Anatomical Reconsideration of the Lateral Collateral Ligament in the Human Knee: Anatomical Observation and Literature Review

Jun Yan, Sanjuro Takeda, Kotaro Fujino, Goro Tajima, Jiro Hitomi

Department of Anatomy, School of Medicine, Iwate Medical University, Morioka, Japan.
Department of Orthopaedic Surgery, School of Medicine, Iwate Medical University, Morioka, Japan.

DOI: 10.4236/ss.2012.310096                

Abstract

In the published literature as well as in the most commonly used textbooks, the lateral collateral ligament (LCL) is described as having 1 attachment at the lateral epicondyle of the femur and another at the head of the fibula. In this article, we reconsider the attachments, the length of the LCL, and the tissues surrounding the LCL by presenting our anatomical observations and by reviewing the literature. Our results have shown that the LCL is not only attached to the lower part of the lateral epicondyle of the femur, but also extends to the upper part of the lateral epicondyle. The attachment of the LCL on the fibula is enclosed by 2 insertion points of the biceps femoris tendon. The average length of the LCL in 71 knees was 51.4 mm. There is an “incomplete gap” on the LCL that is interrupted under the tendon of the biceps femoris.

Keywords

Knee Joint; Lateral Collateral Ligament; Morphological Feature; Incomplete Gap; Human

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	D. C. Covey, “Injuries of the Posterolateral Corner of the Knee,” The Journal of Bone & Joint Surgery, Vol. 83, No. 1, 2001, pp. 106-118.
[2]	R. F. LaPrade, “The Anatomy of the Deep Infrapatellar Bursa of the Knee,” The American Journal of Sports Medicine, Vol. 26, No. 1, pp. 129-132.
[3]	R. F. LaPrade, T. V. Ly, F. A. Wentorf and L. Engebretsen, “The Posterolateral Attachments of the Knee: A Qualitative and Quantitative Morphologic Analysis of the Fibular Collateral Ligament, Popliteus tendon, Popliteofibular Ligament, and Lateral Gastrocnemius Tendon,” The American Journal of Sports Medicine, Vol. 31, No. 6, 2003, pp. 854-860.
[4]	R. F. LaPrade, S. Johansen, F. A. Wentorf, L. Engebretsen, J. L. Esterberg and A. Tso, “An Analysis of an Anatomical porterolateral Knee Reconstruction: An in Vitro Biomechanical Study and Development of a Surgical Technique,” The American Journal of Sports Medicine, Vol. 32, No. 6, 2004, pp. 1405-1414.
[5]	R. F. Laprade, C. Heikes, A. J. Bakker and R. B. Jakobsen, “The Reproducibility and Repeatability of Varus Stress Radiographs in the Assessment of Isolated Fibular Collateral Ligament and Grade-III Posterolateral Knee Injuries: An in Vitro Biomechanical Study,” The Journal of Bone and Joint Surgery: American Volume, Vol. 90, No. 10, 2009, pp. 2069-2076.
[6]	B. W. Jakobsen, B. Lund, S. E. Christiansen and M. C. Lind, “Anatomic Reconstruction of the Posterolateral Corner of the Knee: A Case Series with Isolated Reconstructions in 27 Patiens,” Arthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 26, No. 7, 2010, pp. 918-925.
[7]	R. F. LaPrade, J. F. Wozniczka, M. P. Stellmaker and C. A. Wijdicks, “Analysis of the Static Function of the Popliteus Tendon and Evaluation of an Anatomic Reconstruction,” The American Journal of Sports Medicine, Vol. 38, No. 3, 2010, pp. 543-549. doi:10.1177/0363546509349493
[8]	J. Yan, W. Sasaki and J. Hitomi, “Anatomical Study of the Lateral Collateral Ligament and Its Circumference Structures in Human Knee Joint,” Surgical and Radiologic Anatomy, Vol. 32, No. 2, 2010, pp. 99-106.
[9]	K. Ullrich, W. K. Krudwig and U. Witzel, “Posterolateral Aspect and Stability of the Knee Joint. I. Anatomy and Function of the Popliteus Muscle-Tendon Unit: An Ana- tomical and Biomechanical Study,” Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 10, No. 2, 2002, pp. 86-90. doi:10.1007/s00167-001-0268-5
[10]	T. Zantop, T. Schumacher, N. Diermann, S. Schanz, M. J. Raschke and W. Petersen, “Anterolateral Rotational Knee Instability: Role of Posterolateral Structures,” Archives of Orthopaedic and Trauma Surgery, Vol. 127, No. 9, 2007, pp. 743-752. doi:10.1007/s00402-006-0241-3
[11]	H. R. Gadikota, J. K. Seon, J. L. Wu, T. J. Gill and G. Li, “The Effect of Isolated Popliteus Tendon Complex Injury on Graft Force in Anterior Cruciate Ligament Reconstructed Knee,” International Orthopaedics, Vol. 35, No. 9, 2011, pp. 1403-1408. doi:10.1007/s00264-010-1118-1
[12]	R. F. LaPrade, S. I. Spiridonov, B. R. Coobs, P. R. Ruckert and C. J. Griffith, “Fibular Collateral Ligament Anatomical Reconstructions: A Prospective Outcomes Study,” The American Journal of Sports Medicine, Vol. 38, No. 10, 2010, pp. 2005-2011. doi:10.1177/0363546510370200
[13]	Y. Suda, B. B. Seedhom, H. Matsumoto and T. Otani, “Reconstructive Treatment of Posterolateral Rotatory Instability of the Knee,” The American Journal of Knee Surgery, Vol. 13, No. 2, 2000, pp. 110-116.
[14]	A. Williams, “Pelvic Girdle and Lower Limb,” In: S. Standing, Ed., Gray’s Anatomy, 39th Edition, Churchill Livingstone, New York, 2005, pp. 1471-1488.
[15]	S. M. Desio, R. T. Burks and K. N. Bachus, “Soft Tissue Restraints to Lateral Patellar Translation in Human Knee,” The American Journal of Sports Medicine, Vol. 256, No. 1, 1998, pp. 59-65.
[16]	K. L. Moore and A. F. Dalley, “Clinically Oriented Anatomy,” 5th Edition, Lippincott Williams & Wilkins, New York, 2006, pp. 684-701.
[17]	R. W. Soames, “Skeletal System,” In: P. L. Williams, Ed., Gray’s Anatomy, Churchill Livingstone, New York, 38th Edition, 1995, pp. 697-709.
[18]	R. Walmsley, “Joints,” In: G. J. Romanes, Ed., Cunning- ham’s Textbook of Anatomy, 11th Edition, Oxford University Press, London, 1978, pp. 241-246.
[19]	V. Mahadevan, “Pelvic Girdele and Lower Limb,” In: S. Standing, Ed., Gray’s Anatomy, Churchill Livingstone, London, 40th Edition, 2009, pp. 1327-1465.
[20]	E. Gardner, D. J. Gray and R. O’Rahilly, “Anatomy: A Regional Study of Human Structure,” Philadelphia, London, 2nd Edition, 1966, pp. 283-287.
[21]	W. H. Hollinshead, “Anatomy for Surgeons, Volume 3: The Back and Limbs,” 3rd Edition, Philadelphia, New York, 1982, pp. 749-755.
[22]	T. Sugita and A. A. Amis, “Anatomic and Biomechanical Study of the Lateral Collateral and Popliteofibular Ligaments,” The American Journal of Sports Medicine, Vol. 29, No. 4, 2001, pp. 466-472.
[23]	C. D. Clemente, “Gray’s Anatomy: Anatomyof the Human Body,” 30th Edition, Philadelphia, New York, 1985, pp. 397-408.
[24]	Espregueira-Mendes and M. V. da Silva, “Anatomy of the Lateral Collateral Ligament: A Cadaver and Histological Study,” Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 14, No. 3, 2006, pp. 221-228. doi:10.1007/s00167-005-0681-2
[25]	B. R. Meister, S. P. Michael, R. A. Moyer, J. D. Kelly and C. D. Schneck, “Anatomy and Kinematics of the Lateral Collateral Ligament of the Knee,” The American Journal of Sports Medicine, Vol. 28, No. 6, 2000, pp. 869-878.
[26]	Y. C. Gil, J. A. Park, H. J. Yang and H. Y. Lee, “Anatomy of the Femoral Attachment Site of the Anterior Cruciate Ligament and Posterolateral Structures Related to the Stability of the Knee Joint,” Korean Journal of Anatomy, Vol. 41, No. 1, 2008, pp. 57-65.
[27]	H. Ishigooka, T. Sugihara, K. Shimizu, H. Aoki and K. Hirata, “Anatomical Study of the Popliteofibular Ligament and Surrounding Structures,” Journal of Orthopaedic Science, Vol. 9, No. 1, 2004, pp. 51-58.
[28]	N. Otake, H. Y. Chen, X. F. Yao and S. Shoumura, “Morphologic Study of the Lateral Collateral Ligaments of the Human Knee,” Okajimas Folia Anatomica Japonica, Vol. 83, No. 4, 2007, pp. 115-122. doi:10.2535/ofaj.83.115
[29]	G. H. Jung, J. D. Kim and H. Kim, “Location and Classification of Popliteus Tendon’s Origin: Cadaveric Study,” Archives of Orthopaedic and Trauma Surgery, Vol. 130, No. 10, 2010, pp. 1027-1032.
[30]	R. F. LaPrade, K. A. Kimber, F. A. Wentorf and E. J. Olson, “Anatomy of the Posterolateral Aspect of the Goat Knee,” Journal of Orthopaedic Research, Vol. 24, No. 2, 2005, pp. 141-148.
[31]	M. Kozanek, E. C. Fu, S. K. Van de Velde, T. J. Gill and G. A. Li, “Posterolateral Structures of the Knee in Posterior Cruciate Ligament Deficiency,” The American Journal of Sports Medicine, Vol. 37, No. 3, 2009, pp. 534-541. doi:10.1177/0363546508325664
[32]	M.-H. Lai, S.-T. Chang, Y.-C. Chou, C.-H. Chang, T.-Y. Wang, H.-C. Huang and T.-Y. Li, “Real-Time Ultrasonographic Characteristics of the Lateral Collateral Ligament of the Knee in Cross-leg Position with Varus Stress Maneuver,” Journal of Medical Sciences, Vol. 31, No. 4, 2011, pp. 153-159.
[33]	L. F. Warren and J. L. Marshall, “The Supporting Structures and Layers on the Medial Side of the Knee: An Anatomical Analysis,” The Journal of Bone and Joint Surgery, Vol. 61, No. 1, 1979, pp. 56-62.
[34]	J. R. Seebacher, A. E. Inglis, J. L. Marshall and R. F. Warren, “The Structure of the Posterolateral Aspect of the Knee,” The Journal of Bone and Joint Surgery, Vol. 64, No. 4, 1982, pp. 536-541.
[35]	E. B. Kaplan, “The Fabellofibular and Soft Lateral Ligaments of the Knee Joint,” The Journal of Bone and Joint Surgery, Vol. 43, No. 2, 1961, pp. 169-179.
[36]	R. J. Last, “Anatomy, Regional and Applied,” 5th Edition, Churchill Livingstone, London, 1972, pp. 238-259.
[37]	R. A. Stockwell, “Joints,” In: G. J. Romanes, Ed., Cunnigham’s Textbook of Anatomy, 12th Edition, Oxford University Press, London, 1981, pp. 246-253.
[38]	M. A. R. Freeman and B. D. Wyke, “Innervation of the Knee Joint: An Anatomical and Histological Study in the Cat,” Journal of Anatomy, Vol. 101, No. 3, 1967, pp. 505-532.
[39]	O. Isao, “Studies on the Nerves of the Joints of the Lower Limb. Part II: The Nerves of the Knee Joint,” Medical Journal of Kagoshima University, Vol. 8, No. 2, 1956, pp. 170-198. (Japanese with English Abstract)