2025 ISAKOS Biennial Congress ePoster
Detailed Anatomy of the Meniscotibial Ligament and Clock Face Position of Meniscal Attachments in the Tibia
Keiichi Yoshida, MD, PhD, Tokyo, Tokyo JAPAN
Youngji Kim, MD, PhD, Tokyo JAPAN
Haruka Kaneko, Tokyo JAPAN
Yoshitomo Saita, MD, PhD, Tokyo JAPAN
Mitsuaki Kubota, MD, PhD, Bunkyo-Ku, Tokyo JAPAN
Muneaki Ishijima, MD, PhD, Tokyo JAPAN
Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, JAPAN
FDA Status Not Applicable
Summary
We examined the detailed anatomy of the meniscotibial ligament (MTL) by novel method of clock face position and revealed significant differences in the attachment points of the medial and lateral MTL, providing valuable insights for surgical techniques and anatomical repair.
ePosters will be available shortly before Congress
Abstract
The meniscus attaches securely to the tibia via the anterior root, the posterior root, and the meniscotibial ligament (MTL). In addition to contributing to knee joint stability, the 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 to the tibial rim remains unclear. This study aimed to investigate the detailed anatomy of meniscal attachment to the tibia and to propose
Method
of clock face position.
Twenty knees of the embalmed cadavers were included in this study. We conducted a meticulous macroscopic examination of the attachment of the anterior and posterior roots of the menisci after identifying the medial and lateral menisci. We also identified the tibial attachments of the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). An imaginary line was drawn connecting the medial edge of the patellar tendon to the attachment point of the PCL (Akagi line). Additionally, a line representing the maximum diameter of the medial and lateral sides of the tibia was drawn perpendicular to the Akagi line. The menisci’s attachment positions were analyzed using the clock face positions, 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. To examine the frequencies of the various locations of the MTL attachments to the tibial rim, we employed the shoulder labrum method to determine the locations of the MTL attachments at 1-hour intervals. We recorded the location of the ligament’s attachment to the plateau, edge, or wall of the tibia at each clock position. If the ligament was attached to the wall, the distance from the articular surface to the meniscal tibial ligament attachment was measured.
The attachment points of the anterior and posterior roots of the medial and lateral meniscus, the ACL and the PCL were also shown using the clock face positions. All medial MTL and lateral MTL attachments at 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 7 o'clock and closest at 11 o'clock positions. No ligament attachment was observed at the 8 o'clock position due to the popliteal fossa.
We revealed the detailed anatomy of the tibial meniscal ligament and defined a novel method of clock face position. The medial meniscal tibial ligament was not attached to the articular surface, whereas the lateral meniscal tibial ligament was more anteriorly attached to the articular surface. These findings may facilitate the development more accurate surgical techniques for MTL repair and meniscal centralization.