Radiographic identification of the primary posterolateral knee structures.
BACKGROUND
It is often difficult to identify the attachment sites of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament for chronic posterolateral knee injuries or during revision surgeries. Descriptions of radiographic landmarks for these attachment sites would assist in the intraoperative identification of their locations and also allow for postoperative assessment of the placement of reconstruction tunnels.


OBJECTIVE
Identification of qualitative and quantitative radiographic landmarks for the attachments of the main posterolateral knee structures are reproducible among observers of various experience levels and allow for improved intraoperative and postoperative identification of these attachment sites.


METHODS
Descriptive laboratory study.


METHODS
Dissections were performed on 11 cadaveric knee specimens. The attachments and locations of the investigated structures were labeled with radiopaque markers. The positions of the attachments relative to other attachment sites, labeled bony landmarks, and superimposed reference lines were quantified on anteroposterior and lateral radiographs. Measurements were performed by 3 independent examiners. Intraobserver and interobserver reliability was determined using intraclass correlation coefficients.


RESULTS
Overall intraclass correlation coefficients for intraobserver reproducibility and interobserver reliability were calculated to be 0.981 and 0.983, respectively. On the anteroposterior view, the perpendicular distances from a line intersecting the femoral condyles to the popliteus tendon, proximal fibular collateral ligament, and lateral gastrocnemius tendon were 14.5, 27.1, and 34.5 mm, respectively. On the lateral view, the femoral attachments of the fibular collateral ligament, popliteus tendon, and lateral gastrocnemius tendon were 4.3, 12.2, and 13.1 mm, respectively, from the lateral epicondyle. In addition, the fibular collateral ligament and popliteus tendon were located within 1 mm of a reference line projected along the posterior femoral cortex distally, and also were located within the posteroinferior quadrant bound by the posterior femoral cortex extension reference line and another reference line perpendicular to it at the posterior margin of Blumensaat's line.


CONCLUSIONS
Comprehensive qualitative and quantitative guidelines for assessing posterolateral knee structures on both anteroposterior and lateral knee radiographs were described.


CONCLUSIONS
This radiographic information regarding the attachment sites of posterolateral structures can serve as a valuable reference for preoperative, intraoperative, and postoperative assessments of surgical reconstructions.
Pietrini
Sean D
SD
Division of Sports Medicine and the Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota 55454, USA.
LaPrade
Robert F
RF
Griffith
Chad J
CJ
Wijdicks
Coen A
CA
Ziegler
Connor G
CG
D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D017885:Collateral Ligaments / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D004210:Dissection; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007719:Knee Joint / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D013710:Tendons / Q000033:anatomy & histology / Q000000981:diagnostic imaging*