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Review
. 2021 Feb 22;9(2):2325967120973195.
doi: 10.1177/2325967120973195. eCollection 2021 Feb.

Clinical Anatomy of the Posterior Meniscofemoral Ligament of Wrisberg: An Original MRI Study, Meta-analysis, and Systematic Review

Przemysław A Pękala  1   2 , Dominik P Łazarz  1 , Mateusz A Rosa  1 , Jakub R Pękala  1 , Adam Baginski  1 , Alberto Gobbi  3 , Wadim Wojciechowski  4   5 , Krzysztof A Tomaszewski  1   2 , Robert F LaPrade  6
Affiliations
Review

Clinical Anatomy of the Posterior Meniscofemoral Ligament of Wrisberg: An Original MRI Study, Meta-analysis, and Systematic Review

Przemysław A Pękala et al. Orthop J Sports Med. .

Abstract

Background: The posterior meniscofemoral ligament (pMFL) of Wrisberg attaches to the posterior horn of the lateral meniscus and the lateral intercondylar aspect of the medial femoral condyle and passes posteriorly to the posterior cruciate ligament (PCL). The pMFL plays a role in recovery after PCL injuries and offers stability to the lateral meniscus, promoting normal knee function.

Purpose/hypothesis: The aim of the magnetic resonance imaging (MRI) arm of this study was to evaluate the prevalence of the pMFL in Polish patients. The purpose of the systematic review and meta-analysis was to evaluate the clinical relevance of the pMFL in knee surgery. It was hypothesized that extensive variability exists in reports on the prevalence, function, and clinical significance of the pMFL.

Study design: Cross-sectional study and systematic review; Level of evidence, 3.

Methods: A retrospective MRI investigation was conducted on 100 randomly selected lower limbs of Polish patients (56 male, 44 female) performed in 2019 to determine the prevalence of the pMFL. Additionally, an extensive literature search of major online databases was performed to evaluate all reported data on the pMFL. Assessments of article eligibility and data extraction were completed independently by 2 reviewers, and all disagreements were resolved via a consensus. A quality assessment of the included articles was performed using the Anatomical Quality Assessment tool.

Results: In the MRI arm of this study, the pMFL was observed in 73 of the 100 limbs. In the meta-analysis, 47 studies were included, totaling 4940 lower limbs. The pooled prevalence of the pMFL was found to be 70.4% (95% CI, 63.4%-76.9%); the mean length was 27.7 mm (95% CI, 24.8-30.5 mm) and the mean widths were 4.5, 6.1, and 4.1 mm for the meniscal and femoral attachments and midportion, respectively. The mean pMFL thickness was 2.3 mm (95% CI, 1.8-2.7 mm).

Conclusion: Despite the variability in the literature, the pMFL was found to be a prevalent and large anatomic structure in the knee joint. The shared features of this ligament with the PCL necessitate the consideration of its value in planning and performing arthroscopic procedures of the knee.

Keywords: MRI; clinical anatomy; evidence-based anatomy; ligament of Wrisberg; pMFL; posterior meniscofemoral ligament.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: A.G. has received consulting fees from Anika Therapeutics. R.F.L. has received research support from Smith & Nephew; consulting fees from Arthrex, Ossur, Smith & Nephew, and Linvatec; and royalties from Arthrex, Ossur, and Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from Jagiellonian University Medical College. This project was funded using the statutory funds of the Jagiellonian University Medical College.

Figures

Figure 1.
Figure 1.
The posterior meniscofemoral ligament (pMFL) of Wrisberg in a right knee. (A) Posterior view of the knee joint (the pMFL highlighted with red and marked with black arrow). (B) Coronal magnetic resonance imaging scan of the knee joint. PCL, posterior cruciate ligament; PHLM, posterior horn of the lateral meniscus (the pMFL marked with white arrow).
Figure 2.
Figure 2.
Cadaveric specimen of a right knee with the femur midsagittally resected, the lateral femoral condyle removed, and the posterior meniscofemoral ligament of Wrisberg (arrow) attached to the lateral meniscus (LM) and passing posteriorly to the posterior cruciate ligament (PCL). MFC, medial femoral condyle.
Figure 3.
Figure 3.
Left knee viewed from the anterolateral arthroscopic portal with the posterior meniscofemoral ligament of Wrisberg visible (arrow).
Figure 4.
Figure 4.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of study identification, evaluation, and inclusion into the meta-analysis. MRI, magnetic resonance imaging.
Figure 5.
Figure 5.
Forest plot for the overall pooled prevalence of the posterior meniscofemoral ligament of Wrisberg.
Figure A1.
Figure A1.
Summary of results from the Anatomical Quality Assessment checklist.
See this image and copyright information in PMC

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