POSTEROMEDIAL

CORNER OF THE
KNEE

Introduction
Posteromedial corner - Posterior third
of the medial aspect of the knee.
Structures between posterior border
of the superficial medial collateral
ligament and the medial border of
the posterior cruciate ligament.
Has dynamic stabilizing effect.

Components of the
Posteromedial
Corner
Complex
POL

Suggested Imaging
Planes for MRI
Visualization
Axial

Distal
Sagittal and axial
semimembranosus
myotendinous complex
OPL
Axial and sagittal
Meniscotibial ligament

Coronal

Posterior horn of
medial
meniscus

Sagittal

Posterior
oblique
ligament
POL arises
from adductor
tubercle.
Has branching
insertion with
3 arms.
Superficial,
tibial,
capsular
arms.

POL insertion
Superficial arm blends with the
sheath of the direct insertion of
semimembranosus tendon.
Tibial arm inserts into the medial
meniscus close to the articular
margin of the posterior tibia.
Capsular arm blends with the
posterior capsule and OPL.

Semimembranosis myotendinous
complex
Consists of 5
arms.
Anterior (tibial
or reflected)
Direct
Inferior
(popliteal)
Capsular arms
OPL
expansion

Semimembranosis myotendinous
complex
Anterior arm extends anteriorly, under the
POL to attach to medial aspect of proximal
tibia.
Direct arm inserts at the tibial tubercle on
the posterior aspect of the medial tibial
condyle.
Inferior arm travels more distally than the
direct and anterior arms, to attach just
above the tibial attachment of the MCL.
Capsular arm coalesces with the capsular
portion of the oblique popliteal ligament.

Semimembranosis
tendon..
Pulls PHMM out of
the joint during
flexion.
Act as a dynamic
restraint to valgus
with the knee
extended.
In knee flexion the
muscle acts to
restrict external

Oblique popliteal
ligament
Arises from the confluence of the
lateral expansion of
semimembranosis and the capsular
arm of POL.
Courses superolaterally along the
posterior joint capsule to the arcuate
ligament and lateral head of the
gastrocnemius.

OPL

PHMM, Meniscotibial
ligament
Deep medial
collateral ligamentmade up of
meniscofemoral and
meniscotibial fibres.
Separated from the
superficial MCL by
the MCL bursa.

Clinical significance
Disruption of the posteromedial corner can result
in anteromedial rotatory instability of the knee.
Strong association between PMC and ACL injury.
Isolated ACL deficiency, PMC compensates to
maintain stability.
PMC injury with a ruptured ACL - variable
postoperative outcome after ACL reconstruction.
Isolated injury to the MCL - Conservative
Presence of associated posteromedial corner
injury - surgery

POL injuries
Comprise sprains, partial tears, and
complete tears.
Grade I
microscopic
tear

Ligament of normal thickness and intact,

with edema (T2 high signal) surrounding
the ligament

Grade II
partial tear

Thickening of ligament with partial

disruption of fibres and increased amount
of surrounding edema/hemorrhage

Grade III
complete tear

Complete disruption of the ligament, with

surrounding edema/hemorrhage

POL Injuries

POL Injuries

Injuries to distal
semimembranosis insertion
Occur in up to 70% of posteromedial
corner injuries.
Avulsion fractures- usually occur at
insertion of the direct arm.
Partial tears and strains- usually
involve the capsular arm.
Complete tears, tendinosis.

Injury to the semimembranosis

insertion

Medial meniscocapsular
lesions
Posterior third of medial meniscus has
intimate anatomic relations with the deep
structures.
Firm attachment to the tibia- by the
meniscotibial portion (coronary ligament) of
the deep MCL.
Injuries- disruption, thickening, or bony
avulsion (reverse Segond fracture).
Meniscocapsular separation- fluid between
the periphery of the meniscus and knee joint
capsule with discontinuous or irregular
heterogeneous meniscal attachments.

Medial meniscocapsular
lesions

Injuries to OPL
Primary ligamentous
restraint to knee
hyperextension.
Injuries may manifest
as irregularity of the
fascia like structure,
with edema in the
deep posteromedial
aspect of the knee.

Conclusion
PMC confined in a narrow space, anatomy
does not follow classical imaging planes.
As long as the semimembranosus corner
functions efficiently as a stabilizer, even a
weak or damaged cruciate ligament can
function in a compensated fashion. But if
this stabilizing effect is lost, the anterior
cruciate ligament alone is incapable of
compensating and becomes increasingly
insufficient.- Muller W, 1983