Semin Musculoskelet Radiol 2016; 20(01): 012-025
DOI: 10.1055/s-0036-1579710
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Medial and Posteromedial Ligamentous and Capsular Structures of the Knee: Review of Anatomy and Relevant Imaging Findings

Roar R. Pedersen
1   Department of Radiology, Curato Røntgen Porsgrunn, Porsgrunn, Norway
› Author Affiliations
Further Information

Publication History

Publication Date:
14 April 2016 (online)

Abstract

The medial and posteromedial regions of the knee are important for knee stability but also frequently injured. Medial ligaments and capsule are primary and secondary stabilizers of valgus, rotation, and anterior and posterior translation. In the setting of rupture of the cruciate ligaments, it is important to identify injuries in this region because it can possibly alter the treatment strategy and even delay or prevent successful reconstruction of the cruciate ligaments. Injuries may occur to the superficial and deep medial collateral ligament, the posterior oblique ligament, the posteromedial capsule, and the semimembranosus tendon and its attachments. Meniscocapsular separation is associated with these injuries, and if normal movement of the meniscus and tension of the capsule and ligaments is altered, instability and eventually osteoarthritis may occur. Injuries to the posteromedial corner may be underdiagnosed. This article reviews the anatomy and imaging findings in the medial and posteromedial regions of the knee.

 
  • References

  • 1 Phisitkul P, James SL, Wolf BR, Amendola A. MCL injuries of the knee: current concepts review. Iowa Orthop J 2006; 26: 77-90
  • 2 De Maeseneer M, Van Roy F, Lenchik L, Barbaix E, De Ridder F, Osteaux M. Three layers of the medial capsular and supporting structures of the knee: MR imaging-anatomic correlation. Radiographics 2000; 20 (Spec No) S83-S89
  • 3 Geiger D, Chang E, Pathria M, Chung CB. Posterolateral and posteromedial corner injuries of the knee. Radiol Clin North Am 2013; 51 (3) 413-432
  • 4 Miller TT. Imaging of the medial and lateral ligaments of the knee. Semin Musculoskelet Radiol 2009; 13 (4) 340-352
  • 5 De Maeseneer M, Shahabpour M, Vanderdood K, Van Roy F, Osteaux M. Medial meniscocapsular separation: MR imaging criteria and diagnostic pitfalls. Eur J Radiol 2002; 41 (3) 242-252
  • 6 Loredo R, Hodler J, Pedowitz R, Yeh LR, Trudell D, Resnick D. Posteromedial corner of the knee: MR imaging with gross anatomic correlation. Skeletal Radiol 1999; 28 (6) 305-311
  • 7 Wijdicks CA, Griffith CJ, Johansen S, Engebretsen L, LaPrade RF. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg Am 2010; 92 (5) 1266-1280
  • 8 Robinson JR, Sanchez-Ballester J, Bull AMJ, Thomas Rde W, Amis AA. The posteromedial corner revisited. An anatomical description of the passive restraining structures of the medial aspect of the human knee. J Bone Joint Surg Br 2004; 86 (5) 674-681
  • 9 De Maeseneer M, Shahabpour M, Lenchik L , et al. Distal insertions of the semimembranosus tendon: MR imaging with anatomic correlation. Skeletal Radiol 2014; 43 (6) 781-791
  • 10 Petersen W, Loerch S, Schanz S, Raschke M, Zantop T. The role of the posterior oblique ligament in controlling posterior tibial translation in the posterior cruciate ligament-deficient knee. Am J Sports Med 2008; 36 (3) 495-501
  • 11 LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L. The anatomy of the medial part of the knee. J Bone Joint Surg Am 2007; 89 (9) 2000-2010
  • 12 Bonasia DE, Bruzzone M, Dettoni F , et al. Treatment of medial and posteromedial knee instability: indications, techniques, and review of the results. Iowa Orthop J 2012; 32: 173-183
  • 13 Schein A, Matcuk G, Patel D , et al. Structure and function, injury, pathology, and treatment of the medial collateral ligament of the knee. Emerg Radiol 2012; 19 (6) 489-498
  • 14 Sims WF, Jacobson KE. The posteromedial corner of the knee: medial-sided injury patterns revisited. Am J Sports Med 2004; 32 (2) 337-345
  • 15 Norris MA. Posteromedial corner injury of the knee. Radsource Web Clinic April 2011. Available at: http://radsource.us/posteromedial-corner-injury-of-the-knee/ . Assessed October 12, 2015
  • 16 Beall DP, Googe JD, Moss JT , et al. Magnetic resonance imaging of the collateral ligaments and the anatomic quadrants of the knee. Magn Reson Imaging Clin N Am 2007; 15 (1) 53-72
  • 17 LaPrade RF, Morgan PM, Wentorf FA, Johansen S, Engebretsen L. The anatomy of the posterior aspect of the knee. An anatomic study. J Bone Joint Surg Am 2007; 89 (4) 758-764
  • 18 Beltran J, Matityahu A, Hwang K , et al. The distal semimembranosus complex: normal MR anatomy, variants, biomechanics and pathology. Skeletal Radiol 2003; 32 (8) 435-445
  • 19 Thawait SK, Soldatos T, Thawait GK, Cosgarea AJ, Carrino JA, Chhabra A. High resolution magnetic resonance imaging of the patellar retinaculum: normal anatomy, common injury patterns, and pathologies. Skeletal Radiol 2012; 41 (2) 137-148
  • 20 Marchant Jr MH, Tibor LM, Sekiya JK, Hardaker Jr WT, Garrett Jr WE, Taylor DC. Management of medial-sided knee injuries, part 1: medial collateral ligament. Am J Sports Med 2011; 39 (5) 1102-1113
  • 21 Robinson JR, Bull AMJ, Thomas Rde W, Amis AA. The role of the medial collateral ligament and posteromedial capsule in controlling knee laxity. Am J Sports Med 2006; 34: 11
  • 22 Lundquist RB, Matcuk Jr GR, Schein AJ , et al. Posteromedial corner of the knee: the neglected corner. Radiographics 2015; 35 (4) 1123-1137
  • 23 De Maeseneer M, Shahabpour M, Pouders C. MRI spectrum of medial collateral ligament injuries and pitfalls in diagnosis. JBR-BTR 2010; 93 (2) 97-103
  • 24 Wegmann H, Tschauner S, Singer G, Marterer R, Eberl R, Sorantin E. The pediatric knee: diagnosis and management of ligament injuries. Semin Musculoskelet Radiol 2014; 18 (5) 489-497
  • 25 Bergin D, Keogh C, O'Connell M , et al. Atraumatic medial collateral ligament oedema in medial compartment knee osteoarthritis. Skeletal Radiol 2002; 31 (1) 14-18
  • 26 McAnally JL, Southam SL, Mlady GW. New thoughts on the origin of Pellegrini-Stieda: the association of PCL injury and medial femoral epicondylar periosteal stripping. Skeletal Radiol 2009; 38 (2) 193-198
  • 27 Mendes LFA, Pretterklieber ML, Cho JH, Garcia GM, Resnick DL, Chung CB. Pellegrini-Stieda disease: a heterogeneous disorder not synonymous with ossification/calcification of the tibial collateral ligament-anatomic and imaging investigation. Skeletal Radiol 2006; 35 (12) 916-922
  • 28 McAnally JL, Eberhardt SC, Mlady GW, Fitzpatrick J, Bosch P. Medial collateral ligament tear entrapped within a proximal tibial physeal separation: imaging findings and operative reduction. Skeletal Radiol 2008; 37 (10) 943-946
  • 29 Patel JJ. Intra-articular entrapment of the medial collateral ligament: radiographic and MRI findings. Skeletal Radiol 1999; 28 (11) 658-660
  • 30 Hall FM, Hochman MG. Medial Segond-type fracture: cortical avulsion off the medial tibial plateau associated with tears of the posterior cruciate ligament and medial meniscus. Skeletal Radiol 1997; 26 (9) 553-555
  • 31 Engelsohn E, Umans H, Difelice GS. Marginal fractures of the medial tibial plateau: possible association with medial meniscal root tear. Skeletal Radiol 2007; 36 (1) 73-76
  • 32 Chang EY, Chen KC, Chung CB. The shiny corner of the knee: a sign of meniscal osteochondral unit dysfunction. Skeletal Radiol 2014; 43 (10) 1403-1409
  • 33 Lerer DB, Umans HR, Hu MX, Jones MH. The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion. Skeletal Radiol 2004; 33 (10) 569-574
  • 34 Moosikasuwan JB, Miller TT, Math K, Schultz E. Shifting bone marrow edema of the knee. Skeletal Radiol 2004; 33 (7) 380-385
  • 35 De Maeseneer M, Van Roy P, Shahabpour M, Gosselin R, De Ridder F, Osteaux M. Normal anatomy and pathology of the posterior capsular area of the knee: findings in cadaveric specimens and in patients. AJR Am J Roentgenol 2004; 182 (4) 955-962
  • 36 Khoshnoodi P, Tehranzadeh AD, Dunn JM, Tehranzadeh J. Semimembranosus tendon avulsion fracture of the posteromedial tibial plateau associated with posterior cruciate ligament tear and capsular rupture. Skeletal Radiol 2014; 43 (2) 239-242
  • 37 Bergmann G. Proximal gastrocnemius tendon pathology. Radsource Web Clinic September 2013. Available at: http://radsource.us/proximal-gastrocnemius-tendon-pathology/ Assessed October 12, 2015
  • 38 McKnight A, Southgate J, Price A, Ostlere S. Meniscal tears with displaced fragments: common patterns on magnetic resonance imaging. Skeletal Radiol 2010; 39 (3) 279-283
  • 39 Rennie WJ, Saifuddin A. Pes anserine bursitis: incidence in symptomatic knees and clinical presentation. Skeletal Radiol 2005; 34 (7) 395-398
  • 40 Fenn S, Datir A, Saifuddin A. Synovial recesses of the knee: MR imaging review of anatomical and pathological features. Skeletal Radiol 2009; 38 (4) 317-328
  • 41 Simeone FJ, Huang AJ, Chang CY , et al. Posteromedial knee friction syndrome: an entity with medial knee pain and edema between the femoral condyle, sartorius and gracilis. Skeletal Radiol 2015; 44 (4) 557-563
  • 42 de Abreu MR, Falcão M, Sprinz C, Furian R, Marczyk LR. Adhesive capsulitis of the knee. Skeletal Radiol 2013; 42 (5) 741-746