Olewnik Łukasz, Landfald Ingrid C, Gonera Bartosz, Triantafyllou George, Domosławska Daria, Piagkou Maria, LaPrade Robert F
Department of Clinical Anatomy, Mazovian Academy, 09-402 Płock, Poland.
Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Biomedicines. 2025 Aug 22;13(9):2053. doi: 10.3390/biomedicines13092053.
: The popliteus tendon (PT), though often overlooked, plays a vital role in the functional and mechanical stability of the posterolateral corner (PLC) of the knee. This narrative review consolidates the current anatomical, biomechanical, imaging, clinical, and surgical data on the PT, with an emphasis on its morphological variability and relevance in orthopedic sports medicine. : A comprehensive review of the literature was conducted, including classical anatomical studies, recent classification systems, biomechanical evaluations, imaging protocols, and rehabilitation strategies. Particular focus was given to the anatomical classification proposed by Olewnik et al. and its implications in surgical and diagnostic contexts. : Anatomical investigations have demonstrated considerable variability in the PT, including bifid tendons and accessory fascicles. These variants have a measurable impact on preoperative planning, diagnostic imaging interpretation, and outcomes of surgical procedures, such as anterior cruciate ligament (ACL) and PLC reconstructions. The PT also contributes significantly to knee rotational control and meniscal stabilization, particularly in athletic populations. Imaging modalities, such as MRI and dynamic ultrasound, show high diagnostic utility, while arthroscopy remains the definitive diagnostic and therapeutic modality. Rehabilitation should emphasize neuromuscular re-education and progressive control of tibial rotation. A phase-based rehabilitation framework and clinical action table are proposed. : The PT should be recognized as a critical structure in both the conservative and the surgical management of posterolateral and rotational knee instability. Enhanced awareness of its anatomical variability and functional importance can improve diagnostic accuracy, surgical precision, and clinical outcomes. In particular, MRI and high-resolution ultrasound can aid in identifying accessory fascicles and bifid tendons, while arthroscopy benefits from preoperative knowledge of PT variants to avoid misidentification and iatrogenic injury. Surgical planning for ACL and PLC reconstructions may be refined by applying the classification system described. Future research should focus on refining diagnostic algorithms, developing PT-specific functional tests, and integrating popliteus evaluation into high-level clinical decision-making and surgical navigation systems.
腘肌腱（PT）虽常被忽视，但在膝关节后外侧角（PLC）的功能和机械稳定性中起着至关重要的作用。本叙述性综述整合了目前关于PT的解剖学、生物力学、影像学、临床和手术数据，重点关注其形态变异性及其在骨科运动医学中的相关性。：对文献进行了全面综述，包括经典解剖学研究、近期分类系统、生物力学评估、影像学方案和康复策略。特别关注了Olewnik等人提出的解剖学分类及其在手术和诊断背景下的意义。：解剖学研究表明PT存在相当大的变异性，包括分叉肌腱和副束。这些变异对术前规划、诊断性影像学解读以及手术操作（如前交叉韧带（ACL）和PLC重建）的结果有可测量的影响。PT对膝关节旋转控制和半月板稳定也有显著贡献，尤其是在运动员群体中。MRI和动态超声等影像学检查方法具有较高的诊断效用，而关节镜检查仍然是明确的诊断和治疗方法。康复应强调神经肌肉再教育和对胫骨旋转的逐步控制。提出了一个基于阶段的康复框架和临床行动表。：在膝关节后外侧和旋转不稳定的保守和手术治疗中，PT都应被视为关键结构。提高对其解剖变异性和功能重要性的认识可以提高诊断准确性、手术精度和临床结果。特别是，MRI和高分辨率超声有助于识别副束和分叉肌腱，而关节镜检查则受益于术前对PT变异的了解，以避免误认和医源性损伤。应用所述分类系统可完善ACL和PLC重建的手术规划。未来的研究应集中在完善诊断算法、开发针对PT的功能测试，以及将腘肌评估纳入高级临床决策和手术导航系统。
