Abstract：Objective To investigate the MRI findings of the posterolateral corner(PLC) of the normal knee joint and its clinical significance.Methods A prospective study was conducted in 16 young volunteers who were recruited from the Third Affiliated Hospital of Soochow University between May 2016 and June 2016 for MRI examination of the knee, including 9 males and 7 females, aged 22 to 30 years. There was no operative history and trauma and the physical examinations were normal on both sides of the knee. All volunteers were supine and the knee unbent with 10°-15° of slight external rotation. The MRI sequences, including conventional oblique sagittal turbo spin echo (TSE) T1WI, T2WI, and coronal, oblique sagittal and axial proton density weighted image(PDWI) sequence, were scanned for observation and the morphologic characteristics, attachment points, route, signal strength and the relationship with adjacent structures of the posterolateral corner of the knee, which was composed of fibular collateral ligament, popliteal tendon, popliteofibular ligament, fabellofibular ligament and arcuate ligament were analyzed.Results The specific components of the posterolateral corner of the normal knee that could be clearly identified on PDWI included the fibular collateral ligament, popliteus tendon, popliteofibular ligament, arcuate ligament and fabellofibular ligament. Meanwhile, the displaying rate was 100%(32/32), 100%(32/32), 87.5%(28/32), 81.3%(26/32) and 37.5%(12/32), respectively.The location and route of the fibular collateral ligament was fixed, and this ligament was on average (50.88±4.72) mm in length and, (4.72±0.33) mm in width of the midpoint and (2.55±0.40) mm in thickness.The popliteal tendon was (45.31±1.66) mm in length, (3.15±0.26) mm in thickness and (3.26±0.39) mm in width at the popliteal hiatus. The popliteofibular ligament was (11.66±0.78) mm in length, (3.24±0.32) mm in width of the midpoint and (1.24±0.11) mm in thickness. The display rate of arcuate ligament and fabellofibular ligament was not high in MRI, and appeared with some variability in attachment point, size, morphologic characteristics due to individual differences. There was no significant difference in the length, width and thickness of the fibular collateral ligament,popliteus tendon, popliteofibular ligament between both sides of the knee (all P values>0.05), while there was significant difference in the length and thickness of the fibular collateral ligament as well as the length and width of the popliteal tendon between males and females (all P values<0.05).Conclusions Being familiar with the anatomy and the normal magnetic resonance of PLC is helpful to discover the subtle abnormal changes and improve the radiologists' ability for diagnosing the PLC injuries.
孙玲玲, 邢伟, 陈杰, 丁玖乐, 田小娟, 陈蕾. 正常膝关节后外侧角MRI表现[J]. 中华解剖与临床杂志, 2017, 22(6): 441-447.
Sun Lingling,Xing Wei,Chen Jie,Ding Jiule,Tian Xiaojuan,Chen Lei. MRI of the posterolateral corner of the normal knee. Chinese Journal of Anatomy and Clinics, 2017, 22(6): 441-447.
Barker RP, Lee JC, Healy JC. Normal sonographic anatomy of the posterolateral corner of the knee[J]. AJR Am J Roentgenol, 2009, 192(1): 73-79. DOI:10.2214/AJR.07.3743
[2]
Baker CL Jr, Norwood LA, Hughston JC. Acute posterolateral rotatory instability of the knee[J]. J Bone Joint Surg Am, 1983, 65(5): 614-618. DOI:10.1177/036354658301100403
Vinson EN, Major NM, Helms CA. The posterolateral corner of the knee[J]. AJR Am J Roentgenol, 2008, 190(2): 449-458. DOI:10.2214/AJR.07.2051
[5]
Larsen MW, Toth A. Examination of posterolateral corner injuries[J]. J Knee Surg, 2005, 18(2): 146-150. DOI:10.1055/s-0030-1248173
[6]
Sarkar PS, Swamy A, Saxena D, et al. MRI of posterolateral corner complex injuries of knee and why it should be included in reporting formats[J]. Inter J Orthops Sci, 2017, 3(1e): 275-277. DOI:10.22271/ortho.2017.v3.i1e.43
[7]
Kim SJ, Choi DH, Hwang BY. The influence of posterolateral rotatory instability on ACL reconstruction: comparison between isolated ACL reconstruction and ACL reconstruction combined with posterolateral corner reconstruction[J]. J Bone Joint Surg Am, 2012, 94(3): 253-259. DOI:10.2106/JBJS.J.01686
Kennedy NI, Laprade CM, Laprade RF. Surgical management and treatment of the anterior cruciate ligament/posterolateral corner injured knee[J]. Clinics in sports medicine, 2016, 36(1): 105. DOI:10.1016/j.csm.2016.08.011
[11]
Harner CD, Giffin JR, Vogrin TM, et al. Anatomy and biomechanics of the posterior cruciate ligament and posterolateral corner[J]. Operative Techniques in Sports Medicine, 2001, 9(2): 39-46.DOI:10.1053/otsm.2001.21759
[12]
LaPrade RF, Hamilton CD, Engebretsen Lars 3rd. Treatment or acute and chronic combined anterior cruciate ligament and posterolateral knee ligament injuries [J]. Sports Medicine and Arthroscopy Review, 1997, 5(2): 110-121.DOI:10.1097/00132585-199700520-00002
[13]
Moorman CT 3rd, LaPrade RF. Anatomy and biomechanics of the posterolateral corner of the knee[J]. J Knee Surg, 2005, 18(2): 137-145. DOI:10.1055/s-0030-1248172
[14]
Zantop T, Schumacher T, Diermann N, et al. Anterolateral rotational knee instability: role of posterolateral structures. Winner of the AGA-Don Joy Award 2006[J]. Arch Orthop Trauma Surg, 2007, 127(9): 743-752. DOI:10.1007/s00402-006-0241-3
[15]
LaPrade RF, Terry GC. Injuries to the posterolateral aspect of the knee. Association of anatomic injury patterns with clinical instability[J]. Am J Sports Med, 1997, 25(4): 433-438. DOI:10.1177/036354659702500403
Ferrari DA, Wilson DR, Hayes WC. The effect of release of the popliteus and quadriceps force on rotation of the knee[J]. Clin Orthop Relat Res, 2003(412): 225-233. DOI:10.1097/01.blo.0000071752.41516.6e
[18]
Brown TR, Quinn SF, Wensel JP, et al. Diagnosis of popliteus injuries with MR imaging[J]. Skeletal Radiol, 1995, 24(7): 511-514. DOI:10.1007/bf00202148
[19]
Stubli HU, Birrer S. The popliteus tendon and its fascicles at the popliteal hiatus: gross anatomy and functional arthroscopic evaluation with and without anterior cruciate ligament deficiency[J]. Arthroscopy, 1990, 6(3): 209-220.DOI:10.1016/0749-8063(90)90077-q
Wadia FD, Pimple M, Gajjar SM, et al. An anatomic study of the popliteofibular ligament[J]. Int Orthop, 2003, 27(3): 172-174. DOI:10.1007/s00264-003-0445-x
[22]
Rosas HG. Unraveling the posterolateral corner of the knee[J]. Radiographics, 2016, 36(6): 1776-1791. DOI:10.1148/rg.2016160027
Raheem O, Philpott J, Ryan W, et al. Anatomical variations in the anatomy of the posterolateral corner of the knee[J]. Knee Surg Sports Traumatol Arthrosc,2007, 15(7): 895-900. DOI:10.1007/s00167-007-0301-4
[25]
Thaunat M, Pioger C, Chatellard R, et al. The arcuate ligament revisited: role of the posterolateral structures in providing static stability in the knee joint[J]. Knee Surg Sports Traumatol Arthrosc,2014, 22(9): 2121-2127. DOI:10.1007/s00167-013-2643-4
[26]
LaPrade RF, Gilbert TJ, Bollom TS, et al. The magnetic resonance imaging appearance of individual structures of the posterolateral knee. A prospective study of normal knees and knees with surgically verified grade III injuries[J]. Am J Sports Med, 2000, 28(2): 191-199. DOI:10.1177/03635465000280020901
[27]
Covey DC. Injuries of the posterolateral corner of the knee[J]. J Bone Joint Surg Am, 2001, 83-A(1): 106-118. DOI:10.2106/00004623-200101000-00015
[28]
Hansford BG, Yablon CM. Multiligamentous injury of the knee: MRI diagnosis and injury patterns[J]. Semin Musculoskelet Radiol, 2017, 21(2): 63-74. DOI:10.1055/s-0037-1599208
2017, Vol. 22 
