Complete anatomy of the knee6/11/2023 ![]() ![]() Investigating the extent of injury to the POL and posterior capsule is important in decision-making because the non-operative treatment of these injuries may more likely lead to unsatisfactory results. Additionally, the POL helps prevent excessive external tibial rotation and internal femoral rotation. 4 During a side-step cut, the POL contributes to keeping the pivot leg from opening in valgus, possibly acting in synergy with semimembranosus (SM) muscle activation. Moreover, the POL plays a small role in preventing posterior translation of the tibia on the femur because the posterior cruciate ligament (PCL) is so overpowering. 3 The main role of the POL is to control anteromedial rotatory instability (AMRI) and to provide static resistance to the valgus loads when the knee is fully extended. It is located at the posterior third of the medial collateral ligament, attached proximally to the adductor tubercle of the femur and distally to the tibia and posterior aspect of the joint capsule. 2 Biomechanics and cadaveric studies have demonstrated that the POL can be considered to be the predominant ligamentous structure on the posterior medial corner of the knee joint. 1 Subsequently, however, Robinson et al, in their dissection study, did not find a discrete ligament, and they simply referred to all structures posterior to the superficial medial collateral ligament (sMCL) as the posteromedial joint capsule. The posterior oblique ligament (POL) was described for the first time by Hughston and Eilers in 1973 who assigned clinical and biomechanical significance of the knee’s stability to it. In young patients with high functional demands, return to sports is allowed no earlier than 9–12 months after they have undergone a thorough rehabilitation programme.Ĭite this article: EFORT Open Rev 2021 6:364-371. Surgical treatment of the medial side leads to satisfactory clinical results in a multi-ligamentous reconstruction scenario, but it is known to be associated with secondary stiffness. However, MRI is not sensitive in chronic cases. In acute settings, POL lesions can be easily identified using coronal and axial magnetic resonance imaging (MRI) where the medial collateral ligament (MCL) and POL appear as separate structures. The hallmark of an injury related to POL lesions is the presence of anteromedial rotatory instability (AMRI), which is defined as ‘external rotation with anterior subluxation of the medial tibial plateau relative to the distal femur’. Moreover, three different injury patterns have been reported: those associated with injury to the capsular arm of the semimembranosus (SM), those involving a complete peripheral meniscal detachment and those involving disruption of the SM and peripheral meniscal detachment. ![]() The most common mechanism of injury – accounting for 72% of cases – is related to sports activity, particularly football, basketball and skiing. ![]() The resulting rotational instability, in addition to valgus laxity, may not be tolerated by athletes participating in pivoting sports. A thorough understanding of the anatomy, biomechanics, diagnosis, treatment and rehabilitation of POL injuries will aid orthopaedic surgeons in the management of these injuries. The posterior oblique ligament (POL) is the predominant ligamentous structure on the posterior medial corner of the knee joint. ![]()
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