Concomitant Popliteomeniscal Fascicles Tears Are Found in 21% of Professional Soccer Players With Acute Anterior Cruciate Ligament Injuries

Overview

Journal Arthrosc Sports Med Rehabil

Date 2024 Nov 13

PMID 39534042

Authors

Pier Paolo Mariani

Guglielmo Torre

Michael J Battaglia

Riccardo Ciatti

Rocco Papalia

Affiliations

Soon will be listed here.

Abstract

Purpose: To investigate the incidence of popliteomeniscal fascicles (PMF) tears in anterior cruciate ligament (ACL) rupture in professional soccer players, to describe arthroscopic and magnetic resonance imaging (MRI) findings and treatment of these lesions with clinical outcomes, and to evaluate the incidence of subsequent lateral meniscus tears and ACL reinjury.

Methods: ACL reconstructions on soccer players were retrospectively analyzed, and among them, a cohort of patients with PMFs tears was reviewed. The cohort was assessed with MRI examination, arthrometric testing, Lysholm score, and International Knee Documentation Committee score. The occurrence of subsequent lateral meniscus tears and ACL reinjury were evaluated.

Results: A total of 208 ACL reconstructions were identified. From these, 43 male and 3 female subjects with a mean age of 24 ± 4.2 years were included. Median time from injury to surgery was 5 days. Preoperative MRI showed a tear of posterior PMFs in 24 of 47 knees (51.1%). The mean preoperative arthrometric measured laxity was 4.3 ± 1.65 mm, and postoperatively 0.1 ± 1.1 mm. Preoperative Lysholm score and International Knee Documentation Committee score were, respectively, 50.4 ± 25.4 and 39.6 ± 5, and postoperatively 98 ± 2.4 and 73.6 ± 1.2. Mean time to return to play, at the same preoperative level for all patients, was 184 ± 41.7 days. One patient underwent ACL revision due to a reinjury 9 months after surgery, whereas no lateral meniscus tears occurred in the follow-up period.

Conclusions: PMF tears are found in approximately 20% of professional soccer players with acute ACL injuries. After ACL reconstruction and PMFs repair, outcomes including return to play are good, ACL retear is low, and recurrent lateral meniscus tears were not observed.

Level Of Evidence: Level IV, therapeutic case series.

Citing Articles

Tears of Popliteomeniscal Fascicles and Meniscofibular Ligament in Popliteal Hiatus Area: An Arthroscopic Repair Technique With Suture.

Yan S, Ji T, Shu H, Wei W, Sun L Arthrosc Tech. 2025; 14(2):103199.

PMID: 40041348 PMC: 11873493. DOI: 10.1016/j.eats.2024.103199.

References

Ullrich K, Krudwig W, Witzel U . Posterolateral aspect and stability of the knee joint. I. Anatomy and function of the popliteus muscle-tendon unit: an anatomical and biomechanical study. Knee Surg Sports Traumatol Arthrosc. 2002; 10(2):86-90. DOI: 10.1007/s00167-001-0268-5. View

Chan C, Silas C, Ifran N, Mok Y, Krishna L . Risk Factors for New Meniscal Tears following Anterior Cruciate Ligament Reconstruction. J Knee Surg. 2020; 35(5):529-533. DOI: 10.1055/s-0040-1716361. View

DAddona A, Izzo A, Di Vico G, Rosa D, Maffulli N . The popliteomeniscal fascicles: from diagnosis to surgical repair: a systematic review of current literature. J Orthop Surg Res. 2021; 16(1):148. PMC: 7896406. DOI: 10.1186/s13018-021-02290-z. View

Ahn J, Lee S, Kim K, Nam J . Arthroscopic meniscus repair for recurrent subluxation of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc. 2017; 26(3):787-792. DOI: 10.1007/s00167-017-4420-2. View

Sakai H, Sasho T, Wada Y, Sano S, Iwasaki J, Morita F . MRI of the popliteomeniscal fasciculi. AJR Am J Roentgenol. 2006; 186(2):460-6. DOI: 10.2214/AJR.04.0068. View

Grassi A, Pizza N, Lucidi G, Macchiarola L, Mosca M, Zaffagnini S . Anatomy, magnetic resonance and arthroscopy of the popliteal hiatus of the knee: normal aspect and pathological conditions. EFORT Open Rev. 2021; 6(1):61-74. PMC: 7845568. DOI: 10.1302/2058-5241.6.200089. View

Temponi E, de Carvalho Junior L, Saithna A, Thaunat M, Sonnery-Cottet B . Incidence and MRI characterization of the spectrum of posterolateral corner injuries occurring in association with ACL rupture. Skeletal Radiol. 2017; 46(8):1063-1070. DOI: 10.1007/s00256-017-2649-y. View

Lu Y, Jurgensmeier K, Till S, Reinholz A, Saris D, Camp C . Early ACLR and Risk and Timing of Secondary Meniscal Injury Compared With Delayed ACLR or Nonoperative Treatment: A Time-to-Event Analysis Using Machine Learning. Am J Sports Med. 2022; 50(13):3544-3556. PMC: 10075196. DOI: 10.1177/03635465221124258. View

Cohn A, Mains D . Popliteal hiatus of the lateral meniscus. Anatomy and measurement at dissection of 10 specimens. Am J Sports Med. 1979; 7(4):221-6. DOI: 10.1177/036354657900700402. View

10.

LaPrade R, Konowalchuk B . Popliteomeniscal fascicle tears causing symptomatic lateral compartment knee pain: diagnosis by the figure-4 test and treatment by open repair. Am J Sports Med. 2005; 33(8):1231-6. DOI: 10.1177/0363546504274144. View

11.

Li Z, Zhao H, Dai Z, Chen Z, Liao Y, Fu D . Widening of the popliteal hiatus on magnetic resonance imaging leads to recurrent subluxation of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc. 2019; 28(11):3532-3538. DOI: 10.1007/s00167-019-05800-z. View

12.

Park J, Ro K, Lee D . Snapping knee caused by a popliteomeniscal fascicle tear of the lateral meniscus in a professional Taekwondo athlete. Orthopedics. 2012; 35(7):e1104-7. DOI: 10.3928/01477447-20120621-31. View

13.

van der Wal W, Meijer D, Hoogeslag R, LaPrade R . Meniscal Tears, Posterolateral and Posteromedial Corner Injuries, Increased Coronal Plane, and Increased Sagittal Plane Tibial Slope All Influence Anterior Cruciate Ligament-Related Knee Kinematics and Increase Forces on the Native and Reconstructed.... Arthroscopy. 2021; 38(5):1664-1688.e1. DOI: 10.1016/j.arthro.2021.11.044. View

14.

Maynard M, Deng X, Wickiewicz T, Warren R . The popliteofibular ligament. Rediscovery of a key element in posterolateral stability. Am J Sports Med. 1996; 24(3):311-6. DOI: 10.1177/036354659602400311. View

15.

Johnson R, de Smet A . MR visualization of the popliteomeniscal fascicles. Skeletal Radiol. 1999; 28(10):561-6. DOI: 10.1007/s002560050619. View

16.

Peduto A, Nguyen A, Trudell D, Resnick D . Popliteomeniscal fascicles: anatomic considerations using MR arthrography in cadavers. AJR Am J Roentgenol. 2008; 190(2):442-8. DOI: 10.2214/AJR.07.2643. View

17.

LaPrade R, Terry G . Injuries to the posterolateral aspect of the knee. Association of anatomic injury patterns with clinical instability. Am J Sports Med. 1997; 25(4):433-8. DOI: 10.1177/036354659702500403. View

18.

Kamiya T, Suzuki T, Otsubo H, Kuroda M, Matsumura T, Kubota C . Midterm outcomes after arthroscopic surgery for hypermobile lateral meniscus in adults: Restriction of paradoxical motion. J Orthop Sci. 2018; 23(6):1000-1004. DOI: 10.1016/j.jos.2018.06.003. View

19.

Steinbacher G, Alentorn-Geli E, Alvarado-Calderon M, Barastegui D, Alvarez-Diaz P, Cugat R . Meniscal fixation is a successful treatment for hypermobile lateral meniscus in soccer players. Knee Surg Sports Traumatol Arthrosc. 2018; 27(2):354-360. DOI: 10.1007/s00167-018-5080-6. View

20.

Simonian P, Sussmann P, van Trommel M, Wickiewicz T, Warren R . Popliteomeniscal fasciculi and lateral meniscal stability. Am J Sports Med. 1997; 25(6):849-53. DOI: 10.1177/036354659702500620. View