The popliteofibular ligament (PFL) belongs to the lateral supporting structures of the knee and is one of the three primary stabilizers of the posterolateral corner 1-6.
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Gross anatomy
It is a flattened, thick, and fan-shaped structure of the width of the popliteus muscle and two divisions 1. It takes a proximal oblique and distally a more vertical course 3,4 at an angle of about 60° in relation to the popliteus muscle 4.
It is a restraint to posterior translation and provides posterolateral and in particular external rotatory stability 3,5. More recent studies look at the function of the popliteofibular ligament more as a part of the popliteus tendon complex than as independent 5.
Attachments
The proximal origin encompasses the musculotendinous junction of the popliteus muscle 1,2.
Distally the popliteofibular ligament inserts at the anteromedial downslope, the tip, and the posteromedial aspect of the fibular styloid process 1,2.
Radiographic features
Ultrasound
The popliteofibular ligament can be easily visualized using a high-frequency linear probe as a sheet-like fibrillar band. The examination should be started with the distal end of the probe located on the posterior part of the fibular head (in the long axis of the lower limb). Then, the proximal part of the probe should be shifted posteriorly. The popliteofibular ligament is located just superficial to the hyperechoic cortex of the posterolateral tibia between the popliteus tendon (cross-section) proximally and the head of the fibula (distally) deep to the inferior lateral genicular vessels 5.
MRI
The popliteofibular ligament can be visualized using oblique coronal, standard coronal or sagittal images. It is located deep to the inferior lateral genicular vessels. It is noteworthy that it can be missed in standard MRI examination due to slice thickness (partial volume effect) 7.
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