Radiographic identification of the primary medial knee structures

Area of Science:

• Orthopedic Surgery
• Radiology
• Anatomy

Background:

• Accurate radiographic landmarks for medial knee ligament attachment sites are currently unknown.
• Identifying these landmarks is crucial for preoperative evaluation and postoperative assessment of knee reconstructions.

Purpose of the Study:

• To identify and quantify radiographic landmarks for the femoral and tibial attachments of key medial knee ligaments.
• To establish reliable reference points for anatomic repairs and reconstructions.

Main Methods:

• Radiopaque markers were placed on the superficial medial collateral ligament (SMCL), posterior oblique ligament (POL), and medial patellofemoral ligament (MPFL) attachments in cadaveric knees.
• Anteroposterior and lateral radiographs were taken, and marker locations were measured relative to osseous landmarks and quadrants.
• Intraobserver reproducibility and interobserver reliability were assessed using intraclass correlation coefficients.

Main Results:

• High intraobserver (0.996) and interobserver (0.994) reliability were achieved.
• Specific measurements and quadrant locations were determined for SMCL, POL, and MPFL femoral attachments relative to the joint line, epicondyle, gastrocnemius tubercle, and adductor tubercle.
• Tibial attachments of the SMCL were also quantified relative to the tibial inclination.

Conclusions:

• Qualitative and quantitative correlations between medial knee structure attachment sites and osseous landmarks/radiographic lines were established.
• These identified landmarks demonstrate high agreement among examiners, supporting their clinical utility.