Quantitative and Qualitative Assessment of Posterolateral Meniscal Anatomy: Defining the Popliteal Hiatus, Popliteomeniscal Fascicles, and the Lateral Meniscotibial Ligament

Abstract

Background: Surgical treatment of lateral meniscal tears can be challenging due to the greater mobility of the lateral meniscus, thin capsule, and management of the popliteal hiatus. There has been a lack of quantitative assessments of the structural attachments to the posterior horn of the lateral meniscus (PHLM) to guide repairs. Purpose: To qualitatively and quantitatively describe the anatomy of the PHLM, popliteomeniscal fascicles, and the posterolateral capsule. Study Design: Descriptive laboratory study. Methods: Fourteen male, nonpaired, fresh-frozen cadaveric knees were used. The attachments of the posterolateral capsule, popliteomeniscal fascicles, and meniscofemoral ligaments to the lateral meniscus and the attachment of the meniscotibial ligament to the tibia were identified. A 3-dimensional coordinate measuring system was used to measure the relationships of these attachments to surgically relevant landmarks and their structural relationship with the lateral meniscus. Results: The posterolateral capsule attachment had a confluent attachment at the superior margin of the PHLM, quantitatively attaching to the proximal 11% of the total height of the PHLM. On average, the length of the posterolateral capsule attachment to the superior surface of the PHLM was 16.7 ± 2.7 mm. The average length of the meniscotibial attachment to the posteroinferior aspect of the meniscus was 12.8 ± 3.9 mm. There was a lack of ligamentous attachments to the lateral meniscus between the lateral aspect of the meniscotibial ligament and the anterior aspect of the anterosuperior popliteomeniscal fascicle, where only popliteomeniscal fascicle and capsular attachments to the posterior meniscus were present. Conclusion: This anatomic study provides quantitative guidelines for the complex attachments to the PHLM. Knowledge of the quantitative descriptions of these attachments may aid in an improved intraoperative diagnosis of PHLM tears that extend to the popliteal hiatus, and further studies related to the surgical repair of the intricate attachments to the PHLM are recommended. Clinical Relevance: The findings of this study provide the anatomic foundation for an improved understanding of the role of the meniscocapsular, meniscotibial, and popliteomeniscal fascicle attachments of the posterolateral meniscus. Understanding the differences between the lengths of the superior and inferior aspects of the popliteal hiatus will help to further refine characterization of tears extending into the popliteal hiatus and to avoid potential overconstraint of the more mobile lateral meniscus during a repair by anatomically reproducing its native structural attachments.

Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 1: anatomy, biomechanics and diagnostics

“…According to a recent anatomic study, the midsubstance of the PCL appears to be flat with a mean width and thickness of approximately 13 mm and 5 mm, respectively [31]. The significantly smaller and trapezoidal-shaped tibial attachment site of the PCL covers an area of approximately 160-220 mm 2 and is in close proximity to the posterior root of the medial and lateral menisci [3,4,17]. The centre of the tibial PCL attachment is located slightly distal to the articular surface in a sulcus termed the PCL facet, which is located between the medial and lateral tibial plateau condyle at approximately 50% (measured from the medial tibial border) of the tibial plateau's total medial-lateral diameter [4,17,42,50,55,71].…”

A Modified Arthroscopic All-inside Repair for Lateral Meniscal Tears Anterior to the Popliteal Hiatus: A Retrospective Case Series with Minimum 2-Year Follow-Up

“…In 1979, Cohn was the first to report that the popliteal hiatus was a constant feature of normal knee anatomy, with an average length of 1.3 cm [13]. Similarly, Aman et al described that the mean length of superior popliteal hiatus exceeded 12.1 mm and the mean length of inferior popliteal hiatus was up to 36.9 mm [3]. It is generally considered that a meniscal tear requires surgery for better stability if the length of tear exceeds 1cm [1].…”

“…First, several important structures are immediately behind the lateral meniscus, such as popliteus tendon, inferior lateral genicular artery (ILGA), and common peroneal nerve. There is a consensus regarding the possibility of iatrogenic injury to these adjacent structures during surgical procedure [3][4][5][6][7]. Recently, Uchida et al reported that the rate of popliteus tendon injury could be as high as 94% during lateral meniscal repair anterior to the popliteal hiatus using FasT-Fix system [7].…”

“…Secondly, the joint capsule around the popliteal hiatus is quite thin. Therefore, suture knots or anchors could not be placed securely over the capsule [3]. Thirdly, the connection between the lateral meniscus and the joint capsule in this region is interrupted by popliteal hiatus, resulting in poor vascular supply and low healing rate.…”

Clinical Anatomy of the Anterior Meniscofemoral Ligament of Humphrey: An Original MRI Study, Meta-analysis, and Systematic Review

“…Together with the posterior meniscofemoral ligament (pMFL) of Wrisberg, the meniscotibial ligament, and the popliteomeniscal fascicles, these structures are responsible for the proper mobility and stabilization of the posterolateral part of the lateral meniscus. 4 However, abnormal posttraumatic hypermobility of the lateral meniscus, often associated with ACL and lateral meniscus posterior root tears that may be related to posterolateral tibial plateau fractures, is often poorly diagnosed, leading to lateral meniscal subluxation and the potential early onset of osteoarthritis. [4][5][6]16,56,57 The presence of an intact aMFL contributes to the proper biomechanical function (optimal contact area and pressure) of the lateral compartment of the knee joint and helps to maintain the correct position of the tibia in relation to the femur.…”