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Anatomy in Practice

Anatomy in practice: the Popliteus muscle


Stephanie Woodley BPhty MSc
PhD student
Department of Anatomy & Structural Biology
University of Otago
Dunedin
New Zealand

Susan Mercer BPhty(Hons) MSc PhD


Department of Anatomy & Developmental Biology
School of Biomedical Sciences
The University of Queensland
Australia

ABSTRACT
Examination for trigger points in the popliteus muscle involves palpation of its
muscle belly and proximal tendon of attachment. Review of the popliteus muscle
in situ revealed its location on the oor of the popliteal fossa and the association of
overlying soft tissues and neurovascular bundles. While the premise in clinical texts
is that this muscle is easily accessible, the clinical anatomy of popliteus highlights
that palpation is not as straightforward as often depicted.
Woodley S, Mercer S (2006): Anatomy in practice: the Popliteus muscle. New Zealand
Journal of Physiotherapy 34(1): 25-29.

INTRODUCTION joint capsule, and continues upwards towards its


The differential diagnosis for posterior knee proximal insertion. Attachment proximally is into
pain can be complex, and vascular and neurologic the lateral surface of the lateral condyle of the
pathology needs to be considered alongside femur, below the attachment of the lateral collateral
musculoskeletal disorders (Muche and Lento 2004). ligament (Figure 2) (Frazer 1940, Hollinshead 1969,
From a musculoskeletal perspective, popliteus has Watanabe et al 1993). A bursa is found deep to the
been implicated in complaints of posterior knee tendon where it passes between the lateral collateral
pain that is exacerbated with activities such as ligament and the lateral meniscus.
crouching and either walking or running, downhill Clear associations between popliteus and
or downstairs. One suggestion regarding the pattern surrounding structures have been identied. A
of pain referral from popliteus is that it arises from feature of its eshy attachment to the tibia is that it
an active trigger point located within the middle is covered by dense fascia, which is particularly thick
of its muscle belly. In addition, if symptomatic, medially, thereby acting as an aponeurosis for the
the popliteal tendon and the region of its femoral semimembranosus muscle (Grant and Basmajian
attachment may be tender when palpated. When 1965, Moore and Dalley 2006). Associations have
describing techniques of palpation it has been also been observed with the joint capsule, lateral
proposed that the tibial attachment, the upper meniscus, posterior cruciate ligament, ligaments of
lateral end of popliteus and the femoral attachment Wrisberg and Humphrey, oblique popliteal ligament,
are palpable (Chaitow and Walker DeLany 2002, the arcuate ligament complex, and to the head of
Travell and Simons 1999). Interestingly, the the bula (Figure 1) (Jones et al 1995, Kimura et
topography of the muscle is not included in these al 1992, Last 1948, Last 1950, Terry and LaPrade
clinical descriptions. As the morphology of the 1996, Tria et al 1989, Ullrich et al 2002, Wadia et
popliteus muscle in situ is rarely discussed in al 2003, Watanabe et al 2003).
relationship to musculoskeletal assessment of
the knee region, the purpose of this paper was to Function
present the clinical anatomy of this muscle. Popliteus provides posterolateral stability to
the knee joint and aids in stabilising the lateral
Morphology meniscus and controlling tibial rotation (Jones et
Popliteus is described as a thin or attened al 1995, Muche and Lento 2004, Nyland et al 2005,
triangular shaped muscle. Its broad muscle belly Ullrich et al 2002). This muscle is not thought to
attaches medially to the posterior surface of the contribute signicantly to exion of the knee joint
tibia above the soleal line, tapering to an apex as (Fuss 1989, Kaplan 1962, Moore and Dalley 2006).
it approaches the knee joint (Figure 1) (Grant and However, it has been suggested that popliteus aids
Basmajian 1965, Hollinshead 1969, Gardner et al in unlocking and internally rotating the knee joint
1975). From their distal attachment, the fascicles when initiating exion, and that it may control
of popliteus pass superiorly and laterally, running antero-posterior motion of the lateral meniscus
beneath the arcuate ligament (Last 1948, Watanabe throughout the motion of exion (Fuss 1992, Last
et al 1993). Becoming tendinous, it then passes 1948, Moore and Dalley 2006). In instances when
between the brous and synovial layers of the knee the knee adopts a static exed position, popliteus

NZ Journal of Physiotherapy – March 2006, Vol. 34 (1) 25


Figure 2: Lateral view of a right knee joint. The tendon
of popliteus (PT) is attaching to the lateral aspect of
the lateral femoral condyle (LFC), below the proximal
attachment of the lateral collateral ligament (LCL).
Lateral meniscus (LM), head of the bula (F).

Located at the back of the knee, the popliteal fossa


is a diamond shaped area which may be divided into
an upper and a lower triangle. The upper triangle is
bounded medially by the semimembranosus muscle
and overlying semitendinosus tendon. The short
head of biceps femoris, overlaid and fused with the
long head of biceps femoris, forms the lateral border
(Figure 3). These muscles and tendons embrace
Figure 1: Posterior view of a left knee joint. The popliteus the proximal sides of the lower triangle which are
muscle (P) runs superiorly from the tibial shaft medially comprised of the two heads of gastrocnemius and
above the oblique soleal line (S), to pass under part the very small plantaris muscle, which lies beneath
of the arcuate ligament complex (AL) and lateral the lateral head. The oor of the fossa is largely
collateral ligament (LCL). It attaches to the lateral formed by the posterior aspect of the distal femur
femoral condyle via its tendon (PT). Note the groove which is covered by fat, and the posterior capsule
for the popliteal tendon in the lateral femoral condyle
of the knee joint. The thick fascia covering the
(arrowhead). Fibula (F), posterior cruciate ligament
(PCL), ligament of Wrisberg (LW), insertions of the popliteus muscle completes the oor distally (Figure
lateral head of gastrocnemius (LG) and medial head of 4) (Grant and Basmajian 1965, Hollinshead 1969,
gastrocnemius (MG). Woodburne and Burkel 1988). Covering the fossa
to form a roof are the dense, circularly arranged
is also thought to assist the posterior cruciate bres of the fascia lata, which pass distally to
ligament in preventing anterior displacement of become continuous with the deep fascia of the leg.
the femur on the tibia (Moore and Dalley 2006). As It has been suggested that this overlying popliteal
this paper is concerned with the morphology of the fascia is tensioned when the knee joint is extended
popliteus muscle, readers interested in the function (Gardner et al 1975).
of this muscle are referred to a recent review (Nyland The popliteal fossa contains numerous structures
et al 2005). including the common peroneal and tibial nerves,
popliteal artery and vein, posterior femoral
Popliteal Fossa cutaneous nerve, the genicular branch of the
When contemplating palpation of popliteus, obturator nerve, the small saphenous vein, lymph
the muscle must be considered in situ. From nodes, bursae and fat (Figure 4). All of these various
a physiotherapy perspective, familiarity with structures must be considered when attempting to
the anatomy of the popliteal fossa is therefore palpate the popliteus muscle as they lie between
necessary. the skin and the popliteus muscle (Hollinshead

26 NZ Journal of Physiotherapy – March 2006, Vol. 34 (1)


Figure 3: View of a right popliteal fossa from behind. The
boundaries are: upper medial, the semimembranosus
muscle (SM) and overlying tendon of semitendinosus
(ST); upper lateral, the biceps femoris muscle anked
by the common peroneal nerve (CP) and iliotibial
band (ITB) with the vastus lateralis (VL) and fascia lata
Figure 4: Posteromedial view of a right popliteal
(FL); the lower lateral boundary, the lateral head of
fossa with the medial (MG) and lateral (LG) heads
gastrocnemius (LG) and the lower medial boundary,
of gastrocnemius resected to reveal its contents.
the medial head of gastrocnemius.
The tendon of semitendinous (ST) passes over the
semimembranosus muscle (SM) which anks the medial
head of gastrocnemius. The thick distal expansion (E)
1969, Gardner et al 1975, Woodburne and Burkel of semimembranosus can be seen covering the medial
1988) muscle belly of popliteus (P). The midbelly and lateral
In the midline, the oor is crossed vertically by aspect of the popliteus belly is covered by the tibial
the tibial nerve and popliteal vessels (Figure 4). nerve (TN), popliteal vessels (PV), plantaris muscle (Pl),
the common peroneal nerve (CP) and lateral head of
The popliteal artery lies on the fascia covering the
gastrocnemius (LG) with its associated neurovascular
popliteus. In the upper part of the fossa, the lateral bundle. The lesser saphenous vein (SV) can be seen
and medial superior genicular arteries arise from approaching the popliteal vein. Soleus (S).
the popliteal artery, while the middle genicular
artery arises behind the knee joint. Important to
the therapist considering the popliteus muscle, joining the arterial anastomosis around the knee
the medial and lateral genicular branches pass joint. The terminal branches of the popliteal artery,
medially and laterally over popliteus to run deep the anterior and posterior tibial arteries, arise at
to their corresponding collateral ligaments before the lower border of popliteus. Typically the lesser

NZ Journal of Physiotherapy – March 2006, Vol. 34 (1) 27


saphenous vein pierces the popliteal fascia, passing
between the two heads of gastrocnemius to drain
into the popliteal vein (Grant and Basmajian 1965,
Hollinshead 1969, Gardner et al 1975, Woodburne
and Burkel 1988, Moore and Dalley 2006).
In the upper lateral corner the common
peroneal nerve passes close to the medial border
of biceps femoris. This nerve follows the biceps
tendon as it passes out of the fossa, over the
lateral head of gastrocnemius, to the back of the
head of the bula (Figure 3). Located within the
fossa, the tibial nerve lies in the midline on the
popliteus muscle before passing distally, deep to
the brous arch of the soleus muscle (Figure 4)
(Hollinshead 1969).

Implications for Palpation


Palpation of the popliteus muscle must occur
through the overlying structures of the popliteal
fossa. Consequently the site of the midbelly
Figure 5: Transverse section through a left leg. The
trigger point (Chaitow and Walker DeLany 2002, popliteus muscle (P) lies against the tibia (T), anked by
Travell and Simons 1999) is buried deep beneath the bula laterally (F). Covered from behind by the skin
skin, subcutaneous tissue, deep fascia, the (S), subcutaneous tissue (ST), crural fascia (CF), medial
gastrocnemius muscle and the overlying dense (MG) and lateral (LG) heads of gastrocnemius. Passing
fascia of the popliteus muscle (Figure 5). In addition in the midline are the popliteal vessels and the tibial
the tibial nerve and popliteal vessels pass over the nerve (TN). Patellar ligament (PL).
muscle (Figures 3 and 4).
Popliteus is considered to be most accessible at CONCLUSIONS
two locations - close to the lower medial end, and Examination of the popliteus muscle in situ
to the upper lateral end of the muscle belly (Figure reveals those soft tissues that would hamper specic
1). It has been proposed that the lower medial end palpation of the popliteus muscle. In addition to
of the muscle can be palpated directly between the the skin and subcutaneous tissue supercially, a
semitendinosus tendon and the medial head of the medial approach encounters the substantial crural
gastrocnemius muscle (Figures 3 and 4) (Travell and fascia, medial head of gastrocnemius and the dense
Simons 1999). To access this area, once, and if it aponeurosis of semimembranosus. Laterally, tissues
is possible that the medial head of gastrocnemius such as the crural fascia, tendon of biceps femoris,
can be pushed laterally, contact with popliteus common peroneal nerve and arcuate ligament
would be restricted by overlying skin, subcutaneous impede direct access to the muscle. Potential pain
tissue, the crural fascia, and the overlying dense generating structures such as the lateral collateral
aponeurosis of the semimembranosus muscle ligament, lateral meniscus, bursae and the joint
(Figures 4 and 5). The upper, lateral end of popliteus capsule should also be considered when attempting to
is said to be best palpated as it crosses the knee palpate the popliteal tendon near its femoral insertion.
joint just above the head of the bula, between the Physiotherapists assessing the posterior aspect of the
tendon of biceps femoris and the lateral head of knee joint should be aware of the morphology and
gastrocnemius (Travell and Simons 1999) (Figures 3 relations of the popliteal muscle and its tendon.
and 4). Laterally, the overlying skin, subcutaneous
tissue, crural fascia, tendon of biceps femoris, Key Points
common peroneal nerve and arcuate ligament • The in situ morphology of popliteus is complex
complex would obstruct direct access to the muscle as this musculotendinous unit is associated with,
and attached to, numerous soft tissues and
(Figures 1, 3-5). neurovascular bundles
Travell and Simons (1999) have also stated • Popliteus is located deep, close to the oor of
that when popliteus is involved in the complaint the popliteal fossa
of posterior knee pain, patient examination will • Physiotherapists considering palpation of
reveal tenderness of its tendon as well as the region popliteus need to have an awareness of the
location of this muscle in relation to tissues which
over its tendinous attachment to the femur. When overlie and surround it.
palpating in the area of its proximal attachment
the presence of other local structures also require
consideration. These include the lateral collateral ACKNOWLEDGEMENTS
The authors which to thank Mrs Shannon O’Neill, Mr Brynley
ligament, lateral meniscus, the bursa deep to
Crosado and Mr Russell Barnett for the preparation of the
popliteus, a tendinous expansion from vastus material used to illustrate this paper. This material forms part of
lateralis, the tendon of biceps femoris, fascia lata, the teaching collection of the Department of Anatomy and
and the joint capsule (Figures 2 and 3). Structural Biology at the University of Otago.

28 NZ Journal of Physiotherapy – March 2006, Vol. 34 (1)


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Last RJ (1948). Some anatomical details of the knee joint. Journal
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Last RJ (1950). The popliteus muscle and the lateral meniscus. ADDRESS FOR CORRESPONDENCE
Journal of Bone and Joint Surgery (British) 32: 93-99.
Stephanie Woodley, Department of Anatomy & Structural
Moore KL and Dalley AF (2006): Clinically Oriented Anatomy.
Baltimore: Lippincott Williams and Wilkins. Biology, University of Otago, Dunedin, New Zealand. Dr Susan
Muche JA and Lento PH (2004): Posterior knee pain and its Mercer, Department of Anatomy & Developmental Biology,
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NZ Journal of Physiotherapy – March 2006, Vol. 34 (1) 29


NZSP

Waipuna Lodge Auckland


Life! – with physiotherapy
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Research Laboratory at the University of Montana.

• Return to work: Professor Kathryn McPherson Professor of Rehabilitation Studies at


the Auckland University of Technology.

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University, past president APTA and Executive Committee WCPT.

• Dr Mihi Ratima Associate Professor in Maori Health at the Auckland University of


Technology.
A debate on Advancing the Profession will conclude the conference.

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• Professor David Baxter – Dean School of Physiotherapy, University of Otago. Research


interest: LBP current management and evidence for effectiveness.
• Dr Roslyn Boyd – Murdoch Children’s Research Institute, Melbourne. Research
interests: the scientific foundation of neurological rehabilitation of children with CP.
• Dr Brenda Button – University of Melbourne. Research interests: airways clearance
therapy across the lifespan.
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physiotherapy, the development of physiotherapy and future directions.
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control of gait and Parkinson’s disease.
• Dr Michele Sterling - The Whiplash Research Unit, University of Queensland.
Research interests: whiplash injuries and idiopathic neck pain.
• Assoc Prof Leon Straker – Curtin University. Research interests: prevention of
musculoskeletal disorders associated with computer use by children and adolescents.
• Dr Denise Taylor – Senior Lecturer at AUT in neuro-rehabilitation and Researcher in the
Physical Rehabilitation Research Centre. Research interests: motor control and motor
learning, visuo-vestibular control of balance, falls prevention, upper limb rehabilitation.

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