Meniscofemoral Ligaments

For Medical Students

Structure and Location

Two ligaments run from the posterior horn of the lateral meniscus to the medial femoral condyle, inside the intercondylar notch. Both take their course alongside the posterior cruciate ligament.

The anterior meniscofemoral ligament, the ligament of Humphrey, passes in front of the posterior cruciate.

The posterior meniscofemoral ligament, the ligament of Wrisberg, passes behind it.

Both arise from the posterior horn of the lateral meniscus. Neither has anything to do with the medial meniscus, despite attaching to the medial femoral condyle.

Relations

The posterior cruciate ligament lies between the two, which is the easiest way to remember which is which: Humphrey in front, Wrisberg behind.

Both attach to the lateral surface of the medial femoral condyle in the notch, near the posterior cruciate's own femoral attachment.

At least one is present in most knees. Conventional teaching has one or other present in nearly all knees and both present in about half.

Function

They are a second tether for the posterior horn of the lateral meniscus, pulling it forwards and medially as the knee extends.

That matters because the lateral meniscus is mobile. The fascicles hold it posterolaterally and these ligaments hold it anteromedially, so between them the horn stays under the condyle through the range.

They also carry a small part of the load the posterior cruciate carries, which is why they are described as accessory restraints to posterior tibial translation.

Clinical Relevance

On magnetic resonance imaging a meniscofemoral ligament crossing the posterior horn can mimic a tear, which is a recognised pitfall and the main reason a student needs to know them by name.

In a discoid meniscus of the Wrisberg type, the posterior capsular attachment is absent and this ligament is the main remaining tether.

At arthroscopy they are visible in the notch and can be mistaken for part of the posterior cruciate.

MRCS Level

Structure and Location

Describe each separately. Humphrey, the anterior meniscofemoral ligament, is the smaller of the two and runs obliquely upwards and medially in front of the posterior cruciate to the medial condyle. Wrisberg, the posterior meniscofemoral ligament, is usually the larger and runs behind the posterior cruciate to the same region.

Their size and presence vary. Where only one is present it is more often Wrisberg. Where both are present one is usually dominant.

Both are true ligaments with an enthesis at each end, and the meniscal end blends with the circumferential collagen of the posterior horn rather than attaching to its surface.

Relations

The posterior cruciate ligament lies between them, and all three occupy the posterior part of the notch along with the posterior cruciate's femoral attachment on the medial wall.

The posterior root of the lateral meniscus is adjacent to the meniscal origin of both ligaments, which is why root anatomy and meniscofemoral anatomy are described together.

The middle genicular artery enters the notch nearby and supplies all these structures.

On the medial wall of the notch their femoral attachments lie close to the posterior cruciate's, so a posterior cruciate reconstruction tunnel can involve them.

Blood Supply and Innervation

Supply is from the middle genicular artery, shared with the cruciates, entering through the posterior capsule.

That shared supply is part of why these ligaments are described alongside the posterior cruciate rather than with the meniscus.

Mechanoreceptors are present at their entheses, and their proposed proprioceptive role is the same argument as for the cruciates. 2.7.10 covers the reasoning.

Function

Tethering the posterior horn is the primary function. In extension they pull it anteromedially; the fascicles and popliteus pull it posterolaterally in flexion. The horn is therefore actively positioned rather than passively dragged.

They contribute to posterior stability. With the posterior cruciate deficient, the meniscofemoral ligaments carry some of its load, and in cadaveric work they are shown to reduce posterior translation modestly.

That contribution is one reason posterior cruciate injury does not always produce the instability its anatomy predicts.

Clinical Relevance

The imaging pitfall is the main practical point: a meniscofemoral ligament seen adjacent to the posterior horn produces an apparent oblique tear line, and the pseudotear is a named sign. 5.6 owns the criteria.

At arthroscopy both are seen in the notch and should not be mistaken for a torn posterior cruciate or for a loose body.

In posterior cruciate reconstruction their femoral attachments are close to the tunnel, and preserving them preserves an accessory restraint.

In Wrisberg type discoid meniscus the posterior meniscofemoral ligament is the main tether, so recognising it changes what stabilisation means in that knee.

The prevalence figures on this page are standard teaching, registered and unchecked, and cadaveric series report them differently.

FRCS Level

Relations

In the posterior notch these ligaments, the posterior cruciate and both meniscal posterior roots occupy one small space, with the capsule and the popliteal artery behind. Any procedure there is a matter of choosing which structure to work around.

Their femoral attachments on the medial wall of the notch constrain posterior cruciate tunnel placement, and preserving them is a deliberate choice rather than an accident.

Function

Their contribution to posterior stability is real and small. It explains clinical variability in posterior cruciate injury rather than substituting for the ligament.

Their contribution to meniscal positioning is more important and less discussed. A lateral meniscus with failed fascicles and intact meniscofemoral ligaments behaves differently from one with both gone.

Clinical Relevance

Preserve them in posterior cruciate reconstruction where tunnel placement allows, because they are an accessory restraint to the same movement the graft resists.

Do not report an oblique signal adjacent to the posterior horn as a tear without accounting for them. The pseudotear is common and the consequence of calling it is an unnecessary arthroscopy.

In the unstable discoid meniscus, identify which tethers remain before deciding what to stabilise.

Published dimensions and prevalence vary widely between cadaveric series, and the figures here are the conventional teaching values rather than a consensus.