Identification of Hidden Lesions of the Popliteal Hiatus Through a Systematic Clinical, MRI and Arthroscopic Assessment
Document Type
Article
Publication Title
Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Abstract
Purpose: The aim of this study was to delineate a systematic clinical, MRI, and arthroscopic approach for evaluating the popliteal hiatus and its associated structures, while also exploring the clinical presentations potentially linked to pathological findings.
Methods: A prospective, cross-sectional study was conducted at two high-volume knee surgery centres. Patients scheduled for arthroscopically assisted knee surgery underwent preoperative evaluation using targeted clinical assessments and MRI examinations, incorporating sagittal, coronal, and sagittal-oblique sequences. A standardised, three-stage arthroscopic exploration of the popliteal hiatus and posterolateral capsular recess was performed, with each structure classified as 'healthy', 'injured' or 'not visible'. The diagnostic accuracy of clinical tests and MRI sequences was evaluated in comparison with arthroscopic findings.
Results: In a cohort of 67 patients, systematic arthroscopic evaluation identified pathological findings in the popliteal hiatus and posterolateral capsular recess in 38% of cases. In 20.9% of cases, at least one structure was deemed "not visible" during arthroscopy. The agreement between MRI and arthroscopic findings varied by sequence, with T2-weighted coronal views demonstrating the highest concordance (79.7%). However, overall kappa values indicated minimal to low agreement. Clinical examinations exhibited low sensitivity but relatively high specificity, with the Figure-4 test and locking symptoms emerging as more reliable clinical indicators.
Conclusions: Systematic arthroscopic exploration of the popliteal hiatus and posterolateral capsular recess revealed a notable incidence of occult pathological findings. MRI showed only moderate concordance with arthroscopy, and clinical examination demonstrated low sensitivity but high specificity.
DOI
10.1002/ksa.70131
Publication Date
10-28-2025
Keywords
arthroscopy, magnetic resonance imaging, popliteal hiatus, popliteomeniscal fascicles, posterolateral corner (knee)
ISSN
1433-7347
Recommended Citation
Carrozzo A, Torre G, Gousopoulos L, Daggett M, Vieira TD, Mariani PP, Sonnery-Cottet B. Identification of Hidden Lesions of the Popliteal Hiatus Through a Systematic Clinical, MRI and Arthroscopic Assessment. Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA. 2025; . doi: 10.1002/ksa.70131.
