Meniscus Problems? Muscular attachments to the Meniscus

Meniscal issues are common in the spectrum of knee pain.  There is some debate on whether an actual tear has to be present or if a combination of repetitive loading and possible other intra articular tissues that can cause pain.  Although not always present, there can be tissue connecting muscles around the knee into the menisci, creating a direct mechanical link that could be overlooked during physical examination and therapy.

While doing a little search, came across a paper reviewing the oblique popliteal ligament(free full freaking text also) and its connections into the semimembranosus portion of the medial hamstring.  Here is another paper by the same author further detailing the semimembranosus and its attachments(also FFFT).

oblique-pop-ligament

This paper found that 43.2% of semimembranosi had a tendinous branch inserting into the posterior horn of the lateral meniscus in addition to its more commonly known medial meniscus influence.  So a change in function of the semimembranosus, be it facilitation/inhibition/control/whatever motor control descriptor we want to use, can have a somewhat direct influence into the menisci.

semimembranosus-post-knee-insert

In a previous post reviewed the popliteus muscle and it’s relationship to the lateral meniscus.  During their review they reported finding a study observing 17.5% of knees having a strong popliteus muscle to lateral meniscus attachment, and 37.5% having a flimsy attachment.  Not a huge number, but almost one in five patient with lateral meniscal issues could have a substantial connection to the popliteus, which should not be overlooked or discounted.  Also, this guy wrote about the popliteus and meniscus in 1950, also  FFFT link.  Information from that long ago always impresses me, what has already be published but not implemented into practice, I found a shoulder therapy book from i think the early mid 1960s, kinesitherapy of the shoulder, i think it was belgian, but was discussing autonomic nervous system, role of the long head of the biceps, and need for spinal manipulation for proper rehab, with some basic cervical spine manips illustrated in it, bit ahead of its time. Rant over now. But here is another study which looked at the popliteus as a retractor of the lateral meniscus while performing arthroscopy, and 31/44 knees showed meniscal movement, not bad.

poplitues-with-menisucs-attachment

That’s probably enough for now, but bit of a taste of things to consider when looking at meniscus issues and the muscular components.  I think of it as a bit of a 2 way street, muscular activation abnormalities could cause a meniscus issue, but a true meniscus problem could also cause alteration of the muscle tone, giving a clue to the problem in the joint.  Full history and clinical assessment is required to determine the relationship.

Thanks for Reading

Pete

 

And yet another free full text article.

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