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      Posterior oblique ligament of the knee: state of the art

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          Abstract

          • The posterior oblique ligament (POL) is the predominant ligamentous structure on the posterior medial corner of the knee joint. A thorough understanding of the anatomy, biomechanics, diagnosis, treatment and rehabilitation of POL injuries will aid orthopaedic surgeons in the management of these injuries.

          • The resulting rotational instability, in addition to valgus laxity, may not be tolerated by athletes participating in pivoting sports. The most common mechanism of injury – accounting for 72% of cases – is related to sports activity, particularly football, basketball and skiing. Moreover, three different injury patterns have been reported: those associated with injury to the capsular arm of the semimembranosus (SM), those involving a complete peripheral meniscal detachment and those involving disruption of the SM and peripheral meniscal detachment.

          • The hallmark of an injury related to POL lesions is the presence of anteromedial rotatory instability (AMRI), which is defined as ‘external rotation with anterior subluxation of the medial tibial plateau relative to the distal femur’.

          • In acute settings, POL lesions can be easily identified using coronal and axial magnetic resonance imaging (MRI) where the medial collateral ligament (MCL) and POL appear as separate structures. However, MRI is not sensitive in chronic cases.

          • Surgical treatment of the medial side leads to satisfactory clinical results in a multi-ligamentous reconstruction scenario, but it is known to be associated with secondary stiffness.

          • In young patients with high functional demands, return to sports is allowed no earlier than 9–12 months after they have undergone a thorough rehabilitation programme.

          Cite this article: EFORT Open Rev 2021;6:364-371. DOI: 10.1302/2058-5241.6.200127

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          Most cited references 39

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          The Relationship Between Training Load and Injury, Illness and Soreness: A Systematic and Literature Review.

          Clinically it is understood that rapid increases in training loads expose an athlete to an increased risk of injury; however, there are no systematic reviews to qualify this statement.
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            The anatomy of the medial part of the knee.

            While the anatomy of the medial part of the knee has been described qualitatively, quantitative descriptions of the attachment sites of the main medial knee structures have not been reported. The purpose of the present study was to verify the qualitative anatomy of medial knee structures and to perform a quantitative evaluation of their anatomic attachment sites as well as their relationships to pertinent osseous landmarks. Dissections were performed and measurements were made for eight nonpaired fresh-frozen cadaveric knees with use of an electromagnetic three-dimensional tracking sensor system. In addition to the medial epicondyle and the adductor tubercle, a third osseous prominence, the gastrocnemius tubercle, which corresponded to the attachment site of the medial gastrocnemius tendon, was identified. The average length of the superficial medial (tibial) collateral ligament was 94.8 mm. The superficial medial collateral ligament femoral attachment was 3.2 mm proximal and 4.8 mm posterior to the medial epicondyle. The superficial medial collateral ligament had two separate attachments on the tibia. The distal attachment of the superficial medial collateral ligament on the tibia was 61.2 mm distal to the knee joint. The deep medial collateral ligament consisted of meniscofemoral and meniscotibial portions. The posterior oblique ligament femoral attachment was 7.7 mm distal and 6.4 mm posterior to the adductor tubercle and 1.4 mm distal and 2.9 mm anterior to the gastrocnemius tubercle. The medial patellofemoral ligament attachment on the femur was 1.9 mm anterior and 3.8 mm distal to the adductor tubercle. The medial knee ligament structures have a consistent attachment pattern.
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              The supporting structures and layers on the medial side of the knee: an anatomical analysis.

              The goal of this study was to delineate the consistent anatomical structures in the medial side of the knee and to determine their relationship to one another. One hundred and fifty-four fresh human knee joints were dissected. A three-layered pattern was found in which ligaments could be consistently placed. We have made suggestions regarding the nomenclature of these structures. The limits of of the so-called capsule and its significance as a stabilizer of the knee joint were examined. Only minor variations in the over-all anatomical pattern were found.
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                Author and article information

                Journal
                EFORT Open Rev
                EFORT Open Rev
                EFORT Open Reviews
                British Editorial Society of Bone and Joint Surgery
                2058-5241
                May 2021
                4 May 2021
                : 6
                : 5
                : 364-371
                Affiliations
                [1 ]IRCCS Orthopedic Institute Galeazzi, Milan, Italy
                [2 ]Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
                [3 ]Department of Orthopaedics, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
                [4 ]Casa di Cura Villa Betania, Rome, Italy
                [5 ]Marrelli Hospital, Crotone, Italy
                [6 ]IRCCS Policlinico San Martino, Genova, Italy
                [7 ]Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessalia, University Hospital of Larissa, Larissa, Greece
                Author notes
                Riccardo D’Ambrosi, IRCCS Orthopedic Institute Galeazzi, Via Galeazzi 4, 20161, Milan, Italy. Email: riccardo.dambrosi@ 123456hotmail.it
                Article
                10.1302_2058-5241.6.200127
                10.1302/2058-5241.6.200127
                8183151
                © 2021 The author(s)

                This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.

                Categories
                Sports & Arthroscopy
                13
                Multiple Ligament Injuries
                Posteromedial Corner of the Knee
                Posterior Oblique Ligament of the Knee
                Sports Medicine

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