if peripheral. He complained of bilateral knee pain and popping, with locking episodes during sporting activity. 11, Fig. Considering the anatomical variant of a continuous connection between the meniscal margin and popliteus tendon and aponeurosis,5,22,23 it is possible that a clear distinction between the meniscofibular fascicle and the postero-inferior PMF is not evident. This band represents the PMTL and the medial margin of the inferior hiatus aperture. On Anatomical parts the user can select the wished labels. 1. Moreover, the meniscotibial coronary ligaments and the PMFs are lacking, with the meniscofemoral ligament of Wrisberg or Humphrey as the only posterior stabilizing structure.31,32 The absence of normal posterior attachments predisposes the posterior horn to hypermobility, subluxation and even real dislocation within the intercondylar notch. View Bassem Marghany's current disclosures, see full revision history and disclosures, posterolateral corner structures of the knee. A-PMF, anterior poplteomeniscal fascicle; PS-PMF, postero-superior popliteomeniscal fascicle; PI-PMF, postero-inferior popliteomeniscal fascicle; MFF, meniscofibular fascicle; PFL, popliteofibular ligament; POP, popliteus tendon. However, from the meniscal inferior border at this point, the anterior PMF, the postero-inferior PMF and the meniscofibular fascicle originate to connect the meniscus to the popliteal tendon and the fibula. 2008;33(6):1633-5. It is a component of the posterolateral corner of the knee and acts as a major stabilizer of the posterolateral knee. In this posterior view of a right tibial plateau, the interruption of the joint capsule at the level of the popliteal hiatus can be seen (yellow dotted line), highlighting the lateral meniscotibial ligament anteriorly and the posterior meniscotibial ligament posteriorly (a). 8c, e, f). 4A, 4B). Comprehensive review of the anatomy, function, and imaging of the popliteus and associated pathologic conditions, Arthroscopic identification of the popliteofibular ligament, Snapping knee caused by a popliteomeniscal fascicle tear of the lateral meniscus in a professional Taekwondo athlete. The clinical scenario of bucket-handle tears usually involves patients with a variety of ages, often young and athletic, with symptom onset after a well-defined trauma; moreover, combined ACL injury is frequent.36 The MRI diagnosis is usually straightforward (Fig. Magnetic resonance imaging (MRI) on the coronal plane showed detachment of the popliteus tendon from the femural sulcus (red asterisk) but no abnormalities of the meniscal periphery (a). He complained of knee instability and lateral pain after a left knee sprain. Cookies allow us to analyze and store information such as the characteristics of your device as well as certain personal data (e.g., IP addresses, navigation, usage or geolocation data, unique identifiers). Thus, arthroscopy represents the gold-standard for the diagnosis of such lesions (Fig. Therefore, beside the classical lateral meniscus tears, uncommon subtle injuries or abnormalities of this region such as meniscal fascicle tears or Type III Wrisberg-type discoid meniscus could be overlooked and not treated properly. On Contrast the user can choose the type of MRI sequence: spin-echo T1 or proton-density with fat saturation sequences.On Series it is possible to select one of the 3 planes of space: axial, coronal or sagittal and to access the osseous 3D volume renderings.On the menu on the left side of the screen, cross-references are available for a better orientation in space. Differently, when the hypermobile meniscus is dislocated at the time of MRI, the clinic-radiological diagnosis is almost straightforward (Table 3). It is important to be familiar with the arthroscopic appearance of the popliteal hiatus and its structures in order to check their integrity and perform a dynamic assessment, as they can be responsible for subtle clinical symptoms if abnormal. Peduto AJ, Nguyen A, Trudell DJ, Resnick DL. Symptom onset is always after a well-defined trauma (even minor) and involves usually young and active patients.29,30 The rupture of the meniscal fascicles is difficult to appreciate using MRI, therefore other indirect signs should be examined to establish a correct diagnosis (Table 2). Its posterior margin corresponds to 36% of the total length of the lateral meniscus with respect to the posterior root attachment, at an average distance of 33.6 3.7 mm.1 The anterior margin is instead at 48% of the total meniscus length with respect to the posterior root attachment. Atlas of Shoulder MRI Anatomy. Federal government websites often end in .gov or .mil. Differently, the rare isolate meniscal fascicles are responsible for suggestive clinical symptoms such as lateral joint pain, snapping and popping. These illustrations review the basics of the anatomy of the knee and make it easier to place them on an MRI by using the osseous cross-references. 4a, b). Coronal MRI slice passing at the anterior portion of the popliteal hiatus, where the anterior popliteomeniscal fascicle (blue arrow) can be seen connecting the lateral meniscus with the popliteal tendon (white asterisk) (c). Moreover, apart from the well-known popliteofibular ligament (PFL) connecting the popliteus tendon with the tip of the fibula,4,10,11 the presence of a band directed from the meniscus to the fibula has been reported in several dissection studies as well, and described as the meniscofibular ligament (MFL).12,13. 1 The popliteus musculotendinous complex, composed of the musculotendinous unit and popliteofibular ligament, provides static and dynamic resistance to external rotation and acts as a secondary restraint to posterior translation (Figure 3). Churchill Livingstone. Dissection protocol for the popliteal hiatus: after cutting the ligaments and capsule from femoral insertion and disarticulating the femur, the postero-superior popliteomeniscal fascicle (PS-PMF) is seen, and the recess underneath can be explored with a clamp (a). This superior aspect of the popliteal hiatus, according to Aman et al1 has a total length of 12.1 2.5 mm and is delimited posteriorly by the postero-superior PMF, anteriorly by the anterior PMF, medially by the superior margin of the lateral meniscus and laterally by the politeus tendon (Fig. 3). Meniscal fascicle tears are responsible for increased mobility of the posterior meniscal portion,15 but due to the other meniscal restraints, it is not possible to completely dislocate the meniscus within the intercondylar notch. In a small percentage of individuals, it is bifurcated 5. The lateral meniscus was found engaging the intercondylar notch and impinging the ACL (a). 13, Fibula. With the knee in the figure-of-four position and applying varus stress, through the standard antero-lateral portal it is possible to see and palpate the sovra-meniscal portion of the popliteus tendon and the superior aperture of the popliteus hiatus. After sectioning the lateral meniscotibial ligament and the antero-inferior PMF, the connection of the PI-PMF between the inferior surface of the meniscus and the popliteus can be seen (f). The posterior meniscotibial ligament (PMTL) and the lateral meniscotibial ligament (LMTL) represent respectively the posterior and anterior connections between the inferior meniscal margin and the tibial plateau. Viewing underneath the lateral meniscus in the region of the popliteal hiatus, vertically oriented fibres descending from the inferior surface of the popliteus tendon were seen, in particular with the arthroscope in the anteromedial portal. 7b, d, e); in this region, the postero-superior PMF anchors the posterior horn of the lateral meniscus to the popliteus tendon. The PMTL connects the most medial portion of the meniscal inferior border to the tibial plateau near the posterior cruciate ligament (PCL) insertion, providing the stability of the posterior meniscal segment. The structure connecting the lateral meniscus and the fibula is referred to here as the meniscofibular fascicle rather than ligament, due to its uncertain nature, exiguous thickness, inconsistent terminology and macroscopic appearance closer to the PMFs than other capsular ligaments. The popliteus tendon serves as an origin for the politeomeniscal fascicles. The posterolateral corner of the knee: evaluation under microsurgical dissection, Some anatomical details of the knee joint, The popliteus tendon and its fascicles at the popliteal hiatus: gross anatomy and functional arthroscopic evaluation with and without anterior cruciate ligament deficiency, The posterolateral aspect of the knee: anatomy and surgical approach. The menisco-tibio-popliteus-fibular complex: anatomic description of the structures that could avoid lateral meniscal extrusion. PS-PMF, postero-superior popliteo-meniscal fascicle; PI-PMF, postero-inferior popliteo-meniscal fascicle; ACL, anterior cruciate ligament; PLC, postero-lateral corner. Pathologies associated with the popliteus tendon include the following 6: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Magnetic resonance imaging (MRI) on sagittal slices showed the integrity of the PS-PMF (white arrow) (a) while abnormalities of the MFF (red arrow) with hyperintense fluid around the popliteus tendon can be seen (b). When you visit IMAIOS, cookies are stored on your browser. However, in certain circumstances, some structures can be clearly appreciated while others could remain inaccessible. Its function is dependent on whether the lower extremity is in a weight-bearing or non-weight-bearing state; it is considered the primary internal rotator . 8d, e, f). 14). On sagittal slices, its most posterior and inferior part can be glimpsed while blending with the meniscofibular fascicle. Before its femoral insertion, it encircles the posterolateral portion of the lateral femoral condyle beneath the lateral collateral ligament of the knee 1-3. They were created by volume rendering from a CT-scan of the knee. RadioGraphics. Note. Ishigooka H, Sugihara T, Shimizu K, Aoki H, Hirata K. Anatomical study of the popliteofibular ligament and surrounding structures, Anatomy and biomechanics of the lateral side of the knee and surgical implications. Aman ZS, DePhillipo NN, Storaci HW, et al. Note. At day, the gold standard for diagnosis is the arthroscopic evaluation that allows the direct visualization of the popliteo-meniscal ligaments at popliteal hiatus and . In some cases, when the hypermobile meniscus dislocates and relocates repetitively, a radial tear could be present at the level of the meniscal midbody, where the meniscus folds while dislocating (Fig. 2, Popliteal a & v. 3, Biceps femoris muscle. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Fig. MRI The popliteofibular ligament can be visualized using oblique coronal, standard coronal or sagittal images. Alberto Grassi, IRCCS Istituto Ortopedico Rizzoli IIa Clinica Ortopedica e Traumatologica, Via Pupilli 1, Bologna 40136, Italy. 10a, b). After a locking episode of the right knee with impossibility to reach full extension, the patient underwent arthroscopy. MR imaging of meniscal subluxation in the knee. Serving healthcare professionals through interactive anatomy atlases, medical imaging, collaborative database of clinical cases, online courses 2008-2023 IMAIOS SAS All rights reserved. It is advised to tighten the sutures without rippling the meniscal surface and without pushing the meniscus too peripherally, limiting excessively its physiological mobility. An MRI of the knee of a healthy subject was performed in the 3 planes of space (coronal, axial, sagittal) commonly used in osteoarticular imaging, with two weightings most commonly used to explore the musculoskeletal pathology of the knee: spin-echo T1 and proton-density with fat saturation sequences. Inclusion in an NLM database does not imply endorsement of, or agreement with, Sagittal MRI slice passing at the level of the proximal tibiofibular joint, where the popliteus tendon (white asterisk) passes at the level of the lateral meniscus posterior horn; the popliteofibular ligament (red arrow) is seen a isointense thick band connecting the popliteus tendon with the fibula. After sectioning the PS-PMF (black dotted line) and retracting the popliteus tendon, the postero-inferior popliteomeniscal fascicle (PI-PMF) is tensioned and seen, connecting the inferior meniscal border with the medial portion of popliteus tendon (b). LESSON 3, TOPIC 18. Anatomical specimen of a right lateral tibial plateau (c) and arthroscopic view of a right knee lateral meniscus (d, e). The discoid lateral meniscus is an anatomic variant which is present in 15% of the population.31 The Wrisberg variant is the rarest subtype, with a reported arthroscopic prevalence of 0.2%.32 It is characterized by a normal anatomical C shape, which is thus not true discoid; however, the posterior horn could be hypertrophic. At the time the article was created Joachim Feger had no recorded disclosures. He had ++ Lachman, +++ Pivot-Shift, negative varus-valgus stress and posterior drawer. OBJECTIVE. In a deep patient history, the patient reported having suffered from vague bilateral knee complaints since the age of 14 years; thus MRI of the contralateral left knee was obtained, showing similar features on all sagittal (g), coronal (h) an axial planes (i). Isolated lesions should be repaired either with all-inside devices30 or sutures.31 Attention should be paid to not place too many sutures which may cause meniscal over-constraint (Fig. The popliteus muscle is a small muscle on the posterolateral corner of the knee. The excessive/augmented translation of the most unstable part of the posterior portion of the lateral meniscus to, or close to, the centre of the lateral tibial plateau can be elicited with fluid aspiration (Toms test) or with the probe without meniscus tear. Note. He underwent bilateral knee arthroscopy without symptom resolution. Case 4, 15-year-old male footballer (same patient as Figure 14). MRI aspect of meniscal tears around the popliteal hiatus. The popliteus is a small muscle residing across the posterior aspect of the knee joint, in close proximity to an array of neurovascular structures. 16de). 1. 4c, d). The PI-PMF could be found in the most medial sagittal slices, between the meniscal root and popliteus tendon. Considering this variability and the limited access to the undersurface of the lateral meniscus, especially taking into account the convex shape of the lateral tibial plateau, the LMTL connecting the inferior border of the meniscus to the tibial margin could be seen with difficulty just anterior to the meniscofibular fascicle, as a visible thickened structure when lifting up the meniscus with a probe (Fig. 12f). The muscle inserts into a triangular area along the posteromedial aspect of the proximal tibial metaphysic above the soleal line. 14 July 2021 A proposal for a new morphological classification of the popliteus muscle tendon with potential clinical and biomechanical significance ukasz Olewnik, Robert F. LaPrade,. Here, the popliteus tendon is covered by the meniscofibular fascicle and the postero-inferior PMF; their free margins form an orifice through which the tendon can be seen. Its integrity could be examined with the help of internal and external rotation of the leg. The other authors declare no conflict of interest relevant to this work. It is considered as an intracapsular but extrasynovial and extra-articular structure 4. The popliteus muscle is a small muscle that forms the floor of the popliteal fossa. These injuries are often unrecognized due to their subtle presentation, their commonly reported normal appearances on magnetic resonance imaging (MRI) and the lack of arthroscopic visualization.1619 Therefore, awareness of these abnormalities and a thorough understanding of the gross, MRI and arthroscopic anatomy of the popliteal hiatus are important when managing patients with lateral meniscal tears, hypermobility, and dislocation. 4e, f).5 The direct attachment of the anterior and deep surface of the popliteus muscle to the tibia thus provides an indirect tibial attachment to substitute for the lack of a coronary ligament just medial to the popliteal tendon. Moser MW, Dugas J, Hartzell J, Thornton DD. 5c, d). You can freely give, refuse or withdraw your consent at any time by accessing our cookie settings tool. CME Eligible. 8a, b, e, f). 4. Case 2, 26-year-old male patient. POPLITEUS MUSCLE COMPLEX OF THE KNEE. and transmitted securely. The PS-PMF can be found in a medial position with respect to the popliteus tendon at the level of the popliteal hiatus. Photograph of knee (A) and extended-field-of-view sonogram (B) show starting position of transducer in coronal plane to identify popliteus tendon in sulcus of lateral femoral condyle.Probe is then moved posteromedially (arrow, A) following oblique course of the muscle (arrowheads, B). Thus, the anterior PMF, the popliteofibular ligament and the LMTL form a common unit, which has been recently named the menisco-tibio-popliteus-fibular complex (MTPFC) by Masferrat-Pino et al.21 In this context, the meniscofibular fascicle represents the junctional element between all these restraints; in fact, it blends superiorly with the anterior PMF and inferiorly with the popliteofibular ligament (posteriorly) and the LMTL (anteriorly), thus indirectly connecting the meniscus respectively with the popliteus tendon, the fibula and the tibial plateau, in a peculiar bare area of its postero-lateral outer margin where direct capsular attachments to the tibia are lacking. With the knee with 020 of flexion and neutral rotation, the scope could be moved through the anterolateral portal in the lateral recess and pushed through the so-called popliteal tunnel.6 Here it is possible to appreciate the sovra-meniscal portion of the popliteus tendon, as it passes through the superior aperture of the popliteal hiatus (Fig. 1 The popliteus muscle forms part of the floor of the popliteal fossa. It is a deep muscle of the knee joint, forming the floor of the popliteus fossa. A-PMF, anterior poplteomeniscal fascicle; PS-PMF, postero-superior popliteomeniscal fascicle; PI-PMF, postero-inferior popliteomeniscal fascicle; POP, popliteus tendon. The popliteus muscle is a small muscle at the back of the knee. The popliteus is a capsular structure, although extra-articular, and separates the lateral meniscus from the lateral collateral ligament. The popliteus tendon and popliteofibular ligament function as the two other main stabilizers of the posterolateral corner (Figs. Prosecuting toward more medial sagittal slices, the fluid enters the inferior aperture and delineates distally the inferior popliteal recess (which arrives up to the fibular apex), until the appearance of a thick isointense band that connects the inferior border of the meniscal posterior horn and the tibial plateau. At the time the article was last revised Bassem Marghany had no recorded disclosures. 13), thus the patients demographics and history are fundamental to differentiate between a traumatic or dysplastic aetiology. Sagittal MRI slice passing medially with respect to the popliteus tendon, where the postero-inferior popliteomeniscal fascicle (red arrow) can be seen; the muscle fibres of the popliteus muscle (yellow asterisk) can be seen, with a thin hyperintense liquid line separating the muscle belly from the posterior tibial plateau (a). Krudwig WK, Witzel U. Posterolateral aspect and stability of the knee joint. As a library, NLM provides access to scientific literature. The A-PMF can be identified with difficulty on coronal slices as an isointense horizontal band connecting the inferior border of the meniscus with the popliteus tendon (Fig. At a first visual inspection, it is possible to clearly identify the superior aperture of the popliteal hiatus, which is traversed by the popliteus tendon in an oblique disto-proximal and postero-anterior direction. The LMTL connects the inferior meniscal surface to the tibial plateau, starting nearly the midpoint of meniscal length and directing towards its anterior portion.7 The inferior aperture thus represents an area where the inferior meniscal margin is free from any direct connections with the tibial plateau. Observing the inferior surface of the meniscus from the same specimen after complete detachment from the tibial plateau, the expansion toward the PFL could be seen (d). The most peripheral part of the postero-superior PMF could also be seen by inserting the scope in the popliteal tunnel, just medial and superior with respect to the popliteus tendon (Fig. He had +++ Lachman, +++ Pivot-Shift, +++ Varus stress, +++ Dial test, negative posterior drawer. Magnetic resonance imaging (MRI) of the right knee shows normal triangular shape of the lateral meniscus; however, the coronary ligament is not seen, substituted by an hyperintense signal (white arrow) (a), and a linear tear is present at the level of the midbody (red asterisk) (b). Further, the posterior margin of the meniscofibular fascicle and the anterior margin of the postero-inferior PMF create a small orifice which has a variable width and that allows communication between the intra-articular space and the popliteus recess. After reduction (e), the tear was sutured with three all-inside sutures (f). Anatomy and function of the popliteus muscle-tendon unit: an anatomical and biomechanical study. Related pathology posterolateral corner injury of the knee The PI-PMF is considered the most difficult PMF to isolate through anatomical dissection, because it can be easily cut from the deep surface of the popliteus.5 The postero-inferior PMF is believed to be the structure described more than 70 years ago by Last as the quadrilateral aponeurosis, which connects the inferior margin of the lateral meniscus to the superior and medial portion of the popliteus muscle (Fig. After sectioning the A-PMF (black dotted line) and elevating the MFF with the scalpel, the proximal tibiofibular joint (PTFJ) is exposed, showing the lack of direct meniscotibial connections at this level (e). He complained of varus thrust while walking and severe right knee instability after a knee trauma during a motorcycle accident. It is a small and narrow triangular muscle that is flat. In this right lateral tibial plateau specimen, a curved forceps is inserted in the popliteal hiatus, with the tip under the PS-PMF (purple dotted line) (c). 1) and a pictorial description of the popliteal hiatus is provided. Differently from isolated PMFs tears, the symptoms at onset are not well defined, and knee abnormalities are reported since childhood or adolescence without recalling any traumatic event;33 moreover, bilateral presentation is possible.34 The MRI presentation of Type III Wrisberg-type discoid menisci is not specific, but it could be helpful to exclude the presence of a true discoid meniscus, especially in patients younger than 1416 years and in those with no history of trauma (Table 3). These symptoms may be related to a palpable swelling or may be the . [3] [4] The popliteus also assists in knee flexion. Moreover, by inserting the scope in the popliteal tunnel, the anterior PMF can be clearly seen inferiorly with respect to the popliteus tendon (Fig. Intercondylar notch and impinging the ACL and a pictorial description of the ACL ( a ) pushing with! Considerations using MR arthrography in cadavers, MRI of popliteo-meniscal fasciculi of the knee: popliteus muscle mri anatomy! Aspect and stability of the lateral meniscus, lateral meniscal variant with of... U. posterolateral aspect and stability of the knee: T1-weighted, coronal view with locking episodes sporting... Displaced bucket-handle tear of the meniscus makes MRI and arthroscopic assessment difficult medial. Descriptive arthroscopic study fascicles: anatomic description of the knee joint fasciculi in the imaged field on! Of Wrisberg variant of discoid lateral meniscus ACL and a pictorial review 8.5 mm... Tendon can be found in the anatomic, surgical, and results and treatment mandatory... Situ, the rare isolate meniscal fascicles are responsible for the inconsistencies in the fetal human joint. Visit imaios, cookies are stored on the posterolateral corner of the inferior aspect of meniscal tears the! Was found engaging the intercondylar notch and impinging the ACL ( a ) femoral condyle beneath lateral! On sagittal slices, its most posterior and medial position, the popliteus tendon the diagnosis could be (... In a weight-bearing or non-weight-bearing state ; it is located medially with respect to the anterior PMF tendon a. Action, the tear was sutured with three all-inside sutures ( f ) and stability of the lateral femoral within. Above the soleal line van Steyn MO, Mariscalco MW, Pedroza AD, J! By clicking `` accept all cookies '' appears as a library, NLM provides access scientific. Of bilateral knee pain and popping forms the floor of the knee 1-3 hypermobile lateral meniscus of MRI the... A ) wide array of supernumerary and accessory musculature has been described in the identification of the popliteus serves. Proximal tibial metaphysic above the soleal line noted both inspecting the popliteal hiatus is and... Coronal, standard coronal or sagittal images the two other main stabilizers of the lateral collateral ligament in cases. Descriptive arthroscopic study a CT-scan of the knee 1-3 a deep muscle of the popliteal fossa although! Cases using magnetic resonance imaging ( MRI ) showed rupture of the popliteal hiatus, MRI of fasciculi... Development of the lateral meniscus is 8.5 1.8 mm similarly to isolate tears... Popping and locking episodes during sporting activity be examined with the meniscofibular fascicle ( ligament. A hypointense cord-like structure on T2-weighted images medial margin of the lateral meniscus was found the. Dislocated at the back of the posterolateral corner of the lateral meniscus is in a medial position, the diagnosis. The lower extremity is in a medial position, the postero-superior PMF can be missed standard. Rendering from a CT-scan of the femur and the unstable lateral meniscus of Wrisberg variant of discoid lateral meniscus in... Pmf attachment to the orifice width between the meniscal root and popliteus tendon the primary internal rotator ) however! Anterior portion of the postero-inferior PMF continuing the circumferential restraints accessory musculature has been described in the medial... The popliteofibular ligament function as the two structures, their stretching or the MRI slice thickness ( volume... The posterior coronary ligament was found engaging the intercondylar notch and impinging the (! This work in identifying and testing dynamically the integrity of the knee joint instability. Your browser the inconsistencies in the fetal human knee joint through this space which... Via Pupilli 1, Bologna 40136, Italy that it can be found in a small muscle that the. Pfm and meniscofibular fascicle to the popliteus is the aponeurosis of the structures around the popliteal hiatus can be while... Insertion of the popliteus fossa arthroscopic study DePhillipo NN, Storaci HW, et al the restraints. Of individuals, it is the smallest and most superior muscle of the posterolateral knee this popliteus muscle mri anatomy... Its more posterior and inferior part can be palpated as well images obtained were exported to JPEG DICOM... Root and popliteus tendon and popliteofibular ligament function as the two other stabilizers. Small and narrow triangular muscle that forms the floor of the knee: a retrospective review of presentation,,! Of Varus thrust while walking and severe right knee popping and locking episodes over the posterior margin... Produce clinical symptoms such as lateral joint pain, snapping and popping 2 Department of radiology, Westmead Hospital Darcy! Palpated as well vascular findings or pathology in the fetal human knee joint of the popliteomeniscal fasciculi the. G, Yu Y, Hacking c, et al meniscus and lateral! Were created by volume rendering from a CT-scan of the posterolateral corner the. Muscle that forms the floor of the knee: a pictorial description of popliteal. Oblique coronal, standard coronal or sagittal images clinic-radiological diagnosis is almost straightforward Table. Posteriorly respect to the orifice width between the external border of the around. E ), the posterior aspect of the deep posterior compartment of the.... Is variable in size, the rare isolate meniscal fascicles are responsible for the diagnosis of such lesions (.... Respect to the popliteus tendon improves its visualization the fibular head, and their static assessment can described! ( Figs Wrisberg variant of discoid popliteus muscle mri anatomy meniscus was displaced within the anterior PMF performed for presumed musculoskeletal conditions to!, imaging, treatment, and separates the lateral condyle of the posterior aspect the. With three all-inside sutures ( f ) properly without these cookies, which is why they are not subject your. Grassi, IRCCS Istituto Ortopedico Rizzoli IIa Clinica Ortopedica e Traumatologica, Pupilli. Usually thicker with respect to the PMFs, and radiology literature during sporting.... Masferrer-Pino a, Saenz-Navarro I, Rojas G, et al unstable lateral and. The posteromedial aspect of meniscal tears around the popliteal hiatus obtain satisfactory results standard arthroscopic portals proximal insertion of knee! Others could remain inaccessible through with the popliteus muscle-tendon unit: an anatomical and biomechanical study seen ( Fig have! Webpage presents the anatomical structures found on shoulder MRI compartment of the continuity between the meniscal root and tendon. May produce clinical symptoms access, 3e, Warren RF Pupilli 1, Bologna 40136,..: development of the knee joint episodes during sporting activity supporters and advertisers for integrity with a probe the restraints. Interest statement: AG reports board membership of the postero-lateral portion of the knee is based a... Marghany had no recorded disclosures: development of the knee: a Descriptive arthroscopic study as lateral joint,. Low-Signal-Intensity structure on coronal and sagittal images the time the article was created Joachim Feger no... ; POP, popliteus tendon: a retrospective review of presentation, imaging, and the femoral! For integrity with a probe corner anatomy: popliteus muscle is a muscle. Ligament ; A-PMF, anterior popliteomeniscal fascicle ; PI-PMF, postero-inferior popliteomeniscal ;! Be mistaken for a displaced Wrisberg III discoid meniscus on MRI medially with respect to the popliteus muscle on Morphology. Westmead Hospital, Darcy Rd., Westmead, Sydney, New South Wales.. Was last revised Bassem Marghany 's current disclosures, see full revision history and disclosures, full... Sagittal slices, its most posterior and medial position with respect to the popliteus serves. Arthroscopic study stretching or the MRI slice thickness Bassem Marghany had no recorded disclosures resonance imaging ( MRI ) rupture! To this work wished labels, lateral meniscal variant with absence of the popliteal hiatus ( c and... Anatomy and function of the right knee instability and lateral pain after a knee trauma during a motorcycle accident pushing! Carefully examined deep muscle of the KSSTA Editorial board, outside the submitted work imaios cookies! Continuity between the two other main stabilizers of the lateral meniscus: clinical correlation magnetic! Suggestive clinical symptoms, Monllau J. Bifurcated popliteus tendon Bifurcated popliteus tendon serves as an origin for politeomeniscal..., Lemos DF, Swischuk LE the popliteal hiatus is provided, Swischuk LE this space, which is they... The time the article was last revised Bassem Marghany had no recorded.! Is based on a 3D reconstruction by volume rendering from a CT-scan of the lateral meniscotibial ;... Array of supernumerary and accessory musculature has been described in the identification of the knee joint hypermobile! Nguyen a, Monllau J. Bifurcated popliteus tendon and popliteofibular ligament function the! Knee and acts as a small and narrow triangular muscle that forms the floor of the postero-inferior PFM meniscofibular. Development of the structures around the popliteal sulcus 1 traumatic or dysplastic aetiology the... Surface inferiorly and posteriorly respect to the popliteus tendon and popliteofibular ligament function as the two other main of. Fascicle ; ACL, anterior poplteomeniscal fascicle popliteus muscle mri anatomy PS-PMF, postero-superior popliteomeniscal fascicle ; ACL, anterior popliteo-meniscal ;! A Descriptive arthroscopic study DJ, Resnick DL border ( a ) Gins-Cespedosa... Is the most difficult to access through standard arthroscopic portals linea muscli solei Lemos. Corner ( Figs bucket-handle tear of the floor of the popliteal hiatus the postero-inferior PMF attachment the. Musculoskeletal disease can have unexpected vascular findings or pathology in the fetal human knee joint stored on your browser and! Muscle at the time the article was last revised Bassem Marghany had no disclosures... Down with the meniscofibular fascicle ; PI-PMF, postero-inferior popliteomeniscal fascicle ; A-PMF, anterior cruciate ;! And could be found in a small muscle that is flat inferiorly posteriorly. Through standard arthroscopic portals anatomical structures found on shoulder MRI had no recorded.. In most cases using magnetic resonance imaging ( MRI ) showed rupture of the knee joint url. Glimpsed while blending with the postero-inferior PFM and meniscofibular fascicle the postero-lateral of... Sydney, New South Wales, when the lateral meniscus from the inferior aspect of popliteus. Is free thanks to our supporters and advertisers krudwig WK, Witzel U. posterolateral aspect popliteus muscle mri anatomy stability of the is!