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Anatomy

Knee joint anatomy and biomechanics, focusing on trochlear geometry, ligamentous stability, and the impact of malalignment on surgical planning.

95 citationsUpdated Sep 2026
Illustration: Anatomy

Overview

A detailed understanding of quantitative knee anatomy serves as the foundation for anatomic reconstruction techniques [102]. This knowledge base of anatomy and function is essential to treat all different pathologies appropriately [96]. Three-dimensional images of knee structures can help better understand their anatomy [1]. Regarding bony anatomy, alterations in the femoral anatomy seem to be more important than in the tibial anatomy regarding valgus osteoarthritis of the knee [2]. The bony and cartilaginous anatomy of the patellofemoral joint is a subject of specific anatomical study [96].

Ligamentous anatomy is critical for surgical planning. The human anterior cruciate ligament has macrostructural and ultrastructural properties, with insertion sites and landmarks that may help improve surgical outcomes [7]. The human posterior cruciate ligament has a detailed anatomy regarding its course and footprints described using 3D CT technology [15]. It is important to know the precise anatomy of the posterior cruciate ligament bundles when performing PCL reconstruction [100]. The medial patellofemoral ligament must be reconstructed as anatomically as possible in its insertion and shape [3]. The knee anterolateral ligament consists of two structures described as the superficial and deep ALL [4]. Prior anatomical descriptions of the anterolateral ligament existed before recent claims of it being a new discovery [99]. The anatomy of the knee includes the newly recognized anterolateral ligament [95].

Other anatomical structures include the hamstring muscle–tendon complex, which has a specific proximal attachment, muscle course, and innervation [14]. The glenoid labrum has specific embryology, anatomy, microscopy, biomechanical properties, and clinical lesions [98]. The ulnar tunnel (Guyon canal) has an evolving anatomical description with relevant clinical associations [93].

Osseous Anatomy

Femur

Volumetric differences in intercondylar notch anatomy between males and females are largely attributable to anthropometric variations rather than sex itself [26]. In the context of trochlear dysplasia, the posterior femur exhibits significantly different morphology [23]. When applying absolute metric cut-off values for femoral morphometry, knee size is a critical factor [23].

Tibia

Tibial morphology demonstrates considerable variability at both infratuberosity and supratuberosity levels, underscoring the necessity for patient-specific, anatomy-based planning in posterior tibial slope correction [18]. Increased anthropometric height measures are associated with increased tibial bone area, which may reflect inherently larger bony structures [17]. For medial open wedge high tibial osteotomy, focusing on bone morphology allows surgeons to easily perform visual assessment using preoperative radiographs [21]. Furthermore, morphometrical measurements of the resected surface of the medial and lateral proximal tibia may enable manufacturers to design tibial baseplates that accommodate structural variability between different ethnic groups [25].

General Bony Morphology and Measurement

Anthropometric data aids in understanding bony morphology in relation to the knee, although it remains unclear how much implant mismatch is tolerable or if anatomical designs will improve clinical outcomes [19]. The modified 20% anatomical axis method is the most reproducible and reliable method for measuring posterior tibial slope on radiographs [24]. Three-dimensional images of the posteromedial corner structures help better understand its anatomy [1].

Ligaments and Joint Capsule

General Biomechanics and Restraints

A comprehensive understanding of the knee capsule and ligament biomechanics, including primary and secondary restraints and meniscal function, is essential for assessing and treating single and multi-ligament injuries [44]. Secondary restraints, particularly the posterior capsule and cruciate ligaments, block further joint opening after collateral ligament sectioning, especially near full extension [36]. Joint-preserving ligament surgery is not a universal remedy; success depends on recognizing biological, anatomical functional, surgical, and technical limits and choosing restraint when the joint or patient context counsels it [5]. Immobilization significantly reduces the ultimate load and energy-absorbing capabilities of the bone-ligament complex and causes histological changes at insertion sites [50].

Anterior Cruciate Ligament

The anterior cruciate ligament (ACL) lacks macroscopic or microscopic evidence of discrete subdivisions [61]. Isometric attachment sites have been identified to guide ACL reconstruction [61]. An over-the-top position for ACL reconstruction results in significant ligament elongation [61].

Posterior Cruciate Ligament and Meniscofemoral Ligaments

The posterior cruciate ligament (PCL) consists of two functional bundles: the anterolateral and posteromedial bundles [64]. These bundles exhibit distinct tightening patterns during knee flexion [64]. At least one meniscofemoral ligament is present in 93% of knees [64]. The meniscofemoral ligament acts as a secondary restraint to tibial posterior drawer [64].

Medial Structures

The deep portion of the medial ligament does not act as the prime stabilizer against medial stresses [84].

Lateral and Anterolateral Structures

The primary soft tissue restraint to tibial internal rotation is the deep layer of the iliotibial tract [70]. The anterolateral ligament is relatively weak [70]. Lateral tenodeses are not anatomic but are effective in controlling tibial internal rotation [70]. In paediatric knees, a distinct ligament is not discernible in the anterolateral capsule, as neither histological nor immunohistochemical analysis revealed a structure consistent with a ligament phenotype [82]. The debate regarding the anterolateral ligament will not be resolved by anatomic studies; only well-performed, rigorous, randomized clinical studies will settle the debate [74]. Combined lateral patellofemoral ligament and lateral patellotibial ligament reconstruction provides an anatomic and reproducible method to restore balanced lateral restraint and physiological patellar tracking [71].

Posterior Capsule and Hyperextension Restraints

The oblique popliteal ligament is the primary ligamentous restraint to knee hyperextension [83]. The posterior oblique ligament is an important secondary restraint to posterior tibial translation in the PCL-deficient knee [86]. A distinct plane exists between the posterior knee capsule and the meniscotibial ligament complex in pediatric specimens [85]. The distance between the physis and meniscotibial ligament capsular attachments increases with age [85].

Imaging and Visualization

Three-dimensional images of posteromedial corner structures can help better understand their anatomy [1].

Muscles and Tendons

Hamstrings

The semitendinosus and long head of the biceps femoris share a common origin, while the semimembranosus originates separately [108]. Anatomical dissection and photographic documentation define the hamstring muscle–tendon complex, including specific details on proximal attachment, muscle course, and innervation [14]. Gross anatomic findings and dimensions of the proximal hamstring origin aid surgeons in anchor placement at the anatomical attachment site to facilitate anatomic hamstring repair [108]. Additionally, anatomical data regarding the attachment sites of the proximal hamstrings may aid in better restoring anatomy during repair of proximal hamstring tears [10]. Following isolated semitendinosus harvest for primary anterior cruciate ligament reconstruction, regeneration does not restore native anatomy [106]. Significant muscle shortening, atrophy, and proximal insertion shifts are consistent findings following semitendinosus harvest [106].

Biceps Femoris

The biceps femoris insertion consists of a tibial footprint, distal fibular footprint, medial fibular footprint, and proximal fibular footprint [109]. The gastrocnemiofibular ligament is situated between the biceps and lateral gastrocnemius [104]. This ligament is located just posterior to the area of insertion of the tendon of the biceps muscle [104].

Quadriceps and Rectus Femoris

The rectus femoris tendon is mapped as the superficial layer of the quadriceps tendon [103]. Two consistent confluence zones in the rectus femoris tendon define a harvest corridor [103].

Iliopsoas

The distal muscular projection below the tendinous insertion on the lesser trochanter may maintain the functional connection of the iliopsoas between origin and insertion even after releasing the tendon [114].

Adductor Magnus

The adductor tendon graft presents a graft of significant volume, beneficial anatomic topography, and adequate tensile properties in comparison with the native medial patellofemoral ligament [115].

Neurovascular Anatomy

Familiarity with anatomic landmarks and associated distances allows assessment of the potential area of vulnerability to the sartorial branch of the saphenous nerve intraoperatively during medial knee ligament repair or reconstruction [8]. The saphenous nerve is intimately involved with the gracilis tendon for a portion of its course in the distal thigh, likely predisposing it to damage during passage of the tendon stripper [90]. If the length of the medial patellofemoral ligament is longer than the distance of the adductor magnus from the nerve, partial dissection or direct visualization of the harvesting region might be needed [92].

Sufficient exposure of relevant anatomic landmarks and precise portal preparation reduce the risk of iatrogenic vascular and peroneal nerve injury during arthroscopic approaches to the posterolateral corner of the knee [11]. The physeal-sparing posteromedial portal approach comes in closer proximity to important neurovascular structures, requiring care during technique execution [13]. Proximal fibular osteotomy techniques incorporate specific refinements aimed at minimizing soft tissue disruption and protecting adjacent neurovascular structures [12].

Nerves of bone are usually associated with arterial vessels and most appear to be non-myelinated [59]. A length of nerve plus its accompanying artery and vein can be transplanted as a free graft, but few sites can spare them [48]. There is a marked nerve-mediated regulation of blood vessels supplying the patellar tendon at the level where they course in the loose paratendinous connective tissue [89]. Kaplan fibers have a close topography to the superior lateral genicular artery [97]. No neurovascular injuries occurred in any group during opening-wedge high tibial osteotomy with posteromedial plating and laterally directed screw insertion [91].

Biomechanics and Function

General Principles

Biomechanical studies quantify the magnitude and direction of forces and moments acting on tissues within diarthrodial joints, while measuring corresponding joint kinematics to guide clinical assessment and treatment planning [29]. Ligaments function as the primary static stabilizers, connecting bone to bone and acting as passive restraints that guide joint motion [49]. These structures possess both dominant and load-sharing functions; for instance, the ACL and MCL in the knee exhibit an interdependent load-sharing relationship where deficiency in one structure significantly increases force in the complementary structure [49]. Individual ligaments are characterized by their dominant functions and their capacity to resist unique abnormal displacements, such as the ACL’s role in resisting anterior tibial translation [49].

Ligament mechanical properties are directly influenced by structure, collagen composition, and fiber orientation [49]. At low loads, ligaments behave in a nonlinear viscous-dominated manner, whereas at high loads, they become more elastic-dominated [49]. Compared to the highly aligned collagen of tendons, ligaments feature a more disorganized collagen orientation [49]. Consequently, the toe region is typically elongated in ligaments because it takes more time to align collagen fibers in the direction of loading [49].

Ligament Anatomy and Function

Certain ligaments possess a unique functional anatomy consisting of distinct bands that serve specific functions and are recruited differently throughout the entire joint range of motion [49]. The ACL comprises two distinct bands: the anteromedial band, which has a dominant role in preventing anterior tibial translation, and the posterolateral band, which primarily resists rotation in knee extension [49]. The position of the joint determines which ligament band is most tightly engaged and therefore most susceptible to damage [49]. Additionally, the anatomic and radiographic locations of the posterior oblique ligament, along with its biomechanical properties, have been successfully recorded [81].

Patellofemoral Joint

Biomechanical and clinical studies are required to examine how results translate into kinematic and functional outcomes for patients with episodic patellar dislocation [39]. When performing surgical reconstruction of the medial patellofemoral ligament, its biomechanical behaviour under loading conditions must be considered [52]. Understanding lateral patellofemoral anatomy and biomechanics is essential for addressing conditions of the lateral patellofemoral joint [66]. Small increases in reconstructed patellar thickness significantly alter patellofemoral joint motion and load distribution, particularly affecting lateral facet forces [77].

Regarding exercise stresses, open kinetic chain stresses were not supraphysiologic nor significantly higher than closed kinetic chain exercise stresses throughout the entire flexion range [78]. In kneeling, a difference in rotational kinematics exists between the flexion phase and the extension phase [73].

Cruciate Ligaments and Knee Kinematics

Under physiologic loading conditions, posterior cruciate ligament reconstruction does not restore six degree of freedom knee kinematics [53]. Nonisometric grafts disrupt normal kinematics and joint laxity depending on the fixation angle, leading to overconstraint or underconstraint throughout the motion arc [79]. Previously reported relationships between bony morphology and kinematics or ACL injury risk should not be extrapolated to suggest those features are associated with ACL elongation during high demand activities [63]. Following tibial plateau fractures, kinetic variables improved over time, but no improvements were observed in kinematic variables [54].

Surgical Reconstruction and Implants

Revision anterior cruciate ligament, lateral collateral ligament reconstruction, and osteochondral allograft transplantation restores anatomic load bearing forces and promotes biological repair of cartilaginous structures to achieve optimal kinematics of the knee joint [34]. To better reproduce native biomechanics, fixing the fibular collateral ligament in near-full extension may be advantageous [67]. Similarly, fixing the anterolateral ligament before 60° of flexion may better reproduce native biomechanics [67].

For noncruciate total knee arthroplasty designs to produce more normal motion characteristics, some mechanical configuration acting in concert with the lateral and medial condyles is likely to be necessary [58]. Changes in total knee arthroplasty component sizing should be considered in future biomechanical studies to minimize subluxation [60]. Smaller steps between component sizes, asymmetric designs, or individualized implants may help to minimize subluxation in total knee arthroplasty [60]. Surgical management of combined patellofemoral and proximal tibiofibular joint instability addresses biomechanical abnormalities and improves joint stability [68]. The change in femoral implant stability depends on the loading, flexion angle, and varies in its proportion in between the interface zones [69].

Other Structures

The fibula is a dynamic bone important for the kinematics and kinetics of the knee and ankle joints [76].

Common Sites of Injury

Ligaments and Tendons

Anatomical anomalies in the proximal musculotendinous junction of the adductor longus muscle may explain the difficulty in localizing injury sites [6]. Established anatomical data regarding the attachment sites of the proximal hamstrings aids in better restoring anatomy during repair of proximal hamstring tears [10]. Overlapping proximal and distal tendons and muscle architecture leading to a resultant force not in line with the tendon may predispose to muscle injury [43]. The presence of a raphe might play a role in protecting the muscle against gross injury [43]. In adults, intercondylar eminence fractures of the tibia are more severe due to associated ligamentous damage, often resulting in marked permanent disability [40].

Nerves and Vessels

Knowledge of the patterns of branching of the tibial and peroneal nerves aids in precise evaluation of injuries to nerves from lesions in the area of the knee [42]. Blunt trauma was the predominant cause of popliteal artery injury, and most patients presented with severe signs of ischaemia [35].

Bony Structures and Joints

Cross-sectional imaging can be useful for complete understanding of the fracture pattern and identification of associated injuries in triplane fractures of the proximal tibia [31]. Dislocation of the superior tibio-fibular joint in association with fracture of the tibia appears to be a unique injury type not previously described in the literature [30]. Inferior dislocation of the patella appears to be a unique injury [32].

General Injury Mechanisms and Classification

The sequence of injury to knee structures could be relevant to understanding injury mechanism and treatment, but requires validation [20]. A thorough understanding of the anatomy, physical examination findings, and imaging characteristics of the posteromedial corner of the knee will aid the physician in the management of these injuries [16].

Surgical Anatomy

General Principles and Neurovascular Safety

Joint-preserving ligament surgery success is defined by recognizing biological, anatomical, functional, surgical, and technical limits and choosing restraint when the joint or patient context counsels it [5]. In the posterolateral corner of the knee, sufficient exposure of relevant anatomic landmarks and precise portal preparation reduce the risk of iatrogenic vascular and peroneal nerve injury [11]. The technique for proximal fibular osteotomy incorporates specific refinements aimed at minimizing soft tissue disruption and protecting adjacent neurovascular structures [12]. Conversely, the physeal-sparing posteromedial portal approach comes in closer proximity to important neurovascular structures, requiring care during the technique [13]. To minimize iatrogenic damage to the infrapatellar branch of the saphenous nerve, the direction of incisions should be parallel to the direction of the nerve when technically possible [57]. Ultrasonography-assisted creation of the posterior transseptal portal is safer than conventional surgical methods because it enables identification of surrounding anatomical structures during portal creation and posterior compartment procedures [56].

Specific Anatomical Structures and Variations

Several anatomical anomalies were identified in the proximal musculotendinous junction of the adductor longus muscle, which may explain the difficulty in localizing injury sites [6]. The safe margin of the posteromedial compartment is consistently wider than that of the posterolateral compartment [80]. The popliteal artery is consistently located lateral to the posterior septum [80]. In open-wedge high tibial osteotomy, special caution and protection should be given until the approximately 35 mm portion from the starting point of the posteromedial cortex with consideration for the proximity on the sagittal plane [88].

Surgical Planning and Technique Considerations

The minimally invasive extra-articular anterolateral reinforcement technique does not damage the anterolateral structures and does not require an additional invasive harvest [51]. The minimally invasive approach using 2 posteromedial portals for arthroscopic pull-out technique for posterior cruciate ligament tibial avulsion fractures avoids disruption of the ligamentous anatomy, enhancing surgical safety and optimizing the potential for achieving appropriate tensioning during repair [55]. Both drilling techniques evaluated for femoral tunnel placement during anterior cruciate ligament reconstruction place the graft in an anatomically correct position [65]. Two tensioned wires may be placed without violating the anterior compartment by using four clinically identifiable landmarks in hybrid external fixation of distal tibial fractures [72]. Sagittal anatomy alone is not a primary determinant of surgical planning or gap behaviour during robotic-assisted total knee arthroplasty, supporting the need for a comprehensive, patient-specific and multiplanar approach [75]. The 3D preoperative protocol allows for individual identification of tunnels with anatomical specificity, decreasing surgical time and avoiding unnecessary radiation [87].

Key Evidence

  • [L5] Three-dimensional images of these structures can help better understanding its anatomy. [1] (10.1007/s00167-011-1615-9)
  • [L3] Bony alterations in the femoral anatomy seem to be more important than in the tibial anatomy. [2] (10.1007/s00167-019-05734-6)
  • [L5] Given the importance of this structure, it must be reconstructed as anatomically as possible in its insertion and in its shape. [3] (10.1007/s00167-014-3207-y)
  • [L5] This anatomic study clearly identified 2 structures, described as the superficial and deep ALL, which were consistent with previous but conflicting descriptions of the ALL. [4] (10.1177/2325967116675604)
  • [L5] Joint-preserving ligament surgery is not a universal remedy; success is defined by recognizing biological, anatomical, functional, surgical, and technical limits and choosing restraint when the joint or patient context counsels it. [5] (10.1002/ksa.70306)
  • [L5] Several anatomical anomalies were identified, which may explain the difficulty in localizing injury sites and highlight the importance of individualized treatment. [6] (10.1007/s001670050086)
  • [L4] The article reviews current knowledge of ACL anatomy, including macrostructural and ultrastructural properties, to provide essential information on insertion sites and landmarks that may help improve surgical outcomes. [7] (10.1007/s00167-009-0993-8)
  • [L5] Familiarity with these anatomic landmarks and associated distances allows assessment of the potential area of vulnerability to this nerve branch intraoperatively. [8] (10.1007/s00167-009-0934-6)
  • [L5] The anatomical data established in this study may aid in better restoring the anatomy during repair of proximal hamstring tears. [10] (10.1007/s00167-014-3074-6)
  • [L5] A sufficient exposure of relevant anatomic landmarks and precise portal preparation reduce the risk of iatrogenic vascular and peroneal nerve injury. [11] (10.1007/s00402-021-03864-6)
  • [L5] The technique incorporates specific refinements aimed at minimizing soft tissue disruption and protecting adjacent neurovascular structures. [12] (10.1002/atn2.70154)
  • [L5] Care needs to be taken with this technique as it comes in closer proximity to some of the important neurovascular structures. [13] (10.1007/s00167-020-06043-z)
  • [L5] This pictorial essay provides a detailed review of the anatomy of the hamstring muscle–tendon complex, including proximal attachment, muscle course, and innervation, based on anatomical dissection and photographic documentation. [14] (10.1007/s00167-018-5265-z)
  • [L5] This study is the first to describe the detailed anatomy of the human PCL with respect to its course and footprints using a 3D approach. [15] (10.1007/s00167-012-2332-8)
  • [L5] A thorough understanding of the anatomy, physical examination findings, and imaging characteristics will aid the physician in the management of these injuries. [16] (10.5435/jaaos-d-16-00020)
  • [L4] The association between increased anthropometric height measures and increased tibial bone area may reflect inherently larger bony structures. [17] (10.1186/1471-2474-13-19)
  • [L4] Considerable variability existed regarding tibial morphology at both levels, highlighting the importance of patient-specific, anatomy-based planning. [18] (10.1002/ksa.70003)
  • [L5] Anthropometric data will help to improve the understanding of the bony morphology in relation to the knee, though it remains unclear how much implant mismatch is tolerable or if anatomical designs will improve clinical outcomes. [19] (10.1007/s00167-014-3391-9)
  • [L5] The sequence of injury to these structures could be relevant to understanding injury mechanism and treatment, but requires validation. [20] (10.1016/j.asmr.2025.101207)
  • [L3] Focusing on bone morphology allows surgeons to easily perform visual assessment using preoperative radiographs. [21] (10.1186/s12891-022-05526-z)
  • [L4] This study shows that knee size is important in the application of absolute metric cut-off values and that the posterior femur also shows a significantly different morphology. [23] (10.1007/s00167-013-2573-1)
  • [L4] The modified 20% anatomical axis method was found to be most reproducible and reliable in measuring the posterior tibial slope. [24] (10.1016/j.jisako.2026.101186)
  • [L4] The morphometrical measurements presented may allow manufacturers to design tibial baseplates that accommodate the structural variability between different ethnic groups. [25] (10.1007/s00167-011-1749-9)
  • [L4] There are volumetric differences between male and female intercondylar notch anatomy, but these differences are largely due to anthropometric differences rather than sex itself. [26] (10.1177/03635465020300030501)
  • [L5] Biomechanical studies determine the magnitude and direction of forces and moments of various tissues in and around a diarthrodial joint, as well as measure corresponding joint kinematics, to assist clinicians in assessing function and planning treatment. [29] (10.1177/03635465990270042301)
  • [L5] This type of injury appears to be unique and has not been described in the literature. [30] (10.1016/s0020-1383(97)00046-6)
  • [L5] Cross-sectional imaging can be useful for complete understanding of the fracture pattern and identification of associated injuries. [31] (10.5435/jaaosglobal-d-21-00040)
  • [L5] The injury appears to be unique. [32] (10.1016/s0020-1383(97)00033-8)
  • [L5] This technique restores the anatomic load bearing forces and promotes biological repair of cartilaginous structures to achieve optimal kinematics of the knee joint. [34] (10.1016/j.eats.2022.08.016)
  • [L4] Blunt trauma was the predominant cause of injury, and most patients presented with severe signs of ischaemia. [35] (10.1016/s0020-1383(01)00007-9)
  • [L5] Secondary restraints, particularly the posterior part of the capsule and cruciate ligaments, blocked further opening after sectioning of the collateral ligaments, especially near full extension. [36] (10.2106/00004623-198163080-00007)
  • [L4] Biomechanical and clinical studies are needed to examine how the results translate into kinematic and functional outcomes for patients. [39] (10.2106/jbjs.21.00656)
  • [L4] In adults, the injury is more severe due to associated ligamentous damage, often resulting in marked permanent disability. [40] (10.2106/00004623-195941020-00002)
  • [L5] Knowledge of the patterns of branching of the tibial and peroneal nerves aids in precise evaluation of injuries to nerves from lesions in the area of the knee. [42] (10.2106/00004623-198971050-00022)
  • [L5] It is possible that overlapping proximal and distal tendons as well as muscle architecture are leading to a resultant force not in line with the tendon predispose to muscle injury, whereas the presence of a raphe might plays a role in protecting the muscle against gross injury. [43] (10.1007/s00167-013-2744-0)
  • [L5] A good understanding of the biomechanical behaviour of the knee capsule and ligaments, including primary and secondary restraints and meniscal function, will help the surgeon in the assessment and treatment of single and multi-ligament injuries. [44] (10.1007/s00167-015-3594-8)
  • [L4] A length of nerve plus its accompanying artery and vein can be transplanted as a free graft, but few sites can spare them. [48] (10.1016/s0020-1383(84)80055-8)
  • [L5] Immobilization significantly reduced the ultimate load and energy-absorbing capabilities of the bone-ligament complex and caused histological changes at the insertion sites. [50] (10.2106/00004623-198769080-00014)
  • [L4] This technique does not damage the anterolateral structures and does not require an additional invasive harvest. [51] (10.1016/j.arthro.2006.10.022)
  • [L5] Its biomechanical behaviour under loading conditions should be kept into account when performing surgical reconstruction of this ligamentous structure. [52] (10.1007/s00167-012-2307-9)
  • [L5] Under physiologic loading conditions, posterior cruciate ligament reconstruction does not restore six degree of freedom knee kinematics. [53] (10.1177/03635465030310040901)
  • [L2] While kinetic variables improved over time, there were no improvements observed in kinematic variables. [54] (10.1186/s12891-024-07910-3)
  • [L5] By avoiding disruption of the ligamentous anatomy, this technique not only enhances surgical safety but also optimizes the potential for achieving appropriate tensioning during repair. [55] (10.1016/j.eats.2025.103663)
  • [L5] Our method of creating the posterior portal and TSP assisted by ultrasonography is safer than conventional surgical methods because it enables identification of the surrounding anatomical structures during portal creation and posterior compartment procedures. [56] (10.1016/j.eats.2023.07.001)
  • [L5] To minimize iatrogenic damage to the nerve, the direction of incisions should be parallel to the direction of the nerve when technically possible. [57] (10.2106/jbjs.l.01297)
  • [L5] For noncruciate designs to produce more normal motion characteristics, some mechanical configuration acting in concert with the lateral and medial condyles is likely to be necessary. [58] (10.1016/j.arth.2025.03.014)
  • [L4] The nerves are usually associated with arterial vessels, and most appear to be non-myelinated. [59] (10.2106/00004623-196345030-00010)
  • [L5] These changes should be considered in future biomechanical studies, with smaller steps between component sizes, asymmetric designs, or individualized implants potentially helping to minimize subluxation. [60] (10.1016/j.arth.2016.06.001)
  • [L5] The study found no macroscopic or microscopic evidence of discrete subdivisions of the anterior cruciate ligament and identified isometric attachment sites to guide reconstruction, while noting the over-the-top position results in significant ligament elongation. [61] (10.2106/00004623-198567020-00012)
  • [L4] Previously reported relationships between bony morphology and kinematics or ACL injury risk should not be extrapolated to suggest those features are associated with ACL elongation during high demand activities. [63] (10.1177/2325967124s00233)
  • [L5] The PCL consists of two functional bundles (anterolateral and posteromedial) with distinct tightening patterns during knee flexion, and at least one meniscofemoral ligament is present in 93% of knees, acting as a secondary restraint to tibial posterior drawer. [64] (10.1007/s00167-005-0686-x)
  • [L5] Both drilling techniques place the graft in an anatomically correct position. [65] (10.1177/2325967114525572)
  • [L5] Understanding the lateral patellofemoral anatomy and biomechanics is important for addressing these conditions. [66] (10.5435/jaaosglobal-d-21-00255)
  • [L5] Fixing the FCL in near-full extension and the ALL before 60° of flexion may better reproduce native biomechanics. [67] (10.1177/2325967126s00384)
  • [L5] This technique addresses biomechanical abnormalities and improves joint stability. [68] (10.1016/j.eats.2025.103902)
  • [L5] The change depends on the loading, flexion angle and varies in its proportion in between the interface zones. [69] (10.1186/s12891-023-06151-0)
  • [Paper] The primary soft tissue restraint to tibial internal rotation is the deep layer of the iliotibial tract, while the anterolateral ligament is relatively weak; although lateral tenodeses are not anatomic, they are effective in controlling tibial internal rotation. [70] (10.1016/j.csm.2017.07.004)
  • [L5] The described technique provides an anatomic and reproducible method to restore balanced lateral restraint and physiological patellar tracking. [71] (10.1002/atn2.70082)
  • [Paper] Two tensioned wires may be placed without violating the anterior compartment by using four clinically identifiable landmarks. [72] (10.1007/s00402-004-0724-z)
  • [L4] In kneeling, there was a difference in the rotational kinematics between the flexion phase and the extension phase. [73] (10.1186/s13018-022-03080-x)
  • [L5] The debate regarding the anterolateral ligament will not be resolved by anatomic studies; only well-performed, rigorous, randomized clinical studies will settle the debate. [74] (10.1016/j.arthro.2018.11.031)
  • [L3] These findings suggest that sagittal anatomy alone is not a primary determinant of surgical planning or gap behaviour, supporting the need for a comprehensive, patient-specific and multiplanar approach. [75] (10.1002/ksa.70504)
  • [L5] The study concludes that the fibula is a dynamic bone important for the kinematics and kinetics of the knee and ankle joints. [76] (10.1007/s00402-005-0054-9)
  • [L4] Small increases in reconstructed patellar thickness significantly alter PFJ motion and load distribution, particularly lateral facet forces. [77] (10.1002/ksa.70282)
  • [L5] Open kinetic chain stresses were not supraphysiologic nor significantly higher than closed kinetic chain exercise stresses throughout the entire flexion range. [78] (10.1177/03635465010290041701)
  • [L5] Nonisometric grafts disrupt normal kinematics and joint laxity depending on the fixation angle, leading to overconstraint or underconstraint throughout the motion arc. [79] (10.1007/s001670050221)
  • [L4] The safe margin of the posteromedial compartment is consistently wider than that of the posterolateral compartment, and the popliteal artery is consistently located lateral to the posterior septum. [80] (10.1007/s00167-011-1429-9)
  • [L5] The anatomic and radiographic locations of the POL and its biomechanical properties were successfully recorded. [81] (10.1177/23259671231174857)
  • [L4] The study concludes that a distinct ligament is not discernible in the anterolateral capsule of paediatric knees, as neither histological nor immunohistochemical analysis revealed a structure consistent with a ligament phenotype. [82] (10.1136/jisakos-2019-000339)
  • [L5] The oblique popliteal ligament was found to be the primary ligamentous restraint to knee hyperextension. [83] (10.1177/0363546509348742)
  • [L5] The deep portion of the medial ligament does not act as the prime stabilizer against these stresses. [84] (10.2106/00004623-197456040-00002)
  • [L5] This defines a distinct plane between the posterior knee capsule and the meniscotibial ligament complex, with a distance between the physis and meniscotibial ligament capsular attachments that increases with age. [85] (10.1016/j.asmr.2023.100852)
  • [L5] The posterior oblique ligament is an important secondary restraint to posterior tibial translation in the posterior cruciate ligament–deficient knee. [86] (10.1177/0363546507310077)
  • [L4] The 3D preoperative protocol allows for individual identification of tunnels with anatomical specificity, decreasing surgical time and avoiding unnecessary radiation. [87] (10.1177/2325967118s00179)
  • [L4] Special caution and some protection should be given until the approximately 35 mm portion from the starting point of the posteromedial cortex with consideration for the approximity on the sagittal plane. [88] (10.1007/s00167-013-2503-2)
  • [L4] These observations provide a morphologic correlate for nerve-mediated effects, particularly a marked nerve-mediated regulation of blood vessels supplying the tendon at the level where they course in the loose paratendinous connective tissue. [89] (10.1007/s00167-005-0636-7)
  • [L4] The saphenous nerve is intimately involved with the gracilis tendon for a portion of its course in the distal thigh, likely predisposing it to damage during passage of the tendon stripper. [90] (10.1016/j.arthro.2007.03.099)
  • [L3] There were no neurovascular injuries in any group and no significant differences in clinical or radiological outcomes between the systems. [91] (10.1177/23259671221098421)
  • [L5] If the length of the MPFL is longer than the distance of the ADM from the nerve, partial dissection or direct visualization of the harvesting region might be needed. [92] (10.1007/s00167-023-07451-7)
  • [L5] This article examines the evolution of the anatomical description of the ulnar tunnel and its relevant clinical associations, casting light on the life and contributions of Guyon. [93] (10.1016/j.jhsa.2014.09.026)
  • [L5] A knowledge base of the anatomy and function is essential to treat all different pathologies appropriately. [96] (10.1007/s00167-005-0683-0)
  • [L5] Kaplan fibers can be consistently identified on MRI with use of 3-dimensional sequences, and subsequent anatomic dissection confirmed their close topography to the superior lateral genicular artery. [97] (10.1177/0363546520919986)
  • [L5] This review presents a concise summary of the embryology, anatomy, microscopy, biomechanical properties and clinical lesions involving the glenoid labrum to aid the clinician in understanding its function and pathology. [98] (10.1111/j.1758-5740.2010.00050.x)
  • [L5] The paper argues that while the clinical relevance of the anterolateral ligament (ALL) is significant, the claim that it is a new discovery is sensationalist, as prior anatomical descriptions existed. [99] (10.1016/j.arthro.2014.08.007)
  • [L5] It is very important to know the precise anatomy of PCL bundles when performing PCL reconstruction, and to evaluate PCL reconstruction surgery on an anatomical basis. [100] (10.1007/s00167-006-0192-9)
  • [L5] The basis of anatomic reconstruction techniques is a detailed understanding of quantitative knee anatomy. [102] (10.1007/s00167-015-3629-1)
  • [L5] This cadaveric study mapped the RF tendon as the superficial layer of the QT and identified two consistent confluence zones that define a harvest corridor. [103] (10.1002/ksa.70186)
  • [L4] However, regeneration does not restore native anatomy; significant muscle shortening, atrophy and proximal insertion shifts are consistent findings. [106] (10.1002/ksa.70479)
  • [L5] The semitendinosus and long head of the biceps femoris had a common origin, whereas the semimembranosus originated separately; the reported gross anatomic findings and dimensions may aid surgeons in anchor placement at the anatomical attachment site, thereby facilitating anatomic hamstring repair. [108] (10.1007/s00167-014-3124-0)
  • [L5] A tibial footprint, distal fibular footprint, medial fibular footprint, and proximal fibular footprint were all consistent components of the insertion of the biceps femoris. [109] (10.1177/2325967115602255)
  • [L5] The distal muscular projection below the tendinous insertion on the lesser trochanter may maintain the functional connection of the iliopsoas between origin and insertion even after releasing the tendon. [114] (10.1016/j.asmr.2020.09.017)
  • [L5] The adductor tendon graft presents a graft of significant volume, beneficial anatomic topography, and adequate tensile properties in comparison with the native MPFL. [115] (10.1177/03635465211009540)

See Also

References

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3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.