Semin Musculoskelet Radiol 2016; 20(01): 052-064
DOI: 10.1055/s-0036-1579677
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Collateral Ligaments and Posterolateral Corner: What Radiologists Should Know

Violeta Vasilevska Nikodinovska
1   Department of Radiology, Musculoskeletal Radiology, Medical Faculty, University “Ss. Cyril and Methodius” Skopje, University Surgical Clinic “St. Naum Ohridski” Skopje, Republic of Macedonia
,
Lana H. Gimber
2   Department of Medical Imaging, The University of Arizona, College of Medicine, Banner-University Medical Center, Tucson, Arizona
,
Jolene C. Hardy
3   Department of Orthopaedic Surgery, The University of Arizona, College of Medicine, Banner-University Medical Center, South Campus, Sports Medicine Clinic, Tucson, Arizona
,
Mihra S. Taljanovic
2   Department of Medical Imaging, The University of Arizona, College of Medicine, Banner-University Medical Center, Tucson, Arizona
› Author Affiliations
Further Information

Publication History

Publication Date:
14 April 2016 (online)

Abstract

Ligamentous and tendinous structures of the posterolateral corner of the knee provide important static and dynamic stability to the knee joint and act in conjunction with anterior and posterior cruciate ligaments. Injuries of these structures are not uncommon. Failure to treat posterolateral corner injuries leads to posterolateral instability of the knee and subsequently poor outcome of cruciate ligament reconstructions. Currently, MRI is the diagnostic modality of choice in the evaluation of posterolateral corner injuries of the knee. We review normal MR imaging anatomy of the complex anatomical structures of the posterolateral corner of the knee, their biomechanical function, injuries, and current treatment options.

 
  • References

  • 1 LaPrade RF, Morgan PM, Wentorf FA, Johansen S, Engebretsen L. The anatomy of the posterior aspect of the knee. An anatomic study. J Bone Joint Surg Am 2007; 89 (4) 758-764
  • 2 Veltri DM, Deng X-H, Torzilli PA, Maynard MJ, Warren RF. The role of the popliteofibular ligament in stability of the human knee. A biomechanical study. Am J Sports Med 1996; 24 (1) 19-27
  • 3 Harner CD, Vogrin TM, Höher J, Ma CB, Woo SL. Biomechanical analysis of a posterior cruciate ligament reconstruction. Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med 2000; 28 (1) 32-39
  • 4 Krukhaug Y, Mølster A, Rodt A, Strand T. Lateral ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc 1998; 6 (1) 21-25
  • 5 LaPrade RF, Muench C, Wentorf F, Lewis JL. The effect of injury to the posterolateral structures of the knee on force in a posterior cruciate ligament graft: a biomechanical study. Am J Sports Med 2002; 30 (2) 233-238
  • 6 LaPrade RF, Resig S, Wentorf F, Lewis JL. The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft force. A biomechanical analysis. Am J Sports Med 1999; 27 (4) 469-475
  • 7 Wentorf FA, LaPrade RF, Lewis JL, Resig S. The influence of the integrity of posterolateral structures on tibiofemoral orientation when an anterior cruciate ligament graft is tensioned. Am J Sports Med 2002; 30 (6) 796-799
  • 8 LaPrade RF, Bollom TS. Anatomy and biomechanics of the posterolateral aspect of the knee. Posterior Cruciate Ligament Injuries 2002; 23-46
  • 9 Müeller W. Clinical material and result. In: Müeller W, , ed. The Knee Form, Function, and Ligament Reconstruction. New York, NY: Springer-Verlag; 1982
  • 10 Covey DC. Injuries of the posterolateral corner of the knee. J Bone Joint Surg Am 2001; 83-A (1) 106-118
  • 11 Maynard MJ, Deng X, Wickiewicz TL, Warren RF. The popliteofibular ligament. Rediscovery of a key element in posterolateral stability. Am J Sports Med 1996; 24 (3) 311-316
  • 12 Seebacher JR, Inglis AE, Marshall JL, Warren RF. The structure of the posterolateral aspect of the knee. J Bone Joint Surg Am 1982; 64 (4) 536-541
  • 13 Sudasna S, Harnsiriwattanagit K. The ligamentous structures of the posterolateral aspect of the knee. Bull Hosp Jt Dis Orthop Inst 1990; 50 (1) 35-40
  • 14 Terry GC, LaPrade RF. The posterolateral aspect of the knee. Anatomy and surgical approach. Am J Sports Med 1996; 24 (6) 732-739
  • 15 Geiger D, Chang EY, Pathria MN, Chung CB. Posterolateral and posteromedial corner injuries of the knee. Magn Reson Imaging Clin N Am 2014; 22 (4) 581-599
  • 16 Haims AH, Medvecky MJ, Pavlovich Jr R, Katz LD. MR imaging of the anatomy of and injuries to the lateral and posterolateral aspects of the knee. AJR Am J Roentgenol 2003; 180 (3) 647-653
  • 17 Grood ES, Stowers SF, Noyes FR. Limits of movement in the human knee. Effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg Am 1988; 70 (1) 88-97
  • 18 Branch EA, Anz AW. Distal insertions of the biceps femoris: a quantitative analysis. Orthop J Sports Med 2015; 3 (9) 2325967115602255
  • 19 El-Khoury GY, Usta HY, Berger RA. Meniscotibial (coronary) ligament tears. Skeletal Radiol 1984; 11 (3) 191-196
  • 20 Bikkina RS, Tujo CA, Schraner AB, Major NM. The “floating” meniscus: MRI in knee trauma and implications for surgery. AJR Am J Roentgenol 2005; 184 (1) 200-204
  • 21 LaPrade RF, Gilbert TJ, Bollom TS, Wentorf F, Chaljub G. The magnetic resonance imaging appearance of individual structures of the posterolateral knee. A prospective study of normal knees and knees with surgically verified grade III injuries. Am J Sports Med 2000; 28 (2) 191-199
  • 22 LaPrade RF, Ly TV, Wentorf FA, Engebretsen L. The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med 2003; 31 (6) 854-860
  • 23 Diamantopoulos A, Tokis A, Tzurbakis M, Patsopoulos I, Georgoulis A. The posterolateral corner of the knee: evaluation under microsurgical dissection. Arthroscopy 2005; 21 (7) 826-833
  • 24 Recondo JA, Salvador E, Villanúa JA, Barrera MC, Gervás C, Alústiza JM. Lateral stabilizing structures of the knee: functional anatomy and injuries assessed with MR imaging. Radiographics 2000; 20 (Spec No) S91-S102
  • 25 Miller TT, Gladden P, Staron RB, Henry JH, Feldman F. Posterolateral stabilizers of the knee: anatomy and injuries assessed with MR imaging. AJR Am J Roentgenol 1997; 169 (6) 1641-1647
  • 26 Bencardino JT, Rosenberg ZS, Brown RR, Hassankhani A, Lustrin ES, Beltran J. Traumatic musculotendinous injuries of the knee: diagnosis with MR imaging. Radiographics 2000; 20 (Spec No) S103-S120
  • 27 Simonian PT, Sussmann PS, van Trommel M, Wickiewicz TL, Warren RF. Popliteomeniscal fasciculi and lateral meniscal stability. Am J Sports Med 1997; 25 (6) 849-853
  • 28 McCarthy M, Camarda L, Wijdicks CA, Johansen S, Engebretsen L, Laprade RF. Anatomic posterolateral knee reconstructions require a popliteofibular ligament reconstruction through a tibial tunnel. Am J Sports Med 2010; 38 (8) 1674-1681
  • 29 Wadia FD, Pimple M, Gajjar SM, Narvekar AD. An anatomic study of the popliteofibular ligament. Int Orthop 2003; 27 (3) 172-174
  • 30 Shahane SA, Ibbotson C, Strachan R, Bickerstaff DR. The popliteofibular ligament. An anatomical study of the posterolateral corner of the knee. J Bone Joint Surg Br 1999; 81 (4) 636-642
  • 31 Moorman III CT, LaPrade RF. Anatomy and biomechanics of the posterolateral corner of the knee. J Knee Surg 2005; 18 (2) 137-145
  • 32 Munshi M, Pretterklieber ML, Kwak S, Antonio GE, Trudell DJ, Resnick D. MR imaging, MR arthrography, and specimen correlation of the posterolateral corner of the knee: an anatomic study. AJR Am J Roentgenol 2003; 180 (4) 1095-1101
  • 33 Vieira EL, Vieira EA, da Silva RT, Berlfein PA, Abdalla RJ, Cohen M. An anatomic study of the iliotibial tract. Arthroscopy 2007; 23 (3) 269-274
  • 34 Morgan PM, LaPrade RF, Wentorf FA, Cook JW, Bianco A. The role of the oblique popliteal ligament and other structures in preventing knee hyperextension. Am J Sports Med 2010; 38 (3) 550-557
  • 35 LaPrade RF, Wentorf FA, Fritts H, Gundry C, Hightower CD. A prospective magnetic resonance imaging study of the incidence of posterolateral and multiple ligament injuries in acute knee injuries presenting with a hemarthrosis. Arthroscopy 2007; 23 (12) 1341-1347
  • 36 Yu JS, Salonen DC, Hodler J, Haghighi P, Trudell D, Resnick D. Posterolateral aspect of the knee: improved MR imaging with a coronal oblique technique. Radiology 1996; 198 (1) 199-204
  • 37 Ruiz ME, Erickson SJ. Medial and lateral supporting structures of the knee. Normal MR imaging anatomy and pathologic findings. Magn Reson Imaging Clin N Am 1994; 2 (3) 381-399
  • 38 Tardieu M, Lazennec JY, Christel P, Brasseur JL, Roger B, Grenier P. Normal and pathological MRI aspects of the posterolateral corner of the knee. J Radiol 1995; 76 (9) 605-609
  • 39 Ross G, Chapman AW, Newberg AR, Scheller Jr AD. Magnetic resonance imaging for the evaluation of acute posterolateral complex injuries of the knee. Am J Sports Med 1997; 25 (4) 444-448
  • 40 LaPrade RF, Wentorf F. Diagnosis and treatment of posterolateral knee injuries. Clin Orthop Relat Res 2002; (402) 110-121
  • 41 Vinson EN, Major NM, Helms CA. The posterolateral corner of the knee. AJR Am J Roentgenol 2008; 190 (2) 449-458
  • 42 Bolog N, Hodler J. MR imaging of the posterolateral corner of the knee. Skeletal Radiol 2007; 36 (8) 715-728
  • 43 Krudwig WK, Witzel U, Ullrich K. Posterolateral aspect and stability of the knee joint. II. Posterolateral instability and effect of isolated and combined posterolateral reconstruction on knee stability: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 2002; 10 (2) 91-95
  • 44 Falworth MS, Allum RL. Posterolateral instability of the knee: its diagnosis and management. Curr Orthop 2003; 17: 223-233
  • 45 Davies H, Unwin A, Aichroth P. The posterolateral corner of the knee. Anatomy, biomechanics and management of injuries. Injury 2004; 35 (1) 68-75
  • 46 Fanelli GC, Orcutt DR, Edson CJ. The multiple-ligament injured knee: evaluation, treatment, and results. Arthroscopy 2005; 21 (4) 471-486
  • 47 Hughston JC, Jacobson KE. Chronic posterolateral rotatory instability of the knee. J Bone Joint Surg Am 1985; 67 (3) 351-359
  • 48 LaPrade RF, Terry GC. Injuries to the posterolateral aspect of the knee. Association of anatomic injury patterns with clinical instability. Am J Sports Med 1997; 25 (4) 433-438
  • 49 Fanelli GC. Surgical reconstruction for acute posterolateral injury of the knee. J Knee Surg 2005; 18 (2) 157-162
  • 50 Larsen MW, Toth A. Examination of posterolateral corner injuries. J Knee Surg 2005; 18 (2) 146-150
  • 51 Djian P. Posterolateral knee reconstruction. Orthop Traumatol Surg Res 2015; 101 (1, Suppl) S159-S170
  • 52 Juhng SK, Lee JK, Choi SS, Yoon KH, Roh BS, Won JJ. MR evaluation of the “arcuate” sign of posterolateral knee instability. AJR Am J Roentgenol 2002; 178 (3) 583-588
  • 53 Huang GS, Yu JS, Munshi M , et al. Avulsion fracture of the head of the fibula (the “arcuate” sign): MR imaging findings predictive of injuries to the posterolateral ligaments and posterior cruciate ligament. AJR Am J Roentgenol 2003; 180 (2) 381-387
  • 54 Theodorou DJ, Theodorou SJ, Fithian DC, Paxton L, Garelick DH, Resnick D. Posterolateral complex knee injuries: magnetic resonance imaging with surgical correlation. Acta Radiol 2005; 46 (3) 297-305
  • 55 Feng H, Zhang H, Hong L, Wang XS, Cheng KB, Zhang J. Femoral peel-off lesions in acute posterolateral corner injuries: incidence, classification, and clinical characteristics. Arthroscopy 2011; 27 (7) 951-958
  • 56 Brown TR, Quinn SF, Wensel JP, Kim JH, Demlow T. Diagnosis of popliteus injuries with MR imaging. Skeletal Radiol 1995; 24 (7) 511-514
  • 57 De Maeseneer M, Shahabpour M, Vanderdood K, Van Roy F, Osteaux M. Medial meniscocapsular separation: MR imaging criteria and diagnostic pitfalls. Eur J Radiol 2002; 41 (3) 242-252
  • 58 Pacholke DA, Helms CA. MRI of the posterolateral corner injury: a concise review. J Magn Reson Imaging 2007; 26 (2) 250-255
  • 59 Bennett DL, George MJ, El-Khoury GY, Stanley MD, Sundaram M. Anterior rim tibial plateau fractures and posterolateral corner knee injury. Emerg Radiol 2003; 10 (2) 76-83
  • 60 Segond P. Recherches cliniques et experimentales sur les epanchements sanguins du genou par entorse. Progr Med (Paris) 1879; 7: 297
  • 61 LaPrade RF. Posterolateral Knee Injuries: Anatomy, Evaluation and Treatment. New York, NY: Thieme; 2006
  • 62 De Maeseneer M, Boulet C, Willekens I , et al. Segond fracture: involvement of the iliotibial band, anterolateral ligament, and anterior arm of the biceps femoris in knee trauma. Skeletal Radiol 2015; 44 (3) 413-421
  • 63 Campos JC, Chung CB, Lektrakul N , et al. Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion. Radiology 2001; 219 (2) 381-386
  • 64 Davis DS, Post WR. Segond fracture: lateral capsular ligament avulsion. J Orthop Sports Phys Ther 1997; 25 (2) 103-106
  • 65 Hayes CW, Brigido MK, Jamadar DA, Propeck T. Mechanism-based pattern approach to classification of complex injuries of the knee depicted at MR imaging. Radiographics 2000; 20 (Spec No) S121-S134
  • 66 Sferopoulos NK, Rafailidis D, Traios S, Christoforides J. Avulsion fractures of the lateral tibial condyle in children. Injury 2006; 37 (1) 57-60
  • 67 Crespo B, James EW, Metsavaht L, LaPrade RF. Injuries to posterolateral corner of the knee: a comprehensive review from anatomy to surgical treatment. Rev Bras Ortop 2015; 50 (4) 363-370
  • 68 Stannard JP, Brown SL, Robinson JT, McGwin Jr G, Volgas DA. Reconstruction of the posterolateral corner of the knee. Arthroscopy 2005; 21 (9) 1051-1059
  • 69 Levy BA, Dajani KA, Morgan JA, Shah JP, Dahm DL, Stuart MJ. Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. Am J Sports Med 2010; 38 (4) 804-809
  • 70 Fanelli GC, Stannard JP, Stuart MJ , et al. Management of complex knee ligament injuries. J Bone Joint Surg Am 2010; 92 (12) 2235-2246
  • 71 Arciero RA. Anatomic posterolateral corner knee reconstruction. Arthroscopy 2005; 21 (9) 1147
  • 72 LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Esterberg JL, Tso A. An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med 2004; 32 (6) 1405-1414
  • 73 LaPrade RF, Johansen S, Engebretsen L. Outcomes of an anatomic posterolateral knee reconstruction: surgical technique. J Bone Joint Surg Am 2011; 93 (Suppl. 01) 10-20
  • 74 Clancy Jr WG, Ray JM, Zoltan DJ. Acute tears of the anterior cruciate ligament. Surgical versus conservative treatment. J Bone Joint Surg Am 1988; 70 (10) 1483-1488