Abstract
ObjectiveThe popliteofibular ligament (PFL) is an important stabilizer of the knee found within the posterolateral corner (PLC) of the joint. Injuries to the PLC can cause substantial patient morbidity. Accurate PFL visualization has been historically challenging, impeding injury diagnosis and treatment. The gold standard for in vivo PFL visualization is magnetic resonance imaging (MRI), but this procedure has slice thickness limitations, is costly, and is subject to longer wait times. Ultrasonographic (US) PFL assessment is a potentially viable alternative to MRI. This study aimed to determine the viability of US PFL assessment.Materials and methodsTen fresh-frozen lower limb specimens were evaluated for the presence and morphometric characteristics of the PFL via US using an 18.0-MHz linear transducer. The cadavers were then dissected and reassessed for the presence and morphometric characteristics of the PFLs for comparison with US findings. Moreover, the fracture of the fibular styloid process near the site of the insertion of the PFL (the arcuate sign) was simulated and assessed via US.ResultsThe PFL was visualized and measured in all ten knees via both US and cadaveric assessments. There were no statistically significant differences in PFL morphometric characteristics determined via US examination and dissection. The fibular styloid fracture was easily identified in US examination.ConclusionUS imaging is a viable alternative for accurate and effective assessment of the normal PFL. Moreover, the arcuate sign can be evaluated via US.
Highlights
The popliteofibular ligament (PFL) is an important stabilizer of the knee, located in the deepest layer of its posterolateral corner (PLC) [1,2,3,4]
Working with the popliteus (PT) and lateral collateral ligament (LCL), the PFL assists in preventing external tibial rotation and posterior translation, as well as varus angulation of the knee joint [1]
In recent decades, the characterization of the PFL has improved as a result of advancements in imaging techniques and a more detailed account of PLC anatomy [3, 7,8,9,10,11]
Summary
The popliteofibular ligament (PFL) is an important stabilizer of the knee, located in the deepest layer of its posterolateral corner (PLC) [1,2,3,4]. The PLC is among the most anatomically complex regions of the knee joint. Due to this complexity and the varied presence and morphology of its structures, the accurate and comprehensive characterization of the PLC has historically been difficult. Injuries to such structures may be overlooked by physicians. In recent decades, the characterization of the PFL has improved as a result of advancements in imaging techniques and a more detailed account of PLC anatomy [3, 7,8,9,10,11]. PLC injuries may cause a significant deterioration in patient quality of life
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