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Na HD, Woo IH, Cho SJ, Park CH. Characteristics and Outcomes of Surgical Treatment for Anterolateral Ankle Impingement Due to the Distal Fascicle of the Anterior Inferior Tibiofibular Ligament. Orthop J Sports Med 2024; 12:23259671241275959. [PMID: 39421040 PMCID: PMC11483662 DOI: 10.1177/23259671241275959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/18/2024] [Indexed: 10/19/2024] Open
Abstract
Background The pathomechanism of anterolateral ankle impingement (ALAI) due to the distal fascicle of the anterior inferior tibiofibular ligament (DF-AITFL) has not been fully elucidated. In addition, because of its rarity, no definitive diagnostic criteria have been established for ALAI due to DF-AITFL. Purpose To document the symptom characteristics and magnetic resonance imaging (MRI) and and arthroscopic findings as well as postoperative clinical outcomes of ALAI due to DF-AITFL. Study Design Case series; Level of evidence, 4. Methods Included were 12 patients (5 male and 7 female; mean age, 34.4 years [range, 21-76 years]) who were diagnosed with ALAI due to DF-AITFL and underwent excision of the DF-AITFL from November 2017 to August 2021. Symptom characteristics and symptom-related medical histories were evaluated, as were MRI and arthroscopic findings. Clinical outcomes were assessed using the visual analog scale for pain, American Orthopaedic Foot & Ankle Society ankle-hindfoot functional scale, and Foot Function Index. Results All 12 patients had a history of ankle sprain before symptom onset. DF-AITFL was confirmed by MRI in all patients. Bone edema of the talus was observed in 2 patients (16.7%), and cartilage abnormalities in 3 patients (25%). Arthroscopy showed that the DF-AITFL contacted the anterolateral aspect of the talar dome during range of motion in all patients and that the AITFL was bent where it contacted the anterolateral dome of the talus in 3 patients (25%). Partial tear or adhesion of the DF-AITFL was noted in 7 patients (58.3%), and cartilage deformation at the anterolateral talar dome in 4 patients (33.3%). Mean visual analog scale pain, American Orthopaedic Foot & Ankle Society, and Foot Function Index scores improved significantly from preoperatively to postoperatively. Conclusion ALAI due to DF-AITFL should be considered a possible cause of anterolateral ankle pain after an ankle sprain. The diagnosis can be reliably made with a thorough clinical examination and imaging studies. Half of the patients in this series also had lateral ankle instability. Surgical resection of the DF-AITFL and ligament reconstruction, if necessary, resulted in significant symptom improvement.
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Affiliation(s)
- Ho Dong Na
- Department of Orthopaedic Surgery, MS Jaegeon Hospital, Daegu, Republic of Korea
| | - In Ha Woo
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Seung Jae Cho
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Chul Hyun Park
- Department of Orthopedic Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Lyu P, Liu C, Li S. Diagnostic value of ultrasonography for injury of anterior talofibular ligament and anterior inferior tibiofibular ligament distal fascicle in patients with ankle fractures. Zhejiang Da Xue Xue Bao Yi Xue Ban 2024; 53:411-418. [PMID: 38803280 PMCID: PMC11375498 DOI: 10.3724/zdxbyxb-2023-0602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVES To explore the diagnostic value of ultrasonography for injuries of anterior talofibular ligament (ATFL) and anterior inferior tibiofibular ligament distal fascicle (ATiFL-DF) in patients with ankle fractures. METHODS Clinical data of 51 patients with ankle fractures who were clinically suspected of ligament injuries and underwent ankle ultrasonography examination and arthroscopy in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from April 2019 to March 2023 were retrospectively analyzed. Using arthroscopic results as the gold standard, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ultrasonography in diagnosing ATFL and ATiFL-DF injuries were evaluated, and Kappa consistency test was performed. RESULTS The sensitivity and specificity of ultrasonography in diagnosis of ATFL injury were 100.0% and 92.3%, with the PPV of 92.6% and NPV of 100.0%. Ultrasonography findings exhibited excellent concordance with arthroscopic results (kappa=0.849). The sensitivity and specificity of ultrasonography in diagnosis of ATiFL-DF injury was 86.7% and 33.3%, with the PPV of 90.7% and NPV of 25.0%. However, the consistency between ultrasonography and arthroscopic results was poor (kappa=0.168). CONCLUSIONS Ultrasonography is reliable in assessing injuries of ATFL in patients with ankle fractures, but its specificity in diagnosing ATiFL-DF is poor. Therefore, ankle arthroscopy remains necessary for ankle fracture patients with negative findings of ATiFL-DF in ultrasonography.
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Affiliation(s)
- Panpan Lyu
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
| | - Chao Liu
- Department of Orthopedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Shiyan Li
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
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Wang R, Yang Y, You G, Huang L, Zhou X, Jiang S, Shi H, Wang G, Zhang L. Chronic lateral ankle instability using anterior tibiofibular ligament distal fascicle transfer augmentation repair: an anatomical, biomechanical, and histological study. Front Bioeng Biotechnol 2024; 12:1326036. [PMID: 38515619 PMCID: PMC10955350 DOI: 10.3389/fbioe.2024.1326036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
Background: The transfer of the anterior tibiofibular ligament distal fascicle (ATiFL-DF) for the augmentation repair of the anterior talofibular ligament (ATFL) shows potential as a surgical technique. However, evidences on the benefits and disadvantages of this method in relation to ankle joint function are lacking. Purpose: This study aimed to provide comprehensive experimental data to validate the feasibility of ATiFL-DF transfer augmentation repair of the ATFL. Methods: This study included 50 embalmed ankle specimens to measure various morphological features, such as length, width, thickness, and angle, for evaluating similarities between the ATiFL-DF and ATFL. Furthermore, 24 fresh-frozen ankle specimens were examined for biomechanical testing of the ATiFL-DF transfer augmented repair of the ATFL. Finally, 12 pairs of ATiFL-DF and ATFL tissues from fresh-frozen ankle specimens were treated with gold chloride staining to analyze mechanoreceptor densities. Results: Anatomical studies found that the lengths and thicknesses of the ATFL and ATiFL-DF are similar. Biomechanical outcomes showed that performing ATiFL-DF transfer for ATFL repair can improve the stability of the talus and ankle joints. This is evident from the results of the anterior drawer, axial load, and ultimate failure load tests. However, performing ATiFL-DF transfer may compromise the stability of the distal tibiofibular joint, based on the Cotton and axial load tests at an external rotation of 5°. Analysis of the histological findings revealed that mechanoreceptor densities for four types of mechanoreceptors were comparable between the ATiFL-DF and ATFL groups. Conclusion: ATiFL-DF transfer is a viable method for augmenting ATFL repair. This technique helps to improve the stability of the talus and ankle joints while compensating for proprioception loss. Although ATiFL-DF transfer augmented repair of the ATFL may negatively affect the stability of the distal tibiofibular joint, this procedure can enhance the stability of the talus and ankle joints.
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Affiliation(s)
- Ruihan Wang
- School of Physical Education, Southwest Medical University, Luzhou, China
- Department of Rehabilitation, Yibin Integrated Traditional Chinese and Western Medicine Hospital, Yibin, China
| | - Yingqiu Yang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Guixuan You
- School of Physical Education, Southwest Medical University, Luzhou, China
| | - Lei Huang
- School of Physical Education, Southwest Medical University, Luzhou, China
| | - Xin Zhou
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Luzhou Key Laboratory of Orthopedic Disorders, Luzhou, China
| | - Songtao Jiang
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Houyin Shi
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Luzhou Key Laboratory of Orthopedic Disorders, Luzhou, China
| | - Guoyou Wang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Luzhou Key Laboratory of Orthopedic Disorders, Luzhou, China
| | - Lei Zhang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Luzhou Key Laboratory of Orthopedic Disorders, Luzhou, China
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Lee Y, Park W, Lee H, Choi Y, Kim S, Yeo E, Lee H, Jung K, Lee B, Lee M, Kim W. Is There a Difference in the Distribution of Mechanoreceptors among the Three Sections of the Anterior Talofibular Ligament? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1510. [PMID: 37763629 PMCID: PMC10535615 DOI: 10.3390/medicina59091510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/28/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND We investigated whether the distribution of mechanoreceptors in three sections of the anterior talofibular ligament (ATFL) differed. METHODS The ATFL was obtained from 29 ankles of 21 fresh-frozen cadavers and divided into fibular attachment, mid-ligament, and talar attachment parts. Histologically, mechanoreceptors were classified as Ruffini (type I), Vater-Pacini (type II), Golgi-Mazzoni (type III), and free nerve ending corpuscles (type IV); the presence of these mechanoreceptors was compared among the three ATFL sections. RESULTS Type I mechanoreceptors were significantly more numerous than the other receptor types. Comparing the three sections of the ATFL, the number of type I mechanoreceptors differed significantly between the mid-ligament and fibular attachment (p = 0.006), while the number of type III mechanoreceptors differed significantly between the talar and fibular attachments (p = 0.005) and between the mid-ligament and talar attachment (p = 0.011). CONCLUSIONS The four types of mechanoreceptors were distributed differently among the three sections of the ATFL. Type I mechanoreceptors were more numerous in all sections compared to the other receptors.
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Affiliation(s)
- Youngkoo Lee
- Department of Orthopaedic Surgery, College of Medicine, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea; (Y.L.); (S.K.)
| | - Wonseok Park
- Department of Orthopedic Surgery, Choonhae Hospital, 605 Jungang-daero, Busanjin-gu, Busan 47352, Republic of Korea;
| | - Hyerim Lee
- Hyangseol Clinical Laboratory, Soonchunhyang University, Asan-si 31538, Republic of Korea; (H.L.); (Y.C.)
| | - Youngsuk Choi
- Hyangseol Clinical Laboratory, Soonchunhyang University, Asan-si 31538, Republic of Korea; (H.L.); (Y.C.)
| | - Sunghwan Kim
- Department of Orthopaedic Surgery, College of Medicine, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea; (Y.L.); (S.K.)
| | - Euidong Yeo
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea;
| | - Hongseop Lee
- Nowon Eulji Medical Center, Department of Foot and Ankle Surgery, Eulji University, 68, Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Republic of Korea;
| | - Kijin Jung
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea; (K.J.); (B.L.)
| | - Byungryul Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea; (K.J.); (B.L.)
| | - Myoungjin Lee
- Department of Orthopaedic Surgery, Dong-A University Hospital, 26, Daesingongwon-ro, Seo-gu, Busan 49201, Republic of Korea;
| | - Woojong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea; (K.J.); (B.L.)
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Kennedy MS, Nicholson HD, Woodley SJ. The morphology of the subacromial and related shoulder bursae. An anatomical and histological study. J Anat 2022; 240:941-958. [PMID: 34865216 PMCID: PMC9005683 DOI: 10.1111/joa.13603] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 10/19/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022] Open
Abstract
Shoulder bursae are essential for normal movement and are also implicated in the pathogenesis of shoulder pain and dysfunction. The subacromial bursa (SAB), within the subacromial space, is considered a primary source of shoulder pain. Several other bursae related to the subcoracoid space, including the coracobrachial (CBB), subcoracoid (SCB) and subtendinous bursa of subscapularis (SSB), are also clinically relevant. The detailed morphology and histological characteristics of these bursae are not well described. Sixteen embalmed cadaveric shoulders from eight individuals (five females, three males; mean age 78.6 ± 7.9 years) were investigated using macro-dissection and histological techniques to describe the locations, dimensions and attachments of the bursae, their relationship to surrounding structures and neurovascular supply. Bursal sections were stained with haematoxylin and eosin to examine the synovium and with antibodies against von Willebrand factor and neurofilament to identify blood vessels and neural structures respectively. Four separate bursae were related to the subacromial and subcoracoid spaces. The SAB was large, with a confluent subdeltoid portion in all except one specimen, which displayed a distinct subdeltoid bursa. The SAB roof attached to the lateral edge and deep surface of the acromion and coracoacromial ligament, and the subdeltoid fascia; its floor fused with the supraspinatus tendon and greater tubercle. The CBB (15/16 specimens) was deep to the conjoint tendon of coracobrachialis and short head of biceps brachii and the tip of the coracoid process, while the inconstant SCB (5/16 specimens) was deep to the coracoid process. Located deep to the subscapularis tendon, the SSB was a constant entity that commonly displayed a superior extension. Synovial tissue was predominantly areolar (SAB and SSB) or fibrous (CBB and SCB), with a higher proportion of areolar synovium in the bursal roofs compared to their floors. Blood vessels were consistently present in the subintima with a median density of 3% of the tissue surface area, being greatest in the SSB and SAB roofs (4.9% and 3.4% respectively) and least in the SAB floor (1.8%) and CBB roof and floor (both 1.6%). Nerve bundles and free nerve endings were identified in the subintima in approximately one-third of the samples, while encapsulated nerve endings were present in deeper tissue layers. The extensive expanse and attachments of the SAB support adoption of the term subacromial-subdeltoid bursa. Morphologically, the strong attachments of the bursal roofs and floors along with their free edges manifest as fixed and mobile portions, which enable movement in relation to surrounding structures. The presence of neurovascular structures demonstrates that these bursae potentially contribute blood supply to surrounding structures and are involved in mechanoreception. The anatomical details presented in this study clarify the morphology of the shoulder bursae, including histological findings that offer further insight into their potential function.
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Vega J, Poggio D, Heyrani N, Malagelada F, Guelfi M, Sarcon A, Dalmau-Pastor M. Arthroscopic all-inside ATiFL's distal fascicle transfer for ATFL's superior fascicle reconstruction or biological augmentation of lateral ligament repair. Knee Surg Sports Traumatol Arthrosc 2020; 28:70-78. [PMID: 30888451 DOI: 10.1007/s00167-019-05460-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/28/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Tendon grafts are often utilized for reconstruction of the lateral ligaments unamenable to primary repair. However, tendon and ligaments have different biological roles. The anterior tibiofibular ligament's (ATiFL) distal fascicle may be resected without compromising the stability of the ankle joint. The aim of this study is to describe an all-arthroscopic and intra-articular surgical technique of ATiFL's distal fascicle transfer for the treatment of chronic ankle instability. METHODS Five unpaired cadaver ankles underwent arthroscopic ATiFL's distal fascicle transfer using a non-absorbable suture and a knotless anchor. Injured or absent ATiFL's distal fascicle were excluded from the study. Following arthroscopy, the ankles were dissected and evaluated for entrapment of nearby adjacent anatomical structures. The ligament transfer was also assessed. The distance between the anterolateral (AL) portals and the superficial peroneal nerve (SPN) was measured and the shortest distance was reported. RESULTS All specimens revealed successful transfer of the tibial origin of the ATiFL's distal fascicle onto the talar insertion of anterior talofibular ligament's (ATFL) superior fascicle. The fibular origin of the ATiFL's distal fascicle remained intact. There were no specimens with SPN or extensor tendon entrapment. The median distance between the proximal AL portal and SPN was 3.8 mm. The median distance between the distal AL portal and SPN was 3.9 mm. CONCLUSION An all-arthroscopic approach to an ATiFL's distal fascicle transfer is a reliable method to reconstruct the ATFL's superior fascicle. Transfer of ATiFL's distal fascicle avoids the need for tendon harvest or allograft. The lack of injury to nearby adjacent structures suggests that it is a safe procedure. The clinical relevance of the study is that ATiFL's distal fascicle can be arthroscopically transferred to be used as a biological reinforcement of the ATFL repair, or as an ATFL reconstruction.
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Affiliation(s)
- Jordi Vega
- Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain. .,Foot and Ankle Unit, iMove Tres Torres and Hospital Quirón, Barcelona, Spain. .,Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied (GRECMIP), Merignac, France.
| | - Daniel Poggio
- Orthopaedic and Trauma Surgery, Foot and Ankle Unit, Hospital Clinic Barcelona, Barcelona, Spain
| | - Nasser Heyrani
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Francesc Malagelada
- Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Matteo Guelfi
- Foot and Ankle Unit, Clinica Montallegro, Genoa, Italy.,Human Anatomy and Embryology Unit, Department of Morphological Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Aida Sarcon
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Miki Dalmau-Pastor
- Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain.,Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied (GRECMIP), Merignac, France.,Vilamèdic, Santa Coloma de Gramanet, Barcelona, Spain
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7
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Dalmau-Pastor M, Malagelada F, Kerkhoffs GMMJ, Karlsson J, Manzanares MC, Vega J. The anterior tibiofibular ligament has a constant distal fascicle that contacts the anterolateral part of the talus. Knee Surg Sports Traumatol Arthrosc 2020; 28:48-54. [PMID: 30159737 DOI: 10.1007/s00167-018-5123-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/22/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE The anterior tibiofibular ligament (ATiFL) and its distal fascicle have been the subject of numerous studies, mainly due to the involvement of this ligament in anterolateral soft-tissue impingement of the ankle. There is currently no firm evidence related to the incidence of the distal fascicle or the frequency with which it is in contact with the talus, or whether this is a constant anatomic finding. In addition, the terminology used to refer to this structure is not accurate and varies widely in previous studies. The purpose of this study was to perform an anatomic study on a large number of specimens to clarify the anatomy of the anterior tibiofibular ligament, and specifically its distal fascicle, and its possible role in anterior ankle impingement syndrome. METHODS During a 7-year period (2010-2016), cadaveric ankle specimens dissected at our Anatomy Department were included in this study, accounting for a total of 154 ankles. The incidence of the distal fascicle and its contact with the talus were documented. RESULTS One hundred and seventeen ankles were included [78 men, 39 women, with a median age of 79.3 years (range 51-100 years)]. The ATiFL was found to have a distal fascicle in 100% of ankles, contacting the anterolateral part of the talus in all cases. The contact was increased in plantarflexion and reduced in dorsiflexion and finally disappeared completely in maximum dorsiflexion. CONCLUSIONS The ATiFL has a constant distal fascicle that is in contact with the talus in the neutral position and in plantar flexion. Contact disappears in maximum dorsiflexion.
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Affiliation(s)
- Miki Dalmau-Pastor
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain. .,Manresa Health Science School, University of Vic-Central University of Catalonia, Barcelona, Vic, Spain. .,GRECMIP (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied), Mérignac, France.
| | - F Malagelada
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain.,Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - G M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports Medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - J Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Göthenburg, Sweden
| | - M C Manzanares
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain
| | - J Vega
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain.,GRECMIP (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied), Mérignac, France.,Foot and Ankle Unit, Hospital Quirón Barcelona, Barcelona, Spain
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8
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Morley J, Fan C, McDermott K, Fede C, Hughes E, Stecco C. The crural interosseous membrane re-visited: a histological and microscopic study. Eur J Transl Myol 2019; 29:8340. [PMID: 31579480 PMCID: PMC6767936 DOI: 10.4081/ejtm.2019.8340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/09/2019] [Indexed: 01/01/2023] Open
Abstract
The aim of this study was to characterize the microscopic structure and sensory nerve endings of the crural interosseous membrane (IM). 13 IMs from 7 cadavers were used to analyze the organization of the collagen fibers, IM’s thickness, distribution of elastic fibers and nerve elements. The IM is mainly a two-layer collagen fascicle structure with the collagen fibers of adjacent layers orientated along different directions, forming angles of 30.5 +/- 1.7° at proximal and 26.6 +/- 2.1° at distal part (P>0.05). The percentage of elastic fibers between the two layers and inside the collagen fascicle layer is 10.1 +/- 0.5% and 2.2 +/- 0.1% (P<0.001). The IM’s thickness at proximal, middle, and distal parts is 268.5 +/- 18.6μm; 293.2 +/- 12.5μm; 365.3 +/- 19.3 μm, respectively (Proximal vs Distal: P<0.001; Middle vs Distal: P<0.05). Nerve elements were present and located both inside and on the surface of the IM, whereas the mechanoreceptors are mainly located on the surface of the IM. Free nerve endings (33.3 +/- 5.0/cm2) and Ruffini corpuscles (3.4 +/- 0.6/cm2) were the predominant sensory elements, while Pacinian corpuscles (1.3 +/- 0.7/cm2) were rarely found. The type of mechanoreceptors found suggests that the IM may play a role in proprioception.
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Affiliation(s)
- Joseph Morley
- University of Bridgeport School of Chiropractic, Bridgeport, CT, USA
| | - Chenglei Fan
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Kena McDermott
- University of Bridgeport School of Chiropractic, Bridgeport, CT, USA
| | - Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Emmett Hughes
- University of Bridgeport School of Chiropractic, Bridgeport, CT, USA
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
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Stecco C, Macchi V, Barbieri A, Tiengo C, Porzionato A, De Caro R. Hand fasciae innervation: The palmar aponeurosis. Clin Anat 2018; 31:677-683. [PMID: 29575188 DOI: 10.1002/ca.23076] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/28/2018] [Accepted: 03/13/2018] [Indexed: 11/05/2022]
Abstract
There are few data in the scientific literature about the innervation of fasciae of the hand. The present study first elucidates the density and location of nervous structures in the palmar aponeurosis and, for comparison, in the flexor retinaculum (both can be considered specializations of the deep fascia of the upper limbs). Second, it compares nonpathological with pathological palmar aponeurosis. Samples of nonpathological fascia were taken from the flexor retinaculum and palmar aponeurosis of 16 upper limbs of unembalmed cadavers. Samples of pathological palmar aponeurosis were taken from seven patients with Dupuytren's disease. All samples were stained immunohistochemically with anti-S100 and anti-tubulin antibodies, and analyzed quantitatively and qualitatively by microscopy. The palmar aponeurosis showed higher median density than the retinacula of free nerve endings (22 and 20 elements/cm2 , respectively), Pacinian corpuscles (2 and 0 elements/cm2 ) and Golgi-Mazzoni corpuscles (1.0 and 0.5 element/cm2 ). Some corpuscles were located at the intersections of the fibers in the three directions. Free nerve endings were denser in pathological palmar aponeurosis (38 elements/cm2 ). The results indicate that the palmar aponeurosis is central to proprioception of the hand and that surgery should therefore avoid injuring it. The higher density of free nerve endings in pathological samples indicates that the nervous structures are implicated in the amplified fibrosis of Dupuytren's disease. Clin. Anat. 31:677-683, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Carla Stecco
- Anatomy Institute, Department of Neuroscience, University of Padova, via Gabelli 65, Padova, 35121, Italy
| | - Veronica Macchi
- Anatomy Institute, Department of Neuroscience, University of Padova, via Gabelli 65, Padova, 35121, Italy
| | - Alessandro Barbieri
- Anatomy Institute, Department of Neuroscience, University of Padova, via Gabelli 65, Padova, 35121, Italy.,Clinic of Plastic surgery, Department of Neuroscience, University of Padova, via Giustiniani 2, Padova, 35121, Italy
| | - Cesare Tiengo
- Anatomy Institute, Department of Neuroscience, University of Padova, via Gabelli 65, Padova, 35121, Italy.,Clinic of Plastic surgery, Department of Neuroscience, University of Padova, via Giustiniani 2, Padova, 35121, Italy
| | - Andrea Porzionato
- Anatomy Institute, Department of Neuroscience, University of Padova, via Gabelli 65, Padova, 35121, Italy
| | - Raffaele De Caro
- Anatomy Institute, Department of Neuroscience, University of Padova, via Gabelli 65, Padova, 35121, Italy
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