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MR Imaging, MR Arthrography, and Specimen Correlation of the Posterolateral Corner of the Knee: An Anatomic Study

¹ Department of Radiology, Veterans Administration Medical Center, 3350 La Jolla Village Dr., San Diego, CA 92161.
² Present address: Department of Radiology, Trillium Health Centre,100 Queensway W., Mississauga, Ontario, L5B 1B8 Canada.
³ Present address: Institute of Anatomy, University of Vienna, Waehringerstr. 13, A-1090 Vienna, Austria.
⁴ Department of Radiology, Rush-Copley Medical Center, 2000 Ogden Ave., Aurora, IL 60504.

View larger version (134K): [in a new window]   Fig. 1A. —Cadaveric specimen of skeletally mature knee. Lateral photograph shows course and attachments of tendon of long head of biceps femoris muscle. It is superficial relative to fibular collateral ligament (FC) and has been cut between its anterior arm (alB) and direct arm (dlB) to show its topographic relation to fibular collateral ligament. Superior aspect of knee is on left side of image.

View larger version (115K): [in a new window]   Fig. 2. —Photograph of cadaveric specimen of skeletally mature knee shows proximal aspect of right tibia and fibula and insertions of ligaments and tendons in posterolateral knee. Tendon of long head of biceps femoris is divided into anterior arm (alB) and direct arm (dlB), which are superficial relative to fibular collateral ligament (FC). Short head of biceps femoris muscle is attached to fibula by a direct arm (dsB) and to lateral tibial condyle by an anterior arm (asB). On anterolateral aspect of apex of fibular head, fabellofibular ligament (FF) is attached together with arcuate ligament, which is composed of medial (arcuate) (aA) and lateral (upright) (uA) limbs. Popliteofibular ligament (PF) covers upper facet of apex of fibular head.

View larger version (111K): [in a new window]   Fig. 1C. —Cadaveric specimen of skeletally mature knee. Lateral photograph shows broad connection between popliteus tendon (straight arrows) and lateral meniscus (Lm) via inferior popliteomeniscal fascicle (ipm) that reaches far anteriorly. Femoral insertion of popliteus tendon is deep relative to fibular collateral ligament (FC). Note bursa (arrowheads) separating fibular collateral ligament (FC) from tendon of biceps femoris muscle (B), which has been reflected anteriorly. Superficial aspect of tendon of biceps femoris muscle (curved arrow) is mainly formed by its long head and has been cut at its fibular attachment (broken lines) to show direct arm of short head of biceps femoris muscle (dsB).

View larger version (166K): [in a new window]   Fig. 1D. —Cadaveric specimen of skeletally mature knee. Posterior photograph depicts various reinforcements of fibrous capsule and surrounding structures. Note tendon of biceps femoris muscle (B) superficial relative to fibular collateral ligament (FC). Fabella (f) is embedded within lateral head of gastrocnemius (lG), which has been reflected. Fabella (f) is connected via fabellofibular ligament (fF) to head of fibula. Deep relative to fabellofibular ligament (fF), lateral (upright) limb of arcuate ligament (uA) courses upward to reach lateral femoral condyle. Medial (arcuate) limb of arcuate ligament (aA) borders entrance of popliteus tendon into joint. From tendon of semimembranosus (S), oblique popliteal ligament (O) crosses posterior wall of fibrous capsule to reach lateral femoral condyle, where its fibers merge with those from medial (arcuate) limb of arcuate ligament (aA). P = popliteus muscle.

View larger version (147K): [in a new window]   Fig. 1F. —Cadaveric specimen of skeletally mature knee. Posterior photograph shows attachments of popliteus muscle (P), which has been slightly moved from its tibial origin. Note its insertion on apex of head of fibula via popliteofibular ligament (PF) and on dorsolateral aspect of lateral meniscus via superior popliteomeniscal fascicle (spm). Weaker part of joint capsule has been removed to show inferior border of posterior aspect of medial (arcuate) limb of arcuate ligament (aA). Lateral (upright) limb of arcuate ligament (uA) is still covered by fabellofibular ligament (fF). Note wide gap between joint capsule marked by course of lateral (upright) limb of arcuate ligament (uA) and fibular collateral ligament (FC) which, in turn, has been uncovered from tendon of biceps femoris muscle (B). Small bursa (arrowheads) usually separates fibular collateral ligament (FC) from tendon of biceps femoris muscle (B).

View larger version (167K): [in a new window]   Fig. 1B. —Cadaveric specimen of skeletally mature knee. Posterolateral photograph shows attachments of ligaments on fibular head. Popliteofibular ligament (PF) inserts in upper facet of apex of fibular head. Medial (arcuate) (aA) and lateral (upright) (uA) limbs of arcuate ligament and fabellofibular ligament (fF) insert in anterolateral aspect of apex of fibular head. These three structures are attached close to base of apex of fibular head posterior relative to fibular insertion of fibular collateral ligament (FC) and tendon of biceps femoris muscle (B). Note superficial course of fabellofibular ligament (fF) relative to lateral (upright) limb of arcuate ligament (uA) as well as its connection to fabella (f). Arrow identifies tendon of popliteus muscle. lG = tendon of lateral head of gastrocnemius muscle, P = popliteus muscle.

View larger version (147K): [in a new window]   Fig. 1E. —Cadaveric specimen of skeletally mature knee. Posterior photograph shows attachment of popliteus muscle (P) to posterolateral aspect of lateral meniscus (Lm) via superior popliteomeniscal fascicle (spm). Note relationship between popliteus tendon (P) and lateral meniscus (Lm) and structures reinforcing fibrous capsule. aA = medial (arcuate) limb of arcuate ligament, uA = lateral (upright) limb of arcuate ligament, fF = fabellofibular ligament, FC = fibular collateral ligament.

View larger version (150K): [in a new window]   Fig. 3. —Posterior coronal oblique T1-weighted spin-echo MR arthogram of cadaveric specimen of skeletally mature knee reveals fibular collateral ligament (arrowhead) attaching proximally to distal femur and distally to anterolateral aspect of apex of fibular head. Note popliteus tendon (straight arrow) and lateral meniscus (curved arrow).

View larger version (144K): [in a new window]   Fig. 4. —Axial T1-weighted spin-echo MR arthrogram of cadaveric specimen of skeletally mature knee shows direct arm of short head of biceps femoris muscle (straight white arrow) just proximal relative to fibular attachment. Direct arm of short head is medial relative to direct (black arrow) and anterior (arrowhead) arms of long head of biceps femoris muscle. Note fibular collateral ligament (curved white arrow) anterior relative to tendinous components of biceps femoris muscle.

View larger version (139K): [in a new window]   Fig. 5A. —–Cadaveric specimen of skeletally mature knee. Sagittal T1-weighted spin-echo MR arthrogram (A) and corresponding sagittal MR arthrogram (B) show lateral (upright) limb of arcuate ligament (open arrow) located posterior to popliteus tendon (straight arrow). It attaches distally to base of apex of fibular head. Note inferior popliteomeniscal fascicle (arrowhead) and anterior arm of long head of biceps femoris muscle (curved arrow).

View larger version (129K): [in a new window]   Fig. 5B. —–Cadaveric specimen of skeletally mature knee. Sagittal T1-weighted spin-echo MR arthrogram (A) and corresponding sagittal MR arthrogram (B) show lateral (upright) limb of arcuate ligament (open arrow) located posterior to popliteus tendon (straight arrow). It attaches distally to base of apex of fibular head. Note inferior popliteomeniscal fascicle (arrowhead) and anterior arm of long head of biceps femoris muscle (curved arrow).

View larger version (132K): [in a new window]   Fig. 5C. —–Cadaveric specimen of skeletally mature knee. Sagittal T1-weighted spin-echo MR arthrogram (C) obtained medial to A and B with corresponding sagittal section (D) reveals medial (arcuate) limb of arcuate ligament (open arrows) located posterior to popliteus tendon (curved arrow). Medial limb of arcuate ligament attaches distally to base of apex of fibular head. Note superior popliteomeniscal fascicle (straight black arrow) and tendon of lateral head of gastrocnemius muscle (straight white arrow).

View larger version (135K): [in a new window]   Fig. 5D. —–Cadaveric specimen of skeletally mature knee. Sagittal T1-weighted spin-echo MR arthrogram (C) obtained medial to A and B with corresponding sagittal section (D) reveals medial (arcuate) limb of arcuate ligament (open arrows) located posterior to popliteus tendon (curved arrow). Medial limb of arcuate ligament attaches distally to base of apex of fibular head. Note superior popliteomeniscal fascicle (straight black arrow) and tendon of lateral head of gastrocnemius muscle (straight white arrow).

View larger version (152K): [in a new window]   Fig. 6A. —Cadaveric specimen of skeletally mature knee. Coronal oblique T1-weighted spin-echo MR arthrogram (A) with corresponding coronal oblique section (B) shows popliteofibular ligament (arrowheads). It arises from lateral aspect of musculotendinous junction of popliteus muscle (white arrow) and inserts in upper facet of apex of fibular head. Note fibular collateral ligament (black arrow).

View larger version (139K): [in a new window]   Fig. 6B. —Cadaveric specimen of skeletally mature knee. Coronal oblique T1-weighted spin-echo MR arthrogram (A) with corresponding coronal oblique section (B) shows popliteofibular ligament (arrowheads). It arises from lateral aspect of musculotendinous junction of popliteus muscle (white arrow) and inserts in upper facet of apex of fibular head. Note fibular collateral ligament (black arrow).

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