Variant popliteus tendon anatomy in knee surgery: implications for imaging, biomechanics, and operative strategy.

purposeThe popliteus tendon (PLT) exhibits considerable anatomical variability with direct implications for surgical procedures involving the posterolateral corner (PLC) of the knee. This review aims to translate the morphological classification proposed by Olewnik et al. (Sci Rep 11:14434, 2021 https://doi.org/10.1038/s41598-021-93778-5 ) into a clinically oriented framework for orthopaedic and sports surgeons, integrating imaging, biomechanical, and procedural perspectives.

methodsA comprehensive synthesis of anatomical, radiological, and surgical literature was performed, structured around the four primary PLT types and ten subtypes defined by Olewnik et al. (Sci Rep 11:14434, 2021 https://doi.org/10.1038/s41598-021-93778-5 ). Surgical risks, imaging features (MRI and ultrasound), and biomechanical consequences were analysed. Case-based models and operative recommendations were formulated based on variant morphology.

resultsEach PLT variant demonstrates distinct surgical relevance. Accessory bands especially in Types IIe and IVe pose a risk of misidentification, iatrogenic injury, and graft misplacement. MRI and dynamic ultrasound are complementary tools for preoperative mapping. A structured surgical algorithm, imaging protocol, and educational recommendations were developed. Clinical scenarios underscore the importance of intraoperative recognition.

conclusionThe Olewnik classification provides a reliable anatomical roadmap with direct clinical applicability. Integrating PLT variant identification into preoperative imaging and intraoperative decision-making enhances safety, optimises graft positioning, and supports anatomical restoration. Further biomechanical and surgical validation is warranted.