The oblique popliteal ligament: an anatomic and MRI investigation

Hedderwick, Mandy; Stringer, Mark D.; McRedmond, Liam; Meikle, Grant; Woodley, Stephanie J.

doi:10.1007/s00276-017-1838-7

Cited by 18 publications

(11 citation statements)

References 30 publications

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“…Customarily, these studies have dissected and described the anatomy of fresh-frozen human cadaveric knees and conducted quantitative biomechanical experiments 1 2 3 4 18 19 20 21 . Although these explorations 1 2 3 5 have described the shape and parameters of the OPL and have provided quantitative biomechanics, which have contributed to a better understanding of the role of the OPL in preventing knee hyperextension 2 , the diversity of the morphology of the OPL has rarely been reported to date, and its function of preventing excessive external rotation of the knee was neglected in studies.…”

Section: Discussionmentioning

confidence: 99%

“…Several investigators have attempted to explore the characteristics of the OPL 1 2 3 4 5 . However, descriptions of the morphology and role of the OPL in the knee joint remain inconsistent in the literature.…”

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confidence: 99%

“…However, descriptions of the morphology and role of the OPL in the knee joint remain inconsistent in the literature. Some textbooks and articles 3 4 5 report that the OPL originates with the tendon of the semimembranosus muscle, whereas other sources have described that the OPL is formed by a confluence of the lateral expansion of the semimembranosus tendon and the capsular arm of the posterior oblique ligament 1 6 7 . The course of the OPL is fairly similar, and its terminal attachments are relatively uniform, but the description of its arms or attachments is variable.…”

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confidence: 99%

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Anatomical Characteristics and Biomechanical Properties of the Oblique Popliteal Ligament

Zou

et al. 2017

Sci Rep

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This anatomical study sought to investigate the morphological characteristics and biomechanical properties of the oblique popliteal ligament (OPL). Embalmed cadaveric knees were used for the study. The OPL and its surrounding structures were dissected; its morphology was carefully observed, analyzed and measured; its biomechanical properties were investigated. The origins and insertions of the OPL were relatively similar, but its overall shape was variable. The OPL had two origins: one originated from the posterior surface of the posteromedial tibia condyle, merged with fibers from the semimembranosus tendon, the other originated from the posteromedial part of the capsule. The two origins converged and coursed superolaterally, then attached to the fabella or to the tendon of the lateral head of the gastrocnemius and blended with the posterolateral joint capsule. The OPL was classified into Band-shaped, Y-shaped, Z-shaped, Trident-shaped, and Complex-shaped configurations. The mean length, width, and thickness of the OPL were 39.54, 22.59, and 1.44 mm, respectively. When an external rotation torque (18 N·m) was applied both before and after the OPL was sectioned, external rotation increased by 8.4° (P = 0.0043) on average. The OPL was found to have a significant role in preventing excessive external rotation and hyperextension of the knee.

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Section: Discussionmentioning

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Anatomical Characteristics and Biomechanical Properties of the Oblique Popliteal Ligament

Zou

et al. 2017

Sci Rep

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“…An ossi ed fabella is usually seen at the age of 12 years or older, meanwhile, cartilaginous fabellae are not able to be seen radiologically, but by magnetic resonance imaging (MRI) or anatomic methods [9,17]. Moreover, mathematic procedures calculating either per person, per knee or per gastrocnemius head, arises the confusion in discussing the prevalence of fabella [12,13,37]. Previous studies revealed that both genetic and environmental factors played a role in fabella development [10,30] and showed that Asian people, older people and knee osteoarthritis patients would present with fabellae more frequently [10,12,14,15,17,20,37].…”

Section: Introductionmentioning

confidence: 99%

Fabellar prevalence, parameters and association with medial meniscal tear: causality or coincidence?

Zhong

Zhang

et al. 2021

Preprint

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Background: Fabella is a sesamoid bone of knee that has potential biomechanical function. The correlation between medial meniscal (MM) tear and fabella has not been rigorously examined. The aim of this study is to examine the fabellar prevalence and parameters in Chinese population and test the hypothesis that fabellar presence and morphology are associated with MM tear.Methods: A total of 1011 knee magnetic resonance imaging scans were analyzed. The fabellar presence was documented and parameters were measured. Further ratios were calculated to present fabellar morphology. Differences among subgroups were compared and correlation of fabellar presence and parameters with advancing age was assessed by Spearman correlation analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to investigate whether factors have relationship with MM tear. Diagnostic performance of risk factors was assessed and cut values were determined.Results: The overall prevalence of fabellae was 39.8% and increased with the increasing age (r = .237, P < .001). The fabellar were larger in male and ones with an articulating groove (all p < .001). The length/thickness ratio and width/thickness ratio were found significantly different between gender, age and articulating groove condition (all P < .05) and showed a moderate correlation with age (r = .463, p < .001; r = .303, p < .001), respectively. Fabella presented more often in knees with MM tears with a multivariate OR of 2.960 (95% CI, 1.853-3.903). Age, fabellar length, width, length/thickness ratio and width/thickness ratio yielded an area under the ROC curve (AUC) of 0.604-0.766 to predict an MM tear. In combination with age, fabellar width and length/thickness ratio, the diagnostic performance was improved to an AUC of 0.791 (95% CI, 0.744-0.837), a sensitivity of 73.0% and a specificity of 74.6% (OR, 7.939; 95% CI, 4.094-12.852). Conclusion: The presence of fabellae, increased fabellar length and width as well as flatter fabellar morphology, are significantly associated with an increased risk for MM tear. These findings might aid clinicians in identifying patients at risk for a MM tear and informing them.

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“…A meta-analysis on fabellofibular ligament prevalence compiled data from over 1,000 knees and 23 studies and showed the ligament can be present in the absence of the fabella, and as such suggests the ligament be renamed the gastrocnemiofibular ligament ( Pękala et al, 2019 ). The fabella also often serves as an attachment for the oblique popliteal ligament (OPL; also called the oblique popliteal tendon: Hedderwick et al, 2017 ; Fig. 1 ).…”

Section: Introductionmentioning

confidence: 99%

Unique myological changes associated with ossified fabellae: a femorofabellar ligament and systematic review of the double-headed popliteus

Berthaume

Barnes

Athwal

et al. 2020

PeerJ

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Introduction The fabella is a sesamoid bone embedded in the tendon of the lateral head of the gastrocnemius. It is the only bone in the human body to increase in prevalence in the last 100 years. As the fabella can serve as an origin/insertion for muscles, tendons, and/or ligaments (e.g., the oblique popliteal and fabellofibular ligaments), temporal changes in fabella prevalence could lead to temporal changes in “standard” knee anatomy. The aim of this study was to investigate unique myological changes to the posterolateral corner knee associated with ossified fabella presence and perform a systematic review to contextualize our results. Methods Thirty-three fresh frozen cadaveric knees were considered. As the knees were all used for previous experimentation, the knees were in variable levels of preservation. Those with adequate preservation were used to determine ossified fabella presence/absence. When ossified fabellae were present, unique myologies associated with the fabella were recorded. A systematic review was performed on the double-headed popliteus to investigate possible correlations between this anatomical variant and the fabella. Results Of the 33 knees, 30 preserved enough soft tissue to determine fabella presence/absence: 16/30 knees had fabellae (five cartilaginous and 11 ossified). Eight of the eleven knees with ossified fabellae retained enough soft tissue to investigate the posterolateral knee anatomy. Of these, 4/8 exhibited unique myological changes. One knee had a double-headed popliteus muscle where one head originated from the medial side of a large, bulbous fabella. A systematic review revealed double-headed popliteus muscles are rare, but individuals are 3.7 times more likely to have a fabella if they have a double-headed popliteus. Another knee had a large, thick ligament stretching from the lateral edge of the fabella to the inferoposterior edge of the lateral femoral epicondyle, deep to the lateral collateral ligament (LCL) and near the popliteal sulcus. We found no mention of such a ligament in the literature and refer to it here as the “femorofabellar ligament”. In all four knees, the plantaris and lateral gastrocnemius appeared to share a common tendinous origin, and the fabella was located at/near the junction of these muscles. In the case of the double-headed popliteus, the fabella clearly served as an origin for the plantaris. Conclusions Despite being found in an average of 36.80% of human knees, most standard anatomical models fail to account for the fabella and/or the unique myological changes associated with fabella presence. Although our sample is small, these data highlight aspects of human biological variability generally not considered when creating generalized anatomical models. Further work is needed to identify additional changes associated with ossified fabellae and the functional consequences of omitting these changes from models.

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The oblique popliteal ligament: an anatomic and MRI investigation

Abstract: The OPL is a distinct ligament with identifiable anatomical limits. Based on its morphological characteristics, it appears more tendinous than ligamentous in nature. A better understanding of the OPL may help define its importance in the assessment and treatment of posterior knee injuries.

Cited by 18 publications

References 30 publications

Anatomical Characteristics and Biomechanical Properties of the Oblique Popliteal Ligament

Anatomical Characteristics and Biomechanical Properties of the Oblique Popliteal Ligament

Fabellar prevalence, parameters and association with medial meniscal tear: causality or coincidence?

Unique myological changes associated with ossified fabellae: a femorofabellar ligament and systematic review of the double-headed popliteus

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