Radiographic and Anatomic Landmarks of the Major Knee Ligaments

* A thorough understanding of the anatomic and radiographic landmarks is imperative for reconstructing the native insertions of the major ligaments around the knee. * The 2 cruciate ligaments, the anterior cruciate ligament and the posterior cruciate ligament, each have osseous intra-articular landmarks that separate the ligament bundles and can be used to guide accurate reconstructions. * The 2 collateral ligaments, the medial collateral ligament and the lateral collateral ligament (LCL), each have femoral insertions close to their respective epicondyles, and because of the location of their distal insertions, the ligaments gradually lose tension as the knee is flexed. * The anterolateral ligament is a controversial structure that may have a role in controlling knee internal rotation because of its femoral insertion just proximal and posterior to the LCL and its tibial location just distal to the joint line between Gerdy’s tubercle and the fibular head. * As the primary soft-tissue restraint against lateral patellar instability, the medial patellofemoral ligament inserts on the proximal and posterior aspect of the medial femoral condyle and attaches to the proximal third of the patella, with variable attachments to the medial aspect of the quadriceps tendon.