Picasso Riccardo, Marcenaro Giovanni, Zaottini Federico, Pistoia Federico, Macciò Marta, Jan Barendrecht Ellert, Quarto Emanuele, Pérez Maribel Miguel, Martinoli Carlo
IRCCS Ospedale Policlinico San Martino, Genova, Italy.
Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy.
Eur Radiol. 2025 Jul 29. doi: 10.1007/s00330-025-11868-8.
Unrecognized and untreated injuries of the posteromedial and posterolateral corners of the knee are more common than previously thought and have been linked to poor outcomes after anterior cruciate ligament reconstruction. Amongst imaging modalities, magnetic resonance is currently referred to as the gold standard for the evaluation of these regions, but has several limitations, in particular in the identification of subacute and chronic lesions. Recent technological advancements and the progressive refinement of linear probes have expanded the potential of High-resolution ultrasound in demonstrating the stabilizers of the posteromedial and posterolateral corners in both normal and pathological cases, and now this modality may be considered as a useful complementary tool for the evaluation of these structures. The aim of this work is twofold: (i) to review, also with the support of dedicated dissections and schematic drawings, the normal anatomy and the biomechanical role of the clinically relevant stabilizers of the posteromedial and posterolateral knee, including the distal expansion of the semimembranosus tendon, the popliteus muscle-tendon unit, and the posterior oblique ligament; (ii) to illustrate the normal ultrasound appearance of these structures and the spectrum of pathological findings that this modality may disclose in patients with anterior cruciate ligament tear. KEY POINTS: Question Injuries of the posteromedial and posterolateral knee worsen the outcome after anterior cruciate ligament reconstruction but are often underdiagnosed on imaging. Findings Ultrasound has potential in diagnosing tears of stabilizers of the posteromedial and posterolateral knee and provides complementary information to MRI about ligament status and continuity. Clinical relevance In subacute and chronic injuries, ultrasound has some advantages over MRI as it can disclose subtle abnormalities that might otherwise be unrecognized, thereby improving diagnostic confidence and patient counselling.
膝关节后内侧和后外侧角损伤若未被识别和治疗，比之前认为的更为常见，且与前交叉韧带重建术后的不良预后有关。在各种成像方式中，磁共振成像目前被视为评估这些区域的金标准，但存在一些局限性，尤其是在识别亚急性和慢性损伤方面。最近的技术进步以及线性探头的不断改进，扩大了高分辨率超声在显示正常和病理情况下膝关节后内侧和后外侧角稳定结构方面的潜力，现在这种成像方式可被视为评估这些结构的有用补充工具。这项工作的目的有两个：（i）在专门的解剖和示意图的支持下，回顾膝关节后内侧和后外侧临床相关稳定结构的正常解剖和生物力学作用，包括半膜肌腱的远端扩展、腘肌肌腱单元和后斜韧带；（ii）说明这些结构的正常超声表现以及这种成像方式在前交叉韧带撕裂患者中可能揭示的病理表现谱。关键点：问题膝关节后内侧和后外侧损伤会使前交叉韧带重建术后的预后恶化，但在影像学上常被漏诊。发现超声在诊断膝关节后内侧和后外侧稳定结构撕裂方面具有潜力，并能为MRI提供有关韧带状态和连续性的补充信息。临床意义在亚急性和慢性损伤中，超声比MRI有一些优势，因为它可以发现一些可能无法被其他方式识别的细微异常，从而提高诊断信心并为患者提供咨询。
