J Korean Orthop Assoc.  2017 Jun;52(3):264-271. 10.4055/jkoa.2017.52.3.264.

Locating Femoral Insertion of Superficial Medial Collateral Ligament and Posterior Oblique Ligament Using Adjacent Structures: Magnetic Resonance Imaging Study

Affiliations
  • 1Department of Orthopedic Surgery, National Police Hospital, Seoul, Korea. ish0524@hanmail.net

Abstract

PURPOSE
Anatomical medial knee reconstruction is crucial to the recovery of the knee joint. Our purpose is to determine the location of femoral insertion of the superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) from the attachment site of the adductor magnus and medial gastrocnemius tendon with MRI results.
MATERIALS AND METHODS
A total of 200 knee magnetic resonance imaging results were retrospectively measured. The boundary of femoral insertion of sMCL and POL was marked and measured on the sagittal image. The attachment site of the adductor magnus tendon and medial gastrocnemius tendon was identified. The lineal, anterior-posterior and proximal-distal distances were measured from the attachment site to the center of the femoral insertion of sMCL and POL.
RESULTS
The average size of sMCL and POL was as follows"”sMCL: length of 13.5±1.7 mm, width of 10.9±0.3 mm and POL: length of 9.4±1.3 mm, width of 6.1±0.5 mm. The lineal distances from the insertion of the adductor magnus tendon and medial gastrocnemius tendon to the center of the sMCL and POL were measured"”distances to the sMCL: 17.1±3.8 mm, 15.9±3.2 mm; distances to the POL: 11.9±2.9 mm, 8.2±2.7 mm.
CONCLUSION
This study will help determine the location of the femoral attachment site of sMCL and POL by identifying the attachment section of the adductor magnus tendon and medial gastrocnemius tendon. Moreover, this study will guide the reconstruction of sMCL and POL when palpation of the bony structures become difficult.

Keyword

superficial medial collateral ligament; posterior oblique ligament; injuries; reconstruction; magnetic resonance imaging

MeSH Terms

Collateral Ligaments*
Knee
Knee Joint
Ligaments*
Magnetic Resonance Imaging*
Palpation
Retrospective Studies
Tendons

Figure

  • Figure 1 (A) From the knee magnetic resonance imaging T1-weighted axial and sagittal cross-linked image, we lined the superior and inferior margins of the superficial medial collateral ligament (sMCL) on the sagittal image, using the axial images of sMCL (arrowhead: superior portion of sMCL, arrow: inferior portion of sMCL). (B) From the coronal and sagittal cross-linked image, we lined the anterior and posterior margins of sMCL on the sagittal image, using the coronal images of sMCL (arrowhead: anterior portion of sMCL, arrow: posterior portion of sMCL). (C) Then, we drew an oval shape inside the rectangular margin and checked the width and length of the sMCL attachment site.

  • Figure 2 (A) From the knee magnetic resonance imaging T1-weighted axial and sagittal cross-linked image, we lined the superior and inferior margins of the posterior oblique ligament (POL) on the sagittal image, using the axial images of POL (arrowhead: superior portion of POL, arrow: inferior portion of POL). (B) From the coronal and sagittal cross-linked image, we lined the anterior and posterior margins of POL on the sagittal image, using the coronal images of POL (arrowhead: anterior portion of POL, arrow: posterior portion of POL). (C) Then we drew an oval shpe inside the rectangular margin and checked the width and length of the POL attachment site.

  • Figure 3 (A) On the T1-weighted sagittal image, we checked the attachment site of the adductor magnus (large arrow) and medial gastrocnemius (small arrow) tendon. (B) The reference line is drawn by a bisection line to the femur (arrows); the proximal-to-distal axis was defined as the parallel axis to this line, and the anterior-to-posterior axis was defined as the vertical axis to this line on the sagittal image, where both the anterior and posterior cruciate ligament were visible.

  • Figure 4 (A) Anterior-posterior, proximaldistal and lineal distances from the insertion of the adductor magnus tendon to the center of the superficial medial collateral ligament (sMCL) attachment site were measured. Anterior-posterior, proximal-distal and lineal distances from the insertion of the medial gastrocnemius tendon to the center of the sMCL attachment site were measured. (B) Next, anterior-posterior, proximal-distal and lineal distances from the insertion of the adductor magnus tendon to the center of the posterior oblique ligament (POL) attachment site were measured. Anterior-posterior, proximal-distal and lineal distances from the insertion of the medial gastrocnemius tendon to the center of the POL attachment site were measured.


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