Prevalence, Biomechanics, and Pathologies of the Meniscofemoral Ligaments: A Systematic Review

Abstract

Purpose: To systematically review the literature to examine current understanding of the meniscofemoral ligaments (MFLs), their function, their importance in clinical management, and known anatomical variants. Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, EMBASE, and Cochrane databases. Studies were included if they reported on the biomechanical, radiographic, or arthroscopic evaluation of human MFLs, or if they reported on an anatomical variant. These were then categorized as cadaveric, radiographic, or clinical. Biomechanical, radiographic, patient-reported, and functional outcomes data were recorded. Results: Forty-seven studies were included in the qualitative analysis, and 26 of them were included in the quantitative analysis. Of these, there were 15 cadaveric, 3 arthroscopic, and 9 radiographic studies that reported on the prevalence of MFLs. Overall, when looking at all modalities, the presence of either the anterior or posterior MFL (aMFL, pMFL) has been noted to be 70.8%, with it being the aMFL 17.4% and the pMFL 40.6%. The presence of both ligaments occurs in approximately 17.6% of individuals. Eleven reported on mean MFL length and thickness. When evaluating mean length in both men and women, the aMFL has been reported between 21.6 and 28.3 mm and the pMFL length in this population is between 23.4 and 31.2 mm. Five reported on cross-sectional area. Nine additional papers report anatomical variants. Conclusions: This review shows that there continues to be a variable incidence of MFLs reported in the literature, but our understanding of their function continues to broaden. A growing number of anatomic and biomechanical studies have demonstrated the importance of the MFLs in supporting knee stability. Specifically, the MFLs serve an important role in protecting the lateral meniscus and augmenting the function of the posterior cruciate ligament. Clinical Relevance: Our findings will aid the clinician in both identifying and treating pathologies of the meniscofemoral ligaments.

Intrameniscal degeneration and meniscotibial ligament loosening are associated factors with meniscal extrusion of symptomatic discoid lateral meniscus

“…The reported prevalence of an MFL is inconsistent. In their systematic review, Deckey et al reported that a posterior MFL was present in 24-86% of patients conirmed by the cadaveric study and in 11.9-78.3% in the MRI study [6]. In the present study, 22.2% of patients with symptomatic DLM did not have an MFL, but the efect on extrusion was small.…”

The “Bankart knee”: high‐grade impression fractures of the posterolateral tibial plateau lead to increased translational and anterolateral rotational instability of the ACL‐deficient knee

“…However, the stability of the LM is crucial for maintaining its biomechanical function. This is attained through bony support by the lateral tibial plateau, integrity of the meniscofemoral ligaments (MFL) and anchoring of its roots [10, 14, 18, 24]. In terms of the correlation between injuries of the LM and PLTP impression fractures, Bernholt et al [4] found an increased incidence of LM tears in patients with depressed fragment fractures (IIIB), as well as an increased incidence of lateral meniscus posterior horn and root lesions in patients with shear fragment fractures (IIIA).…”

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Knee

“…Commonly in different sports players, overuse injuries of the medial collateral ligament can ensue and cause joint instability. 19 Involvement of the meniscofemoral ligament is more frequent and dynamic examination under valgus stress would be noteworthy, especially for partial-thickness tears. Further detailed examination of this area can be done as described previously, also/especially the histological junction between the medial meniscus and the meniscofemoral or meniscotibial ligament after trauma.…”

“…Commonly in different sports players, overuse injuries of the medial collateral ligament can ensue and cause joint instability 19 . Involvement of the meniscofemoral ligament is more frequent and dynamic examination under valgus stress would be noteworthy, especially for partial-thickness tears.…”

“…The pes anserine complex is composed by the intermingling tendons of the sartorius, gracilis, and semitendinosus muscles. It inserts into the anteromedial aspect of the tibial metaphysis, 5–6 cm below the joint line 19 (Fig. 4).…”