Content uploaded by Joao Espregueira-Mendes
Author content
All content in this area was uploaded by Joao Espregueira-Mendes on Oct 22, 2015
Content may be subject to copyright.
Introduction
The anatomy of the lateral aspect of the knee is a
complex arrangement of static (ligaments) and dynamic
(tendons and muscles) stabilizing structures [22]. The
complexity of that anatomy is due in a large part to
the evolutionary changes in the anatomic relationship
of the fibular head, the popliteal tendon, and the bi-
ceps femoris muscle [19]. Although the function of the
ligaments is somewhat complex, their primary role is to
restrain abnormal motion. Studies have shown that the
lateral collateral ligament (LCL) is the major restraint
to primary varus rotation at all positions of knee
flexion [8]. Isolated sectioning of the LCL resulted in
at least a small but significant increase in varus rota-
tion at all angles of knee flexion. The LCL also serves
in concert with its surrounding posterolateral struc-
tures to control axial rotation of the tibia: isolated
sectioning of the LCL as well as the popliteus complex
brought about a significant increase in external tibial
rotation [14].
Biomechanics has been studied largely by cadaver
sequential sectioning studies. Selective cutting studies
have demonstrated that a section of both the pos-
terolateral structures (dividing the popliteus tendon
(PT) from the posterolateral capsular structures) and a
section of LCL result in a slight increase of posterior
translation at all angles of flexion. Studies have shown
that the posterolateral structures (popliteus, LCL, etc.)
definitely act as secondary restraints to posterior tibial
translation.
The lateral structures of the knee can be divided into
three distinct layers. The deepest layer, the lateral part of
the capsule, divides into two laminae just posterior to
the over lying iliotibial tract. These laminae encompass
three ligaments: the LCL, the fabellofibular, and the
arcuate ligaments.
The purpose of this study was to evaluate the top o-
graphical and morphological parameters of the LCL.
We have done an anatomic study based on the dissection
of cadaver knees and an analysis of the histological
sections.
Anatomic study
Materials and methods
Twenty normal cadaver knees were dissected according
to an adaptation of LaPrade and Hamiltons technique
Espregueira-Mendes
M. Vieira da Silva
Anatomy of the lateral collateral ligament:
a cadaver and histological study
Received: 15 February 2005
Accepted: 2 April 2005
Published online: 12 October 2005
Ó Springer-Verlag 2005
Abstract This paper describes the
anatomy of the lateral collateral
ligament (LCL). The dimensions of
the ligament and its femoral and
fibular attachments are given. The
relationships between the LCL and
other anatomical structures are de-
scribed, particularly the terminal fi-
ber branches of the biceps femoris.
The histological features of the lig-
ament fibers and their osseous
attachments are also described.
Keywords Lateral collateral
ligament Æ Anatomy Æ Histology
DOI 10.1007/s00167-005-0681-2
Espregueira-Mendes
Porto University, Porto, Portugal
M. Vieira da Silva
Hospital St. Anto
´
nio, Porto, Portugal
Knee Surg Sports Traumatol Arthrosc
(2006) 14: 221–228
KNEE
Espregueira-Mendes (&)
Orthopaedic Department,
Hospital S. Sebastia
˜
o, Feira, Portugal
E-mail: joaoespregueira@netcabo.pt
Fax: +351-22-6054040
[13] in order to obtain a detailed understanding of the
lateral anatomy of the knee.
There were 7 right and 13 left knees from 20 male
cadavers. The average age of the donors was 50 years
(SD 10.7, range 35–64 years old). The average weight
was 71 kg (SD 7.4 kg) and the average height was
175 cm (SD 4.3 cm). After the skin and subcutaneous
tissues of the lateral aspect of the knee were carefully
dissected away, the iliotibial band was longitudinally
incised in line with its fibers and retracted to expose
the superior aspect of the LCL and the lateral apo-
neurotic attachments of the long and short head of the
biceps femoris muscle. Once the LCL was identified,
the iliotibial band was transected and retracted both
proximally and distally so that the attachme nt of the
LCL on the femur could be identified. Dissection of
the lateral aponeurosis of the long head of the biceps
femoris muscle from the lateral an d posterio r aspect of
the LCL was then performed for better identification
of the margins of the LCL. At this point, the proximal
three-fourth of the LCL were exposed (Fig. 1). The
more distal portion of the LCL was covered by the
anterior arm of the long head of the biceps femoris
muscle. We identified the fibular colla teral ligament–
biceps femoris bursa by means of a coronal incision
between the anterior arm of the long head of the bi-
ceps femoris muscle and its lateral aponeurosis. This
incision allowed access to the most superior aspect of
the bursa. The interval between the an terior arm and
the direct arm attachment of the long head of the
biceps femoris muscle was then identified and devel-
oped further by a splitting incision between these two
structures in the sagittal plane proximal to the bursa.
Thus, the anterior arm was dissected sharply away
from the direct arm, the main tendinous unit of the
long head of the biceps femoris muscle that inserts on
the posterolateral aspect of the fibular head just lateral
to the fibular styloid. We divided the anterior arm of
the biceps approximately 5 cm proximal to the fibular
head to separate it from the main tendinous substance
of the long head of the biceps femoris muscle, and the
anterior arm of biceps was then retracted distally. This
allowed the identification of the LCL–biceps femoris
bursa as it lay deep to the anterior arm of the long
head of the bicep s femoris muscle and superficial to
the fibular collateral ligament. The attachment of the
LCL on the lateral aspect of the fibular head could
also be identified at this point (Fig. 2). Some topo-
graphical and morphological parameters were then
recorded.
Results
Total length of the ligament
The mean length was 63.1 mm (SD 5.2, range 55–
71 mm).
Shape of the proximal and distal attachments
All cases had a semicircular-shaped attachment on the
femoral condyle, with well-defined limits (Fig. 1). All
fibular attachments had a fan-like shape, with the most
lateral fibers continuing distally as a reinforcement of
the fascia over the peroneus longus muscle of the lateral
compartment of the leg (Fig. 3).
Fig. 2 The distal LCL has a bursa that separates it from the
overlying biceps
Fig. 1 The LCL is exposed after retraction of the iliotibial tract.
The distal LCL is hidden by the biceps tendon (BT )
222
Distance between the proximal attachment
and the inferior limit of the lateral femoral condyle
The mean distance between the most inferior part of the
proximal attachment and the inferior limit of the lateral
femoral condyle was 22.7 mm (SD 3.2, range 18–
30 mm) (Fig. 4).
Distance between the proximal attachment
and posterosuperior limit of the lateral femoral condyle
The mean distance between the most superior part of the
femoral attachment and the posterosuperior limit of the
femoral condyle was 13 mm (SD 2.5, range 10–18 mm)
(Fig. 5).
Distance between the proximal attachment
and the posterior limit of the lateral femoral condyle
The mean distance between the most anterior part of
the femoral attachment and the posterior limit of the
femoral condyle 32 mm (SD 2.8, range 28–36 mm)
(Fig. 4).
Size of the proximal attachment on the femoral condyle
This was measured in three planes:
Proximal–distal—10.9 mm (SD 0.1, range 10–12 mm)
Anteroposterior—10 mm (SD 0.1, range 8–12 mm)
Thickness—1.8 mm (SD 0.4, range 1–2 mm).
Relative position of the proximal attachment
of the LCL on the lateral femoral condyle
Considering a vertical line through the centre of the
proximal attachment of the LCL, the centre was situated
at 70% of its diameter from both the distal and anterior
margins (Fig. 5).
Width of the LCL at the level of the articular line
of the knee joint
This was measured in two planes:
Anteroposterior—the mean width was 8.5 mm (SD
2.2, range 5–12 mm)
Thickness—the mean thickness was 2.6 mm (SD 0.6,
range 2–4 mm).
Fig. 3 The superficial fibers of the LCL fan out distally to reinforce
the fascia overlying peroneus longus
Fig. 4 The position of the femoral attachment of the LCL in
relation to the outline of the condyle
Fig. 5 The femoral attachment was 70% of the condyle diameter
from its distal and anterior margins
223
Localization of the LCL attachment on the fibular
head
More medial fibers were inserted into a groove at the
lateral edge of the fibular head, about 1 cm anterior to
its apex, anterior to the fibular styloid. This small
saddle was approximately midway acro ss the fibular
head.
Presence of a bursa between the LCL and the biceps
femoris
In all cases a bursa was present between the distal
quarter of the LCL and the biceps femoris (Fig. 2).
According to Laprade and Hamilton [13], the bursa
forms an inverted ‘‘J’’ shape around the lateral, anterior,
and anteromedial portions of the ligament . Its distal
margin is just proximal to the fibu lar head where the
LCL inserts, and its proximal edge is at the superior
edge of the anterior arm of the long head of the biceps
femoris muscle. The functional importance of this bursa
is not clear at this time.
Dimension of the distal attachment on the fibular head
This was measured in three planes:
Proximal–distal—me an 10.9 mm, SD 1, range 10–
12 mm
Anteroposterior—mean 8.7 mm, SD 1.6, range 7–
12 mm
Thickness—mean 1.8 mm, SD 0.4, range 1–2 mm.
Angle between the LCL and the biceps femoris
With the knee at 90° of flexion, it had a mean value of
78° (SD 6, range 70–86°) (Fig. 1).
Angle between the LCL and the lateral gastrocnemius
tendon
With the knee at 90° of flexion, it had a mean value of
19° (SD 8, range 10–36°).
Angle between the LCL and the popliteal tendon
With the knee at 90° of flexion, it had a mean value of
25° (SD 5, range 12–32°) (Fig. 6).
Anatomic relation with other structures
The biceps femoris ha s an extensive, laminated, fan-
shaped tendon insertion into the head of the fibula,
LCL, and the lateral tibial condyle with expansions to
the crural fascia covering the anterior, lateral, and pos-
terior compartments of the leg [20]. The long head of the
biceps femoris has six components at the posterolateral
aspect of the knee. The anterior arm pa rtially attaches to
the distal and lateral aspect of the fibular styloid, and
then extends distally around the lateral aspect of the
LCL, sepa rated from the anterolateral distal quarter of
the LCL by a bursa (Fig. 2). After the anterior arm of
the long head of the biceps femoris passes the LCL, it
forms a fascial sheath termed the anterior aponeurosis,
which extends distally and anterolaterally over the leg
(Fig. 7). A lateral aponeurosis also extends from the
anteromedial aspect of the long head of the biceps
femoris and attaches to the posterior and lateral aspect
of the LCL proximal to the biceps bursa (Fig. 8)[13, 16,
19, 20, 22, 26].
The short head of the biceps femoris muscle has five
major components at the posterolateral aspect of the
knee. The tendinous anterior arm of the short head of
the biceps femoris extends medial to the LCL and at-
taches on the proximal lateral tibia approximately 1 cm
posterior to Gerdy’s tubercle. The distal border of the
capsular arm of the head of the biceps femoris extends
from just lateral to the tip of the fibular styloid to the
fabella or fabellar analogue and is known as the fab-
ellofibular ligament (FFL; Fig. 2). The lateral aponeu-
rosis, which is a fine aponeurotic attachment from the
main tendinous portion of the short head of the biceps
femoris, attaches onto the posteromedial aspect of the
LCL [13, 16, 19, 20 , 22].
The fabellofibular ligament descended distally and
laterally to attach on the fibular styloid from the lateral
part of the favela. If no osseous fabella was present, the
ligament’s ori gin was the posterior aspect of the su-
pracondylar process of the femur, where it blende d with
the anterior fibers of the lateral gastrocnemius tendon. It
then inserted on the fibular styloid process just posterior
to the lateral arm of the arcuate ligament [22].
Fig. 6 The LCL is at 25° to the popliteus tendon at 90° knee flexion
224
The arcuate ligament is not a single ligament but
actually several structures that combine to form an ar-
ched or arcuate appearance [22]. It is a Y-shaped
thickening of the capsule [18]. Its distal insertion is on
the apex of the fibular styloid process. It ascends verti-
cally on the free edges of the respective capsular laminae
to the lateral head of the gastrocnemius, where they are
joined by the termina tion of the oblique popliteal liga-
ment of Winslow.
The popliteus tendon (Fig. 6) arises below the LCL in
a small sulcus on the lateral femoral condyle, passes
under the LCL, descends into the popliteus hiatus, then
passes under the arcuate ligament, and becomes extra-
articular before finally joining its muscle belly, which
attaches to the posteromedial surface of the proximal
tibia. The PT sends attachments to the lateral meniscus
(the pop liteomeniscal ligament) and to the styloid pro-
cess of the fibula (the popliteofibular ligament) [22]. The
popliteomeniscal ligament prevents excessive forward
displacement of the lateral meniscus during knee exten-
sion. The popliteofibular ligament acts as a constraint
that controls the line of action of the muscle during
contraction [4, 18, 23].
The peroneal nerve enters the lateral compartment of
the leg below the termination of the distal fibers of the
LCL. There is an osseous ridge on the fibula, which
demarcates the distal LCL fibers from the peroneal
nerve. The peroneal nerve arborizes into the lateral and
anterior compartments and is located 2–3 cm below the
joint line.
Histology
Materials and methods
The tissue blocks for the histological study were ob-
tained from the attachments of the LCL on the femur
and fibula, plus the mid-third of the LCL. Extraneous
tissue was then dissected free. Anatomical landmarks
and measurements paralleling those in the cadaver
portion of the study were present in all the sectioned
specimens processed for histological staining and were
marked for future identification. We placed these spec-
imens into tissue containers.
The tissue blocks were fixed in formaldehyde for 2
days, washed, dehydrated in alcohol, embedded in
paraplast, and cut into 7-lm sectio ns for the histo-
chemical investigation. The sections were deparaffinized
in xylene and rehydrated in graded ethanol. Subse-
quently, the sections were stained with hem atoxylin and
counterstained with eosin for qualitative assessment.
Results
Microscopically, the LCL is composed of cells and ma-
trix. Most of the cells are fibroblasts, which appear as
elongated structures parallel to the matrix fibers. The
ligament contains relatively few cells, so fibroblasts
represent a small portion of the total ligament volume.
The matrix, the material that surrounds the cells, is
principally composed of regularly oriented, parallel
bundles of collagen fibers (Fig. 9). The collagen that
makes up the ligaments is grouped into bundles with a
characteristic crimp—a sinusoidal, undulating waviness
that allows the ligament to elongate or shorten slig htly
in an accordion-like fashion to adapt to external stresses.
Ligaments attach to the bone by the interdigitation of
the collagen fibers of the ligament with those of the
adjacent bone. The change from flexible ligamentous
tissue to that of a rigid bone is mediated by transitional
zones of fibrocartilage and mineralized fibrocartilage
(Fig. 9). In the fibrocartilage zone, the cells are larger
Fig. 8 A lateral aponeurosis joins the long head of the biceps to the
posterior edge of the LCL
Fig. 7 The biceps blends distally into an anterior aponeurosis
225
and more spherical than the fibroblasts of the ligament.
Analyzing the attachment of the ligament to the bone,
we think that is a direct insertion. We have seen that
most of the collagen fibrils pass directly from the sub-
stance of the ligament into the bone cortex, usually
entering at a right angle to the bone surface. These fibrils
then mingle with the collagen fibrils of the organic ma-
trix of the bone creating a strong bond between the
ligament and the bone matrix. Where dense fibrous tis-
sue structures ap proach the bone surface at oblique
angles, the colla gen fibrils may make a sharp turn to
enter the bone at a right angle. A sharp border separates
the zone of unmineralized fibrocartilage from the min-
eralized fibrocartilage zone.
Compared to other organ systems, ligaments are
relatively avascular. Some vessels penetrate ligament
surfaces and course between fibrils. These vessels come
mostly from adjacent soft tissues, with little or no con-
tribution from the ligament–bone attachments.
Discussion
Injuries to the lateral aspect of the knee are less common
than injuries to the medial structures, but may be more
disabling because they are subjected to greater force
during gait. The physiological varus angulation of the
limb axis increases and reaches maximum with full
extension of the knee during the stance phase of the gait
cycle, in which the lateral structures are stretched. Lat-
eral compartment injuries are often associated with
damage to the cruciate ligaments; isolated damage to
these structures is rare. The wide range and complexity
of these injuries cause difficulties in clinical diagnosis,
and some damaged structures may go undetected during
a clinical examination. In fact, clinically unrecognized
posterolateral injuries have been suggested as a cause of
chronic instability of the knee after trauma and post-
surgical failure of the cruciate ligaments. In severe
trauma, all the stabilizing structures of the knee may be
disrupted. In this situation, the common peroneal nerve
and the gastrocnemius muscle can also be injured [2, 10,
11, 24].
Surgeons and anatomists have named ligaments by
their location and bony attachment or by their rela-
tion to other ligaments [1, 3, 5]. The LCL is a one
rounded bundle, pencil-like cord, which is entirely
separate from the capsule of the knee joint, being an
extraarticular structure. Its femoral attachment is
semicircular, in the ‘‘saddle’’ between the lateral ep-
icondyle and the supracondylar process, above and
behind the groove for the popliteus muscle, directly
anterior to the origin of the lateral head of the gas-
trocnemius muscle, jus t proximal and posterior to the
lateral epicondyle.
The LCL is oriented slightly posteriorly and laterally as
it extends dis tally from its femoral attachment to its fib-
ular attachment. As the ligament courses distally, its more
medial fibers insert into a groove at the lateral edge of the
fibular head, about 1 cm anterior to its apex, anterior to
the fibular styloid, in a small saddle at a point approxi-
mately midway across the fibular head. The lateral fibers
of the ligament then continue distally, medial to the
anterior arm of the long head of the biceps muscle, as a
reinforcement to the fascia over the peroneus longus
muscle of the lateral compartment of the leg. The proxi-
mal part of the posterior aspect of the LCL is directly
connected to the lateral aponeurotic expansions of the
short head and is covered laterally by the lateral apo-
neurosis of the long head of the biceps muscle.
According to Sugita and Amis [21] the inclination of
the LCL relative to the antero-posterior direction in the
sagittal plane increased significantly with knee flexion
from 74±3 ° at 0° of knee flexion to 96±13° at 90° of
knee flexion. The LCL passed through vertical at
approximately 70° of knee flexion.
In our study, the LCL had a mean length of 63 mm.
The length reduced significantly and slackened as the
knee flexed. The length at 90° of knee flexion was sig-
nificantly less than at 0° . The LCL resists tibial external
rotation immediately from neutral tibial rotation at 0° of
knee flexion. However, nearly 40° of external tibial
rotation is required before it becomes taut at 90° of knee
flexion, so the popliteofibular ligament complex is
dominant and will rupture before the LCL in this situ-
ation. Abnormal increased external tibial rotation at 90°
of knee flexion does not mean that the LCL is damaged,
because a large external rotation is needed to even bring
Fig. 9 A histological section slowing the LCL fibers attaching to a
bone via an intermediate fibrocartilagenous layer (H&E stain)
226
it to the slack–taut transition point [21]. The LCL is the
primary passive restraint to varus tibial rotation
(adduction) with the knee extended [8], so this test must
be applied to check LCL integrity. The LCL is a sec-
ondary restraint of posterior translation. Coupled
external rotation and lateral translation accompany
posterior translation. The isolated loss of the posterior
cruciate ligament results in an increase in posterior
translation to a maximum of 15–20 mm at 90° knee
flexion as well as a loss of couple d external rotation.
When the posterior aspect of the capsule, the postero-
lateral structures, and the LCL are sectioned, however,
the coupled external rotation is increased. No change
occurred in posterior translation after the isolated sec-
tion of the LCL [ 6, 8, 9, 12, 25].
The LCL appears to be dynamically controlled by the
actions of the short and long heads of the biceps femoris
and their attachment to the LCL. This can be demon-
strated in vivo by applying a muscle stimulator to the
muscle fibers of the short head of the biceps femoris and
observing its bowstring effects on the LCL during its
contraction [13].
Sugita and Amis [21] found the tensile strength of the
LCL to be 309 N, whereas Maynard et al. [17] found itto be
750 N. It is possible that the lower strength seen in Sugita’s
study was due to a more complete dissection of the over-
lying fascial tissue and not due to the specimen’s age.
Importance of clinical anatomy
The reconstructive surgeon of today must know the
anatomy and understand the key principles of normal
ligament function to be able to restore the injured knee
to its previous level of performance. The lateral com-
partment of the knee has a complex and variable anat-
omy, and the results of reconstructive surgery have been
inconsistent. However, there has recen tly been an
increasing awareness of the importance of the structures
crossing the lateral and posterolateral corner of the knee
in providing function. One of the factors that makes
surgery of the lateral and posterolateral corner so diffi-
cult, and hence limits its success, is its anatomical vari-
ability. Watanabe et al. [26] examined the incidence of
different posterolateral stru ctures and found a pop-
liteofibular ligament in 94% of the115 knees; they
showed that different combinations among the LCL,
popliteofibular, arcuate, and FFLs can be encountered
in different knees.
Repair and reconstruction of the LCL, popliteofibu-
lar ligament, or both, dependon the assessment of what
has been damaged. Attention is focused on these struc-
tures because the LCL is a primary restraint against
varus (adduction) angulation [8] and the popliteofibul ar
ligament against tibial external rotation [17 ].
The knowledge of this anatomy and how variable the
structures of this part of the knee can be is necessary for
the treatment of acute injuries to the lateral aspect of the
knee joint, especially for reconstruction necessitated by
lesions that cause chronic rotatory instability of the
knee. With a firm understanding of the anatomy of the
lateral knee, one may understand the underlying
importance of the diagnosis and treatment of a lateral
and posterolateral knee ligament injury. Further ad-
vances in understanding and research regarding the
posterolateral knee are dependent on a uniform
description of anatomic structures.
Acknowledgments The authors express their extreme gratitude to
Servic¸ o de Anatomia Patolo
´
gica do HGSA-Porto (Dr. Isabel
Calhim) for the histologic preparation and evaluation and Insti-
tuto de Medicina Legal do Porto for the cadavers used for dis-
section.
References
1. Amiel D, Frank CB, Harwood FL et al
(1984) Tendons and ligaments: a mor-
phological and biochemical compari-
son. J Orthop Res 1:257
2. Baker CL Jr, Noewood LA, Hughston
JC (1983) Acute posterolateral rotatory
instability of the knee. J Bone Joint
Surg Am 65:614–618
3. Cooper RR, Misol S (1970) Tendon and
ligament insertion. J Bone Joint Surg
Am 52:1
4. Fabbriciani C, Oransky M (1992) The
popliteus muscle. In: Jakob RP, Staubli
HU (eds) The knee and the cruciate
ligaments. Springer, Berlin Heidelberg
New York, pp 48–61
5. Frank CB, Amiel D, Woo SL-Y (1985)
Normal ligament properties and liga-
ment healing. Clin Orthop 196:15
6. Fu F, Harner CD, Johnson DL, Miller
MD, Woo S (1993) Biomechanics of
knee ligaments. J Bone Joint Surg Am
75:1716–1725
7. Gollehon DL, Torzilli PA, Warren RF
(1987) The role of the posterolateral and
cruciate ligaments in stability of the
human knee. J Bone Joint Surg Am
69:233–242
8. Grood ES, Noyes FR, Butler DL,
Suntay WJ (1981) Ligamentous and
capsular restraints preventing straight
medial and lateral laxity in intact hu-
man cadaver knees. J Bone Joint Surg
Am 63:1257–1269
9. Grood ES, Stowers SF, Noyes FR
(1988) Limits of movement in the hu-
man knee. Effect of sectioning the pos-
terior cruciate ligament and
posterolateral structures. J Bone Joint
Surg Am 70:88–97
10. Hughston JC, Jacobson KE (1985)
Chronic posterolateral rotatory insta-
bility of the knee. J Bone Joint Surg Am
67:351–359
11. Hughston JC, Andrews JR, Cross MJ,
Moschi A (1969) Classification of knee
ligament instability. Part II. The lateral
compartment. J Bone Joint Surg Am
58:173–179
227
12. Kaplan EB (1962) Some aspects of
functional anatomy of the human knee
joint. Clin Orthop 23:18–29
13. LaPrade RF, Hamilton CD (1997) The
fibular collateral ligament-biceps fem-
oris bursa. Am J Sports Med 25(4):439–
443
14. LaPrade RF, Terry GC (1997) Injuries
to the posterolateral aspect of the knee:
association of anatomic injury patterns
with clinical instability. Am J Sports
Med 25:433–438
15. LaPrade RF, Gilbert TJ, Bollom TS,
Wentorf F, Chaljub G (2000) The
magnetic resonance appearance of
individual structures of the posterolat-
eral knee. Am J Sports Med 28:191–199
16. Marshall JG, Girgis FG, Zelko RR
(1972) The biceps femoris tendon and
its functional significance. J Bone Joint
Surg Am 54:1444–1450
17. Maynard MJ, Deng XH, Wickiewicz
TL et al (1996) The popliteofibular lig-
ament: rediscovery of a key element in
posterolateral stability. Am J Sports
Med 24:311–316
18. Redondo JA, Salvador E, Villanua JA,
Barrera MC, Gervas C, Alustiza JM
(2000) Lateral stabilizing structures of
the knee: functional anatomy and inju-
ries assessed with MR imaging. Radio-
graphics 20:92–102
19. Seebacher JR, Inglis AE, Marshall JL
et al (1982) The structure of the pos-
terolateral aspect of the knee. J Bone
Joint Surg Am 64:536–541
20. Sneath RS (1955) The insertion of the
biceps femoris. J Anat 89:550–553
21. Sugita T, Amis A (2001) Anatomic and
biomechanical study of the lateral col-
lateral and popliteofibular ligaments.
Am J Sports Med 29:466–472
22. Terry GC, LaPrade RF (1996) The
posterolateral aspect of the knee. Am
J Sports Med 24:732–739
23. Tria AJ Jr, Johnson CD, Zawadsky JP
(1989) The popliteus tendon. J Bone
Joint Surg 71:714–716
24. Trillat A, Ficat P, Bousquet G et al
(1972) Symposium sur les laxites trau-
matiques du genou. Rev Chir Orthop
58:31–116
25. Veltri DM, Deng XH, Torzilli PA,
Warren RF, Maynard MJ (1995) The
role of the cruciate and posterolateral
ligaments in stability of the knee. Am
J Sports Med 23:436–443
26. Watanabe Y, Moriya H, Takahashi K
et al (1993) Functional anatomy of the
posterolateral structures of the knee.
Arthroscopy 9:57–62
27. Yu JS, Salomen DC, Hodler J, Hag-
highi P, Trudell D, Resnic D (1996)
Posterolateral aspect of the knee: im-
proved MR imaging with a coronal
oblique technique. Radiology
198:199–204
228
