Posteromedial Corner Injuries of the Knee: Imaging Findings

Abstract

The posteromedial corner (PMC) of the knee is an anatomical region formed by ligamentous structures (medial collateral ligament, posterior oblique ligament, oblique popliteal ligament), the semimembranosus tendon and its expansions, the posteromedial joint capsule, and the posterior horn of the medial meniscus. Injuries to the structures of the PMC frequently occur in acute knee trauma in association with other ligamentous or meniscal tears. The correct assessment of PMC injuries is crucial because the deficiency of these supporting structures can lead to anteromedial rotation instability or the failure of cruciate ligaments grafts. This article reviews the anatomy and biomechanics of the PMC to aid radiologists in identifying injuries potentially involving PMC components.

Keywords

posteromedial corner - knee magnetic resonance imaging - multiligamentous knee injury - anteromedial rotation instability

Publikationsverlauf

Artikel online veröffentlicht:
20. Mai 2024

• References

• 1 Dold AP, Swensen S, Strauss E, Alaia M. The posteromedial corner of the knee: anatomy, pathology, and management strategies. J Am Acad Orthop Surg 2017; 25 (11) 752-761
• 2 Lundquist RB, Matcuk Jr GR, Schein AJ. et al. Posteromedial corner of the knee: the neglected corner. Radiographics 2015; 35 (04) 1123-1137
• 3 Tibor LM, Marchant Jr MH, Taylor DC, Hardaker Jr WT, Garrett Jr WE, Sekiya JK. Management of medial-sided knee injuries, part 2: posteromedial corner. Am J Sports Med 2011; 39 (06) 1332-1340
• 4 Sconfienza LM, Albano D, Allen G. et al. Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal Radiology (ESSR) consensus. Eur Radiol 2018; 28 (12) 5338-5351
• 5 Albano D, Aringhieri G, Messina C, De Flaviis L, Sconfienza LM. High-frequency and ultra-high frequency ultrasound: musculoskeletal imaging up to 70 MHz. Semin Musculoskelet Radiol 2020; 24 (02) 125-134
• 6 Geiger D, Chang E, Pathria M, Chung CB. Posterolateral and posteromedial corner injuries of the knee. Radiol Clin North Am 2013; 51 (03) 413-432
• 7 Bellelli A, Silvestri E, Barile A. et al. Position paper on magnetic resonance imaging protocols in the musculoskeletal system (excluding the spine) by the Italian College of Musculoskeletal Radiology. Radiol Med (Torino) 2019; 124 (06) 522-538
• 8 Sconfienza LM, Albano D, Messina C, Silvestri E, Tagliafico AS. How, when, why in magnetic resonance arthrography: an international survey by the European Society of Musculoskeletal Radiology (ESSR). Eur Radiol 2018; 28 (06) 2356-2368
• 9 Warren LF, Marshall JL. The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am 1979; 61 (01) 56-62
• 10 Robinson JR, Sanchez-Ballester J, Bull AMJ, Thomas RdeW, Amis AA. The posteromedial corner revisited. An anatomical description of the passive restraining structures of the medial aspect of the human knee. J Bone Joint Surg Br 2004; 86 (05) 674-681
• 11 Chahla J, Kunze KN, LaPrade RF. et al. The posteromedial corner of the knee: an international expert consensus statement on diagnosis, classification, treatment, and rehabilitation. Knee Surg Sports Traumatol Arthrosc 2021; 29 (09) 2976-2986
• 12 Khodarahmi I, Alizai H, Alaia E, Gyftopoulos S. MR imaging of the knee posterolateral and posteromedial corner injuries. Magn Reson Imaging Clin N Am 2022; 30 (02) 215-226
• 13 Figueroa D, Guiloff R, Vaisman A, Figueroa F, Schenck Jr RC. Medial side knee injuries: simplifying the controversies: current concepts. J ISAKOS 2020; 5 (03) 134-143
• 14 Cinque ME, Chahla J, Kruckeberg BM, DePhillipo NN, Moatshe G, LaPrade RF. Posteromedial corner knee injuries: diagnosis, management, and outcomes: a critical analysis review. JBJS Rev 2017; 5 (11) e4-e4
• 15 LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L. The anatomy of the medial part of the knee. J Bone Joint Surg Am 2007; 89 (09) 2000-2010
• 16 Pedersen RR. The medial and posteromedial ligamentous and capsular structures of the knee: review of anatomy and relevant imaging findings. Semin Musculoskelet Radiol 2016; 20 (01) 12-25
• 17 Müller W. The Knee: Form, Function, and Ligament Reconstruction. Berlin, Germany:: Springer; 1983
• 18 Kittl C, Becker DK, Raschke MJ. et al. Dynamic restraints of the medial side of the knee: the semimembranosus corner revisited. Am J Sports Med 2019; 47 (04) 863-869
• 19 Sconfienza LM, Albano D, Messina C, Gitto S, Mariani PP, Zappia M. Imaging of anatomical variants around the knee. Semin Musculoskelet Radiol 2023; 27 (02) 198-205
• 20 De Maeseneer M, Shahabpour M, Lenchik L. et al. Distal insertions of the semimembranosus tendon: MR imaging with anatomic correlation. Skeletal Radiol 2014; 43 (06) 781-791
• 21 Beltran J, Matityahu A, Hwang K. et al. The distal semimembranosus complex: normal MR anatomy, variants, biomechanics and pathology. Skeletal Radiol 2003; 32 (08) 435-445
• 22 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 (04) 758-764
• 23 Hughston JC, Eilers AF. The role of the posterior oblique ligament in repairs of acute medial (collateral) ligament tears of the knee. J Bone Joint Surg Am 1973; 55 (05) 923-940
• 24 Wijdicks CA, Griffith CJ, LaPrade RF. et al. Radiographic identification of the primary medial knee structures. J Bone Joint Surg Am 2009; 91 (03) 521-529
• 25 Hedderwick M, Stringer MD, McRedmond L, Meikle GR, Woodley SJ. The oblique popliteal ligament: an anatomic and MRI investigation. Surg Radiol Anat 2017; 39 (09) 1017-1027
• 26 Zappia M, Sconfienza LM, Guarino S, Tumminello M, Iannella G, Mariani PP. Meniscal ramp lesions: diagnostic performance of MRI with arthroscopy as reference standard. Radiol Med (Torino) 2021; 126 (08) 1106-1116
• 27 House CV, Connell DA, Saifuddin A. Posteromedial corner injuries of the knee. Clin Radiol 2007; 62 (06) 539-546
• 28 Sims WF, Jacobson KE. The posteromedial corner of the knee: medial-sided injury patterns revisited. Am J Sports Med 2004; 32 (02) 337-345
• 29 D'Ambrosi R, Corona K, Guerra G. et al. Posterior oblique ligament of the knee: state of the art. EFORT Open Rev 2021; 6 (05) 364-371
• 30 Petersen W, Loerch S, Schanz S, Raschke M, Zantop T. The role of the posterior oblique ligament in controlling posterior tibial translation in the posterior cruciate ligament-deficient knee. Am J Sports Med 2008; 36 (03) 495-501
• 31 Robinson JR, Bull AMJ, Thomas RR, Amis AA. The role of the medial collateral ligament and posteromedial capsule in controlling knee laxity. Am J Sports Med 2006; 34 (11) 1815-1823
• 32 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 (03) 550-557
• 33 Peltier A, Lording T, Maubisson L, Ballis R, Neyret P, Lustig S. The role of the meniscotibial ligament in posteromedial rotational knee stability. Knee Surg Sports Traumatol Arthrosc 2015; 23 (10) 2967-2973
• 34 Hansford BG, Yablon CM. Multiligamentous injury of the knee: MRI diagnosis and injury patterns. Semin Musculoskelet Radiol 2017; 21 (02) 63-74
• 35 D'Ambrosi R, Corona K, Guerra G. et al. Midterm outcomes, complications, and return to sports after medial collateral ligament and posterior oblique ligament reconstruction for medial knee instability: a systematic review. Orthop J Sports Med 2021; 9 (11) 23 259671211056070
• 36 LaPrade RF, Moulton SG, Nitri M, Mueller W, Engebretsen L. Clinically relevant anatomy and what anatomic reconstruction means. Knee Surg Sports Traumatol Arthrosc 2015; 23 (10) 2950-2959
• 37 Phisitkul P, James SL, Wolf BR, Amendola A. MCL injuries of the knee: current concepts review. Iowa Orthop J 2006; 26: 77-90
• 38 Schein A, Matcuk G, Patel D. et al. Structure and function, injury, pathology, and treatment of the medial collateral ligament of the knee. Emerg Radiol 2012; 19 (06) 489-498
• 39 Beall DP, Googe JD, Moss JT. et al. Magnetic resonance imaging of the collateral ligaments and the anatomic quadrants of the knee. Radiol Clin North Am 2007; 45 (06) 983-1002 , vi
• 40 Alaia EF, Rosenberg ZS, Alaia MJ. Stener-like lesions of the superficial medial collateral ligament of the knee: MRI features. AJR Am J Roentgenol 2019; 213 (06) W272-W276
• 41 Sanghvi D, Srivastav A, Agrawal S, Nakshiwala V. The posterior oblique ligament in MRI of acute knee trauma. Skeletal Radiol 2022; 51 (05) 1063-1071
• 42 Sonnery-Cottet B, Serra Cruz R, Vieira TD, Goes RA, Saithna A. Ramp lesions: an unrecognized posteromedial instability?. Clin Sports Med 2020; 39 (01) 69-81
• 43 Greif DN, Baraga MG, Rizzo MG. et al. MRI appearance of the different meniscal ramp lesion types, with clinical and arthroscopic correlation. Skeletal Radiol 2020; 49 (05) 677-689
• 44 Tomsan H, Gorbachova T, Fritz RC. et al. Knee MRI: meniscus roots, ramps, repairs, and repercussions. Radiographics 2023; 43 (07) e220208
• 45 Escobedo EM, Mills WJ, Hunter JC. The “reverse Segond” fracture: association with a tear of the posterior cruciate ligament and medial meniscus. AJR Am J Roentgenol 2002; 178 (04) 979-983