Lateral stabilizing structures of the knee: functional anatomy and injuries assessed with MR imaging

The lateral aspect of the knee is stabilized by a complex arrangement of ligaments, tendons, and muscles. These structures can be demonstrated with routine spin-echo magnetic resonance (MR) imaging sequences performed in the sagittal, coronal, and axial planes. Anterolateral stabilization is provided by the capsule and iliotibial tract. Posterolateral stabilization is provided by the arcuate ligament complex, which comprises the lateral collateral ligament; biceps femoris tendon; popliteus muscle and tendon; popliteal meniscal and popliteal fibular ligaments; oblique popliteal, arcuate, and fabellofibular ligaments; and lateral gastrocnemius muscle. Injuries to lateral knee structures are less common than injuries to medial knee structures but may be more disabling. Most lateral compartment injuries are associated with damage to the cruciate ligaments and medial knee structures. Moreover, such injuries are frequently overlooked at clinical examination. Structures of the anterolateral quadrant are the most frequently injured; posterolateral instability is considerably less common. Practically all tears of the lateral collateral ligament are associated with damage to posterolateral knee structures. Most injuries of the popliteus muscle and tendon are associated with damage to other knee structures. MR imaging can demonstrate these injuries. Familiarity with the musculotendinous anatomy of the knee will facilitate accurate diagnosis with MR imaging.