The effect of isolated popliteus tendon complex injury on graft force in anterior cruciate ligament reconstructed knees

Abstract

Failure to diagnose injury to the posterolateral structures has been found to increase the forces experienced by the anterior cruciate ligament (ACL) and ACL grafts which may cause their subsequent failure. An isolated injury to the popliteus complex (PC) consisting of the popliteus tendon and popliteofibular ligament is not uncommon. Therefore, the purpose of this study was to discover if an isolated injury to the PC can significantly affect the forces experienced by the ACL graft under external loading conditions. We hypothesised that, under external tibial torque, the ACL graft will experience a significant increase in force, in knees with PC injury compared to the intact PC condition. Under varus tibial torque (10 N m), we observed minimal changes in the varus tibial rotation due to isolated sectioning of the PC in an ACL reconstructed knee (P> 0.05). Consequently, no significant increase in the ACL graft force was observed under varus tibial torque. In contrast, sectioning the PC resulted in a significant increase in the external tibial rotation compared to the intact PC knee condition under the external rotational tibial torque (5 N m) at all flexion angles (P<0.05). These changes in kinematics under external tibial torque were manifested as elevated ACL graft forces at all selected flexion angles (P<0.05). Prompt diagnosis of isolated PC injury and its treatment are warranted to prevent potential failure of ACL reconstruction.

Anatomic study of popliteus complex of the knee in a Chinese population

“…The structures of the PLS can be divided into two primary components: the lateral collateral ligament (LCL) and the popliteus complex (PC; Ullrich et al 2002;Zantop et al 2007;Gadikota et al 2010;Jung et al 2010;Yang et al 2011). The PC consists of the popliteus muscletendon unit, i.e., the popliteus tendon (PT), and the ligamentous connections between PT on one hand, and the fibula and meniscus on the other hand, i.e., the popliteofibular ligament (PFL) and popliteomeniscal fascicles (Ullrich et al 2002;Zantop et al 2007).…”

“…To better understand this complex area, many investigations have attempted to define the quantitative anatomy and specific function of PC through laboratory, radiographic, and surgical studies(Pasque et al 2003;LaPrade et al 2003;Wadia et al 2003;Ishigooka et al 2004;Moorman and LaPrade 2005;Gadikota et al 2010;Jung et al 2010;Yang et al 2011). These fundamental studies have demonstrated that the PC consists of the popliteus muscle-tendon unit, PFL and the popliteomeniscal fascicles(Ullrich et al 2002;Zantop et al 2007).…”

“…Haslam and Bickerstaff 2007;Jung et al 2008;McCarthy et al 2010;Gadikota et al 2010). To better understand this complex area, many investigations have attempted to define the quantitative anatomy and specific function of PC through laboratory, radiographic, and surgical studies(Pasque et al 2003;LaPrade et al 2003;Wadia et al 2003;Ishigooka et al 2004;Moorman and LaPrade 2005;Gadikota et al 2010;Jung et al 2010;Yang et al 2011).…”

“…These fundamental studies have demonstrated that the PC consists of the popliteus muscle-tendon unit, PFL and the popliteomeniscal fascicles(Ullrich et al 2002;Zantop et al 2007). The PT, which functions as the fifth major ligament of the knee, and the PFL are the two key structures of the PC(Ullrich et al 2002;LaPrade et al 2003;Zantop et al 2007;Gadikota et al 2010;LaPrade et al 2010). In agreement with previous literature(LaPrade et al 2003;Raheem et al 2007;Gadikota et al 2010;Jung et al 2010;Yang et al 2011)…”

Anatomical Reconsideration of the Lateral Collateral Ligament in the Human Knee: Anatomical Observation and Literature Review

“…The lateral patellofemoral ligament, popliteus tendon, popliteofibular ligament, and fabellofibular ligament have all been described in detail [3,[9][10][11][12][13]], but to date descriptions of the attachments of the LCL remain incomplete in the published literature.…”