The Journal of Bone and Joint Surgery (American). 2007;89:2000-2010.
doi:10.2106/JBJS.F.01176
© 2007 The Journal of Bone and Joint Surgery, Inc.
The Anatomy of the Medial Part of the Knee
Robert F. LaPrade, MD, PhD1,
Anders Hauge Engebretsen, Medical Student2,
Thuan V. Ly, MD1,
Steinar Johansen, MD2,
Fred A. Wentorf, MS1 and
Lars Engebretsen, MD, PhD2
1 Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside
Avenue, R200, Minneapolis, MN 55454. E-mail address for R.F. LaPrade:
lapra001{at}umn.edu
2 Department of Orthopaedic Surgery, Ulleval University Hospital, University of
Oslo, N-0407 Oslo, Norway
Investigation performed at the University of Minnesota, Minneapolis,
Minnesota
Disclosure: In support of their research for or preparation of this
work, one or more of the authors received, in any one year, outside funding or
grants in excess of $10,000 from Health East, Norway, and the Norwegian
Research Council (grant #42692) and the Sports Medicine Research Fund of the
Minnesota Medical Foundation. Neither they nor a member of their immediate
families received payments or other benefits or a commitment or agreement to
provide such benefits from a commercial entity. No commercial entity paid or
directed, or agreed to pay or direct, any benefits to any research fund,
foundation, division, center, clinical practice, or other charitable or
nonprofit organization with which the authors, or a member of their immediate
families, are affiliated or associated.
Background: 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.
Methods: Dissections were performed and measurements were made for
eight nonpaired fresh-frozen cadaveric knees with use of an electromagnetic
three-dimensional tracking sensor system.
Results: 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.
Conclusions: The medial knee ligament structures have a consistent
attachment pattern.
Clinical Relevance: Identification of the gastrocnemius tubercle and
the quantitative relationships presented here will be useful in the study of
anatomic repairs and reconstructions of complex ligamentous injuries that
involve the medial knee structures.
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