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Semin Musculoskelet Radiol 2024; 28(03): 305-317
DOI: 10.1055/s-0044-1781431
Review Article

Demystifying the “Dark Side of the Knee”: An Update on Imaging of the Posterolateral Corner

Miguel Oliveira Castro 
1   Radiology Department, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
2   Lagoa Centro - Imagens Médicas, Lagoa, Portugal
,
Diogo Correia Baptista
3   Radiology Department, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal
,
P. Diana Afonso 
4   Musculoskeletal Imaging Unit, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Lisbon, Portugal
5   Radiology Department, Hospital Particular da Madeira, Grupo HPA, Funchal, Portugal
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Abstract

The posterolateral corner (PLC) of the knee is a complex anatomical-functional unit that includes ligamentous and tendinous structures that are crucial for joint stability. This review discusses the intricate anatomy, biomechanics, and imaging modalities, as well as the current challenges in diagnosing PLC injuries, with an emphasis on magnetic resonance imaging (MRI). Recognizing the normal MRI anatomy is critical in identifying abnormalities and guiding effective treatment strategies. Identification of the smaller structures of the PLC, traditionally difficult to depict on imaging, may not be necessary to diagnose a clinically significant PLC injury. Injuries to the PLC, often associated with cruciate ligament tears, should be promptly identified because failure to recognize them may result in persistent instability, secondary osteoarthritis, and cruciate graft failure.

Keywords

posterolateral corner - knee - stabilizers - magnetic resonance imaging

Supplementary Material



Publication History

Article published online:
20 May 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Rosas HG. Unraveling the posterolateral corner of the knee. Radiographics 2016; 36 (06) 1776-1791
    CrossrefPubMedGoogle Scholar
  • 2 Figueroa F, Figueroa D, Putnis S, Guiloff R, Caro P, Espregueira-Mendes J. Posterolateral corner knee injuries: a narrative review. EFORT Open Rev 2021; 6 (08) 676-685
    CrossrefPubMedGoogle Scholar
  • 3 Dean RS, LaPrade RF. ACL and posterolateral corner injuries. Curr Rev Musculoskelet Med 2020; 13 (01) 123-132
    CrossrefPubMedGoogle Scholar
  • 4 Chahla J, Murray IR, Robinson J. et al. Posterolateral corner of the knee: an expert consensus statement on diagnosis, classification, treatment, and rehabilitation. Knee Surg Sports Traumatol Arthrosc 2019; 27 (08) 2520-2529
    CrossrefPubMedGoogle Scholar
  • 5 Porrino J, Sharp JW, Ashimolowo T, Dunham G. An update and comprehensive review of the posterolateral corner of the knee. Radiol Clin North Am 2018; 56 (06) 935-951
    CrossrefPubMedGoogle Scholar
  • 6 Vasilevska Nikodinovska V, Gimber LH, Hardy JC, Taljanovic MS. The collateral ligaments and posterolateral corner: what radiologists should know. Semin Musculoskelet Radiol 2016; 20 (01) 052-064
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Góralczyk A, Jancewicz P, Hermanowicz K. Injuries of the posterolateral corner of the knee—diagnosis and treatment options for beginning and advanced arthroscopic surgeons. In: Suarez-Ahedo C. ed. Arthroscopy. IntechOpen; 2022
    CrossrefGoogle Scholar
  • 8 LaPrade RF. Posterolateral Knee Injuries: Anatomy, Evaluation, and Treatment. New York, NY: Thieme; 2006
    Article in Thieme ConnectGoogle Scholar
  • 9 Filli L, Rosskopf AB, Sutter R, Fucentese SF, Pfirrmann CWA. MRI predictors of posterolateral corner instability: a decision tree analysis of patients with acute anterior cruciate ligament tear. Radiology 2018; 289 (01) 170-180
    CrossrefPubMedGoogle Scholar
  • 10 Chahla J, Moatshe G, Dean CS, LaPrade RF. Posterolateral corner of the knee: Current concepts. Arch Bone Jt Surg 2016; 4 (02) 97-103
    PubMedGoogle Scholar
  • 11 Shon OJ, Park JW, Kim BJ. Current concepts of posterolateral corner injuries of the knee. Knee Surg Relat Res 2017; 29 (04) 256-268
    CrossrefPubMedGoogle Scholar
  • 12 Toyooka S, Persson A, LaPrade RF, Engebretsen L, Moatshe G. Injury patterns in posterolateral corner knee injury. Orthop J Sports Med 2023; 11 (08) 23 259671231184468
    CrossrefPubMedGoogle Scholar
  • 13 Moorman III CT, LaPrade RF. Anatomy and biomechanics of the posterolateral corner of the knee. J Knee Surg 2005; 18 (02) 137-145
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 LaPrade RF, Ly TV, Wentorf FA, Engebretsen L. The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med 2003; 31 (06) 854-860
    CrossrefPubMedGoogle Scholar
  • 15 Bolog N, Hodler J. MR imaging of the posterolateral corner of the knee. Skeletal Radiol 2007; 36 (08) 715-728
    CrossrefPubMedGoogle Scholar
  • 16 Geiger D, Chang EY, Pathria MN, Chung CB. Posterolateral and posteromedial corner injuries of the knee. Magn Reson Imaging Clin N Am 2014; 22 (04) 581-599
    CrossrefPubMedGoogle Scholar
  • 17 Baker Jr CL, Norwood LA, Hughston JC. Acute posterolateral rotatory instability of the knee. J Bone Joint Surg Am 1983; 65 (05) 614-618
    CrossrefPubMedGoogle Scholar
  • 18 Harner CD, Vogrin TM, Höher J, Ma CB, Woo SLY. Biomechanical analysis of a posterior cruciate ligament reconstruction. Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med 2000; 28 (01) 32-39
    CrossrefPubMedGoogle Scholar
  • 19 LaPrade RF, Resig S, Wentorf F, Lewis JL. The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft force. A biomechanical analysis. Am J Sports Med 1999; 27 (04) 469-475
    CrossrefPubMedGoogle Scholar
  • 20 Covey DC. Injuries of the posterolateral corner of the knee. J Bone Joint Surg Am 2001; 83 (01) 106-118
    CrossrefPubMedGoogle Scholar
  • 21 Larsen MW, Toth A. Examination of posterolateral corner injuries. J Knee Surg 2005; 18 (02) 146-150
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 De Maeseneer M, Shahabpour M, Vanderdood K, De Ridder F, Van Roy F, Osteaux M. Posterolateral supporting structures of the knee: findings on anatomic dissection, anatomic slices and MR images. Eur Radiol 2001; 11 (11) 2170-2177
    CrossrefPubMedGoogle Scholar
  • 23 Rajeswaran G, Lee JC, Healy JC. MRI of the popliteofibular ligament: isotropic 3D WE-DESS versus coronal oblique fat-suppressed T2W MRI. Skeletal Radiol 2007; 36 (12) 1141-1146
    CrossrefPubMedGoogle Scholar
  • 24 Collins MS, Bond JR, Crush AB, Stuart MJ, King AH, Levy BA. MRI injury patterns in surgically confirmed and reconstructed posterolateral corner knee injuries. Knee Surg Sports Traumatol Arthrosc 2015; 23 (10) 2943-2949
    CrossrefPubMedGoogle Scholar
  • 25 Seebacher JR, Inglis AE, Marshall JL, Warren RF. The structure of the posterolateral aspect of the knee. J Bone Joint Surg Am 1982; 64 (04) 536-541
    CrossrefPubMedGoogle Scholar
  • 26 Hughston JC, Andrews JR, Cross MJ, Moschi A. Classification of knee ligament instabilities. Part II. The lateral compartment. J Bone Joint Surg Am 1976; 58 (02) 173-179
    CrossrefPubMedGoogle Scholar
  • 27 Pacholke DA, Helms CA. MRI of the posterolateral corner injury: a concise review. J Magn Reson Imaging 2007; 26 (02) 250-255
    CrossrefPubMedGoogle Scholar
  • 28 Jadhav SP, More SR, Riascos RF, Lemos DF, Swischuk LE. Comprehensive review of the anatomy, function, and imaging of the popliteus and associated pathologic conditions. Radiographics 2014; 34 (02) 496-513
    CrossrefPubMedGoogle Scholar
  • 29 Munshi M, Pretterklieber ML, Kwak S, Antonio GE, Trudell DJ, Resnick D. MR imaging, MR arthrography, and specimen correlation of the posterolateral corner of the knee: an anatomic study. AJR Am J Roentgenol 2003; 180 (04) 1095-1101
    CrossrefPubMedGoogle Scholar
  • 30 Perdikakis E, Skiadas V. MRI characteristics of cysts and “cyst-like” lesions in and around the knee: what the radiologist needs to know. Insights Imaging 2013; 4 (03) 257-272
    CrossrefPubMedGoogle Scholar
  • 31 Vinson EN, Major NM, Helms CA. The posterolateral corner of the knee. AJR Am J Roentgenol 2008; 190 (02) 449-458
    CrossrefPubMedGoogle Scholar
  • 32 De Smet AA, Asinger DA, Johnson RL. Abnormal superior popliteomeniscal fascicle and posterior pericapsular edema: indirect MR imaging signs of a lateral meniscal tear. AJR Am J Roentgenol 2001; 176 (01) 63-66
    CrossrefPubMedGoogle Scholar
  • 33 Wadia FD, Pimple M, Gajjar SM, Narvekar AD. An anatomic study of the popliteofibular ligament. Int Orthop 2003; 27 (03) 172-174
    CrossrefPubMedGoogle Scholar
  • 34 Watanabe Y, Moriya H, Takahashi K. et al. Functional anatomy of the posterolateral structures of the knee. Arthroscopy 1993; 9 (01) 57-62
    CrossrefPubMedGoogle Scholar
  • 35 Maynard MJ, Deng X, Wickiewicz TL, Warren RF. The popliteofibular ligament. Rediscovery of a key element in posterolateral stability. Am J Sports Med 1996; 24 (03) 311-316
    CrossrefPubMedGoogle Scholar
  • 36 Sudasna S, Harnsiriwattanagit K. The ligamentous structures of the posterolateral aspect of the knee. Bull Hosp Jt Dis Orthop Inst 1990; 50 (01) 35-40
    PubMedGoogle Scholar
  • 37 Diamantopoulos A, Tokis A, Tzurbakis M, Patsopoulos I, Georgoulis A. The posterolateral corner of the knee: evaluation under microsurgical dissection. Arthroscopy 2005; 21 (07) 826-833
    CrossrefPubMedGoogle Scholar
  • 38 Yu JS, Salonen DC, Hodler J, Haghighi P, Trudell D, Resnick D. Posterolateral aspect of the knee: improved MR imaging with a coronal oblique technique. Radiology 1996; 198 (01) 199-204
    CrossrefPubMedGoogle Scholar
  • 39 Ahn SJ, Jeong YM, Lee BG. et al. Using three-dimensional isotropic SPACE MRI to detect posterolateral corner injury of the knee. Acta Radiol 2016; 57 (10) 1251-1260
    CrossrefPubMedGoogle Scholar
  • 40 Porrino Jr J, Maloney E, Richardson M, Mulcahy H, Ha A, Chew FS. The anterolateral ligament of the knee: MRI appearance, association with the Segond fracture, and historical perspective. AJR Am J Roentgenol 2015; 204 (02) 367-373
    CrossrefPubMedGoogle Scholar
  • 41 LaPrade RF, Gilbert TJ, Bollom TS, Wentorf F, Chaljub G. 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. Am J Sports Med 2000; 28 (02) 191-199
    CrossrefPubMedGoogle Scholar
  • 42 Flato R, Passanante GJ, Skalski MR, Patel DB, White EA, Matcuk Jr GR. The iliotibial tract: imaging, anatomy, injuries, and other pathology. Skeletal Radiol 2017; 46 (05) 605-622
    CrossrefPubMedGoogle Scholar
  • 43 Ahn JH, Patel NA, Lin CC, Lee TQ. The anterolateral ligament of the knee joint: a review of the anatomy, biomechanics, and anterolateral ligament surgery. Knee Surg Relat Res 2019; 31 (01) 12
    CrossrefPubMedGoogle Scholar
  • 44 Andrade R, Rebelo-Marques A, Bastos R. et al. Identification of normal and injured anterolateral ligaments of the knee: a systematic review of magnetic resonance imaging studies. Arthroscopy 2019; 35 (05) 1594-1613.e1
    CrossrefPubMedGoogle Scholar
  • 45 Ferretti A, Monaco E, Redler A. et al. High prevalence of anterolateral ligament abnormalities on MRI in knees with acute anterior cruciate ligament injuries: a case-control series from the SANTI study group. Orthop J Sports Med 2019; 7 (06) 23 25967119852916
    CrossrefPubMedGoogle Scholar
  • 46 Vieira RL, Rosenberg ZS, Kiprovski K. MRI of the distal biceps femoris muscle: normal anatomy, variants, and association with common peroneal entrapment neuropathy. AJR Am J Roentgenol 2007; 189 (03) 549-555
    CrossrefPubMedGoogle Scholar
  • 47 Branch EA, Anz AW. Distal insertions of the biceps femoris: a quantitative analysis. Orthop J Sports Med 2015; 3 (09) 23 25967115602255
    PubMedGoogle Scholar
  • 48 Mansour R, Yoong P, McKean D, Teh JL. The iliotibial band in acute knee trauma: patterns of injury on MR imaging. Skeletal Radiol 2014; 43 (10) 1369-1375
    CrossrefPubMedGoogle Scholar
  • 49 Ross G, Chapman AW, Newberg AR, Scheller Jr AD. Magnetic resonance imaging for the evaluation of acute posterolateral complex injuries of the knee. Am J Sports Med 1997; 25 (04) 444-448
    CrossrefPubMedGoogle Scholar
  • 50 Hayes CW, Brigido MK, Jamadar DA, Propeck T. Mechanism-based pattern approach to classification of complex injuries of the knee depicted at MR imaging. Radiographics 2000; 20: S121-S134
    CrossrefPubMedGoogle Scholar
  • 51 Sferopoulos NK, Rafailidis D, Traios S, Christoforides J. Avulsion fractures of the lateral tibial condyle in children. Injury 2006; 37 (01) 57-60
    CrossrefPubMedGoogle Scholar
  • 52 Harish S, O'Donnell P, Connell D, Saifuddin A. Imaging of the posterolateral corner of the knee. Clin Radiol 2006; 61 (06) 457-466
    CrossrefPubMedGoogle Scholar
  • 53 LaPrade RF, Heikes C, Bakker AJ, Jakobsen RB. The reproducibility and repeatability of varus stress radiographs in the assessment of isolated fibular collateral ligament and grade-III posterolateral knee injuries. An in vitro biomechanical study. J Bone Joint Surg Am 2008; 90 (10) 2069-2076
    CrossrefPubMedGoogle Scholar
  • 54 Sekiya JK, Jacobson JA, Wojtys EM. Sonographic imaging of the posterolateral structures of the knee: findings in human cadavers. Arthroscopy 2002; 18 (08) 872-881
    CrossrefPubMedGoogle Scholar
  • 55 Barker RP, Lee JC, Healy JC. Normal sonographic anatomy of the posterolateral corner of the knee. AJR Am J Roentgenol 2009; 192 (01) 73-79
    CrossrefPubMedGoogle Scholar
  • 56 Temponi EF, de Carvalho Júnior LH, Saithna A, Thaunat M, Sonnery-Cottet B. Incidence and MRI characterization of the spectrum of posterolateral corner injuries occurring in association with ACL rupture. Skeletal Radiol 2017; 46 (08) 1063-1070
    CrossrefPubMedGoogle Scholar
  • 57 Pacheco RJ, Ayre CA, Bollen SR. Posterolateral corner injuries of the knee: a serious injury commonly missed. J Bone Joint Surg Br 2011; 93 (02) 194-197
    CrossrefPubMedGoogle Scholar
  • 58 Huang GS, Yu JS, Munshi M. et al. Avulsion fracture of the head of the fibula (the “arcuate” sign): MR imaging findings predictive of injuries to the posterolateral ligaments and posterior cruciate ligament. AJR Am J Roentgenol 2003; 180 (02) 381-387
    CrossrefPubMedGoogle Scholar
  • 59 Geeslin AG, LaPrade RF. Location of bone bruises and other osseous injuries associated with acute grade III isolated and combined posterolateral knee injuries. Am J Sports Med 2010; 38 (12) 2502-2508
    CrossrefPubMedGoogle Scholar
  • 60 LaPrade RF, Wentorf FA, Fritts H, Gundry C, Hightower CD. A prospective magnetic resonance imaging study of the incidence of posterolateral and multiple ligament injuries in acute knee injuries presenting with a hemarthrosis. Arthroscopy 2007; 23 (12) 1341-1347
    CrossrefPubMedGoogle Scholar
  • 61 Fanelli GC, Edson CJ. Posterior cruciate ligament injuries in trauma patients: Part II. Arthroscopy 1995; 11 (05) 526-529
    CrossrefPubMedGoogle Scholar
  • 62 Juhng SK, Lee JK, Choi SS, Yoon KH, Roh BS, Won JJ. MR evaluation of the “arcuate” sign of posterolateral knee instability. AJR Am J Roentgenol 2002; 178 (03) 583-588
    CrossrefPubMedGoogle Scholar
  • 63 Strub WM. The arcuate sign. Radiology 2007; 244 (02) 620-621
    CrossrefPubMedGoogle Scholar
  • 64 Lee J, Papakonstantinou O, Brookenthal KR, Trudell D, Resnick DL. Arcuate sign of posterolateral knee injuries: anatomic, radiographic, and MR imaging data related to patterns of injury. Skeletal Radiol 2003; 32 (11) 619-627
    CrossrefPubMedGoogle Scholar
  • 65 Shaikh H, Herbst E, Rahnemai-Azar AA. et al. The Segond fracture is an avulsion of the anterolateral complex. Am J Sports Med 2017; 45 (10) 2247-2252
    CrossrefPubMedGoogle Scholar
  • 66 Goldman AB, Pavlov H, Rubenstein D. The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. AJR Am J Roentgenol 1988; 151 (06) 1163-1167
    CrossrefPubMedGoogle Scholar
  • 67 Dietz GW, Wilcox DM, Montgomery JB. Segond tibial condyle fracture: lateral capsular ligament avulsion. Radiology 1986; 159 (02) 467-469
    CrossrefPubMedGoogle Scholar
  • 68 De Maeseneer M, Boulet C, Willekens I. et al. Segond fracture: involvement of the iliotibial band, anterolateral ligament, and anterior arm of the biceps femoris in knee trauma. Skeletal Radiol 2015; 44 (03) 413-421
    CrossrefPubMedGoogle Scholar
  • 69 Hess T, Gleitz M, Liebler J. Lateral tibia avulsion fractures and disruptions to the anterior cruciate ligament. Clin Orthop Relat Res 1994; (303) 193-197
    PubMedGoogle Scholar
  • 70 Skinner EJ, Davis DD, Varacallo M. Segond fracture. StatPearls; 2023. Available at: http://www.ncbi.nlm.nih.gov/books/NBK557810/ Accessed January 18, 2024
    PubMed
  • 71 Moran J, Schneble CA, Katz LD. et al. Examining the bone bruise patterns in multiligament knee injuries with peroneal nerve injury. Am J Sports Med 2022; 50 (06) 1618-1626
    CrossrefPubMedGoogle Scholar
  • 72 Kahan JB, Li D, Schneble CA. et al. The pathoanatomy of posterolateral corner ligamentous disruption in multiligament knee injuries is predictive of peroneal nerve injury. Am J Sports Med 2020; 48 (14) 3541-3548
    CrossrefPubMedGoogle Scholar
  • 73 Ridley TJ, McCarthy MA, Bollier MJ, Wolf BR, Amendola A. The incidence and clinical outcomes of peroneal nerve injuries associated with posterolateral corner injuries of the knee. Knee Surg Sports Traumatol Arthrosc 2018; 26 (03) 806-811
    CrossrefPubMedGoogle Scholar
  • 74 Moatshe G, Dornan GJ, Løken S, Ludvigsen TC, LaPrade RF, Engebretsen L. Demographics and injuries associated with knee dislocation: a prospective review of 303 patients. Orthop J Sports Med 2017; 5 (05) 23 25967117706521
    CrossrefPubMedGoogle Scholar
  • 75 Stannard JP, Schreiner AJ. Vascular injuries following knee dislocation. J Knee Surg 2020; 33 (04) 351-356
    Article in Thieme ConnectPubMedGoogle Scholar
  • 76 Kannus P. Nonoperative treatment of grade II and III sprains of the lateral ligament compartment of the knee. Am J Sports Med 1989; 17 (01) 83-88
    CrossrefPubMedGoogle Scholar
  • 77 Geeslin AG, LaPrade RF. Outcomes of treatment of acute grade-III isolated and combined posterolateral knee injuries: a prospective case series and surgical technique. J Bone Joint Surg Am 2011; 93 (18) 1672-1683
    CrossrefPubMedGoogle Scholar