Detailed anatomy of the meniscotibial ligament and clock face position of meniscal attachments in the tibia

Background

The meniscotibial ligament (MTL) is linked to meniscal extrusion that leads to knee osteoarthritis. There have been some reports on surgical treatment of MTL, however, the precise anatomy of the MTL attachment remains unclear. This study aimed to investigate the detailed anatomy of the attachment and to propose a method of clock face position.

Methods

Twenty knees of embalmed cadavers were included. Imaginary clock face positions were drawn on the tibial joint surface, with the anterior side defined as 12 o’clock, the posterior side as 6 o’clock, the medial side as 3 o’clock, and the lateral side as 9 o’clock. The MTL attachments to the tibial rim were then analyzed at 1-h intervals.

Results

All medial MTL and lateral MTL attachments at the 7 o’clock position were attached to the wall. MTL attachments on the articular surface were observed in certain cases at the 9 o’clock, 10 o’clock, and 11 o’clock positions. The medial MTL attachment was furthest from the articular surface at the 1 o’clock position and closest at the 4 o’clock position. The lateral MTL attachment was furthest at the 7 o’clock and closest at the 11 o’clock positions.

Conclusions

We revealed the detailed anatomy of the MTL and defined a novel method of clock face position. The medial MTL was not attached to the articular surface, whereas the lateral MTL was more anteriorly attached to the articular surface. These findings may facilitate the development of more accurate surgical techniques.