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Communication Between the Proximal Tibiofibular Joint and Knee via the Subpopliteal Recess: MR Arthrography with Histologic Correlation and Stratigraphic Dissection

¹ Department of Radiology, University of California, San Diego, VA San Diego Healthcare System, San Diego, CA 92161.
² Present address: Department of Radiology, Atatürk State Teaching Hospital, 69 sok. No: 33 A Blok, Daire: 17 Uckuyular/Izmir, Turkey 35350.
³ Department of Applied Anatomy, Center of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Left knee from cadaver of 79-year-old man. From lateral (A) to medial (D) views, serial sagittal T1-weighted spin-echo MR images (TR/TE, 550/20) obtained after injection of gadolinium-containing contrast material in cadaveric knee specimen show contrast material in proximal tibiofibular joint (TFJ) cavity (open arrow, B–D), which indicates communication between proximal TFJ and knee joint. Defect in medial part of posterior ligament of fibular head (solid white arrows) and subpopliteal recess (black arrow, D) are also seen. T = tibia, F = fibula.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Left knee from cadaver of 79-year-old man. From lateral (A) to medial (D) views, serial sagittal T1-weighted spin-echo MR images (TR/TE, 550/20) obtained after injection of gadolinium-containing contrast material in cadaveric knee specimen show contrast material in proximal tibiofibular joint (TFJ) cavity (open arrow, B–D), which indicates communication between proximal TFJ and knee joint. Defect in medial part of posterior ligament of fibular head (solid white arrows) and subpopliteal recess (black arrow, D) are also seen. T = tibia, F = fibula.

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Left knee from cadaver of 79-year-old man. From lateral (A) to medial (D) views, serial sagittal T1-weighted spin-echo MR images (TR/TE, 550/20) obtained after injection of gadolinium-containing contrast material in cadaveric knee specimen show contrast material in proximal tibiofibular joint (TFJ) cavity (open arrow, B–D), which indicates communication between proximal TFJ and knee joint. Defect in medial part of posterior ligament of fibular head (solid white arrows) and subpopliteal recess (black arrow, D) are also seen. T = tibia, F = fibula.

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Left knee from cadaver of 79-year-old man. From lateral (A) to medial (D) views, serial sagittal T1-weighted spin-echo MR images (TR/TE, 550/20) obtained after injection of gadolinium-containing contrast material in cadaveric knee specimen show contrast material in proximal tibiofibular joint (TFJ) cavity (open arrow, B–D), which indicates communication between proximal TFJ and knee joint. Defect in medial part of posterior ligament of fibular head (solid white arrows) and subpopliteal recess (black arrow, D) are also seen. T = tibia, F = fibula.

View larger version (213K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —Left knee from cadaver of 79-year-old man. Anatomic photograph of cadaveric knee specimen shows defect within posterior ligament of fibular head (black arrows) that led to communication between proximal TFJ (white arrow) and knee joint via subpopliteal recess (arrowheads). P = popliteal tendon, F = fibula, T = tibia.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Knee from cadaver of 74-year-old woman. From lateral (A) to medial (C) views, serial sagittal T1-weighted spin-echo MR images (TR/TE, 550/20) obtained after injection of gadolinium-containing contrast material in cadaveric knee specimen show intact posterior ligament of fibular head (arrow), subpopliteal recess (arrowhead), tibia (T), and fibula (F).

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Knee from cadaver of 74-year-old woman. From lateral (A) to medial (C) views, serial sagittal T1-weighted spin-echo MR images (TR/TE, 550/20) obtained after injection of gadolinium-containing contrast material in cadaveric knee specimen show intact posterior ligament of fibular head (arrow), subpopliteal recess (arrowhead), tibia (T), and fibula (F).

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Knee from cadaver of 74-year-old woman. From lateral (A) to medial (C) views, serial sagittal T1-weighted spin-echo MR images (TR/TE, 550/20) obtained after injection of gadolinium-containing contrast material in cadaveric knee specimen show intact posterior ligament of fibular head (arrow), subpopliteal recess (arrowhead), tibia (T), and fibula (F).

View larger version (161K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —Knee from cadaver of 74-year-old woman. Anatomic photograph of cadaveric knee specimen shows intact posterior ligament of fibular head (arrow), subpopliteal recess (arrowheads), popliteal tendon (P), tibia (T), and fibula (F).

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —Knee from cadaver of 74-year-old woman. Photomicrograph of histologic section shows intact posterior ligament of fibular head (straight arrow), subpopliteal recess (arrowheads), popliteofibular ligament (curved arrow), popliteal tendon (P), cavity of knee joint (KJ), cavity of proximal tibiofibular joint (PTFJ), tibia (T), and fibula (F). (H and E, original magnification)

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Right knee from cadaver of 79-year-old man. Sagittal T1-weighted spin-echo MR image (TR/TE, 550/20) with fat suppression obtained after injection of gadolinium-containing contrast material in cadaveric knee specimen shows popliteal hiatus (arrowheads), subpopliteal recess (arrows), popliteal tendon (P), femur (FM), lateral meniscus (LM), tibia (T), and fibula (F).

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Right knee from cadaver of 79-year-old man. Anatomic photograph of cadaveric knee specimen shows subpopliteal recess (arrows), anteroinferior popliteomeniscal fascicle (arrowheads), lateral meniscus (LM), popliteal tendon (P), femur (FM), tibia (T), and fibula (F).

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Right knee from cadaver of 79-year-old man. Coronal T1-weighted spin-echo MR image (550/20) with fat suppression obtained after injection of gadolinium-containing contrast material in cadaveric knee specimen shows popliteal hiatus (black arrowheads), subpopliteal recess (straight arrow), anteroinferior (curved arrow) and posterosuperior (white arrowhead) popliteomeniscal fascicles, popliteal tendon (P), lateral meniscus (LM), femur (FM), tibia (T), and fibula (F).

View larger version (171K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Knee from cadaver of 90-year-old woman. Anatomic photograph of cadaveric knee specimen shows ruptured anteroinferior popliteomeniscal fascicle (arrows), lateral meniscus (LM), popliteal tendon (P), femur (FM), tibia (T), and fibula (F).

View larger version (159K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Knee from cadaver of 90-year-old woman. Lateral (B) and medial (C) serial sagittal T1-weighted spin-echo MR images (TR/TE, 550/20) obtained after injection of gadolinium-containing contrast material in cadaveric knee specimen show ruptured anteroinferior popliteomeniscal fascicle (arrow, B), detachment of popliteofibular ligament from fibular head (arrowhead, B), ruptured posterior ligament of fibular head (arrowheads, C) which led to communication (arrow, C) between knee joint and proximal tibiofibular joint, lateral meniscus (LM, B), popliteal tendon (P, B), femur (FM, B), tibia (T), and fibula (F).

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Knee from cadaver of 90-year-old woman. Lateral (B) and medial (C) serial sagittal T1-weighted spin-echo MR images (TR/TE, 550/20) obtained after injection of gadolinium-containing contrast material in cadaveric knee specimen show ruptured anteroinferior popliteomeniscal fascicle (arrow, B), detachment of popliteofibular ligament from fibular head (arrowhead, B), ruptured posterior ligament of fibular head (arrowheads, C) which led to communication (arrow, C) between knee joint and proximal tibiofibular joint, lateral meniscus (LM, B), popliteal tendon (P, B), femur (FM, B), tibia (T), and fibula (F).

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —Knee from cadaver of 90-year-old woman. Sagittal T1-weighted spin-echo MR image (550/20) with fat suppression obtained after injection of gadolinium-containing contrast material in cadaveric knee specimen shows ruptured posteroinferior popliteomeniscal fascicle (solid arrow), ruptured posterior ligament of fibular head (arrowheads) that led to communication (open arrow) between knee joint and proximal tibiofibular joint, lateral meniscus (LM), femur (FM), tibia (T), and fibula (F).

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4E —Knee from cadaver of 90-year-old woman. Photomicrograph of histologic section shows curved appearance of margin of ruptured posterior ligament of fibular head (arrowheads), which indicates posttraumatic fibrosis, and degenerative cystic changes in ruptured ligament (arrows). (H and E, x10)

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Dissection photos of embalmed knee specimens. Photograph of embalmed knee specimen, posterior aspect, of 77-year-old man. Subpopliteal recess has been opened by carefully mobilizing popliteus muscle. Note strong posterior ligament of fibular head (probe) lined with synovial membrane separating subpopliteal recess (SR) from proximal tibiofibular joint (TFJ). F = fibular head, P = popliteus muscle, asterisk = popliteal hiatus.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Dissection photos of embalmed knee specimens. Photograph of embalmed knee specimen of 78-year-old man shows total dehiscence of posterior ligament of fibular head. Probe shows open communication between proximal TFJ and subpopliteal recess. P = popliteus muscle, asterisk = popliteal hiatus.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —Dissection photos of embalmed knee specimens. Photograph of embalmed knee specimen, posterior view, of 80-year-old woman. Note stain emerging from proximal TFJ via very thin and translucent membrane incompletely separating subpopliteal recess from proximal TFJ. Posterior ligament of fibular head is absent. F = fibular head, P = popliteus muscle.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —Embalmed knee specimen, lateral aspect, of 75-year-old man. Note different position of fibular head during dorsiflexion (A) and plantarflexion (B) of foot indicating functional significance of proximal tibiofibular joint, guaranteeing full range of movement in talocrural joint. In lateral rotation of fibula accompanying dorsiflexion of ankle, posterior ligament of fibular head is relaxed, whereas it becomes gradually taut during medial rotation of fibula which, in turn, occurs in plantarflexion of ankle.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —Embalmed knee specimen, lateral aspect, of 75-year-old man. Note different position of fibular head during dorsiflexion (A) and plantarflexion (B) of foot indicating functional significance of proximal tibiofibular joint, guaranteeing full range of movement in talocrural joint. In lateral rotation of fibula accompanying dorsiflexion of ankle, posterior ligament of fibular head is relaxed, whereas it becomes gradually taut during medial rotation of fibula which, in turn, occurs in plantarflexion of ankle.

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