The Popliteofibular Ligament: A Narrative Review of Anatomical Variants and Surgical Relevance

The popliteofibular ligament (PFL) plays a vital role in knee joint stability, particularly within the posterolateral corner (PLC) of the knee. Located between the femoral condyle and the fibular head, the PFL resists excessive external rotation and lateral translation of the tibia, thus preventing knee instability during dynamic activities. This ligament, although integral in maintaining knee integrity, has often been overlooked in clinical practice and research. This review synthesizes the current literature on the anatomy, biomechanics, and clinical relevance of the PFL, highlighting its morphological variations, functional significance, and implications for knee injuries, particularly in relation to PLC trauma. Anatomical studies have identified significant variations in the PFL’s structure, including single, bifurcated, and double ligament forms, each influencing the ligament’s mechanical properties and its susceptibility to injury. Additionally, the PFL’s interaction with other knee structures, such as the fibular collateral ligament and popliteus tendon, is crucial for resisting rotational and translational forces, especially during high-stress movements like pivoting and cutting. Injuries to the PFL, often occurring in conjunction with other PLC structures, can lead to chronic knee instability and require precise diagnostic techniques, including MRI and ultrasound, for accurate assessment. Surgical management, including PFL reconstruction, has shown promising results in restoring knee stability, especially when tailored to the patient’s anatomical variant. This review provides a comprehensive understanding of the PFL’s role in knee function and its clinical implications, emphasizing the need for individualized treatment strategies in knee reconstruction