POPLITEUS MUSCLE COMPLEX OF THE KNEE. D, Intact posterior cruciate ligament. The literature describes a few case reports of bilateral accessory popliteus muscle, a rare variant of the popliteus muscle. UW MSK resident projects: popliteus muscle injury. . During the examination, patients present tenderness at the lateral epicondyle of the femur, along the popliteus, and at its insertion. Anterior Bursae. As the tendon runs posteriorly and distally behind the knee, it gives off 3 fascicles that attach to and stabilize the lateral meniscus. Tenderness when pressing on the back of the knee area . Popliteus has three basic motions: flexing the knee, laterally rotating the upper leg on the lower leg when the foot is planted, and medially rotating the lower leg under the upper leg. These "cystic lesions" may be related to bursae, cysts, or other cyst-like lesions and could be soft tissue or intraosseous in origin. Popliteofibular ligament and popliteus tendon - the tibial insertion of the popliteus tendon was made through an anterior-posterior tunnel, 5 mm below the center point of Gerdy's tubercle, with a 7-mm drill, ending 15 mm from the intra-articular line in the posterior region of the tibia. As referenced earlier, LaPrade and associates 26 reported that the popliteus inserted an average of 18.5 mm from the FCL on the femur. Introduction. Burstein DB, Fischer DA. The capsular attachments are intact. MR Imaging Pitfalls On T2-weighted images, a fluid-filled popliteus bursa appears as a well-defined area of high sig-nal intensity surrounding the popliteus muscle and tendon (Fig 6). C, Intact LCL. 2-4). Popliteus Tendon Tear. B, Calcified popliteus tendon with a lack of continuity on axial image. The popliteus muscle originates from the popliteal saddle on the lateral femoral condyle. Inserting just posterior to the LCL This deformity might reflect the proximity of the fibular collateral ligament attachment to the distal femoral physis. Lateral condyle of tibia. Hip Imaging in Athletes: Sports Imaging Series. Ultrasound-guided aspiration of symptomatic ganglion cysts about peripheral joints is a valuable and routinely performed therapeutic modality. Three-dimensional images were created, and the surface area . The green arrow on image 1 indicates the popliteus muscle (there is a mytotendinous strain in this case), and the red arrows on image 2 point to the arcuate ligament (there is an arcuate ligament tear with fluid leaking from the joint capsule). It arises by a strong tendon about 2.5 cm. Diyaa Abdul Rauf Algazwi From the Radiology Department, Dammam Medical Complex, Dammam, Saudi Arabia (DARA); and National University Health System, Singapore (DARA, QST, GLE, ESE, VSYT, JTPDH). Moreover, it was found that the centre of the femoral insertion of the popliteus muscle-tendon complex is situated posterior and distal to the lateral epicondyle The extra-articular segment of the tendon quickly joins its muscle belly, which in turn attaches to the posteromedial proximal tibial surface. It takes origin from the posterior surface of proximal medial tibia, extends via the popliteus hiatus, and inserts into the posterior horn of lateral meniscus and lateral margin of lateral femoral condyle. The popliteus tendon ascends the posterolateral corner of the knee in a superolateral direction, running through the popliteal hiatus deep to the arcuate and fabellofibular ligaments. Popliteus muscle injuries seldom occur in isolation and are an important ancillary finding of internal derangement of the knee joint. Figure 4: Normal medial gastrocnemius tendon and myotendinous region in 21 year-old male. The current results combined with those from previous studies suggest that the popliteus tendon and popliteofibular ligament act as a unit to resist external rotation. The popliteus muscle originates from the lateral surface of the lateral condyle of the femur by a rounded tendon. The iliotibial band also contributes to knee stability in varus and extension. 1990;6(3):238-241. In about 80% of the cases, bursae are characterized by a thin septum 1.. As the other bursae of the knee, it is a synovial-lined structure and usually collapsed 2 and may . Lies deep to the LCL on the femur. Purpose To clarify the femoral insertion of the lateral collateral ligament (LCL) and popliteus tendon (PT) and related osseous landmarks on three-dimensional images. Origin: Anterior part of the popliteal groove on lateral surface of lateral femoral condyle. epiphysis at the site of popliteus tendon insertion with partial lateral collateral ligament involvement. Additionally, the patient reported mild . Nonoperative . The popliteus tendon originates on the anterior aspect of the popliteus groove just anterior and inferior to the origin of the lateral collateral ligament and extends inferiorly and medially to insert on the posterior medial aspect of the tibia (Fig. Tibialis Posterior. 4 Most popliteus tendon injuries are femoral attachment peel-off injuries or musculotendinous junction avulsions. Arise from the anterior part of the popliteal grove on the lateral surface of the condyle of the femur. They are mostly benign lesions; however, not all hypoechoic or T2 . The popliteus tendon provides static and dynamic stabilization to the knee during posterolateral rotation. It inserts on the back of the shinbone, or tibia, and runs . A multifactorial electromyographic study. It is a component of the posterolateral corner of the knee and acts as a major stabilizer of the posterolateral knee. There is no chondromalacia or other arthropathy in the lateral compartment. This might result of a concomitant avulsion Oval tendon similar in appearance to the bicep in the shoulder. 3 and 4).1,2,3 Trace fluid is normal in the deep infrapatellar bursa; bursitis The popliteus muscle extends over the posterior aspect of the knee joint.It originates from the femur and the posterior horn of the lateral . However, the ALL appeared loose. For the popliteus muscle, some of these main symptoms that may be present in the event of a strain or tear: Pain in the back of the knee. It courses through the popliteal hiatus of the coronary ligament and inserts on the posterior tibia under the tibial condyles (1). • Flores et al. Anterior translation of the fe-mur with respect to the tibia accompanied by rotation during knee flexion is thought to be the mechanism of injury. Popliteus muscle (Musculus popliteus) The popliteus muscle is a small muscle that forms the floor of the popliteal fossa.It belongs to the deep posterior leg muscles, along with tibialis posterior, flexor digitorum longus and flexor hallucis longus.. A popliteus tendon and fibular collateral ligament avulsion injury has been reported in one conservatively managed case to cause growth disturbance and severe valgus deformity requiring a wedge osteotomy . . These imaging findings are identical to the case first reported by Duc et al. The popliteus muscle is unremarkable. Isolated popliteal tendon avulsion, Pediatric Radiology ,vol. (B) Arthroscopic view of popliteus tendon (black arrow) and sheath . The common femoral insertion was made 5 mm anterior and . Four cases of isolated popliteus tendon avulsion in skeletally immature patients that presented to our institution over an 11 month period are reviewed. Origin & Insertion. insertion, rather than the medial meniscus and its posterior medial meniscal root. 2003;37(4):358-360. In summary, the arcuate sign, which can be seen on standard anteroposterior radiographs of the knee, is useful in diagnosing trauma to the posterolateral corner of the knee. Isolated Popliteus Tendon Avulsion Fracture. It is important to be aware of the normal magnetic resonance (MR) imaging appearance of the popliteus musculotendinous complex and its relation to other structures of the posterolateral corner for accurate . Popliteus Tendinopathy. Popliteus tendon rupture: a case report and review of the literature. 4A, 4B).The popliteus tendon has strong attachments to the lateral meniscus posteriorly. "Sunrise" or "skyview" of patella. Popliteus arises from the outer surface of the lateral femoral condyle, from within the joint capsule, below the lateral epicondyle and the superior attachment of the lateral collateral ligament. Plantaris injuries are not as common as injuries of the gastrocnemius, which is known to be particularly vulnerable due to its superficial location that spans two joints (the knee and the ankle) and its composition of type IIb muscle fibers [ 17, 25 ]. and scattered calcifications with posterior shadowing at the distal insertion site of the left quadriceps tendon and the proximal insertion site of the right patellar. 3. The popliteus is the smallest and most superior muscle of the deep posterior compartment of the leg.. Summary. In this review we described the anatomy and biomechanics of popliteus muscle and its tendon. As in our expectation, ALL injuries are associated with ACL injuries. Tibiofibular joint. Lack of abnormal The popliteus tendon runs beneath the lateral collateral ligament and tendon of biceps femoris.The muscle also runs above the lateral meniscus but has no . [ 6 ] The popliteus is a relatively small but unique muscle of the knee. This webpage presents the anatomical structures found on knee MRI. tendon insertion sites [8]. The popliteus tendon is a dynamic stabi- Action: Rotates knee medially and flexes the leg on the thigh. The popliteus tendon proceeds proximally through a hiatus in the coronary ligament of the lateral meniscus, then deep to the FCL to ultimately insert anterior and distal to the insertion of the FCL (see Fig. post-traumatic, in sport injuries, in rheumatological disorders, in oncological imaging), the number of incidental cystic and "cyst-like" lesions in and around the knee joint found on routine knee MRI scans has also increased [1-4]. The Popliteus is a thin, flat, triangular muscle, which forms the lower part of the floor of the popliteal fossa. All the cases had characteristic features on the initial knee radiograph and the diagnosis was confirmed using magnetic resonance imaging (MRI). It is a deep muscle of the knee joint, forming the floor of the popliteus fossa. Its fibers pass downward and medially. The popliteus muscle arises from three origins—that is, the lateral femoral condyle, the fibula head, and the lateral meniscus—and inserts into the proximal tibia above the soleal line. Insertion: Splits into two slips after passing inferior to plantar . Acute calcific tendinopathy of the popliteus tendon is a rare medical entity associated with significant patient discomfort. Radiology 2016; 260: 351-369 References For the proximal portion of ALL, we compared the axial view and the coronal view to delineate the ALL as the femoral epicondyle is a common origin of ALL, LCL, and popliteus muscle insertion. Popliteus muscle injury symptoms can occur gradually through overuse or may result from a sudden twisting, fall or collision and include: Pain at the back of your knee joint. A close relationship was noted with the proximal part of the lateral collateral ligament and not with the popliteus tendon, the latter running an intra-articular but extra . the level of the distal patellar tendon (Figs. (a) Overview of the course of the popliteus tendon (arrow) and its intimately related synovial recess (white arrow heads) on a coronal MRI fat saturated T2-weighted image of the dorsal aspect of the left knee without effusion in a 64-year-old male floor layer. It is, therefore, not surprising that adults are more likely to ex-perience intrasubstance tears of the popliteus tendon [5, 6]. Femoral insertion of the LCL and PT was identified and marked. Gross anatomy. ( 4 ). This case report highlights an unusual cause of anterolateral knee pain. Using 10 cadaveric knee specimens, Harner et al17 reported that the addition of a 44-N force to the popliteus muscle reduced PCL forces by 9% and 36% at 90° and 30° of knee flexion, respectively . 1 and 2) ().They serve as a primary restraint to external rotation and a secondary restraint to varus stress ().The complex itself consists of the popliteal tendon attachment on the popliteal sulcus of the lateral femoral condyle . This communicates widely with the knee joint in most adults functioning as a recess due to the involution of an embryonic septum that exists between the bursa and the remaining joint, which occurs at about the . It also makes up the lateral musculature of . [5] Imaging Perspective A brief literature review is included. Popliteus. Six consecutive T1 weighted sagittal images demonstrate the thicker low-signal medial aspect of the tendon (arrows) inserting just posterior to the adductor magnus insertion and adductor tubercle (blue arrow, 4a), and the more attenuated tendon fibers towards the intercondylar region (arrowheads, 4b). The stout tendon passes backwards, downwards and medially over the outer border of the lateral meniscus, to which it attaches. The popliteus tendon inserts onto the fibular head, anterior and distal to the lateral collateral insertion. long, from a depression at the anterior part of the groove on the lateral condyle of the femur, and to a small extent from the oblique popliteal ligament of the knee-joint; and is inserted . Lateral condyle of femur. 7. A study by Koulouris et al. There are three main anatomical regions of the popliteus musculotendinous complex: the proximal origin, the mid-portion, the distal part on the tibia. It may be subjected to a number of pathologies including tenosynovitis, acute calcific tendonitis, rupture, and even avulsion. origin: lateral femoral condyle; insertion: posterior surface of proximal tibia; action. The posterolateral corner (PLC) of the knee is a complex functional unit consisting of several important ligaments and is responsible for posterolateral stabilization of the joint [].There is some variability in the definition of the posterolateral corner (PLC) in the literature, but most descriptions include the lateral collateral ligament (LCL), the anterior oblique band (AOB), the popliteal . Popliteus tendinopathy causes lateral knee pain. The popliteus muscle inserts into the posterior surface of the proximal tibia, above the soleal line. The popliteus tendon runs across its posterolateral margin to the popliteus tunnel which lies immediately adjacent to the lateral meniscus. ally cutting the popliteus tendon, substantially greater external rotation and a more externally rotated neutral tibial rotation position were noted. 1, 2) [50]. Accessory muscles around the knee include the 3 rd head of the gastrocnemius, the accessory plantaris, the accessory popliteus, and the tensor fasciae suralis muscle. The popliteus tendon and popliteofibular ligament function as the two other main stabilizers of the posterolateral corner (Figs. RadioGraphics 2018; 38:124-148 • Agten et al. One of the more common imaging findings when evaluating the knee, whether by ultrasound or MRI, is the "cystic lesion.". Popliteus is a small muscle located at the back of the knee joint. The magnetic resonance (MR) appearances of popliteus muscle and tendon injuries are described, finding that they usually occur in conjunction with other significant injuries of the knee and can be characterized with MR imaging. In Posterior Tibial Ligament this comparison, the popliteus muscle and the tendon A ligamentous structure originating from the lateral were clearly identified in all cadaveric MRI with the part of the capsule medial to the popliteus tendon and popliteus tendon seen with low signal intensity and Fig. Overuse of any tendon in the body can result . Coronal views which are useful for assessing the posterior portions of the meniscal bodies and the posterior attachments of the menisci which are called the meniscal struts. 2. The popliteus tendon was found to always be attached to the anterior-inferior portion of the femoral attachment site of the LCL, and the average distance from the origin of the popliteal tendon . Femuropatellar joint. Image Gallery. It then runs deep to the lateral collateral ligament (LCL) and then goes intraarticular. This bursa may be confused with a tear of the popliteus muscle and tendon or of the posterior capsule (10). Your knee will feel tender when pressing in at the back. Synonym(s): musculus popliteus [TA] , popliteal muscle. stabilizes knee joint (resists lateral rotation of tibia on femur) unlocks knee joint (laterally rotates femur on fixed tibia) MRI enables the most comprehensive imaging assessment of the knee and, when performed early after injury, can aid in predicting which patients require further treatment. In all of our 40 cadaveric dissections, however, the ALL was found to originate proximal and posterior to the popliteus tendon insertion, on the lateral femoral epicondyle. segment of the popliteus tendon originates just below and passes beneath the FCL (through the popliteus hiatus), and then the arcuate ligament. Popliteus. The popliteus tendon's main attachment is on the femur at the proximal portion of the popliteus sulcus. Popliteus muscle is one of the deep flexors of the knee. Isolated popliteal tendon avulsion fractures are relatively uncommon in the pediatric population as other posterolateral lateral structures are often involved. The popliteus tendon also contributes to lateral stability and should be evaluated for injury on knee MRI, but will not be discussed further in this article. Because of the numerous contributors to the lateral complex, increased force is required to cause injury in this location. It inserts onto the posterior surface of tibia, above the soleal line. the rupture of the popliteus tendon might have been caused by recent trauma rather than chronic . The popliteus tendon passes beneath the LCL, and its fibres are attached to the popliteal groove, however, the main fascicle of fibres is inserted underneath the LCL (Fig. MR Imaging of Muscle Trauma: Anatomy, Biomechanics, Pathophysiology, and Imaging Appearance. The muscle wraps around the bottom half of the femur, or thighbone. Table 1 It is however a dynamic stabilizer, externally rotating the knee during hyperflexion. Br J Sports Med. Functions of the popliteus muscle in man. The popliteus tendon is the most prominent structure in the PLC. Figure 4. Arthroscopy. MRI is an accurate and cost-effective means of evaluating a wide spectrum of knee injuries, ranging from cruciate-collateral ligament injuries to cartilage deficiencies. proximal part of the popliteus tendon. There must also be attention for asymmetry, erythema of the involved tendon, change in range of motion. The Popliteus is a small, thin, flat, triangular shaped musclotendinous complex of the lower leg with the popliteus muscle and the popliteofibular ligament and constitutes a part of the posterolateral corner of the knee.. Popliteus injury symptoms. Figure 2. lntraoperative photo showing the osteochondral fragment (arrow) with the popliteus tendon attached. Given the fact that magnetic resonance imaging (MRI) is being performed more frequently for assessment of the knee joint (e.g. Gross anatomy. Inserts into the posterior surface of the Tibia in a fan like . Site of insertion of popliteus muscle. It is a thin triangular muscle with narrow tendinous origin and broad insertion at the posterior aspect of the knee joint. The tendon runs deep to the lateral collateral ligament and Figure 1 (A) Magnetic resonance imaging scan showing increased fluid around the popliteus tendon (black arrow). The popliteus muscle offers posterolateral stability to the knee by internally rotating the tibia. The avulsed bony fragment is usually attached to the fibular collateral ligament, the biceps femoris tendon, or the conjoined tendon ( 9 ). Biceps femoris. Before its femoral insertion, it encircles the posterolateral portion of the lateral femoral condyle beneath the lateral collateral ligament of the knee 1-3. Insertion: Posterior surface of tibia in a fan-like fashion, just superior to the popliteal line. Innervation: Tibial nerve (L4, L5, S1) Arterial Supply: Medial inferior genicular . This tendinous attachment is located anterior and inferior to the attachment of the lateral collateral ligament, which lies more proximally on the . In this series, a total of 11 scans (30.6%) reveal ALL injuries. Figure 2 A, Calcific popliteus tendon with a lack of continu-ity at its insertion onto the femur. 5 We report a case of a patient with both femoral attachment peel-off injury and musculotendinous junction avulsion of the popliteus that were treated successfully . The accessory muscle is very similar to the normal popliteus muscle in that it is situated in the deep plane of the popliteal fossa as well as its course paralleling to the normal popliteus muscle. Bony avulsion dimensions were 10mmðAPÞ×4mmðMLÞ×18ðPDÞmm with 1mm displacement from its bed (1mm). Echogenic fibrillar tendon. The tendon is then inserted at the outer side of the lateral condyle of the femur in a bony depression. While each tear can differ in severity, generally Popliteus Tendon Tears are treated conservatively and are diagnosed via MRI or arthroscopic examination. Patients also present swelling and redness. LCL insertion avulsion at the right knee. Furthermore, we combined the anatomy with clinics and discussed a wide spectrum of disorders regarding the popliteus and its musculotendinous complex. popliteus tendon avulsion in skeletally immature patients, . in 2002 with MRI found that the medial head of the gastrocnemius . Fluid extending along the popliteus bursa. length of the popliteus tendon on the AP radiograph. Evaluation of articular cartilage reveals the cartilage over the femoro-tibial and patello femoral joints to be maintained, without . . We present the case of a previously healthy 48-year-old female who presented to the emergency department with acute onset of left knee pain. The popliteus muscle is a band of muscular tissue located in the leg. 2,22,24,30,40 These lesions were not accompanied by hemorrhage, avulsion fractures, or arthroscopic or magnetic resonance imaging evidence of a torn tendon insertion. This report describes two skeletally immature male patients who presented with knee injuries without ligamentous instability and were subsequently diagnosed with isolated popliteus tendon avulsion fractures. Sagittal (a) and coronal (b) T2-weighted images show fluid in the popliteus bursa (arrow), which may be mistaken for a popliteus muscle or tendon tear. C D A B Structure. 1 Department of Radiology, College of Medicine, Hanyang University, Korea. Articular surface of femur. Postoperative radiograph showing reduction of the avulsed fragment with AO navicular screw and washer. These ganglion cysts are usually sma … Injuries can be sudden onset (acute) or gradual onset (chronic) overuse injuries. . The popliteus tendon passes below two structures, which are the lateral collateral ligament (LCL) and the tendon of the biceps femoris muscle. Case report: isolated rupture of the popliteus tendon in a professional athlete. Medical images from an MRI allow medical professionals to distinguish . Initial radiographs revealed calci … Origin: Posterior aspect of interosseous membrane, superior 2/3 of medial posterior surface of fibula, superior aspect of posterior surface of tibia, and from intermuscular septum between muscles of posterior compartment and deep transverse septum. Intratendinous and peritendinous ganglia involving the popliteus tendon are rare, with only 3 cases previously reported. Injury to the popliteus muscle will occur with any sprain or strain of the knee and chronic . Methods Twenty-six non-paired, formalin-fixed human cadaveric knees were evaluated in this study. Synovial recess along the popliteus tendon presented at three distances from the popliteus hiatus. Guha AR, Gorgees KA, Walker DI. It is possible to rupture the Popliteus tendon, however, an isolated rupture is a rare occurrence. Atlas of Knee MRI Anatomy. Right knee MRI confirmed that the LCL, popliteus tendon, IT band, and anterolateral ligament (ALL) were intact. Magnetic resonance imaging (MRI) is a radiologic procedure that uses a magnetic field and radio waves to develop detailed image cross-sections of the body, including the knee (1). It is located in the subcutaneous tissue between the distal patellar tendon insertion at the tibial tuberosity and the overlying skin 1-4.It is flat and about 2 x 2 x 0.2 cm in size and not always present. Accessory muscles are isointense to skeletal muscle on all pulse sequences and typically attach by muscular or tendinous insertions. The Suprapatellar bursa or recess is an anterior midline structure located deep to the distal quadriceps and superficial to the pre-femoral fat pad and distal femur. Radiograph of the left knee showing avulsion of the popliteus tendon insertion from the distal lateral femoral condyle (arrow). ,no., p. . 1. Patella. 2 and 3).1,2 The deep infrapatellar bursa, or retropatellar bursa, is a small bursa located directly posterior to the distal third of the patellar tendon, just proximal to its insertion on the tibial tubercle (Fig. We report a case of a 24-year-old male patient with acute pain and inability to flex the left knee, without a traumatic event. 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