Biomedicines, Vol. 13, Pages 2053: Popliteus Tendon Morphology: Anatomical Classification and Clinical Implications—A Narrative Review

Biomedicines doi: 10.3390/biomedicines13092053

Authors:
Łukasz Olewnik
Ingrid C. Landfald
Bartosz Gonera
George Triantafyllou
Daria Domosławska
Maria Piagkou
Robert F. LaPrade

Purpose: The popliteus tendon (PT), though often overlooked, plays a vital role in the functional and mechanical stability of the posterolateral corner (PLC) of the knee. This narrative review consolidates the current anatomical, biomechanical, imaging, clinical, and surgical data on the PT, with an emphasis on its morphological variability and relevance in orthopedic sports medicine. Methods: A comprehensive review of the literature was conducted, including classical anatomical studies, recent classification systems, biomechanical evaluations, imaging protocols, and rehabilitation strategies. Particular focus was given to the anatomical classification proposed by Olewnik et al. and its implications in surgical and diagnostic contexts. Results: Anatomical investigations have demonstrated considerable variability in the PT, including bifid tendons and accessory fascicles. These variants have a measurable impact on preoperative planning, diagnostic imaging interpretation, and outcomes of surgical procedures, such as anterior cruciate ligament (ACL) and PLC reconstructions. The PT also contributes significantly to knee rotational control and meniscal stabilization, particularly in athletic populations. Imaging modalities, such as MRI and dynamic ultrasound, show high diagnostic utility, while arthroscopy remains the definitive diagnostic and therapeutic modality. Rehabilitation should emphasize neuromuscular re-education and progressive control of tibial rotation. A phase-based rehabilitation framework and clinical action table are proposed. Conclusion: The PT should be recognized as a critical structure in both the conservative and the surgical management of posterolateral and rotational knee instability. Enhanced awareness of its anatomical variability and functional importance can improve diagnostic accuracy, surgical precision, and clinical outcomes. In particular, MRI and high-resolution ultrasound can aid in identifying accessory fascicles and bifid tendons, while arthroscopy benefits from preoperative knowledge of PT variants to avoid misidentification and iatrogenic injury. Surgical planning for ACL and PLC reconstructions may be refined by applying the classification system described. Future research should focus on refining diagnostic algorithms, developing PT-specific functional tests, and integrating popliteus evaluation into high-level clinical decision-making and surgical navigation systems.

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Łukasz Olewnik www.mdpi.com