Steadman Philippon Research Institute, Vail, Colorado, USA.
The Steadman Clinic, Vail, Colorado, USA.
Am J Sports Med. 2019 Jul;47(8):1797-1803. doi: 10.1177/0363546519849933. Epub 2019 May 28.
Surgical treatment of lateral meniscal tears can be challenging due to the greater mobility of the lateral meniscus, thin capsule, and management of the popliteal hiatus. There has been a lack of quantitative assessments of the structural attachments to the posterior horn of the lateral meniscus (PHLM) to guide repairs.
To qualitatively and quantitatively describe the anatomy of the PHLM, popliteomeniscal fascicles, and the posterolateral capsule.
Descriptive laboratory study.
Fourteen male, nonpaired, fresh-frozen cadaveric knees were used. The attachments of the posterolateral capsule, popliteomeniscal fascicles, and meniscofemoral ligaments to the lateral meniscus and the attachment of the meniscotibial ligament to the tibia were identified. A 3-dimensional coordinate measuring system was used to measure the relationships of these attachments to surgically relevant landmarks and their structural relationship with the lateral meniscus.
The posterolateral capsule attachment had a confluent attachment at the superior margin of the PHLM, quantitatively attaching to the proximal 11% of the total height of the PHLM. On average, the length of the posterolateral capsule attachment to the superior surface of the PHLM was 16.7 ± 2.7 mm. The average length of the meniscotibial attachment to the posteroinferior aspect of the meniscus was 12.8 ± 3.9 mm. There was a lack of ligamentous attachments to the lateral meniscus between the lateral aspect of the meniscotibial ligament and the anterior aspect of the anterosuperior popliteomeniscal fascicle, where only popliteomeniscal fascicle and capsular attachments to the posterior meniscus were present.
This anatomic study provides quantitative guidelines for the complex attachments to the PHLM. Knowledge of the quantitative descriptions of these attachments may aid in an improved intraoperative diagnosis of PHLM tears that extend to the popliteal hiatus, and further studies related to the surgical repair of the intricate attachments to the PHLM are recommended.
The findings of this study provide the anatomic foundation for an improved understanding of the role of the meniscocapsular, meniscotibial, and popliteomeniscal fascicle attachments of the posterolateral meniscus. Understanding the differences between the lengths of the superior and inferior aspects of the popliteal hiatus will help to further refine characterization of tears extending into the popliteal hiatus and to avoid potential overconstraint of the more mobile lateral meniscus during a repair by anatomically reproducing its native structural attachments.
由于外侧半月板的较大活动性、薄囊和腘窝间隙的管理，外侧半月板撕裂的手术治疗具有挑战性。一直缺乏对指导修复的外侧半月板后角（PHLM）结构附着的定量评估。
定性和定量描述 PHLM、腘半月板束和后外侧囊的解剖结构。
描述性实验室研究。
使用 14 个男性、非配对、新鲜冷冻的尸体膝关节。确定后外侧囊、腘半月板束和半月板胫骨韧带与外侧半月板的附着关系，以及半月板胫骨韧带与胫骨的附着关系。使用三维坐标测量系统测量这些附着物与手术相关标志的关系及其与外侧半月板的结构关系。
后外侧囊附着在 PHLM 的上缘，在数量上附着于 PHLM 总高度的近端 11%。平均而言，后外侧囊附着于 PHLM 上表面的长度为 16.7 ± 2.7 毫米。半月板胫骨附着于半月板后下表面的平均长度为 12.8 ± 3.9 毫米。在半月板胫骨韧带的外侧与前上腘半月板束的前侧之间，外侧半月板没有韧带附着，只有腘半月板束和后半月板的囊附着。
这项解剖研究为 PHLM 的复杂附着提供了定量指南。了解这些附着的定量描述可能有助于提高对延伸至腘窝间隙的 PHLM 撕裂的术中诊断，并建议进一步研究与 PHLM 复杂附着的手术修复相关。
本研究的发现为更好地理解后外侧半月板的半月板囊、半月板胫骨和腘半月板束附着的作用提供了解剖学基础。了解腘窝间隙上下部分的长度差异将有助于进一步细化对延伸至腘窝间隙的撕裂的特征描述，并避免在修复时通过解剖复制其固有结构附着来避免潜在的过度限制更具活动性的外侧半月板。
