The Menisco-Tibio-Popliteus-Fibular Complex: Anatomic Description of the Structures That Could Avoid Lateral Meniscal Extrusion
Por:
Masferrer-Pino, A, Saenz-Navarro, I, Rojas, G, Perelli, S, Erquicia, J, Gelber, PE, Monllau, JC
Publicada:
1 jul 2020
Resumen:
Purpose: To analyze, quantify, and rede fine the anatomy of the peripheral attachments of the lateral meniscal body to further understand how the structures might play a part in preventing meniscal extrusion and how it might be applied to surgical techniques. Methods: Ten nonpaired fresh -frozen cadaveric knees without prior injury, a surgical history, or gross anatomic abnormality were included. There were 5 right and 5 left knees, and 50% were from male donors and 50% were from female donors. All the dissections were performed by a group of 3 experts in knee surgery (2 knee surgeons and 1 anatomy professor who oversaw the design of the dissection protocol and guided this protocol). The main peripheral structures associated with the lateral meniscus body were dissected to determine the insertion, size, thickness, and location of the lateral meniscotibial ligament (LMTL), popliteo fibular ligament (PFL), and popliteomeniscal ligament (PML). The distance to various landmarks in the lateral compartment was also determined using an electronic caliper. Moreover, a histopathologic study was carried out. Results: The average thickness of the LMTL was 0.62 +/- 0.18 mm (95% con fidence interval [CI], 0.49-0.75 mm); that of the PFL-PML area was 1.05 +/- 0.27 mm (95% CI, 0.85-1.24 mm). The ante- roposterior distance measured 15.80 +/- 4.80 mm (95% CI, 12.40-19.30 mm) for the LMTL and 10.40 +/- 1.70 mm (95% CI, 9.21-11.63 mm) for the PFL-PML area. The anteroposterior distance of the whole menisco-tibio-popliteus- fibular complex (MTPFC) was 28.20 +/- 4.95 mm (95% CI, 24.70-31.70 mm). The average distance from the MTPFC to the posterior horn of the lateral meniscal root was 29.30 +/- 2.29 mm (95% CI, 27.60-30.90 mm), whereas that to the anterior horn was 32.00 +/- 4.80 mm (95% CI, 28.60-35.50 mm). The average distance from the tibial insertion of the LMTL to the articular surface was 5.59 +/- 1.22 mm (95% CI, 4.72-6.46 mm). In all the anatomic components of the knee, a consistent morphologic and histologic pattern was observed between the fibers of the LMTL, PFL, and PML and those of the lateral meniscal body, making up the proposed MTPFC. Conclusions: A consistent anatomic pattern has been identi fied between the lateral meniscal body and the LMTL, PFL, and PML, forming an interconnected complex that would seem appropriate to denominate the MTPFC. A precise study of this region and appropriate nomenclature for it could contribute to a better understanding of the mechanism of lateral meniscal injuries at this level, as well as the development of surgical techniques to treat these lesions and prevent extrusion. Clinical Relevance: This study contributes to the understanding of the lateral meniscal body attachments and the functions they serve. This will lead to improvements in the treatment of lesions in this region, including the development of surgical techniques.
Filiaciones:
Masferrer-Pino, A:
Univ Autonoma Barcelona, Inst Catala Traumatol & Med Esport ICATME, Hosp Univ Dexeus, Barcelona, Spain
Saenz-Navarro, I:
Fundacio Hosp Esperit St, Dept Orthopaed Surg, Barcelona, Spain
Univ Barcelona, Dept Anat, Barcelona, Spain
Rojas, G:
Hosp Reg Talca, Dept Orthopaed Surg, Talca, Chile
Perelli, S:
Univ Autonoma Barcelona, Inst Catala Traumatol & Med Esport ICATME, Hosp Univ Dexeus, Barcelona, Spain
Erquicia, J:
Univ Autonoma Barcelona, Inst Catala Traumatol & Med Esport ICATME, Hosp Univ Dexeus, Barcelona, Spain
Gelber, PE:
Univ Autonoma Barcelona, Inst Catala Traumatol & Med Esport ICATME, Hosp Univ Dexeus, Barcelona, Spain
Hosp Santa Creu & Sant Pau, Dept Orthopaed Surg, Barcelona, Spain
Monllau, JC:
Univ Autonoma Barcelona, Inst Catala Traumatol & Med Esport ICATME, Hosp Univ Dexeus, Barcelona, Spain
Univ Autonoma Barcelona, Hosp del Mar, Dept Orthopaed Surg, Barcelona, Spain
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