Clinical prevalence of palmaris longus agenesis: a systematic review and meta-analysis

Anomalous retrogressive palmaris longus

An interesting case of unusual unilateral variant of palmaris longus (PL) tendon of forearm was noticed by us. We found two bellies of PL as well as their different insertions. These observations will help in understanding morphological variations of this muscle and its clinical implications. PL is a fusiform muscle in the superficial flexor group of muscles of forearm. It originates from medial epicondyle of humerus by common flexor tendon. We found PL having one origin, i.e., from medial epicondyle from common tendinous origin of flexor muscles and then it divided to form two bellies having two long tendons distally. Understanding of presence or absence or anomalies of PL is not only important for medical professionals but also for evolutionary biologists. Awareness of anatomy and variations of flexor tendons is important for health care practitioners for the correct diagnosis and management of pain, disease, and trauma of forearm and hand.

Dorsal dry needling to the pronator quadratus muscle is a safe and valid technique: A cadaveric study

BACKGROUND

The pronator quadratus (PQ) muscle is an important stabilizer of the distal radio-ulnar joint and its pain referral pattern can mimic median or ulnar neuropathy. Research on treatment safety and efficacy with dry needling is scarce.

OBJECTIVE

To determine if a solid filiform needle accurately and safely penetrates the PQ during simulated clinical application of dry needling.

METHODS

A cadaveric descriptive study was conducted. Needling insertion of PQ was performed in 10 cryopreserved forearms with a 30*0.32 mm solid filiform needle. With the forearm pronated, the needle was inserted 3 cm proximal to the ulnar styloid in an anterior direction toward the muscle. The needle was advanced into the PQ based upon clinician judgment. Safety was assessed by calculating the distance from the needle to the surrounding neurovascular bundles.

RESULTS

Accurate needle penetration of the PQ was observed in 90% of the cadavers (needle penetration: 19.8 ± 4.0 mm, 95%CI 17.0 to 22.6 mm). No neurovascular bundle was pierced during needling in any specimen forearms. The distance from the tip of the needle was 15.1 ± 4.8 mm (95%CI 11.7 to 18.5 mm) to the ulnar nerve, 15.6 ± 7.6 mm (95%CI 10.0 to 21 mm) to the ulnar artery, 11.2 ± 3.3 mm (95%CI 8.8 to 13.6 mm) to the median nerve, and 4.9 ± 1.4 mm (95%CI 3.9 to 5.9 mm) to the anterior interosseous neurovascular bundle.

CONCLUSION

The results from this cadaveric study support the assumption that needling of the PQ by the dorsal aspect of the forearm can be accurately and safely conducted by an experienced clinician. Studies investigating the clinical safety and effectiveness of this interventions are needed.

The Critical Appraisal Tool for Anatomical Meta-analysis (CATAM): A framework for critically appraising anatomical meta-analyses

The hallmark of evidence-based medicine is the meta-analysis (MA). For much of its rich history, the field of anatomy has been dominated by descriptive, cadaveric studies. In the last two decades, quantitative measurements and statistical analyses have frequently accompanied such studies. These studies have directly led to the publication of anatomical MAs, which have ushered in the exciting field of evidence-based anatomy. Although critical appraisal tools exist for clinical MAs, none of them are specifically tailored for anatomical MAs. Therefore, the purpose of this paper is to provide a framework by which clinical anatomists and others can critically appraise anatomical MAs using the Critical Appraisal Tool for Anatomical Meta-analysis (CATAM). Using a running example from a recently published MA, we show how to use the CATAM rubric in a step-by-step fashion. Each scored section of the CATAM rubric is summated into a total score (maximum 50 points). This score is then referenced to a conversion chart, which assigns a qualitative value to the MA in a range from "very good" to "poor." Future studies can investigate the interrater reliability of the instrument, and possibly subject the CATAM rubric to a Delphi panel. As anatomical MAs become more commonplace at surgical grand rounds and journal clubs in academic medical centers throughout the world, we hope that the CATAM rubric can help facilitate meaningful discussions about the quality and clinical relevance of anatomical MAs. This article is protected by copyright. All rights reserved.

The Palmaris Longus and Its Association with Carpal Tunnel Syndrome

Background  The palmaris tendon inserts into the palmar fascia and is positioned in close association with the transverse carpal ligament. Loading of this tendon has been demonstrated to increase carpal tunnel pressures. Purpose  The purpose of this study was to determine if a relationship exists between the palmaris tendon, carpal tunnel syndrome (CTS), and handedness. The sensitivity, specificity, positive predictive value, and negative predictive value for Schaeffer's test were calculated. Methods  A retrospective review of patient charts undergoing endoscopic carpal tunnel release was performed. Rates of palmaris longus agenesis (PLA) were compared to a population matched data set. Statistical analysis was performed using a one-proportion z -test. Schaeffer's test for the palmaris longus tendon was performed on all patients and compared to intraoperative confirmation. Results  A total of 520 carpal tunnel releases were performed in 389 consecutive patients. The frequency of PLA in this surgical cohort was significantly lower compared to the population matched dataset. No correlation between handedness and laterality of CTS or PLA was found. Schaeffer's test was evaluated to yield sensitivity (93.6%), specificity (100%), positive predictive value (100%), and negative predictive value (50.8%). Conclusion  The palmaris tendon was more prevalent in a population of patients undergoing carpal tunnel release. These findings can be used to provide further insight into the pathophysiology of CTS. While Schaeffer's test was accurate in detecting the palmaris longus tendon, a negative test was frequently incorrect. Further imaging is recommended in patients with a negative Schaeffer's test when the palmaris longus is desired for surgical utilization. Level of Evidence  This is a Level III, prognostic study.

Prevalence, variants, and morphometrics of Palmaris Longus tendon: a magnetic resonance imaging study

PURPOSE

The palmaris longus (PL) tendon present a high degree of variations; the commonest is its absence which could reach more than 40% in some populations. The PL tendon is highly relevant in hand reconstructive surgery; however, MRI variations of PL tendon have been exceptionally reported. To this, this study investigated PL tendon variations using MRI in a Lebanese population.

METHODS

This is a retrospective study of distal forearm MRI examinations to evaluate the presence, anatomical variations and morphometric of PL tendon. The outcomes were set as overall frequency, gender-based and side-base frequencies, correlations between prevalence and gender/side, morphological variants, thickness, and width of PL tendon.

RESULTS

The sample comprised 335 patients including a total of 339 MRI scans. The PL was present in 221 wrists (65.2%), and bilaterally in only one (25%) out of the 4 bilateral cases. All PL were located using the Axial T1 views. Univariate and multivariate analyses showed no correlation with side, gender, or Tesla power. The only morphological variation was a reversed PL in 2 cases (0.6%). The mean width was 4.24 ± 1.2 mm. The mean thickness was 2.75 ± 0.6 mm.

CONCLUSION

As far as we know, this is the first study to report the total array of variations of PL tendon using MRI, and its prevalence in a Lebanese population. The mean width of PL tendon calculated with high quality MR imaging was found to be similar to that reported by cadaveric studies.

Variations and morphometrics of palmaris longus in fetuses: a meta-analysis of cadaveric studies

The palmaris longus muscle, and its tendon, is one of the most variable muscles in humans. Though it has been extensively researched in the adult population, its variations and development in the fetal period were rarely investigated. The aim of this meta-analysis is to conduct an evidence synthesis on PL variations and the prevalence of its agenesis during intrauterine development. Seven studies met the inclusion criteria comprising 497 fetuses and 1027 fetal limbs. The true and crude weighted prevalence rates were of 81.2% and 77%, respectively. The bilateral and unilateral prevalence estimates were of 62.2% and 15%, respectively. No significant differences were found for side-based and gender-based prevalence values. There were significant frequency differences between the studied populations (p < 0.0001).The Japanese population had the highest prevalence, the Turkish had the lowest and the European value was in between. Out of 494 studied muscles, 67 (13.5%) variations were noted. The weighted proportions of the commonest morphological variations were as follows: (a) bifid tendon in 10 (2%) cases, (b) inverted PL muscle in 9 (1.9%), muscle duplication in 6 (1.36%), and digastric muscle in 25 (5.1%). Prevalence values of the fetal PL were similar to those reported in adults; however, variations seem to be higher than in older populations. The true, crude, and ancestry-based prevalence presence rates of PL in fetuses were found to be similar to those of the adult population.

Morphometric analysis and surgical adequacy of palmaris longus as a tendon graft. A systematic review of cadaveric studies

INTRODUCTION

The tendon of the palmaris longus is commonly used as a tendon graft in many reconstructive surgeries. Easy to access and at proximity to the hand, the palmaris longus tendon is considered as the optimal tendon source for hand reconstructive surgery. However, and besides its inconsistency, the size of the palmaris longus tendon is reported to show variability. The aim of this study is to look for the surgical adequacy of the palmaris longus tendon by conducting a quantitative synthesis on its length and width in human populations and its correlation with the forearm length.

METHODS

Twenty-four studies met the inclusion criteria including 1761 cadaveric limbs.

RESULTS

The results were as following: (a) the mean palmaris longus tendon length was of 13.9 ± 2.6 cm, (b) the mean ratio palmaris longus tendon length/forearm length was of 0.545 ± 0.06, (c) the weighted correlation value was of 0.686, and (d) the mean palmaris longus tendon width was of 4.0 ± 1.7 mm. Only five studies reported a palmaris longus tendon length of more than 15 cm. The palmaris longus tendon length was shown to vary between ancestries; the Japanese had the shortest while Malaysian the longest palmaris longus tendons. All studies but one reported a palmaris longus tendon mean width of more than 3 mm where the minimal mean palmaris longus tendon width was of 2.5 mm.

CONCLUSION

While the requested length depends on the recipient site and/or type of reconstructive surgery, the palmaris longus tendon often met the required diameter for grafting. Our review demonstrated that while palmaris longus length varies between ancestries, its width is often adequate for grafting. In addition, the forearm length could be a good predictor of palmaris longus tendon length; such correlation could assist surgeons when planning to use palmaris longus tendon as a graft source.

Bilateral reversed palmaris longus muscle: a case report and systematic literature review

PURPOSE

We present a case of a bilateral reversed palmaris longus muscle and a systematic review of the literature on this anatomical variation.

METHODS

Routine dissection of a 90-year-old male cadaver revealed a rare bilateral reversed palmaris longus. This was documented photographically, and length and relation to anatomical landmarks were recorded. This finding stimulated a systematic review of the literature on the reversed palmaris longus variation, from which measurements were collated and statistical analysis performed to determine the prevalence, average length, relationship to side and sex, and to discuss its clinical and evolutionary implications.

RESULTS

The average length of the muscle belly and tendon of reversed palmaris longus was 135 mm and 126 mm, respectively. Statistical analysis revealed no disparity in presentation due to sex and side; however, bilateral reversed palmaris longus has only been reported in males. A high proportion (70.8%) of reversed palmaris longus were discovered in the right upper limb compared to the left.

CONCLUSION

Variations in palmaris longus are purported to be as a result of phylogenetic regression. Clinically, patients with this variant may present with pain or swelling of the distal forearm, often as a result of intense physical exertion related to occupation or sport. Clinicians should be aware of this muscle variant as its presence could lead to confusion during tendon allograft harvesting procedures in reconstructive and tendon grafting surgery.

Predicting Tendon Tissue Grafting Source From the Extensors of Long Fingers: A Systematic Review of Cadaveric Studies

Background: The use of tendon tissue for transfer and grafting is a common practice in hand surgery. Many local tendons are usually used, mainly that of the palmaris longus muscle. However, this tendon could be absent in up to 46%. Extra slips of the extensor digitorum communis (EDC) and extra tendons such as the extensor indicis (EI) and the extensor digiti minimi (EDM) could be valuable sources for tendon tissue. Methods: A systematic review was conducted to quantify the proportion of extra slips in relation to each tendon and extra tendons in relation to each long finger. The aim is to better predict the location of tendon tissue sources on the dorsum of the hand in reconstructive surgery. Results: Based on 39 studies including 7847 hands, the cumulative frequencies of extra slips and extra tendons and the association between double-slip frequency and ancestry were as follows: (1) the little finger showed the highest cumulative frequency of extra slips (96.54%), followed by the ring (37.5%), long (30.6%), and index (9.5%) fingers; (2) the index with its EI and its variants and the little finger with its EDM bear by far the highest cumulative frequency of extra tendons (≈100%); and (3) double slips are found to be rare in Indian populations, most prevalent in Japanese populations, more prevalent in the index and little fingers of Caucasians, and more prevalent in the ring fingers of Middle Eastern populations. Conclusions: Knowledge of the frequencies of extra slips for each long extensor tendon and extra tendons for each long finger along with their prevalence in different populations would improve: (1) location prevision of tendon source for tendon grafting; and (2) surgical planning while supporting a patient-centered approach. Evidence-based hand anatomy would have a major potential to contribute to the practice of an evidence-based hand surgery. Predicting the possible tendon sources that could be present on the dorsum of the hand is thought to be very valuable for hand surgeons. In addition and from an evolutionary perspective, we hypothesized that the observed significantly higher frequency values of the double-slip and triple-slip types of the EDC of the ring finger, EDC of the little finger, and EDM might indicate a natural selection tendency for a higher independence of the former digits in the future evolution of the human hand.

A cadaveric study for the volar needle approach to the pronator quadratus using the palmaris longus tendon landmark

INTRODUCTION

Our aim in this work was to determine the safety and accuracy of the volar approach to the pronator quadratus (PQ) through cadaver dissection.

METHODS

Twenty upper limbs from 10 fresh cadavers were investigated. At the level 3 cm proximal to the ulnar styloid process (USP), a needle was inserted just medial to the palmaris longus (PL) tendon. Distances of the median nerve (MN) and ulnar artery (UA) from the needle insertion point (IP) were measured using ultrasonography and cadaver dissection.

RESULTS

The PQ was located at a depth of 10.8-19.9 mm from the skin and had a median thickness of 9.1 mm, measured 3 cm proximal to the USP. The median distances of the MN and UA from the IP were 7.6 and 13.4 mm, respectively.

DISCUSSION

A needle insertion for the volar approach to the PQ was safe at 3 cm proximal to the USP, just medial to the PL tendon.

Palmaris Longus Muscle Variations: Clinical Significance and Proposal of New Classifications

BACKGROUND

The palmaris longus muscle is one of the most variable muscles in the human body and there have been numerous variations reported. The different palmaris longus variations are interesting not only from an anatomical point of view, but they could also have definite clinical significance.

AIM

The aim of this study was to examine the different types of variations of palmaris longus muscle in the Bulgarian population.

MATERIALS AND METHODS

Over a period of 15 years, 56 formol-carbol fixed human cadavers were studied to investigate the different variations of palmaris longus muscle (PLM).

RESULTS

Various anatomical variations of PLM have been reported: absence (2.68%); reversed palmaris longus coexisting with an additional abductor digiti minimi muscle (0.89%); digastric (0.89%); palmaris longus with intermediate muscle belly (1.79%) and duplication (1.79%).

CONCLUSIONS

To reveal the wide variety of the types of palmaris longus muscle and their importance for clinical practice, we make a brief literature review concerning the different types of variations, their role in the median and ulnar neuropathy in the wrist or as structures simulating a soft tissue tumour and the application of palmaris longus tendon in plastic and reconstructive surgery as grafting material. We also present new systematic anatomical and clinical classifications of palmaris longus variations by dividing them into two simple groups.

A Meta-Analysis of the Surgical Availability and Morphology of the Plantaris Tendon

Background: The tendon of the plantaris muscle (PM) is highly relevant in surgical practice. It is used as a graft for tendon/ligament repair or reconstruction in hand surgery whenever palmaris longus (PL) is lacking. Its occurrence in humans is reported to be high.

Methods: A meta-analysis based on cadaveric studies was conducted to quantitatively assess PM frequency and size.

Results: Data from 41 studies including 10062 leg specimens yielded the following: overall true prevalence ≈ 93%, overall crude prevalence = 90.6%, bilateral prevalence ≈ 92%, significantly more frequent on the right side, no gender significance, and no significant differences between ethnicities except that of Brazilian populations. The pooled mean length (± SD) of the PM tendon (PT) was 30.63 ± 5.87 cm and that of its width was 3.68 ± 1.37 mm. Pooled frequencies of the types of PT insertion are reported.

Conclusions: This meta-analysis demonstrated a higher prevalence of PM when compared to clinical PL frequency in the literature with a tendon length double than that of PL along with an acceptable width. The surgical availability of the PM tendon was found stable across human populations; a clinical advantage when compared to the high variability of PL ethnicity-based frequency. Our results indicate that the PT is of high clinical relevance as a reliable and suitable resource for tendon grafting and reconstruction.

A modified technique of two-staged extensor tendon reconstruction in zones 6-8 in a patient with absent palmaris/plantaris tendons: A case report

INTRODUCTION

The indications for two-staged extensor tendon reconstruction are rare and only 14 previously reported cases were found in the literature. In these cases, silicone rods are inserted in the first stage. Few months later, the palmaris longus / plantaris tendon grafts are usually used to replace the silicone rods.

CASE REPORT

we encountered a patient with major defects of the extensor tendons of all fingers extending from the proximal one third of zone 6 to zone 8. The patient had no palmaris or plantaris tendons. We utilized a modified technique of reconstruction using the split flexor carpi radialis as the tendon graft and the flexor carpi ulnaris as the motor tendon. At final follow-up, there was full active extension of the fingers. However, there was limitation of wrist flexion because of the harvesting of both wrist flexors.

DISCUSSION

We describe a modified technique of two-staged extensor tendon reconstruction which may be used in patients with absent palmaris/ plantaris tendons.

CONCLUSION

In patients with absent palmaris/ plantaris tendons and major defects of the extensor tendons of all fingers, the use of split flexor carpi radialis is an adequate alternative for reconstruction and gives a good functional outcome.

Ultrasound determination of presence, length and diameter of the palmaris longus tendon

Inadvertent median nerve harvest is a devastating complication of palmaris longus harvest. Accurate assessment of palmaris longus presence and dimensions preoperatively would minimize this risk and assure safe harvest. We hypothesized that ultrasound would accurately predict palmaris longus presence, length and diameter. Seventeen cadaveric forearms were studied using a LOGIQ-E9 ultrasound. Two radiologists assessed palmaris longus presence and dimensions. Each wrist was explored, and the tendon was harvested and measured. Inter-rater reliability and agreement between measurements was assessed. The palmaris longus was present in 13 of 17 forearms. Both radiologists correctly identified the tendon and its absence (sensitivity and specificity, 100%). Ultrasound assessment of palmaris longus dimensions significantly correlated with surgical measurements. Intraclass correlation coefficient between radiologists was 0.97. We conclude that ultrasound can determine palmaris longus presence and dimensions with excellent accuracy and inter-observer reliability. Ultrasound is useful for preoperative evaluation of the palmaris longus and its use will increase patient safety.

Clinical Assessment of the Congenital Absence of Palmaris Longus and Flexor Digitorum Superficialis Muscles in Young Saudi Population

Introduction. Congenital Palmaris Longus (PL) absence was found in 15%-20.25% of population globally. This condition and Flexor Digitorum Superficialis (FDS) tendon absence in little finger are not known in Saudi Arabia. We studied prevalence of PL and FDS agenesis in Saudi Arabian population. Methods. A random cross-sectional study was carried out after an ethical approval in the Riyadh universities. Schaeffer's test was used to examine PL absence. The Modified test was used to examine FDS absence. Data was analyzed using Microsoft Excel and the SPSS Software version 22. Results. The volunteers, 331, males 164 (49.5%) and females 167 (50.5%), mean age of 23 (SD ± 5.3), showed right hand dominance in 294 (88.8%) and bilateral absence of PL and FDS in 15.1% and 14.8%, respectively. The hand dominance showed no significant relation between PL and FDS absence, p value = 0.788, 0.835, respectively. Generally, we found a weak correlation between absence of the PL and FDS, p value ≥ 0.595. Conclusion. The bilateral absence of PL and FDS was found as 15.1% and 14.8%, respectively. Variation of the FDS tendon absence was an independent entity for the PL absence. The dominance of hands was not related to the tested variables found in PL and FDS agenesis.

Modified Long Toe Extensor Tendon Harvest for Use as Intercalary Graft in Upper Extremity Reconstruction

Autograft tendon harvested from the long toe extensors are of great utility as intercalary grafts in upper extremity reconstruction. However, standard full-length harvest is complicated by the presence of extensor retinacula and multiple juncturae between adjacent extensors, which often necessitate extensive dissection, increasing the potential for morbidity. We describe a modified technique for partial harvest of the long toe extensors, which is performed entirely proximal to the superior extensor retinaculum. This technique requires a single incision and provides adequate length of graft for the majority of forearm to fingertip reconstructions. The technique is described in the context of our preliminary cadaver findings, with a case example provided to further illustrate the utility of this technique.

Estudio de las unidades neurofuncionales del flexor carpi ulnaris y su utilidad en las transferencias tendinosas

Objetivos: Este trabajo pretende documentar la inervación intramuscular del flexor carpi ulnaris (FCU), su vascularización, y su consecuente organización en unidades neurofuncionales. Así mismo, se discute la relevancia de dichas unidades en la realización de transferencias tendinosas de este músculo con su tendón dividido. Aunque en algunos centros ya se ha puesto en práctica la idea de dividir el tendón, hay pocos trabajos en la literatura que demuestren fotográficamente el sustrato anatómico subyacente.

Material y métodos: Se tiñeron según la técnica de Sihler 6 FCU extraídos de cadáveres humanos criopreservados. Para estudiar su vascularización, en 5 de ellos se inyectó el árbol arterial con látex negro.

Resultados: En todos los especímenes ambas cabezas del FCU se correspondían con dos unidades neurofuncionales que presentaban una inervación independiente (tipo iii de Taylor). Los 5 especímenes inyectados pertenecían a los tipos ii y iii de Mathes-Nahai.

Conclusiones: La divisibilidad del músculo en 2 unidades neurofuncionales independientes con vascularización e inervación propia permite obtener 2 tendones transferibles a 2 músculos diferentes, optimizándose la transferencia.

The Prevalence of Absence of the Palmaris Longus Muscle Tendon in the North of Iran: A Comparative Study

BACKGROUND

The palmaris longus is a degenerating weak flexor muscle in the anterior of the forearm. Many techniques for clinically determining the presence of the palmaris longus have been described. Ethnic variations in the prevalence of the absence of the palmaris longus are well known.

OBJECTIVES

This study considered the prevalence of absence of the palmaris longus muscle tendon in the north of Iran.

PATIENTS AND METHODS

The presence of the palmaris longus was clinically determined in 562 men and women from the Guilan population, using the standard technique (Schaeffer's test). In subjects with an absent palmaris longus, three other tests (Thompson, Pushpakumar and Mishra tests) were performed to confirm the absence.

RESULTS

The overall prevalence of right, left, bilateral and total absence of the palmaris longus were 4.1%, 5.2%, 3.9% and 13.2%, respectively. There was no significant difference in its absence with regard to the body side or gender (P > 0.05).

CONCLUSIONS

This study demonstrated that the presence of the palmaris longus muscle tendon in the Guilan population was considerably higher than the absence of the palmaris longus tendon. The overall prevalence of right, left, bilateral and total absence of the palmaris longus was not significantly different between men and women. The prevalence of the left-absent palmaris longus was more common in the present study.

Palmaris Longus Muscle's Prevalence in Different Nations and Interesting Anatomical Variations: Review of the Literature

The prevalence of the palmaris longus (PL) muscle varies more than any other muscle in the human body. Its absence across the world ranges between 1.5% and 63.9%. It presents with many different anomalies, discovered either clinically, intraoperatively or after anatomical examination of cadavers. This paper includes recent studies and reports about the presence and variations of the PL muscle, thereby illustrating the differences between ethnic groups, as well as emphasizing the different ways of finding it, during daily clinical and surgical practice.

Flexor pollicis longus reconstruction using the palmaris longus in anterior interosseus nerve syndrome

In anterior interosseus nerve syndrome, reconstruction of the paralyzed flexor pollicis longus is occasionally required. Traditionally, the brachioradialis has been used as a motor, but we utilised the palmaris longus, which is expendable. The palmaris longus tendon was transferred in an end-to-side manner, leaving the flexor pollicis longus in situ. The procedure was performed in three patients. All patients regained a full range of thumb interphalangeal joint motion and an average 90% of the pinch strength. The only complication noted was thenar pain due to the adhesion of the palmar branch of the median nerve with the transferred tendon in one patient. This can be avoided if the interlacing suture was placed more proximally. Palmaris longus transfer is a simple technique that gives a satisfactory result.

Evidence-based anatomy

Anatomy is a descriptive basic medical science that is no longer considered a research-led discipline. Many publications in clinical anatomy are prevalence studies treating clinically relevant anatomical variations and reporting their frequencies and/or associations with variables such as age, sex, side, laterality, and ancestry. This article discusses the need to make sense of the available literature. A new concept, evidence-based anatomy (EBA), is proposed to find, appraise, and synthetize the results reported in such publications. It consists in applying evidence-based principles to the field of epidemiological anatomy research through evidence synthesis using systematic reviews and meta-analyses to generate weighted pooled results. Pooled frequencies and associations based on large pooled sample size are likely to be more accurate and to reflect true population statistics and associations more closely. A checklist of a typical systematic review in anatomy is suggested and the implications of EBA for practice and future research, along with its scope, are discussed. The EBA approach would have positive implications for the future preservation of anatomy as a keystone basic science, for sound knowledge of anatomical variants, and for the safety of medical practice. Clin. Anat. 27:847–852, 2014.