Posterior Cruciate Meniscofemoral Complex Morphology – Functional and Clinical Implications

Background: The posterior cruciate meniscofemoral ligament (MFL) complex is considered an important stabilizing structure in the human knee joint. Its role in preventing tibial translation and preventing lateral meniscus injuries is increasingly being recognized. The knowledge of the anatomy of this complex, however, lags behind as compared to our knowledge and understating of its counterpart, the anterior cruciate ligament. Methods: Sixteen adult cadaveric knee joints (eight left and eight right) were utilized for this study. The posterior cruciate ligament (PCL) complex was resected out and its morphologic and morphometric assessment was done. Results: The PCL was short and stout ligamentous complex, mostly (but not always) clasped by either anterior MFLs, posterior MFL, or both. The tibial footprint was more or less circular, whereas the femoral footprint was oval and mediolaterally flattened. The PCL was constituted of two distinct fiber bundles, namely anterolateral and posteromedial. The MFLs originated from the posterior margin of the lateral meniscus just proximal to the posterior horn. The two MFLs ascend from their origin, bifurcate, and diverge to clasp the PCL. At least one MFL was observed in all specimens. Conclusion: The anatomical relationship of PCL, meniscofemoral, popliteus, and lateral meniscus suggests that they complement each other for a fine interplay and balance to execute terminal extension while simultaneously protecting the lateral meniscus. The findings of the present study contribute toward improving surgical repairs in double-bundle PCL repairs.