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. 2023 Oct 30;58(5):e755-e759.
doi: 10.1055/s-0043-1776137. eCollection 2023 Oct.

Medial Meniscotibial Ligament of the Knee: A Step by-Step Dissection

Jonatas Brito de Alencar Neto  1 , Alexia Barros Cardoso  1 , Gerônimo de Souza Munhoz  1 , Luiz Holanda Pinto Neto  1 , Renata Clazzer  2 , Diego Ariel de Lima  2   3
Affiliations

Medial Meniscotibial Ligament of the Knee: A Step by-Step Dissection

Jonatas Brito de Alencar Neto et al. Rev Bras Ortop (Sao Paulo). .

Abstract

Objective Considerable attention has been paid to meniscotibial ligaments (MTLs), also known as coronary ligaments, especially after the "Save the Meniscus" initiative gained importance among knee surgeons. Technically challenging, the diagnosis and treatment of ramp lesion show the importance of MTLs. These ligaments were discovered long ago, but their contribution to knee stability has only recently been studied and still lacks information. Thus, the aim of the present study was to describe step-by-step an dissection technique of the medial MTL, efficient, reproducible and that may lead to further research. Method Twenty fresh cadaver knees were used, with no preference for sex or age. The knees were dissected using the same technique standardized by our team. Each dissection step was recorded digitally. Results The medial MTL was found in all 20 knees studied using the aforementioned technique. In our sample, the medial MTL exhibited an average length of 70.0 ± 13.4 mm and width of 32.25 ± 3.09 mm, thickness of 35.3 ± 2.7 mm and weight of 0.672 ± 0.134 g. In all the cases, the medial MTL originated proximally and deeply to the deep MTL in the tibia. Conclusion We describe a simple effective and reproducible medial MTL dissection technique that makes it possible to identify the ligament over the entire medial extension of the knee.

Keywords: dissection; ligaments; menisci, tibial.

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Conflict of interest statement

Conflito de Interesses Os autores não têm conflitos de interesses a declarar.

Figures

Fig. 1
Fig. 1
Access for exeresis of the medial MTLs. ( A ) The cutaneous incision starts in the topography proximal to the medial epicondyle toward the posterior edge of the tibia. ( B ) First medial layer of the knee. (P: Patella; AL: Articular Line; F: Femur; T: Tibia; FA: Sartorius Fascia; *: Cutaneous Incision).
Fig. 2
Fig. 2
Access for exeresis of the medial MTLs. Second medial layer of the knee. Needles demonstrate the exact position of the articular line. Medial collateral ligament between the needles (Red asterisk: 25 × 7mm needles; Blue asterisk: medial collateral ligamentl).
Fig. 3
Fig. 3
Access for exeresis of the medial MTLs. Third medial layer of the knee. Medial collateral ligament displaced proximally, to enable visualization of the medial meniscus and medial MTL (inserted). (MCL: Medial collateral ligament; MTL: Meniscotibial ligament; MP: Medial plateau; MM: Medial meniscus).
Fig. 4
Fig. 4
Access for exeresis of the medial MTLs. Third medial layer of the knee. Medial MTL insertion (displaced proximally). (MTL: Medial tibial meniscus ligament; MM: Medial meniscus; MFC: Medial femoral condyle; MP: Medial plateau; C: Cartilage).
Fig. 5
Fig. 5
Access for exeresis of the medial MTLs. Disinsertion of the medial MTL of the medial meniscus and its tibial insertion (MTL: Medial tibial meniscus ligament; MM: Medial meniscus; MFC: Medial femoral condyle; MP: Medial plateau).
Fig. 1
Fig. 1
Acesso para exérese dos LMTs mediais. (A) A incisão cutânea começou na topografia proximal ao epicôndilo medial em direção à borda posterior da tíbia. (B) Primeira camada medial do joelho. (P: Patela; AL: Linha articular; F: Fêmur; T: Tíbia; FA: Fáscia do sartório; *: Incisão Cutânea).
Fig. 2
Fig. 2
Acesso para exérese dos LMTs mediais. Segunda camada medial do joelho. As agulhas revelam a posição exata da linha articular. O ligamento colateral medial está entre as agulhas (Asterisco vermelho: agulhas 25 × 7 mm; Asterisco azul: ligamento colateral medial).
Fig. 3
Fig. 3
Acesso para exérese dos LMTs mediais. Terceira camada medial do joelho. O ligamento colateral medial foi deslocado em sentido proximal para permitir a visualização do menisco medial e do LMT medial (inserido). (MCL: Ligamento colateral medial; MTL: Ligamento meniscotibial; MP: Platô medial; MM: Menisco medial).
Fig. 4
Fig. 4
Acesso para exérese dos LMTs mediais. Terceira camada medial do joelho. Inserção do LMT medial (deslocado em sentido proximal). (MTL: Menisco tibial medial; MM: Menisco medial; MFC: Côndilo femoral medial; MP: Platô medial; C: Cartilagem).
Fig. 5
Fig. 5
Acesso para exérese dos LMTs mediais. Rebatimento do LMT medial do menisco medial e sua inserção tibial (MTL: Menisco tibial medial; MM: Menisco medial; MFC: Côndilo femoral medial; MP: Platô medial).
See this image and copyright information in PMC

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