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Popliteomeniscal Fascicles: Anatomic Considerations Using MR Arthrography in Cadavers

¹ Department of Radiology, Veterans Affairs Healthcare System, San Diego, CA.
² Department of Radiology, Westmead Hospital, Darcy Rd., Westmead, Sydney, New South Wales, Australia 2145.

View larger version (49K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Drawing shows superolateral view of posterolateral corner of knee with femur and superficial fibular attachments removed. Arrangement between popliteus muscle (8) and tendon (9) (cut proximally and reflected) and anteroinferior (11) and posterosuperior (10) popliteomeniscal fascicles is apparent. Inferolateral portion of anteroinferior popliteomeniscal fascicle (11) forms common fibular styloid attachment with anterior arm of popliteofibular ligament (6). 1 = anterior cruciate ligament, 2 = posterior cruciate ligament, 3 = lateral meniscus, 4 = anterior meniscofemoral ligament of Humphry, 5 = posterior meniscofemoral ligament of Wrisberg, 7 = posterior arm of popliteofibular ligament, 12 = fibula. (Reprinted with permission from Stäubli HU, Birrer S. The popliteus tendon and its fascicles at the popliteal hiatus: gross anatomy and functional arthroscopic evaluation with and without anterior cruciate ligament deficiency. Arthroscopy 1990; 6:209–220 [3])

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Anteroinferior popliteomeniscal fascicle and popliteofibular ligament of cadaver specimens. A and B are matching MRI and anatomic sections from one cadaver; C and D are matching MRI and anatomic sections from another cadaver. Sagittal T1-weighted MR arthrographic images with corresponding cadaveric sections show anteroinferior popliteomeniscal fascicle extending in posteroinferior course from lateral aspect of lateral meniscus (LM) and to blend with popliteus tendon. Conjoined attachment of anteroinferior popliteomeniscal fascicle and popliteofibular ligament (asterisk) at styloid process of fibula (f) is evident. Variable appearance of anteroinferior popliteomeniscal fascicle (arrows) is thin and membrane-like in A and B and thick in C and D. POP = popliteus tendon.

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Anteroinferior popliteomeniscal fascicle and popliteofibular ligament of cadaver specimens. A and B are matching MRI and anatomic sections from one cadaver; C and D are matching MRI and anatomic sections from another cadaver. Sagittal T1-weighted MR arthrographic images with corresponding cadaveric sections show anteroinferior popliteomeniscal fascicle extending in posteroinferior course from lateral aspect of lateral meniscus (LM) and to blend with popliteus tendon. Conjoined attachment of anteroinferior popliteomeniscal fascicle and popliteofibular ligament (asterisk) at styloid process of fibula (f) is evident. Variable appearance of anteroinferior popliteomeniscal fascicle (arrows) is thin and membrane-like in A and B and thick in C and D. POP = popliteus tendon.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Anteroinferior popliteomeniscal fascicle and popliteofibular ligament of cadaver specimens. A and B are matching MRI and anatomic sections from one cadaver; C and D are matching MRI and anatomic sections from another cadaver. Sagittal T1-weighted MR arthrographic images with corresponding cadaveric sections show anteroinferior popliteomeniscal fascicle extending in posteroinferior course from lateral aspect of lateral meniscus (LM) and to blend with popliteus tendon. Conjoined attachment of anteroinferior popliteomeniscal fascicle and popliteofibular ligament (asterisk) at styloid process of fibula (f) is evident. Variable appearance of anteroinferior popliteomeniscal fascicle (arrows) is thin and membrane-like in A and B and thick in C and D. POP = popliteus tendon.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —Anteroinferior popliteomeniscal fascicle and popliteofibular ligament of cadaver specimens. A and B are matching MRI and anatomic sections from one cadaver; C and D are matching MRI and anatomic sections from another cadaver. Sagittal T1-weighted MR arthrographic images with corresponding cadaveric sections show anteroinferior popliteomeniscal fascicle extending in posteroinferior course from lateral aspect of lateral meniscus (LM) and to blend with popliteus tendon. Conjoined attachment of anteroinferior popliteomeniscal fascicle and popliteofibular ligament (asterisk) at styloid process of fibula (f) is evident. Variable appearance of anteroinferior popliteomeniscal fascicle (arrows) is thin and membrane-like in A and B and thick in C and D. POP = popliteus tendon.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Popliteomeniscal fascicular attachments of cadaver specimen. Series of sagittal T1-weighted MR arthrographic images of lateral meniscus extending from lateral to medial shows three popliteomeniscal fascicular attachments. Anteroinferior popliteomeniscal fascicle (AI-PMF) is thinner than posterosuperior popliteomeniscal fascicle (PS-PMF) in this knee. The posteroinferior popliteomeniscal fascicle (PI-PMF) extends upward and in medial direction from medial aponeurotic extension (arrowheads, F and G) of popliteus musculotendinous region and attaches to inferior margin of posterior horn of lateral meniscus immediately below posterior meniscofemoral ligament of Wrisberg (curved arrow in G).

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Popliteomeniscal fascicular attachments of cadaver specimen. Series of sagittal T1-weighted MR arthrographic images of lateral meniscus extending from lateral to medial shows three popliteomeniscal fascicular attachments. Anteroinferior popliteomeniscal fascicle (AI-PMF) is thinner than posterosuperior popliteomeniscal fascicle (PS-PMF) in this knee. The posteroinferior popliteomeniscal fascicle (PI-PMF) extends upward and in medial direction from medial aponeurotic extension (arrowheads, F and G) of popliteus musculotendinous region and attaches to inferior margin of posterior horn of lateral meniscus immediately below posterior meniscofemoral ligament of Wrisberg (curved arrow in G).

View larger version (103K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Popliteomeniscal fascicular attachments of cadaver specimen. Series of sagittal T1-weighted MR arthrographic images of lateral meniscus extending from lateral to medial shows three popliteomeniscal fascicular attachments. Anteroinferior popliteomeniscal fascicle (AI-PMF) is thinner than posterosuperior popliteomeniscal fascicle (PS-PMF) in this knee. The posteroinferior popliteomeniscal fascicle (PI-PMF) extends upward and in medial direction from medial aponeurotic extension (arrowheads, F and G) of popliteus musculotendinous region and attaches to inferior margin of posterior horn of lateral meniscus immediately below posterior meniscofemoral ligament of Wrisberg (curved arrow in G).

View larger version (106K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —Popliteomeniscal fascicular attachments of cadaver specimen. Series of sagittal T1-weighted MR arthrographic images of lateral meniscus extending from lateral to medial shows three popliteomeniscal fascicular attachments. Anteroinferior popliteomeniscal fascicle (AI-PMF) is thinner than posterosuperior popliteomeniscal fascicle (PS-PMF) in this knee. The posteroinferior popliteomeniscal fascicle (PI-PMF) extends upward and in medial direction from medial aponeurotic extension (arrowheads, F and G) of popliteus musculotendinous region and attaches to inferior margin of posterior horn of lateral meniscus immediately below posterior meniscofemoral ligament of Wrisberg (curved arrow in G).

View larger version (106K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —Popliteomeniscal fascicular attachments of cadaver specimen. Series of sagittal T1-weighted MR arthrographic images of lateral meniscus extending from lateral to medial shows three popliteomeniscal fascicular attachments. Anteroinferior popliteomeniscal fascicle (AI-PMF) is thinner than posterosuperior popliteomeniscal fascicle (PS-PMF) in this knee. The posteroinferior popliteomeniscal fascicle (PI-PMF) extends upward and in medial direction from medial aponeurotic extension (arrowheads, F and G) of popliteus musculotendinous region and attaches to inferior margin of posterior horn of lateral meniscus immediately below posterior meniscofemoral ligament of Wrisberg (curved arrow in G).

View larger version (103K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3F —Popliteomeniscal fascicular attachments of cadaver specimen. Series of sagittal T1-weighted MR arthrographic images of lateral meniscus extending from lateral to medial shows three popliteomeniscal fascicular attachments. Anteroinferior popliteomeniscal fascicle (AI-PMF) is thinner than posterosuperior popliteomeniscal fascicle (PS-PMF) in this knee. The posteroinferior popliteomeniscal fascicle (PI-PMF) extends upward and in medial direction from medial aponeurotic extension (arrowheads, F and G) of popliteus musculotendinous region and attaches to inferior margin of posterior horn of lateral meniscus immediately below posterior meniscofemoral ligament of Wrisberg (curved arrow in G).

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3G —Popliteomeniscal fascicular attachments of cadaver specimen. Series of sagittal T1-weighted MR arthrographic images of lateral meniscus extending from lateral to medial shows three popliteomeniscal fascicular attachments. Anteroinferior popliteomeniscal fascicle (AI-PMF) is thinner than posterosuperior popliteomeniscal fascicle (PS-PMF) in this knee. The posteroinferior popliteomeniscal fascicle (PI-PMF) extends upward and in medial direction from medial aponeurotic extension (arrowheads, F and G) of popliteus musculotendinous region and attaches to inferior margin of posterior horn of lateral meniscus immediately below posterior meniscofemoral ligament of Wrisberg (curved arrow in G).

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Attachment of medial aponeurosis to posterior cruciate ligament. Axial T1-weighted MR arthrographic image shows inferomedial extension from medial aponeurosis to inferolateral aspect (arrows) of posterior cruciate ligament (PCL).

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Attachment of medial aponeurosis to posterior cruciate ligament. Axial section of different specimen from A with traction on medial aponeurotic extension of popliteus muscle–tendon unit shows attachment to posterior cruciate ligament (arrows). POP = popliteus tendon.

View larger version (75K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Medial aponeurosis attachments of cadaver specimen. Series of axial T1-weighted MR arthrographic images from inferior (A) to superior (D) aspects. PCL = posterior cruciate ligament. MR arthrographic image shows relation between popliteus tendon (POP) and medial aponeurosis (arrowheads). Medial attachments to posterior capsule (large arrow) and ligament of Wrisberg (small arrow) extend from medial aponeurosis. LM = lateral meniscus.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Medial aponeurosis attachments of cadaver specimen. Series of axial T1-weighted MR arthrographic images from inferior (A) to superior (D) aspects. PCL = posterior cruciate ligament. Successive superior MR arthrographic images show Wrisberg extension (short arrows) of medial aponeurosis can be followed upward. Upward extension of medial aponeurosis (arrowheads) forms inferior connection with oblique popliteal ligament (long arrows, D). Asterisk (B and C) indicates meniscofemoral ligament of Humphry.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —Medial aponeurosis attachments of cadaver specimen. Series of axial T1-weighted MR arthrographic images from inferior (A) to superior (D) aspects. PCL = posterior cruciate ligament. Successive superior MR arthrographic images show Wrisberg extension (short arrows) of medial aponeurosis can be followed upward. Upward extension of medial aponeurosis (arrowheads) forms inferior connection with oblique popliteal ligament (long arrows, D). Asterisk (B and C) indicates meniscofemoral ligament of Humphry.

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —Medial aponeurosis attachments of cadaver specimen. Series of axial T1-weighted MR arthrographic images from inferior (A) to superior (D) aspects. PCL = posterior cruciate ligament. Successive superior MR arthrographic images show Wrisberg extension (short arrows) of medial aponeurosis can be followed upward. Upward extension of medial aponeurosis (arrowheads) forms inferior connection with oblique popliteal ligament (long arrows, D). Asterisk (B and C) indicates meniscofemoral ligament of Humphry.

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