1
|
Ryskalin L, Morucci G, Soldani P, Gesi M. Do the fasciae of the soleus have a role in plantar fasciitis? Clin Anat 2024; 37:413-424. [PMID: 37539773 DOI: 10.1002/ca.24102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/21/2023] [Accepted: 07/16/2023] [Indexed: 08/05/2023]
Abstract
Plantar fasciitis is a chronic, self-limiting, and painful disabling condition affecting the inferomedial aspect of the heel, usually extending toward the metatarsophalangeal joints. There is compelling evidence for a strong correlation between Achilles tendon (AT) loading and plantar aponeurosis (PA) tension. In line with this, tightness of the AT is found in almost 80% of patients affected by plantar fasciitis. A positive correlation has also been reported between gastrocnemius-soleus tightness and heel pain severity in this condition. Despite its high prevalence, the exact etiology and pathological mechanisms underlying plantar heel pain remain unclear. Therefore, the aim of the present paper is to discuss the anatomical and biomechanical substrates of plantar fasciitis with special emphasis on the emerging, though largely neglected, fascial system. In particular, the relationship between the fascia, triceps surae muscle, AT, and PA will be analyzed. We then proceed to discuss how structural and biomechanical alterations of the muscle-tendon-fascia complex due to muscle overuse or injury can create the conditions for the onset of PA pathology. A deeper knowledge of the possible molecular mechanisms underpinning changes in the mechanical properties of the fascial system in response to altered loading and/or muscle contraction could help healthcare professionals and clinicians refine nonoperative treatment strategies and rehabilitation protocols for plantar fasciitis.
Collapse
Affiliation(s)
- Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Gabriele Morucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Paola Soldani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Marco Gesi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| |
Collapse
|
2
|
Shi H, Jv L, Xu J, Qian X. An in-depth study on the magnetic resonance imaging characteristics of tendon rupture in sports injuries and its correlation with patients' clinical symptoms. Eur J Transl Myol 2024; 34:12424. [PMID: 38618892 PMCID: PMC11264227 DOI: 10.4081/ejtm.2024.12424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
Muscle injuries, such as Achilles and quadriceps tendon ruptures, pose a significant challenge in elite sports, accounting for more than 30% of all sports-related injuries. Our primary goal is to investigate the MR imaging characteristics of tendon rupture in sports injuries and their relationship with patients' clinical symptoms. In our retrospective study at Zhejiang University of Traditional Chinese Medicine's Second Affiliated Hospital (Zhejiang Xinhua Hospital), we compared the clinical presentation and MRI results of 106 patients with isolated AT and QT ruptures. In the AT, the enthesis was identified as a common site of bony avulsions (30.2%). In contrast, insertional ruptures were more common in the gastrocnemius heads (69.8% and 66.0%). The low frequency of mid-substance tears (13.2% to 20.8%) demonstrated the central tendon region's inherent tensile strength. The ruptured musculotendinous junctions affected the soleus (20.8%). In QT, bony avulsions play a minor role (5.1% to 11.3%). The patella was the primary site of tears (42.2% - 45.3%), with the Vastus intermedius favoring proximal tears (58.5%). Our examination of AT and QT ruptures across sub-components sheds light on their distinct patterns and the implications for clinical practice in terms of precise diagnosis, personalized treatment, and, ultimately, better patient outcomes for these debilitating injuries.
Collapse
Affiliation(s)
- Haihua Shi
- Department of Radiology, Hangzhou Shangcheng District People's Hospital, Hangzhou City, Zhejiang Province.
| | - Lingjuan Jv
- Department of Internal Medicine, Tongxiang Third People's Hospital, Jiaxing City, Zhejiang Province.
| | - Jungang Xu
- Department of Orthopedics, Hangzhou Shangcheng District People's Hospital, Hangzhou City, Zhejiang Province.
| | - Xiangyu Qian
- Department of Radiology, Tongxiang TCM Hospital, Jiaxing City, Zhejiang Province.
| |
Collapse
|
3
|
Zhong S, Xu G, Zhao J. [Anatomical and biomechanical characteristics of plantaris tendon and its application in ligament reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:234-239. [PMID: 38385238 PMCID: PMC10882231 DOI: 10.7507/1002-1892.202311032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Objective To improve the clinical utility of the plantaris tendon mainly by summarizing its anatomical characteristics, biomechanical properties, harvesting methods, and its applications in ligament reconstruction. Methods The relevant literature from domestic and international databases regarding the anatomical and biomechanical characteristics of the plantaris tendon and its applications in ligament reconstruction was comprehensively reviewed and systematically summarized. Results The plantaris tendons have an absence. The majority of plantaris tendon forms a fan-shape on the anterior and medial sides of the Achilles tendon and terminates at the calcaneal tuberosity. There are significant differences in biomechanical parameters between plantaris tendon with different numbers of strands, and multi strand plantaris tendon have significant advantages over single strand tendon. The plantaris tendon can be harvested through proximal and distal approaches, and it is necessary to ensure that there are no obvious anatomical variations or adhesions in the surrounding area before harvesting. The plantaris tendon is commonly utilized in ligament reconstruction around the ankle joint or suture reinforcement for Achilles tendon rupture, with satisfactory effectiveness. There is limited research on the use of plantar tendon in the reconstruction of upper limb and knee joint ligaments. Conclusion The plantaris tendon is relatively superficial, easy to be harvested, and has less impact on local function. The plantaris tendon is commonly utilized in ligaments reconstruction around the ankle joint or suture reinforcement for Achilles tendon rupture. The study on the plantaris tendon for upper limbs and knee joints ligament reconstruction is rarely and require further research.
Collapse
Affiliation(s)
- Shijiang Zhong
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P. R. China
| | - Guijun Xu
- Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, 300211, P. R. China
| | - Jiaguo Zhao
- Department of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100176, P. R. China
| |
Collapse
|
4
|
Olewnik Ł, Zielinska N, Ruzik K, Podgórski M, Kiciński P, Diogo R, Paulsen F. Morphological variability of the fibularis brevis tendon in human fetuses. Ann Anat 2024; 251:152154. [PMID: 37757974 DOI: 10.1016/j.aanat.2023.152154] [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] [Received: 05/22/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION The morphological variability of the fibularis brevis tendon in adults is well known. However, studies on its classification in the human fetus do not exist. The aim of this study was to provide the first comprehensive classification of the fibularis brevis tendon based on its insertion in human fetuses. The second aim of the study is to evaluate the prevalence of fibularis digiti quinti. MATERIAL AND METHODS Forty-three spontaneously aborted human fetuses were studied (21 male, 22 female, 86 lower limbs). All were from a Central European population), aged 18-38 weeks of gestation at the time of death. RESULTS Three main types of fibularis brevis tendon were distinguished. The most common was Type I (77%), characterized by a single distal attachment. The tendon was attached to the tuberosity at the base of the fifth metatarsal, on the lateral side. The second most common was Type II (19%) - a bifurcated distal attachment. The main tendon was attached to the tuberosity at the base of the fifth metatarsal on the lateral side. Based on the attachment site of the accessory tendon, four subtypes were determined: Type IIA - the accessory tendon attached to the dorsal surface of the base of the fifth metatarsal. At the side of attachment, the fibularis brevis tendon was connected with a portion of the fibularis tertius tendon. Type IIB - the accessory tendon attached to the proximal part of the shaft of the fifth metatarsal. Type IIC - the accessory tendon was attached to the fascia covering the fourth interosseous space. Type IID - the accessory tendon was fused with fibularis longus tendon. Type III is the rarest (4%) - triple branched distal attachment. The main tendon was attached to the tuberosity at the base of the fifth metatarsal. The first accessory tendon was attached to the proximal part of the shaft of the fifth metatarsal, and the second accessory tendon was attached to the fascia covering the fourth interosseous space. The fibularis digiti quinti was present in 24 feet (28%) of the 86 lower limbs dissected. CONCLUSION The fibularis brevis is characterized by high morphological variability. The proposed classification consists of three main Types (I-III), with Type II divided into subtypes (A-D). The fibularis digiti quinti is not closely related to the type of fibularis brevis tendon.
Collapse
Affiliation(s)
- Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Kacper Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Michał Podgórski
- Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Przemysław Kiciński
- Department of Angiology, Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - Rui Diogo
- Howard University, Department of Anatomy, Washington, DC, USA
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia
| |
Collapse
|
5
|
Zielinska N, LaPrade RF, Olewnik Ł. Morphological variations of the calcaneal tendon: clinical significance. J Orthop Surg Res 2023; 18:275. [PMID: 37016428 PMCID: PMC10074894 DOI: 10.1186/s13018-023-03748-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/24/2023] [Indexed: 04/06/2023] Open
Abstract
The calcaneal tendon, the largest and strongest in the human body, is created by the common junction of tendons of the gastrocnemius and soleus muscles. It is not a homogenous structure, being represented by layers in various arrangements. Morphological variability can be seen in the connection between the aponeurosis of the gastrocnemius muscle and the soleus muscle. Some types of plantaris tendon can be associated with a higher possibility of Achilles tendinopathy. Moreover, the presence of accessory structures, such as an accessory soleus muscle or additional gastrocnemius muscle heads may result in symptomatic pathologies. The main aim of this review is to summarize the current state of knowledge regarding the calcaneal tendon. Another aim is to present morphological variations of the calcaneal tendon and their clinical significance. Such information may be useful for clinicians, especially orthopedists, and surgeons. This review also provides an overview of embryological development and morphological variation among fetuses. Materials and methods: review was conducted according to PRISMA guidelines. An electronic search was conducted in five databases. Top quality tools were used to assess the quality of evidence in the studies reviewed. Research papers that made up the database of this review were analyzed, selected and assessed by two independently working researchers.
Collapse
Affiliation(s)
- Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | | | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
| |
Collapse
|
6
|
Hayashi S, Kim JH, Jin ZW, Murakami G, Rodríguez-Vázquez JF, Abe H. Development and growth of the calcaneal tendon sheath with special reference to its topographical relationship with the tendon of the plantaris muscle: a histological study of human fetuses. Surg Radiol Anat 2023; 45:247-253. [PMID: 36689056 DOI: 10.1007/s00276-023-03086-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/12/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND PURPOSE The calcaneal tendon sheath has several vascular routes and is a common site of inflammation. In adults, it is associated with the plantaris muscle tendon, but there are individual variations in the architecture and insertion site. We describe changes of the tendon sheath during fetal development. MATERIALS AND METHODS Histological sections of the unilateral ankles of 20 fetuses were examined, ten at 8-12 weeks gestational age (GA) and twelve at 26-39 weeks GA. RESULTS At 8-12 weeks GA, the tendon sheath simply consisted of a multilaminar layer that involved the plantaris tendon. At 26-39 weeks, each calcaneal tendon had a multilaminar sheath that could be roughly divided into three layers. The innermost layer was attached to the tendon and sometimes contained the plantaris tendon; the multilaminar intermediate layer contained vessels and often contained the plantaris tendon; and the outermost layer was thick and joined other fascial structures, such as a tibial nerve sheath and subcutaneous plantar fascia. The intermediate layer merged with the outermost layer near the insertion to the calcaneus. CONCLUSION In spite of significant variations among adults, the fetal plantar tendon was always contained in an innermost or intermediate layer of the calcaneal tendon sheath in near-term fetuses. After birth, mechanical stresses such as walking might lead to fusion or separation of the multilaminar sheath in various manners. When reconstruction occurs postnatally, there may be individual variations in blood supply routes and morphology of the distal end of the plantaris tendon.
Collapse
Affiliation(s)
- Shogo Hayashi
- Department of Anatomy, Division of Basic Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Ji Hyun Kim
- Department of Anatomy, Jeonbuk National University Medical School, Geunji-ro 20, Deokjin-gu, Jeonju, 54907, Republic of Korea.
| | - Zhe Wu Jin
- Department of Anatomy, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Gen Murakami
- Division of Internal Medicine, Cupid Clinic, Iwamizawa, Japan
| | | | - Hiroshi Abe
- Emeritus Professor of Akita University School of Medicine, Akita, Japan
| |
Collapse
|
7
|
Kim YD, Bardovskaya YI, Romanova SN, Pankratov AS, Shitikov DS. Novel classification of Achilles tendon ruptures. BULLETIN OF THE MEDICAL INSTITUTE "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH) 2022. [DOI: 10.20340/vmi-rvz.2022.6.clin.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the literature, the treatment of patients with Achilles tendon ruptures begins with diagnosis and diagnosis. Depending on the classification of Achilles tendon rupture, treatment tactics are determined. From our point of view, the existing classification of Achilles tendon ruptures does not sufficiently reflect and systematize the approach to surgical treatment, which served as a more detailed study and addition to the existing classification of Achilles tendon ruptures.
Collapse
|
8
|
Meyer P, Pesquer L, Boudahmane S, Poussange N, Demondion X, Dallaudière B. Evaluation of the plantaris tendon: cadaver anatomy study with ultrasonographic and clinical correlation with tennis leg injury in 759 calves. Skeletal Radiol 2022; 51:1797-1806. [PMID: 35229194 DOI: 10.1007/s00256-022-04019-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The role of the plantaris muscle (PM) in the literature is not clear. The objectives of this study were as follows: (1) to study PM at the interface between the medial gastrocnemius and soleus muscle in a cadaveric series, (2) to compare anatomic results with ultrasound (US) in the general population, and (3) to identify the potential role of the PM in the genesis of tennis leg (TL) injury. METHODS First, a cadaveric study was undertaken on six cadavers for descriptive and functional PM anatomy. Second, US evaluation was carried out for 670 calves in 335 subjects with no suspicion of a clinical tear in the thigh or calf muscle (group 1) and for 89 calves in 89 patients with tear symptoms (group 2). Study criteria were the presence or absence of PM tendon and the width measurement if present. RESULTS The PM was present in all cadavers. Traction on the tendon showed its "limited" mobility due to the connective tissue adherence mentioned with no apparent gliding of PM, promoting TL injury. In US, 37 PM were absent (4.35%) in 23 subjects. PM tendon width measurement of group 1 and group 2 was, respectively, 3.93 + / - 1.10 mm and 3.96 + / - 1.10 mm. No statistically significant differences between width measurements were found according to side (P = 0.74) or group (P = 0.69). Significant differences in width were only found between genders in group 1 (P = 0.014). CONCLUSION PM were absent in 4.35% population. The contraction of PM can promote tennis leg injury by increasing the shear forces at the level of the distal inter-aponeurotic region.
Collapse
Affiliation(s)
- P Meyer
- Centre d'Imagerie Ostéo-Articulaire, Clinique du Sport de Bordeaux-Mérignac, 2, rue Georges Négrevergne, 33700, Mérignac, France
| | - L Pesquer
- Centre d'Imagerie Ostéo-Articulaire, Clinique du Sport de Bordeaux-Mérignac, 2, rue Georges Négrevergne, 33700, Mérignac, France
| | - S Boudahmane
- Centre d'Imagerie Ostéo-Articulaire, Clinique du Sport de Bordeaux-Mérignac, 2, rue Georges Négrevergne, 33700, Mérignac, France
| | - N Poussange
- Centre d'Imagerie Ostéo-Articulaire, Clinique du Sport de Bordeaux-Mérignac, 2, rue Georges Négrevergne, 33700, Mérignac, France
| | - X Demondion
- Laboratoire d'Anatomie, Faculté de Médecine de Lille, 1 place de Verdun, 59000, Lille, France
| | - B Dallaudière
- Centre d'Imagerie Ostéo-Articulaire, Clinique du Sport de Bordeaux-Mérignac, 2, rue Georges Négrevergne, 33700, Mérignac, France.
- Département d'Imagerie Musculo-Squelettique, Centre Hospitalier Universitaire Pellegrin, Place Amélie Léon Rabat, 33000, Bordeaux, France.
- Centre de Résonance Magnétique Des Systèmes Biologiques, UMR 5536, CNRS, Université de Bordeaux, 146 rue Léo Saignat, 33076, Bordeaux, France.
| |
Collapse
|
9
|
Park JH, Cho J, Kim D, Kwon HW, Lee M, Choi YJ, Yoon KH, Park KR. Anatomical Classification for Plantaris Tendon Insertion and Its Clinical Implications: A Cadaveric Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5795. [PMID: 35627332 PMCID: PMC9140714 DOI: 10.3390/ijerph19105795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/20/2022] [Accepted: 05/09/2022] [Indexed: 02/06/2023]
Abstract
The purposes of this study were to ascertain the morphological characteristics of a plantaris tendon (PT) insertion using a larger-scale dissection of Korean cadavers and to classify the types of PT insertion related to the calcaneal tendon (CT). A total of 108 feet from adult formalin-fixed cadavers (34 males, 20 females) were dissected. The morphological characteristics and measurements of the PT insertion were evaluated. Five types of PT insertion were classified, wherein the most common type was Type 1 (39 feet, 63.1%). Type 2 and Type 3 were similar, with 16 feet (14.8%) and 15 feet (13.9%), respectively. Type 4 (6 feet, 5.6%) was the rarest type, and Type 5 had 25 feet (23.1%). The case of an absent PT was noted in 7 feet (6.5%). In the proximal portion, the tendon had a thick and narrow shape, became thin and wide in the middle portion, and then changed to thick and narrow again just before the insertion into the calcaneal tuberosity. This study confirmed the five types according to the location of the PT and the area of its insertion-related CT. The morphology of the PT insertion may be anatomically likely to influence the occurrence of tendinopathy in the CT.
Collapse
Affiliation(s)
- Jeong-Hyun Park
- Department of Anatomy & Cell Biology, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (J.-H.P.); (D.K.); (H.-W.K.); (M.L.); (Y.-J.C.)
| | - Jaeho Cho
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon 24253, Korea;
| | - Digud Kim
- Department of Anatomy & Cell Biology, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (J.-H.P.); (D.K.); (H.-W.K.); (M.L.); (Y.-J.C.)
| | - Hyung-Wook Kwon
- Department of Anatomy & Cell Biology, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (J.-H.P.); (D.K.); (H.-W.K.); (M.L.); (Y.-J.C.)
| | - Mijeong Lee
- Department of Anatomy & Cell Biology, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (J.-H.P.); (D.K.); (H.-W.K.); (M.L.); (Y.-J.C.)
| | - Yu-Jin Choi
- Department of Anatomy & Cell Biology, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (J.-H.P.); (D.K.); (H.-W.K.); (M.L.); (Y.-J.C.)
| | - Kwan Hyun Yoon
- Division in Biomedical Art, Incheon Catholic University Graduate School, Incheon 21987, Korea;
| | - Kwang-Rak Park
- Department of Anatomy, School of Medicine, Keimyung University, Daegu 42601, Korea
| |
Collapse
|
10
|
Ruzik K, Westrych K, Zielinska N, Podgórski M, Karauda P, Diogo R, Paulsen F, Polguj M, Olewnik Ł. The morphological variability of fibularis tertius origin in human foetuses. Ann Anat 2022; 243:151920. [PMID: 35278660 DOI: 10.1016/j.aanat.2022.151920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 01/24/2022] [Accepted: 02/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to characterize the morphology of the fibularis tertius (FT) in human fetuses, and to provide a classification based on its modes of origin in human fetuses. METHODS The material comprised 100extremities from 50 spontaneously aborted human fetuses (19 male, 31 female, 100 lowerlimbs in total), aged 18- 38 weeks of gestation. These were dissected and the presence or absence of the FT muscle as well as the type of its proximal attachment were determined, and the FT was measured morphometrically. RESULTS The FT was present in 50% of fetuses. Four types of FT muscle origin were identified. The most common was Type 2, characterized by an origin on the middle third of the fibula and the intermuscular septum. Three other types were observed: Type 1 with an origin located on proximal third of the fibula and to the intermuscular septum, Type 3 characterized by an absent muscle belly, and an independent tendon originating from the that of the extensor digitorum longus, and Type 4 with an origin located on the distal third of the fibula and the intermuscular septum. CONCLUSIONS The fibularis tertius demonstrates high morphological variability, with the most common origin located on third of the fibula and to the intermuscular septum.
Collapse
Affiliation(s)
- K Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia.
| | - K Westrych
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia.
| | - N Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia.
| | - M Podgórski
- Department of Diagnostic Imaging Lodz, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia.
| | - P Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia.
| | - R Diogo
- Howard University, Department of Anatomy, Washington DC, USA; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia.
| | - F Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia.
| | - M Polguj
- Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia; Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland.
| | - Ł Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia.
| |
Collapse
|
11
|
Kotelnikov GP, Kim YD, Shitikov DS, Pankratov AS, Knyazev NA. [Method of surgical treatment of patients with a chronic rupture of the Achilles tendon]. Khirurgiia (Mosk) 2022:38-44. [PMID: 35146998 DOI: 10.17116/hirurgia202202138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To improve treatment outcomes in patients with long-standing Achilles tendon ruptures with severe diastasis and dysfunction of the calf muscle via the use of a new method of surgical treatment. MATERIAL AND METHODS The authors proposed a new method of Achilles tendon repair for diastasis from 5 to 10 cm. This technique consists in elimination of diastasis with a tendon of the long peroneal muscle on the distal base. Surgical stages are described. The authors also report a patient with long-standing Achilles tendon rupture. Surgical treatment and postoperative outcomes are described. RESULTS Postoperative outcomes were assessed in 23 patients. The control group consisted of 21 patients who underwent reconstruction according to Chernavsky's and Krasnov's methods. Assessment was carried out using clinical and biomechanical methods. The authors analyzed gait asymmetry and functional myography data. Their data indicate the advantage of treatment in the main group.
Collapse
Affiliation(s)
- G P Kotelnikov
- Samara State Medical University, Samara, Russian Federation
| | - Yu D Kim
- Samara State Medical University of the Ministry of Health of Russia Samara State Medical University Clinics, Samara, Russia
| | - D S Shitikov
- Samara State Medical University, Samara, Russian Federation
| | - A S Pankratov
- Samara State Medical University of the Ministry of Health of Russia Samara State Medical University Clinics, Samara, Russia
| | - N A Knyazev
- Samara State Medical University, Samara, Russian Federation
| |
Collapse
|
12
|
Morphological variability of the fibularis longus tendon in human fetuses. Ann Anat 2021; 239:151838. [PMID: 34637900 DOI: 10.1016/j.aanat.2021.151838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/18/2021] [Accepted: 10/01/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The morphological variability of the fibularis longus tendon (FLT) in adults is well understood. However, no comprehensive classification exists in human fetuses. The goal of this study was to prepare the first comprehensive classification of the fibularis longus tendon based on its insertion in human fetuses. MATERIAL AND METHODS Forty-seven spontaneously-aborted human fetuses were examined: 38 male, 56 female, a total of 94 lower limbs (Central European population). Age ranged from18-38 weeks of gestation at death. RESULTS The classification comprised three types of FLT. The most common type was Type I (49%), characterized by the single distal attachment. This type was divided into two subtypes (A-B): A - the tendon inserts to the lateral tubercle of the base of the 1st metatarsal bone, B - the tendon inserts to the head of the 1st metatarsal bone. The second most type was Type II, characterized by a bifurcated distal attachment (24.5%). This type was divided into three subtypes (A-C): A - the main tendon inserts to the lateral tubercle of the base of the 1st metatarsal bone and the accessory band inserts to the medial cuneiform bone; B - the strong, main tendon inserts to both the base of the 1st metatarsal bone and medial cuneiform bone, including the first metatarsal-cuneiform joint, and the accessory bands inserts to the fourth interosseus dorsalis muscle; C - the main tendon inserts to the lateral tubercle of the base of the 1st metatarsal bone and the accessory band inserts to the first interosseus dorsalis muscle. The rarest type was Type III, characterized by a trifurcated distal attachment: the main tendon inserts to the lateral tubercle of the base of the 1st metatarsal bone and the first accessory band inserts to the medial cuneiform bone and the second accessory bands inserts to the first interosseus dorsalis muscle. The anterior frenular ligament was observed in 16% of all cases, and posterior frenular ligament in 6.4%. CONCLUSION The FLT displays high morphological variability. The proposed classification consists of three main types, with Type I and Type II divided into sub-types; it also provides additional data regarding its accessory tendon bands.
Collapse
|
13
|
Drakonaki EE, Gataa KG, Szaro P. The anatomical variant of high soleus muscle may predispose to tendinopathy: a preliminary MR study. Surg Radiol Anat 2021; 43:1681-1689. [PMID: 34032901 PMCID: PMC8455493 DOI: 10.1007/s00276-021-02768-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/12/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE This study aimed to examine the anatomic variations at the level of the distal soleus musculotendinous junction and the possible association between the length of the free tendon and the development of symptomatic Achilles tendinopathy. METHODS We retrospectively assessed 72 ankle MRI studies with findings of Achilles tendinopathy (study group, 26 females/46 males, mean age 52.6 ± 10.5 years, 30 right/42 left) and 72 ankle MRI studies with normal Achilles tendon (control group, 32 females/40 males, mean age 35.7 ± 13.7 years, 42 right/30 left side). We measured the distance from the lowest outline of the soleus myotendinous junction to the proximal outline of the Achilles tendon insertion (length of the free tendon, diameter a) and to the distal outline of the insertion (distance B). We also measured the maximum thickness of the free tendon (diameter c) and the distance between the levels of maximum thickness to the proximal outline of the Achilles tendon insertion (distance D). All measurements were assessed twice. Statistical analysis was performed using independent t test. RESULTS Distances A and B were significantly larger in tendinopathic tendons (59.7 and 83.4 mm, respectively) than normal Achilles tendons (38.5 and 60.8 mm, respectively) (p = 0.001). Mean distance C was larger in tendinopathic than normal tendons (11.2 versus 4.9 mm). Distances C and D were significantly larger in males than females. There was no significant difference in the measurements between sides. CONCLUSION There is wide anatomical variation in the length of the free Achilles tendon. Tendinopathy may be associated with the thicker free part of the Achilles tendon. The anatomical variant of the high soleus musculotendinous junction resulting in a longer free Achilles tendon may be a predisposing factor to the development of tendinopathy.
Collapse
Affiliation(s)
| | - Khaldun Ghali Gataa
- Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Göteborgsvägen 31, 431 80, Gothenburg, Sweden
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pawel Szaro
- Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Göteborgsvägen 31, 431 80, Gothenburg, Sweden.
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland.
| |
Collapse
|
14
|
Lopes R, Andrieu M, Molinier F, Colin F, Morin V. PT4: New arthroscopic technique for isolated reconstruction of the anterior talofibular ligament using a quadrupled plantaris tendon. Orthop Traumatol Surg Res 2021; 107:102995. [PMID: 34198006 DOI: 10.1016/j.otsr.2021.102995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 03/01/2020] [Accepted: 03/11/2020] [Indexed: 02/03/2023]
Abstract
The strategy for surgical treatment of chronic ankle instability is becoming increasingly refined. In instances of isolated symptomatic non-repairable anterior talofibular ligament (ATFL) injury, there is a surgical indication for isolated ATFL reconstruction. However, we feel that the typical gracilis tendon graft is not always appropriate. Interest in using the plantaris tendon as a graft has picked up since a biomechanics study found the tensile strength of a quadrupled plantaris tendon is comparable to that of the ATFL. Here, we describe an original arthroscopic technique for isolated ATFL reconstruction using a quadrupled plantaris tendon (PT4) graft.
Collapse
Affiliation(s)
- Rony Lopes
- Clinique Brétéché, 3, rue de la Béraudière, 44000 Nantes, France; Santé Atlantique, Avenue Claude Bernard, 44800 Saint-Herblain, France.
| | - Mickaël Andrieu
- Clinique du Pont de Chaume, 330 Avenue Marcel Unal, 82017 Montauban cedex, France
| | | | - Fabrice Colin
- Clinique Mutualiste Catalane, 60, rue Louis Mouillard, 66000 Perpignan, France
| | - Vincent Morin
- Clinique Médipôle de Savoie, 300, Avenue des Massettes, 73190 Challes-les-Eaux, France
| |
Collapse
|
15
|
Annamalai A, Iwanaga J, Olewnik Ł, Korndorffer ML, Dumont AS, Georgiev GP, Tubbs RS. Simultaneous duplication of the tendon of plantaris with multiple tendinous connections into the crural fascia. Morphologie 2021; 105:247-251. [PMID: 34511180 DOI: 10.1016/j.morpho.2020.09.005] [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] [Received: 09/16/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022]
Abstract
The plantaris muscle (PM) typically begins with a short, fusiform muscle belly and continues as a slim tendon traversing distally between the gastrocnemius and soleus to attach into the calcaneus directly or Achilles tendon. Conventionally, it has been of most interest as a donor for surgeons plantaris tendon (PT) grafting and recent studies have implicated the PT in the development of Achilles tendinopathy. During routine cadaveric dissection, one such anatomical variation was identified in a cadaver with two distal tendons of the PM and also multiple tendon connections into the crural fascia. While similar variants have been reported before in isolation, to our knowledge, this has been rarely reported illustrating the coexistence of a duplicated PT with simultaneous fascial connections into the crural fascia. The clinical implications of such a finding are discussed.
Collapse
Affiliation(s)
- A Annamalai
- Department of structural & cellular biology, Tulane university school of medicine, New Orleans, LA, USA
| | - J Iwanaga
- Department of neurosurgery, Tulane centre for clinical neurosciences, Tulane university school of medicine, 131, S.-Robertson St, Suite 1300, 70112 New Orleans, LA, USA; Division of gross and clinical anatomy, department of anatomy, Kurume university school of medicine, Kurume, Fukuoka, Japan.
| | - Ł Olewnik
- Department of normal and clinical anatomy, medical university of Lodz, Lodz, Poland; Department of anatomical dissection and donation, medical university of Lodz, Lodz, Poland
| | - M L Korndorffer
- Department of structural & cellular biology, Tulane university school of medicine, New Orleans, LA, USA
| | - A S Dumont
- Department of neurosurgery, Tulane centre for clinical neurosciences, Tulane university school of medicine, 131, S.-Robertson St, Suite 1300, 70112 New Orleans, LA, USA
| | - G P Georgiev
- Department of orthopedics and traumatology, university hospital Queen-Giovanna - ISUL, medical university of Sofia, Sofia, Bulgaria
| | - R S Tubbs
- Department of neurosurgery, Tulane centre for clinical neurosciences, Tulane university school of medicine, 131, S.-Robertson St, Suite 1300, 70112 New Orleans, LA, USA; Department of structural & cellular biology, Tulane university school of medicine, New Orleans, LA, USA; Department of neurosurgery and Ochsner neuroscience institute, Ochsner health system, New Orleans, LA, USA; Department of anatomical sciences, St. George's university, St. George's, Grenada
| |
Collapse
|
16
|
Vo TP, Ho GWK, Andrea J. Achilles Tendinopathy, A Brief Review and Update of Current Literature. Curr Sports Med Rep 2021; 20:453-461. [PMID: 34524189 DOI: 10.1249/jsr.0000000000000884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Chronic pain in the Achilles tendon is a common problem in both athletes and nonathletes alike. The etiology for the development of Achilles tendinopathy has not been fully elucidated, and there remains multiple theories to explain the pain and dysfunction accompanying this condition. The diagnosis of Achilles tendon problems continues to rely on the clinical history and physical examination. The optimal management of pain, restoration of function, and return-to-sports participation with Achilles tendinopathy are evolving because of the advancement in technologies and research regarding its pathophysiology. This article aims to provide a brief review of the relevant anatomy, differential diagnosis, imaging findings, and an update of the literature on conservative and minimally invasive managements of chronic Achilles tendinopathy.
Collapse
Affiliation(s)
- Thuy Phuong Vo
- Prince William Family Medicine, an Inova Partner, Manassas, VA
| | | | - John Andrea
- Inova Fairfax Family Medicine Program, Fairfax, VA
| |
Collapse
|
17
|
Waśniewska-Włodarczyk A, Paulsen F, Olewnik Ł, Polguj M. Morphological variability of the plantaris tendon in the human fetus. Sci Rep 2021; 11:16871. [PMID: 34413401 PMCID: PMC8376867 DOI: 10.1038/s41598-021-96391-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/09/2021] [Indexed: 11/08/2022] Open
Abstract
Muscular anatomy often differs between species and individuals. In particular, the plantaris muscle (PM) demonstrates great morphological variability in its course and its proximal and distal attachments. The aim of this study was to investigate the morphological variation of the PM tendon in human fetuses. Forty-six spontaneously aborted human fetuses (23 male, 23 female) aged 18-38 weeks of gestation were studied. Morphology of the attachment of the PM was assessed in both lower extremities (n = 92). The PM was present in 72 lower limbs (78.26%) and absent in 20 (21.74%). Eight types of PM distal attachment were identified. We propose an eight-fold classification of PM insertion in fetuses. Leg length, length of tendon, extension point (ExP) from the calcaneus, and ExP thickness differed significantly among types of PM insertion.
Collapse
Affiliation(s)
- Anna Waśniewska-Włodarczyk
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland.
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Topographic Anatomy and Operative Surgery, Sechenov University, Moscow, Russia
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
18
|
Olewnik Ł, LaPrade RF, Paulsen F, Gonera B, Kurtys K, Podgórski M, Aragonés P, Sanudo JR, Polguj M. A proposal for a new morphological classification of the popliteus muscle tendon with potential clinical and biomechanical significance. Sci Rep 2021; 11:14434. [PMID: 34262097 PMCID: PMC8280136 DOI: 10.1038/s41598-021-93778-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/21/2021] [Indexed: 01/11/2023] Open
Abstract
The purpose of this study was to characterize the morphological variations in the proximal attachments and create an accurate classification of the PPM for use in planning surgical procedures in this area, for evaluating radiological imaging and rehabilitation. One hundred and thirty-four lower limbs of body donors (52 woman and 82 man) fixed in 10% formalin solution were examined. The popliteus muscle was present in all 134 limbs. Four main types were identified with subtypes. The most common type was Type I (34.3%), characterized by a single tendon in the popliteus sulcus. Type II (30.6%) characterized by a main tendon in the popliteus sulcus and accessory bands. This type was divided into five subtypes (A-E) based on presence of specific accessory bands. Type III (15.3%) was characterized by two tendons in the popliteal sulcus. Type IV (19.4%) was characterized by two tendons in the popliteus sulcus and additional bands. This type was also divided into five subtypes (A-E) based on presence of specific accessory bands. The popliteofibular ligament was present in 90.3% of cases. A new classification based on a proximal attachment is proposed. The popliteus tendon is characterized by a very high morphological variability, which can affect posterolateral knee stability and the natural rotation of the tibia. Such a classification system may be useful for clinicians performing medical procedures within the knee joint, including orthopedic surgeons.
Collapse
Affiliation(s)
- Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
| | | | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Topographic Anatomy and Operative Surgery, Sechenov University, Moscow, Russia
| | - Bartosz Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Konrad Kurtys
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Michał Podgórski
- Department of Imaging Diagnostic, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Paloma Aragonés
- Department of Orthopedics Surgery. Hospital Santa Cristina, Madrid, Spain
| | - J Ramón Sanudo
- Department of Human Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
19
|
Waśniewska A, Olewnik Ł, Diogo R, Polguj M. Morphological variability of the plantaris muscle origin in human fetuses. Ann Anat 2021; 239:151794. [PMID: 34217832 DOI: 10.1016/j.aanat.2021.151794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The plantaris muscle (PM) is a small, fusiform muscle located between the gastrocnemius muscle (GM) and soleus muscle (SM). PM supports movements of the knee and ankle. This muscle presents a great variability, and also has a high clinical significance. Nevertheless, data concerns morphology and morphometry of the origin of PM in human fetuses are scarce. MATERIAL AND METHODS Forty-seven spontaneously-aborted human fetuses (23 male, 24 female) aged 18-38 weeks of gestation were examined. The morphology and morphometry of the origin of PM were evaluated. RESULTS PM was present in 74 lower limbs (78.7%), and absent on 20 limbs (21.3%). We distinguished VI types of the proximal attachment of PM. Belly width and thickness, as well as thickness of the tendon and MT junction differed significantly between types of PM origin. CONCLUSIONS We distinguished six (I-VI) types of origin of PM in human fetuses. The most common type was type Ia, characterized by an attachment to the lateral head of GM, lateral femoral condyle and to the knee joint capsule. Our results of PM anatomical variation in fetuses will pave the way for detailed comparisons with studies carried out on adult cadavers.
Collapse
Affiliation(s)
- Anna Waśniewska
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland.
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Rui Diogo
- Department of Anatomy, Howard University College of Medicine, Washington, DC, United States
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
20
|
Heo Y, Lee H, Hwang SJ. Bicipital origin and the course of the plantaris muscle. Anat Cell Biol 2021; 54:289-291. [PMID: 34053915 PMCID: PMC8225482 DOI: 10.5115/acb.21.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/07/2021] [Indexed: 11/27/2022] Open
Abstract
The plantaris muscle (PM) has a small fusiform muscle belly and a long slender tendon sandwiched between the soleus (SM) and gastrocnemius muscle (GM). During routine dissection for research, an additional PM in the popliteal region of a 75-year-old Korean female was discovered. Two distinct PMs were present, the superior PM (sPM) and inferior PM (iPM). While the sPM originates from the lower lateral supracondylar ridge and the knee capsule, the iPM originates from the femoral condyle and sPM tendon splitting into two parts at the distal belly. The lateral side of the iPM tendon travels between GM and SM and ends at the calcaneal tendon. sPM and the medial side of the iPM tendon run along with the sPM tendon and inserts at the fascia at the inner surface of proximal 1/3 of the medial head of GM. This case report introduces a new variation of the PM that should be taken into consideration.
Collapse
Affiliation(s)
- Yijin Heo
- Department of Anatomy, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hyemin Lee
- Clinical Anatomy Education Center, Asan Medical Center, Seoul, Korea
| | - Seung-Jun Hwang
- Department of Anatomy, College of Medicine, University of Ulsan, Seoul, Korea.,Clinical Anatomy Education Center, Asan Medical Center, Seoul, Korea
| |
Collapse
|
21
|
Variant Plantaris Anatomy During Tendon Harvest. J Hand Surg Am 2021; 46:431.e1-431.e4. [PMID: 33741215 DOI: 10.1016/j.jhsa.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 10/23/2020] [Accepted: 01/06/2021] [Indexed: 02/02/2023]
Abstract
The plantaris tendon is commonly used in upper extremity reconstruction as a tendon graft. Variations in plantaris anatomy are described as terminating proximally into the calcaneal tendon or gastrocnemius in certain cases, making the tendon an unusable length as a graft. A case of anomalous attachment of the gastrocnemius muscle to the plantaris tendon is described. After division of this attachment through a counterincision, complete harvest of the plantaris tendon was possible. Further exploration when resistance is encountered in standard plantaris tendon harvest is recommended to avoid unnecessary abandonment of a plantaris harvest.
Collapse
|
22
|
Szaro P, Nilsson-Helander K, Carmont M. MRI of the Achilles tendon-A comprehensive pictorial review. Part one. Eur J Radiol Open 2021; 8:100342. [PMID: 33850971 PMCID: PMC8039565 DOI: 10.1016/j.ejro.2021.100342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/18/2021] [Accepted: 03/20/2021] [Indexed: 12/28/2022] Open
Abstract
Presence of normal septation between subtendons may mimic an intrasubstance tear. MRI is superior to ultrasound in detection of partial tears. Ultrasound is as useful as MRI in detection of tendinopathy and full-thickness tears. Kager's fat pad is involved in infection more than in postoperative changes. The Achilles tendon xanthoma has a higher signal on T1- and T2-weighted sequences.
The normal Achilles tendon is composed of twisted subtendons separated by thin high signal septae, which are a potential pitfall on MRI because they mimic a tendon tear. Tendinopathy and full thickness tears may be assessed effectively both on MRI and ultrasound. MRI is superior to ultrasound in detection of partial tears and for postoperative assessment. The use of fat suppression sequences allows the ability to detect focal lesions. Sagittal and coronal sections are useful for assessing the distance between stumps of a ruptured tendon. Sequences with contrast are indicated in postoperative investigations and suspicion of infection, arthritis or tumor. MRI may reveal inflammatory changes with minor symptoms long before the clinical manifestations of seronegative spondyloarthropathy. The most common non-traumatic focal lesion of the Achilles tendon is Achilles tendon xanthoma, which is manifested by intermediate or slightly higher signal on T1- and T2-weighted images compared to that in the normal Achilles tendon. Other tumors of the Achilles tendon are very rare, whereas the involvement of the tendon from tumor in adjacent structures is more frequent. The novel MRI sequences may help to detect disorders of the Achilles tendon more specifically before clinical manifestation. Regeneration or remodeling of the Achilles tendon can be non‐invasively detected and monitored in diffusion tensor imaging. Assessment of healing is possible using T2-mapping while evaluating the tendon vascularization in intravoxel incoherent motion MRI.
Collapse
Affiliation(s)
- Pawel Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
| | - Katarina Nilsson-Helander
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Michael Carmont
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,The Department of Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury & Telford Hospital NHS Trust, Shropshire, UK
| |
Collapse
|
23
|
Olewnik Ł, Karauda P, Gonera B, Kurtys K, Tubbs RS, Paulsen F, Szymański R, Polguj M. Impact of plantaris ligamentous tendon. Sci Rep 2021; 11:4550. [PMID: 33633305 PMCID: PMC7907062 DOI: 10.1038/s41598-021-84186-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 02/11/2021] [Indexed: 01/11/2023] Open
Abstract
There are countless morphological variations among the muscles, tendons, ligaments, arteries, veins and nerves of the human body, many of which remain undescribed. Anatomical structures are also subject to evolution, many disappearing and others continually emerging. The main goal of this pilot study was to describe a previously undetected anatomical structure, the plantaris ligamentous tendon, and to determine its frequency and histology. Twenty-two lower limbs from 11 adult cadavers (11 left, and 11 right) fixed in 10% formalin were examined. The mean age of the cadavers at death was 60.1 years (range 38–85). The group comprised six women and five men from a Central European population. All anatomical dissections of the leg and foot area accorded with the pre-established protocol. Among the 22 lower limbs, the PLT was present in 16 (72.7%) and absent in six (27.3%). It originated as a strong fan-shaped ligamentous tendon from the superior part of the plantaris muscle, the posterior surface of the femur and the lateral aspect of the knee joint capsule. It inserted to the ilio-tibial band. Histologically, a tendon and ligament were observed extending parallel to each other. A new anatomical structure has been found, for which the name plantaris ligamentous tendon is proposed. It occurs around the popliteal region between the plantaris muscle, the posterior surface of the femur, and the ilio-tibial band.
Collapse
Affiliation(s)
- Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
| | - Piotr Karauda
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Bartosz Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Konrad Kurtys
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA.,Department of Anatomical Sciences, St. George's University, West Indies, Grenada
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Department of Topographic Anatomy and Operative Surgery, Sechenov University, Moscow, Russia
| | - Rafał Szymański
- Department of Histology, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
24
|
Gonera B, Kurtys K, Paulsen F, Polguj M, LaPrade RF, Grzelecki D, Karauda P, Olewnik Ł. The plantaris muscle - Anatomical curiosity or a structure with important clinical value? - A comprehensive review of the current literature. Ann Anat 2021; 235:151681. [PMID: 33561523 DOI: 10.1016/j.aanat.2021.151681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Although the plantaris muscle is vestigial in humans, it is far too important to remain omitted. The aim of this study is to provide a comprehensive review of the existing literature focused on plantaris muscle clinical value, grafting usefulness and its morphological variations. Hopefully this study will be of great use for every medical practitioner due to its clarity and conciseness despite such broaden scope of this article. MATERIAL AND METHODS The article is written based on 100 studies published since 1868 until 2020. During careful selection process 12 papers were dismissed due to their insufficient sample size, wrong methods used or results that were previously discovered. RESULTS Many aspects concerning the plantaris muscle are already well examined, summarized and described. However this study has shown how much we still do not know and which fields require further investigations. CONCLUSION The anatomical variations of plantaris muscle morphology may cause mid-portion Achilles tendinopathy, tennis leg syndrome or increase the risk of failure while harvesting the tendons.
Collapse
Affiliation(s)
- Bartosz Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
| | - Konrad Kurtys
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | | | - Dariusz Grzelecki
- Centre of Postgraduate Medical Education, Department of Orthopedics and Rheumoorthopedics, Otwock, Poland
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| |
Collapse
|
25
|
Kotelnikov GP, Ardatov SV, Kim YD, Shitikov DS. [A new method of surgical treatment of patients with chronic distal Achilles tendon rupture]. Khirurgiia (Mosk) 2021:62-68. [PMID: 33395514 DOI: 10.17116/hirurgia202101162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To improve postoperative outcomes in patients with distal Achilles tendon rupture by using of a new method of surgical treatment. MATERIAL AND METHODS The authors proposed a new method to restore the Achilles tendon for its distal rupture (within 2 cm from attachment to the calcaneus). This approach implies forming a canal in the calcaneus and minimally invasive harvesting of the plantar tendon. At the next stage, the plantar tendon is passed through the canal of the calcaneus in U-shaped fashion and proximal part of Achilles tendon with maximum approximation of its fragments and imposing of interrupted sutures on the plantar and Achilles tendons to hold the position. The end of plantar tendon is used to reinforce damaged area. The schemes and surgical stages are shown in the figures. We reported a patient with distal Achilles tendon rupture and postoperative outcome. RESULTS An above-mentioned approach was applied in 26 patients. The control group consisted of 21 patients who underwent recovery with anchor fixers. Early and long-term postoperative results, as well as adverse events were analyzed in both groups. Biomechanical parameters of gait were evaluated from the standpoint of evidence-based medicine using podography and functional myography. We confirmed an advantage of treatment in the main group.
Collapse
Affiliation(s)
| | - S V Ardatov
- Samara State Medical University, Samara, Russia
| | - Yu D Kim
- Samara State Medical University, Samara, Russia
| | | |
Collapse
|
26
|
The twisted structure of the fetal calcaneal tendon is already visible in the second trimester. Surg Radiol Anat 2020; 43:1075-1082. [PMID: 33237333 PMCID: PMC8273059 DOI: 10.1007/s00276-020-02618-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/05/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The progress in morphological science results from the greater possibilities of intra-pubic diagnosis and treatment of congenital disabilities, including the motor system. However, the structure and macroscopic development of the calcaneal tendon have not been investigated in detail. Studies on the adult calcaneal tendon showed that the calcaneal tendon is composed of twisted subtendons. This study aimed to investigate the internal structure of the fetal calcaneal tendon in the second trimester. MATERIALS AND METHODS Thirty-six fetuses fixed in 10% formaldehyde were dissected using the layer-by-layer method and a surgical microscope. RESULTS The twisted structure of the calcaneal tendon was revealed in all specimens. The posterior layer of the calcaneal tendon is formed by the subtendon from the medial head of the gastrocnemius muscle. In contrast, the anterior layer is formed by the subtendon from the lateral head of the gastrocnemius muscle. The subtendon from the soleus muscle constitutes the anteromedial outline of the calcaneal tendon. The lateral outline of the calcaneal tendon is formed by the subtendon originating from the medial head of the gastrocnemius muscle. In contrast, the medial outline is formed by the subtendon from the soleus muscle. In most of the examined limbs, the plantaris tendon attached to the tuber calcanei was not directly connected to the calcaneal tendon. CONCLUSIONS The twisted structure of the subtendons of the fetal calcaneal tendon is already visible in the second trimester and is similar to that seen in adults.
Collapse
|
27
|
Is the plantaris muscle the most undefined human skeletal muscle? Anat Sci Int 2020; 96:471-477. [PMID: 33159667 PMCID: PMC8139894 DOI: 10.1007/s12565-020-00586-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/26/2020] [Indexed: 01/11/2023]
Abstract
The plantaris muscle is located in the posterior aspect of the superficial compartment of the lower leg, running from the lateral condyle of the femur to the calcaneal tuberosity. Classically, it is characterized by a small and fusiform muscle belly, which then changes into a long slender tendon. From the evolutionary point of view, the muscle is considered vestigial. However, it has recently been suspected of being a highly specialized sensory muscle because of its high density of muscle spindles. It has a noticeable tendency to vary in respect of both origin and insertion. Researchers have published many reports on the potential clinical significance of the muscle belly and tendon, including mid-portion Achilles tendinopathy, ‘tennis leg syndrome’, and popliteal artery entrapment syndrome. The right knee joint area was subjected to classical anatomical dissection, during which an atypical plantaris muscle was found and examined in detail. Accurate morphometric measurements were made. The muscle belly was assessed as bifurcated. Morphologically, superior and inferior parts were presented. There was a tendinous connection (named band A) with the iliotibial tract and an additional insertion (named band B) to the semimembranosus tendon. Both bands A and B presented very broad fan-shaped attachments. The human plantaris muscle is of considerable interest and has frequent morphological variations in its proximal part. Its specific characteristics can cause clinical problems and lead to confusion in diagnosis. More studies are needed to define its actual features and functions.
Collapse
|
28
|
Szaro P, Cifuentes Ramirez W, Borkmann S, Bengtsson A, Polaczek M, Ciszek B. Distribution of the subtendons in the midportion of the Achilles tendon revealed in vivo on MRI. Sci Rep 2020; 10:16348. [PMID: 33004938 PMCID: PMC7529808 DOI: 10.1038/s41598-020-73345-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/15/2020] [Indexed: 12/28/2022] Open
Abstract
The aim of the study was to check if the subtendons of the Achilles tendon can be identified in vivo on MRI in the midportion of the tendon. The relation of the plantaris tendon to the Achilles tendon was also examined. A retrospective study of 200 MRI of ankle joints including the Achilles tendon was conducted. Statistical analysis of the correlation between the possibility of identifying the subtendons and the side, gender, presence of the central soleus tendon and plantaris tendon variation was performed. The inter-observer agreement between two reviewers in their evaluation of the subtendons was assessed using kappa statistics. The subtendon from the lateral head of the gastrocnemius muscle was identified in 65% (k = 0.63) and was located in the anterior part of the Achilles tendon. The subtendon from the soleus muscle was recognized in 12% (k = 0.75) comprising anterior part of the tendon. In 6% the subtendon from the medial head of the gastrocnemius muscle was identified (k = 0.58). The central soleus tendon was identified in 85% of cases. Statistical analysis shows the weak correlation of the presence of the central soleus tendon and the possibility of identifying the subtendon from the soleus muscle. The plantaris tendon was directly related to the insertion of the Achilles tendon in 42.5%. Identification of the subtendons of the Achilles tendon on MRI is challenging, and most often it is only possible to find the subtendon of the lateral head of the gastrocnemius muscle.
Collapse
Affiliation(s)
- Paweł Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Gothenburg, Sweden. .,Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | | | - Simon Borkmann
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alexander Bengtsson
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mateusz Polaczek
- Third Department of Lung Diseases and Oncology, National Tuberculosis and Lung Diseases Research Institute, Medical University of Warsaw, Warsaw, Poland
| | - Bogdan Ciszek
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
29
|
Sederberg M, Cushman DM. Current Treatments of Insertional Achilles Tendinopathy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00288-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
30
|
Olewnik Ł, Tubbs RS, Ruzik K, Podgórski M, Aragonés P, Waśniewska A, Karauda P, Szewczyk B, Sanudo JR, Polguj M. Quadriceps or multiceps femoris?-Cadaveric study. Clin Anat 2020; 34:71-81. [PMID: 32644202 DOI: 10.1002/ca.23646] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The quadriceps femoris (QF) consists of four muscles: the rectus femoris; vastus medialis; vastus lateralis, and vastus intermediate. The tendons of all of these parts join together into a single tendon that attaches to the patella. The QF is a powerful extensor of the knee joint that is needed for walking. A growing number of publications have examined the fifth head of the QF muscle. There is no information about the possibility of other heads, and there is no correct classification of their proximal attachments. Further, the frequency of occurrence of additional heads/components of the QF remains unclear. METHODS One hundred and six lower limbs (34 male and 18 female) fixed in 10% formalin solution were examined. RESULTS Additional heads of the QF were present in 64.1% of the limbs. Three main types were identified and included subtypes. The most common was Type I (44.1%), which had an independent fifth head. This type was divided into two subtypes (A-B) depending on its location relative to the vastus intermediate. The second most common type was Type II (30.8%), which originated from other muscles: IIA from the vastus lateralis; IIB from the vastus intermediate, and IIC from the gluteus minimus. In addition, Type III (25%) was characterized by multiple heads: IIIA-two heads with a single common tendon; IIIB-two heads with two separate tendons; IIIC-three heads (lateral, intermediate, medial), and IIID-four heads (bifurcated lateral and bifurcated medial). CONCLUSION The introduction of a new classification based on a proximal attachment is necessary. The presence of the fifth, sixth, seventh, or eighth head varies.
Collapse
Affiliation(s)
- Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Richard Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA.,Department of Anatomical Sciences, St. George's University, True Blue, Grenada
| | - Kacper Ruzik
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Michał Podgórski
- Department of Imaging Diagnostic, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Paloma Aragonés
- Department of Orthopedics Surgery, Hospital Santa Cristina, Madrid, Spain
| | - Anna Waśniewska
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Bartłomiej Szewczyk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Jose Ramón Sanudo
- Department of Human Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
31
|
Szaro P, Polaczek M, Ciszek B. The Kager's fat pad radiological anatomy revised. Surg Radiol Anat 2020; 43:79-86. [PMID: 32813031 PMCID: PMC7838075 DOI: 10.1007/s00276-020-02552-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/12/2020] [Indexed: 12/17/2022]
Abstract
Purpose The aim of the study was to map connections within the Kager’s fat pad between the structures which limit it.
Methods A retrospective re-review of 200 ankle magnetic resonance imaging (MRI) examination was conducted. Connections within the Kager’s fat pad between the superior peroneal retinaculum, the fibulotalocalcaneal ligament, the posterior talocalcaneal ligament, the flexor hallucis longus, the paratenon of the Achilles tendon, the flexor retinaculum and bones were studied and a model of the connections was constructed.
Results The superior peroneal retinaculum was directly connected with the fibulotalocalcaneal ligament in 85.5% of cases, the lateral part of the paratenon in 82.5%, the processus posterior tali in 78.5%, the posterior talofibular ligament in 32%, the flexor retinaculum in 29.5% and the anterior talofibular ligament in 9%. The fibulotalocalcaneal ligament was connected with the paratenon (on the medial side 88.5%, on the lateral side 68.5%), the flexor retinaculum in 70%, the posterior process of the talus in 79%, the osteofibrosus tunnel for the flexor hallucis longus in 53%, the posterior talofibular ligament in 43.5% and the calcaneofibular ligament in 10.5%. The posterior talocalcaneal ligament was connected with the fibulotalocalcaneal ligament in 71%, with the osteofibrosus tunnel for the flexor hallucis longus in 76.5%, with the flexor retinaculum in 70%. The plantaris tendon showed projection to the crural fascia in 34 of % cases.
Conclusion In the Kager’s fat pad there are present more connections than previously reported. All the connections unit at the level of the posterior process of the talus.
Collapse
Affiliation(s)
- Paweł Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Gothenburg, Sweden. .,Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Göteborgsvägen 31, 431 80, Gothenburg, Sweden.
| | - Mateusz Polaczek
- Third Department of Lung Diseases and Oncology, National Tuberculosis and Lung Diseases Research Institute, Plocka 26, 01138, Warsaw, Poland
| | - Bogdan Ciszek
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
32
|
A proposal for a new classification of soleus muscle morphology. Ann Anat 2020; 232:151584. [PMID: 32810614 DOI: 10.1016/j.aanat.2020.151584] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The soleus muscle (SM) is located in the superficial posterior compartment of the leg, together with the gastrocnemius muscle (GM) and plantaris muscle. There is little information on the morphological variability (pennation) of the SM. The aim of the study is to characterize the variations in the morphology of the pennation of the SM and to create the first accurate classification. MATERIAL AND METHODS Eighty lower limbs (40 left, and 40 right) fixed in 10% formalin solution were examined. The morphology of the central tendon, medial and lateral aponeuroses was evaluated, together with the pennation angle. RESULTS In all cases, the soleus muscle was present. Four types could be distinguished based on muscle fibre morphology. In order of frequency: Type 1 - bipennate (43.75%); Type 4 - non-pennate (36.25%); Type 2 - unipennate (15%); Type 3 - multipennate (5%). No significant difference in type distribution was observed with regard to body side (p=0.9018) or gender (p=0.0844). CONCLUSION The soleus muscle is characterized by high morphological variability. Based on the pennation angle, four types (1-4) of soleus muscle are distinguishable.
Collapse
|
33
|
A three-headed plantaris muscle: evidence that the plantaris is not a vestigial muscle? Surg Radiol Anat 2020; 42:1189-1193. [PMID: 32382814 PMCID: PMC7366563 DOI: 10.1007/s00276-020-02478-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/17/2020] [Indexed: 11/08/2022]
Abstract
The plantaris is a small muscle that typically originates at the lateral supracondylar line of the femur and the knee joint capsule, from where it continues distally, forming a long and slender tendon. However, considerable controversy surrounds the status of this seemingly inconspicuous muscle: is it a residual muscle, or one that it is just developing? In addition, both the proximal and distal attachments are highly morphologically variable. These variations can lead to many diseases. Interestingly, the course of the PM tendon is also variable. The present case study presents a new description of a complex origin type and a rare course of the PM tendon. Understanding of the PM and its tendon has clear clinical value and is a significant indicator of the development of interest in this overlooked muscle.
Collapse
|
34
|
Gonera B, Kurtys K, Karauda P, Olewnik Ł, Polguj M. Possible effect of morphological variations of plantaris muscle tendon on harvesting at reconstruction surgery-case report. Surg Radiol Anat 2020; 42:1183-1188. [PMID: 32248255 PMCID: PMC7366566 DOI: 10.1007/s00276-020-02463-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/23/2020] [Indexed: 01/11/2023]
Abstract
Purpose Seemingly a well-known, weak, and vestigial plantaris muscle should not be a revelation. However, recent studies have shown that this structure is incredibly underestimated and perceived only as an infirm flexor of the talocrural joint, the knee joint or a great source of graft tissue. Usually, the origin of this inconspicuous muscle begins at the lateral supracondylar line of the femur and the knee joint capsule. It continues distally, forming a long and slender tendon. In most cases, it inserts onto the calcaneal tuberosity on the medial side of the Achilles tendon. However, many morphological variations have been discovered during anatomical dissections and surgical procedures. Nevertheless, according to the present literature, no other studies presented such a complex insertion variant, with indisputable clinical value and significant proof of development of this forgotten muscle. Methods The dissection of the right thigh, knee, crural and talocrural region was performed using standard techniques according to a strictly specified protocol. Results Four different insertion points were observed. The first band (A) inserted near to the tarsal canal flexor retinaculum. The second band (B) bifurcates into two branches—B1 and B2. B1 is located on the medial side and B2 is located on the lateral side of the calcaneal tuberosity. The third band (C) is inserted into the superior nonarticular calcaneal surface of the calcaneus anteriorly to the Achilles tendon. Conclusion A differently shaped plantaris tendon could be considered a cause of harvesting procedure failure. In the light of new case reports perhaps what we are now witnessing is remodeling and transformation of the Plantaris muscle. If so, the awareness of the influence on the onset of Achilles midportion tendinopathy or a potential role in tibialis posterior conflict can be crucial for every clinician.
Collapse
Affiliation(s)
- B Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Mechaniczna 5a, 92-310, Lodz, Poland.
| | - K Kurtys
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Mechaniczna 5a, 92-310, Lodz, Poland
| | - P Karauda
- Department of Normal and Clinical Anatomy, Medical University of Lodz, Lodz, Poland
| | - Ł Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Mechaniczna 5a, 92-310, Lodz, Poland
| | - M Polguj
- Department of Normal and Clinical Anatomy, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
35
|
Kurtys K, Gonera B, Olewnik Ł, Karauda P, Polguj M. A highly complex variant of the plantaris tendon insertion and its potential clinical relevance. Anat Sci Int 2020; 95:553-558. [PMID: 32248353 PMCID: PMC7381478 DOI: 10.1007/s12565-020-00540-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/25/2020] [Indexed: 01/11/2023]
Abstract
The body is home to a number of unique and intriguing anatomical structures, plenty of which concern the muscles and their tendons. Of these, the plantaris muscle is reported to present a particularly high range of morphological variations. The muscle, passing distally throughout the length of the lower leg, consists of a small muscle belly and a long, thin tendon. It originates, traditionally, on the popliteal surface of the femur and the knee joint capsule, and then inserts to the calcaneal tuberosity. It has been suggested that mid-portion Achilles tendinopathy may be caused by certain plantaris tendon morphologies. This case report describes a new anomalous plantaris tendon insertion, closely related to the Achilles tendon. It comprise four distinct insertions and one direct merge with the calcaneal tendon. The current classification should be extended to accommodate such ‘rare cases’ to facilitate more successful Achilles tendinopathy treatment.
Collapse
Affiliation(s)
- K Kurtys
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Żeligowskiego 7/9, 90-136, Łódź, Poland.
| | - B Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Żeligowskiego 7/9, 90-136, Łódź, Poland
| | - Ł Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Żeligowskiego 7/9, 90-136, Łódź, Poland
| | - P Karauda
- Department of Normal and Clinical Anatomy, Medical University of Lodz, Żeligowskiego 7/9, 90-136, Łódź, Poland
| | - M Polguj
- Department of Normal and Clinical Anatomy, Medical University of Lodz, Żeligowskiego 7/9, 90-136, Łódź, Poland
| |
Collapse
|
36
|
Olewnik Ł, Kurtys K, Gonera B, Podgórski M, Sibiński M, Polguj M. Proposal for a new classification of plantaris muscle origin and its potential effect on the knee joint. Ann Anat 2020; 231:151506. [PMID: 32173563 DOI: 10.1016/j.aanat.2020.151506] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/29/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The plantaris muscle (PM) is typically characterized by a short, slim and spindle-shaped muscle belly and long, thin tendon. It is situated posterior to the popliteal muscle, and anterior to the lateral head of the gastrocnemius muscle (GM). Little information exists regarding the high variability of origin of the PM. The main aim of the study was hence to characterize the morphology of the PM and its place of origin, classify it and evaluate its prevalence. METHODS Classical anatomical dissection was performed on 142 lower limbs (77 left, and 65 right) fixed in 10% formalin solution. The morphology of the origin of the PM and its prevalence was evaluated. RESULTS The PM was present in 128 lower limbs (90.1%). Six types of origin were observed, the most common being Type I (48.4%). This type was divided into two subtypes (A-B): subtype A attaching to the lateral head of the GM, lateral femoral condyle and to the capsule of the knee joint, and subtype B, attaching to the lateral head of the GM, the lateral femoral condyle, knee joint capsule and the popliteal surface of the femur. The second most common type was Type II (25%), attaching to the capsule of the knee joint and, indirectly, to the lateral head of the GM through the lateral femoral condyle. The third most common type was Type III (10.15%), attaching to the lateral femoral condyle and the knee joint capsule. Type IV (6.25%), the rarest type, attached to the lateral femoral condyle, knee joint capsule and to the iliotibial band. Type V (8.6%) originated only from the lateral condyle of the femur. Type VI (1.6%) contains only "rare cases". CONCLUSION The PM presents high morphological variability, and its status as a residual muscle should be reconsidered. Our presented classification of its types of origin is a valuable addition for both clinicians and anatomists. Level of Evidence - II Basic Science Research.
Collapse
Affiliation(s)
- Ł Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
| | - K Kurtys
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - B Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - M Podgórski
- Polish Mother's Memorial Hospital Research Institute, Lodz, Department of Diagnostic Imaging, Lodz, Poland
| | - M Sibiński
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland
| | - M Polguj
- Department of Normal and Clinical Anatomy, Medical University of Lodz, Poland
| |
Collapse
|
37
|
It is possible to release the plantaris tendon under ultrasound guidance: a technical description of ultrasound guided plantaris tendon release (UPTR) in the treatment of non-insertional Achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc 2019; 27:2858-2862. [PMID: 30847522 DOI: 10.1007/s00167-019-05451-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Open plantaris tendon excision and ventral paratendinous stripping is a recognised treatment option in selected patients with non-insertional Achilles tendinopathy. The aim of this study was to develop a minimally invasive outpatient technique of ultrasound guided plantaris tendon release (UPTR). METHODS A 19 gauge needle, 15 gauge scalpel blade, hook knife (Smith and Nephew, Boston, MA, USA) and a beaver blade (Arthrex, Naples, FL, USA), were used under ultrasound guidance to identify and divide the plantaris tendon in 12 cadaveric legs. Specimens were dissected to identify whether division of the plantaris tendon had been successful. UPTR was subsequently performed on patients. RESULTS The 15 gauge scalpel blade, hook knife (Smith and Nephew, Boston, MA, USA) and beaver blade (Arthrex, Naples, FL, USA) were all able to cut the plantaris tendon. However, on dissection the hook knife (Smith and Nephew, Boston MA) caused less damage to surrounding structures. Subsequently, the plantaris tendon was successfully divided in three patients using UPTR technique without complication. CONCLUSION UPTR is a viable technique for treating plantaris related non-insertional Achilles tendinopathy.
Collapse
|
38
|
Olewnik Ł. Fibularis Tertius: Anatomical Study and Review of the Literature. Clin Anat 2019; 32:1082-1093. [PMID: 31408221 DOI: 10.1002/ca.23449] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 12/19/2022]
Abstract
Although there is much morphological variation in the anterior compartment of the leg, there is little information about the morphological variability of the fibularis tertius muscle (FTM). The main aim of the present study was to characterize the morphology (origin and insertion) and frequency of occurrence of the FTM and to use these findings as the basis for a new classification of the fibularis tertius tendon. Classical anatomical dissection was performed on 106 lower limbs fixed in 10% formalin. The presence of the FTM and the morphology of both its origin and its insertion were described. The FTM was present in 91 limbs (85.8%). Three types of origin were observed: Type 1, the most common type, with its origin on the distal half fibula (67%); Type 2, with the origin on the distal third fibula (22%); and Type 3, with an origin from the tendon of the extensor digitorum longus (11%). In addition, six types of insertion were distinguished. The most common was Type I (45%), a single distal attachment where the tendon inserts into the shaft of the fifth metatarsal bone. The rarest was Type VI, characterized by fusion with an additional band of the fibularis brevis tendon, which gives rise to the fourth interosseus dorsalis muscle. Two morphological variants of insertion could be distinguished, fan-shaped and band-shaped. Both the origin and insertion of the FTM are very morphologically variable, with three types of origin (Types 1-3) and six types of insertion point (Types I-VI) observed. Knowledge of such variations is essential for both clinicians and anatomists. Clin. Anat. 32:1082-1093, 2019. © 2019 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Łukasz Olewnik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Łódź, Poland
| |
Collapse
|
39
|
Olewnik Ł, Podgórski M, Polguj M, Ruzik K, Topol M. A cadaveric study of the morphology of the extensor hallucis longus - a proposal for a new classification. BMC Musculoskelet Disord 2019; 20:310. [PMID: 31266496 PMCID: PMC6607556 DOI: 10.1186/s12891-019-2688-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/20/2019] [Indexed: 01/11/2023] Open
Abstract
Background Morphological variations of the EHL concern mainly the accessory tendons and the site of their insertion. The aim of our study is to present a new classification of the EHL. Methods Classical anatomical dissection was performed on 104 lower limbs (51 right, 53 left, fixed in 10% formalin solution). Results In the cadavers, three types of morphology (insertion and addidtional band) were observed. Type I, the most common type, was characterized by a single tendon that ends as an extensor hood on the dorsal aspect of the base of the distal phalanx of the big toe (57.7%). Type II was characterized by two distal tendons and was subdivided into three subtypes according to (A-29.9%, B-4.8% and C-5.7%). Type III was characterised by three distal tendons (two cases - 1.9%). Conclusion The EHL presents high morphological variability. Knowledge of particular types of insertion is essential for both clinicians and anatomists. Electronic supplementary material The online version of this article (10.1186/s12891-019-2688-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Łukasz Olewnik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland.
| | - Michał Podgórski
- Department of Diagnostic Imaging Lodz, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Kacper Ruzik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
40
|
Prevalence of Coexistent Plantaris Tendon Pathology in Patients with Mid-Portion Achilles Pathology: A Retrospective MRI Study. Sports (Basel) 2019; 7:sports7050124. [PMID: 31121856 PMCID: PMC6571766 DOI: 10.3390/sports7050124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 11/17/2022] Open
Abstract
Co-existence of Plantaris tendinopathy (PT) in patients with mid-Achilles tendinopathy (Mid-AT) is of clinical significance. This study aims to describe the MRI-based pathological characteristics of co-existing PT and Mid-AT. One-hundred MRI studies of patients diagnosed with Mid-AT were retrospectively analysed by an experienced musculoskeletal radiologist. Presence or absence of a Plantaris tendon, co-existing PT with Mid-AT, insertional characteristics of Plantaris tendon, and maximum anteroposterior thickness of the tendon in Mid-AT (axial images) were evaluated. When PT co-existed with Mid-AT, the location of the tendon pathologies in relation to calcaneal insertion was assessed (sagittal images) and their association was analysed using the coefficient of variation (CV) and Pearson’s correlation coefficient. Plantaris was present in 84 cases (84%), and Mid-AT and PT co-existed in 10 cases (10%). A greater variability in the location of Plantaris pathology (CV = 42%) than Achilles tendinopathy (CV = 42%) was observed. The correlation coefficient also revealed a low and non-significant association between the location of two pathologies when they exist together (r = +0.06; p = 0.88). Clinical evaluation of Achilles tendon pain needs careful consideration into the possible co-existence of Plantaris pathology. The considerable difference observed in the location of PT and Mid-AT suggest possible isolated pathologies and differentials for Achilles tendon pain.
Collapse
|
41
|
Smith J, Alfredson H, Masci L, Sellon JL, Woods CD. Sonographically Guided Plantaris Tendon Release: A Cadaveric Validation Study. PM R 2019; 11:56-63. [PMID: 29908296 DOI: 10.1016/j.pmrj.2018.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 05/28/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND The plantaris tendon (PT) has been implicated in the pathogenesis of symptoms in a subset of patients with Achilles region pain syndromes and traditionally has been managed via open surgical resection. Although the PT can be visualized on ultrasound, a minimally invasive technique for sonographically guided PT release has not been formally described. OBJECTIVE To validate a technique to perform sonographically guided PT release in an unembalmed cadaveric model. DESIGN Prospective, cadaveric laboratory investigation. SETTING Procedural skills laboratory in a tertiary medical center. SUBJECTS Twenty unembalmed cadaveric knee-ankle-foot specimens (10 right, 10 left) obtained from 16 donors (6 male, 10 female) ages 55-96 years (mean 82.6 years) with body mass indexes of 14.1-33.2 kg/m2 (mean 23.3 kg/m2 ). METHODS After simulated local anesthesia and sonographically guided hydrodissection of the plantaris tendon-Achilles tendon interval, a single experienced operator performed sonographically guided PT release on each specimen using an in-plane, lateral-to-medial approach, a commercially available, disposable 3.0-mm hook knife, and either a 17-5 MHz or 15-7 MHz linear array transducer. Each specimen was subsequently dissected to assess for PT release and iatrogenic injury. MAIN OUTCOME Status of the PT, Achilles tendon, and regional neurovascular structures as determined by dissection. RESULTS All 20 PT releases were completed in a single attempt through a 3- to 5-mm incision. Dissection confirmed complete PT release in all specimens without damage to the adjacent Achilles tendon or regional neurovascular structures. CONCLUSION Sonographically guided PT release is technically feasible and can be performed while avoiding injury to the Achilles tendon and regional neurovascular structures. Additional research is warranted to further define the role of sonographically guided PT release in patients with suspected PT-mediated Achilles region pain syndromes. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Jay Smith
- Departments of Physical Medicine & Rehabilitation, Radiology, and Anatomy, Mayo Clinic Sports Medicine Center, Mayo Clinic, 200 1st St, SW, Rochester, MN 55905
| | - Håkan Alfredson
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.,Alfredson Tendon Clinic, Pure Sports Medicine Clinic, London, United Kingdom
| | - Lorenzo Masci
- Alfredson Tendon Clinic, Pure Sports Medicine Clinic, London, United Kingdom
| | - Jacob L Sellon
- Department of Physical Medicine & Rehabilitation, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, MN
| | - Charonn D Woods
- Department of Physical Medicine & Rehabilitation, Rochester, MN
| |
Collapse
|
42
|
Olewnik Ł, Gonera B, Podgórski M, Polguj M, Jezierski H, Topol M. A proposal for a new classification of pes anserinus morphology. Knee Surg Sports Traumatol Arthrosc 2019; 27:2984-2993. [PMID: 30535546 PMCID: PMC6706366 DOI: 10.1007/s00167-018-5318-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/04/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE The pes anserinus (PA) is characterized by high morphological diversity. As the semitendinosus and gracilis muscle tendons are routinely harvested for the reconstruction of other tendons, especially the anterior cruciate ligament (ACL), it is of clinical importance. The presence of accessory bands within PA tendons can handicap the harvesting process. Therefore, the purpose of the study was to suggest a new morphological classification of the PA morphology. METHODS Classical anatomical dissection was performed on 102 lower limbs (56 right, 46 left) fixed in 10% formalin solution. The morphology and insertion of the PA (including accessory bands) were assessed, and morphometric measurements were taken. RESULTS In all cases, the PA was present and composed of the sartorius, gracilis and semitendinosus tendons. Six types of PA were distinguished based on the presence of accessory bands. The most common composed of monotendinous sartorius, gracilis and semitendinosus-54 limbs (52.9%). Additionally, three types of insertion were noted (short, band-shaped and fan-shaped). The mean length between the insertion and the origin of the accessory bands to the fascia of the gastrocnemius muscle was 63.5 mm. CONCLUSION The morphology of the PA was highly variable. The gracilis and semitendinosus tendons often had accessory bands that would complicate the harvesting process. The planning of surgical procedures may be improved by our proposed classification.
Collapse
Affiliation(s)
- Łukasz Olewnik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland.
| | - Bartosz Gonera
- 0000 0001 2165 3025grid.8267.bDepartment of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Michał Podgórski
- 0000 0004 0575 4012grid.415071.6Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Michał Polguj
- 0000 0001 2165 3025grid.8267.bDepartment of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Łódź, Poland
| | - Hubert Jezierski
- Department of Trauma and Orthopaedic Surgery, Hospital of Ministry of Interior and Administration, Lodz, ul. Północna 42, 91-425 Łódź, Poland
| | - Mirosław Topol
- 0000 0001 2165 3025grid.8267.bDepartment of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
43
|
Kotelnikov GP, Chernov AP, Ardatov SV, Kim YD, Shitikov DS. [New surgical method for chronic rupture of the Achilles tendon]. Khirurgiia (Mosk) 2018:91-95. [PMID: 30560852 DOI: 10.17116/hirurgia201812191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To improve the outcomes in patients with chronic ruptures of the Achilles tendon followed by advanced diastase and reduced function of the gastrocnemius muscle by using of new surgical method. MATERIAL AND METHODS The authors proposed a new method of Achilles tendon repair for diastase over 10 cm. It imposes transposition of the tendons of short fibular muscle and posterior tibial muscle. Schemes and stages of surgery are presented in figures. The authors described clinical example of patient with chronic rupture of the Achilles tendon, illustrations of surgical stages and the outcome. RESULTS New surgical approach was applied in 16 patients. The control group consisted of 21 patients who underwent repair by Chernavsky, Krasnov. Clinical and biomechanical methods were used for evaluation. Functional myography and podography to assess the asymmetry of gait were performed. Our data confirmed the advantage of new approach.
Collapse
Affiliation(s)
- G P Kotelnikov
- Samara State Medical University of Healthcare Ministry of the Russia, Samara, Russia
| | - A P Chernov
- Samara State Medical University of Healthcare Ministry of the Russia, Samara, Russia
| | - S V Ardatov
- Samara State Medical University of Healthcare Ministry of the Russia, Samara, Russia
| | - Yu D Kim
- Samara State Medical University of Healthcare Ministry of the Russia, Samara, Russia
| | - D S Shitikov
- Samara State Medical University of Healthcare Ministry of the Russia, Samara, Russia
| |
Collapse
|
44
|
Olewnik Ł, Gonera B, Kurtys K, Podgórski M, Polguj M, Topol M. A proposal for a new classification of the fibular (lateral) collateral ligament based on morphological variations. Ann Anat 2018; 222:1-11. [PMID: 30408521 DOI: 10.1016/j.aanat.2018.10.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 10/15/2018] [Accepted: 10/24/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND The fibular collateral ligament (FCL) is subject to varus forces at all knee flexion angles and is also resistant to external rotation near extension. It originates on the lateral epicondyle of the femur and inserts on the lateral surface of the head of the fibula. However, its anatomical characteristics are inconsistent. Recent publications have focused on morphological variations concerning mainly femoral and fibular attachments, as well as morphometric measurements. Less attention has been paid to the morphology of the FCL and its relationship to the antero-lateral ligament (ALL). QUESTION/PURPOSES The aim of this paper is therefore to introduce the first complete classification of the FCL that includes all important aspects of morphological variability. METHODS Classical anatomical dissection was performed on 111 lower limbs (25 isolated and 86 paired) fixed in 10% formalin solution. The lateral compartment of the knee was investigated in detail. RESULTS The fibular collateral ligament was present in all specimens. The FCL originated most commonly (72.1% of cases) from the lateral femoral epicondyle, and the inserted on the lateral surface of the head of the fibula (Type I). In addition, bifurcated (Type IIa - 12.6%) and trifurcated (Type IIb - 0.9%) ligaments were also found with two and three distal bands, respectively. A double FCL was also found (Type III - 6.3%), as was fusion of the FCL and ALL (Type IV - 8.1%). CONCLUSION The FCL is characterized by high morphological variability. Knowledge of these variants is essential for surgeries performed in this region concerning the FCL and the ALL. CLINICAL RELEVANCE Distinguishing FCL from the FCL-ALL Complex is necessary when planning surgical procedures.
Collapse
Affiliation(s)
- Łukasz Olewnik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland.
| | - Bartosz Gonera
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - Konrad Kurtys
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - Michał Podgórski
- Polish Mother's Memorial Hospital Research Institute, Department of Diagnostic Imaging, Lodz, Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland
| |
Collapse
|
45
|
Olewnik Ł, Gonera B, Kurtys K, Podgórski M, Polguj M, Sibiński M, Topol M. The Anterolateral Ligament of the Knee: A Proposed Classification System. Clin Anat 2018; 31:966-973. [PMID: 30144325 DOI: 10.1002/ca.23267] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/08/2018] [Accepted: 08/17/2018] [Indexed: 12/30/2022]
Abstract
The anterolateral ligament (ALL) is a potential stabilizer of the knee and cooperates with the anterior cruciate ligament (ACL). It originates on the lateral epicondyle of the femur, to which it is mainly posterior and proximal; insertion is posterior to Gerdy's tubercle. Its anatomical characteristics vary. Recent publications have focused on morphological variations concerning mainly the femoral and tibial attachments, and on morphometric measurements. Histological and cystochemical examinations have also been performed. Classical anatomical dissection was performed on 111 lower limbs (25 isolated and 86 paired) fixed in 10% formalin. The knee region was dissected using traditional techniques and the morphological features of the ALL were assessed: morphometric measurements and the types of ALL. The ALL was present in 70 individuals (37 woman and 33 men). In 30 cases, it was absent symmetrically, and in 11, it was present on just one side (P = 0.0011). The ALL was morphologically very variable. In type I (the most common form - 64.3%), a single band traveled parallel to the fibular collateral ligament (FCL); in type II the band crossed it. In type III, the origin was located on the lateral epicondyle of the femur and also on the lateral-posterior surface of the joint capsule, and the insertion was in the deep fascia of the leg: this type could be called a capsule. Type IV was characterized by a double ALL, type IIb by ligaments that bifurcated, and type V by the ALL starting directly from the FCL rather than the femoral epicondyle. The ALL is characterized by high morphological variability, both in its femoral and in its tibial attachments and in its course. Clin. Anat. 31:966-973, 2018. © 2018 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Łukasz Olewnik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - Bartosz Gonera
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - Konrad Kurtys
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - Michał Podgórski
- Department of Diagnostic Imaging Lodz, Polish Mother's Memorial Hospital Research Institute, Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - Marcin Sibiński
- Clinic of Orthopaedics and Paediatric Orthopaedics, Medical University of Lodz, Poland
| | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland
| |
Collapse
|
46
|
|
47
|
Mattiussi G, Moreno C. Percutaneous Electrochemical Debridement of the Plantaris Tendon. J Am Podiatr Med Assoc 2018; 108:437-441. [PMID: 34670342 DOI: 10.7547/17-078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Plantaris tendon disorders are a well-known source of midportion Achilles tendinopathy. Plantaris tendon thickening and fibrous tissue formation between the tendons are the histologic abnormalities that are typically observed. Surgical approaches (scraping of the Achilles medial and ventral paratendinous tissues and excision of the plantaris tendon) have already shown good clinical outcomes; despite this, the cost-benefit ratio of these interventions may be unfavorable, and their accessibility is limited. Percutaneous needle electrolysis is a minimally invasive ablative technique increasingly being considered for the treatment of tendinopathies and associated conditions. Herein we introduce a novel procedure to treat plantaris tendon-related midportion Achilles tendinopathy. The procedure starts with the ultrasound-guided insertion of an uncoated needle (diameter, 0.30-0.40 mm; length, 30 mm) between the plantaris and Achilles tendons. Subsequently, galvanic current (intensity, 2 mA) is locally transferred, which induces instant nonthermal electrochemical ablation of the intertendinous tissues in close proximity to the needle, finally debriding the plantaris tendon. To further promote its release, the second part of the procedure involves partial tenotomy of the lateral peripheral aspects of the plantaris tendon. Usually, the session does not exceed 30 min. Percutaneous needle electrolysis may be considered as a valid alternative to surgery. The outpatient procedure presented herein is, in fact, safe and quick to perform. In addition, long suspension of working or sporting activities after treatment is not required. Future investigations are needed to ascertain the short- and long-term therapeutic outcomes of plantaris tendon-related midportion Achilles tendinopathy treatment, in particular by comparing them with those obtained with other mini-invasive interventions.
Collapse
Affiliation(s)
| | - Carlos Moreno
- Medical Services, Udinese Football Club, Udine, Italy
| |
Collapse
|
48
|
Olewnik Ł, Waśniewska A, Polguj M, Podgórski M, Łabętowicz P, Ruzik K, Topol M. Morphological variability of the palmaris longus muscle in human fetuses. Surg Radiol Anat 2018; 40:1283-1291. [PMID: 30022223 PMCID: PMC6208680 DOI: 10.1007/s00276-018-2069-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/11/2018] [Indexed: 11/26/2022]
Abstract
Purpose The palmaris longus (PL) muscle is characterized by high-morphological variability. It is clinically important as it is routinely harvested for the reconstruction of other tendons. The study characterizes the morphology of the PL in human fetuses and creates a new classification based on its variations that would relate to the spectrum of morphological variability in adults. Methods Eighty spontaneously aborted human foetuses (44 male, 36 female, 160 upper limbs), aged 18–38 weeks of gestation, were examined. Results The palmaris longus muscle was present in 62.5% of fetuses. The absence was bilateral in 26.25%, and unilateral in 22.5%. Nine types of palmaris longus muscles were identified based on the morphology of its insertion (Types I–IX). All types originated on the medial epicondyle of the humerus. The most common type was Type I, which was characterized by insertion to the palmar aponeurosis (52%). The rarest types were Type VII and Type IX (1% each). Type VII was characterized by partial doubling of the muscle belly, which then turned into two separate tendons that inserted together into the palmar aponeurosis. Type IX was characterized by fusion with the flexor carpi ulnaris muscle. Conclusion Our findings concerning morphological variability of the PL in fetuses present a new perspective on the understanding nature of the morphological variation of the PL muscle in adults. List of evidence Basic Science Study.
Collapse
Affiliation(s)
- Łukasz Olewnik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Narutowicza 60, 90-136, Lodz, Poland.
| | - Anna Waśniewska
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Narutowicza 60, 90-136, Lodz, Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Michał Podgórski
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Piotr Łabętowicz
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Kacper Ruzik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Narutowicza 60, 90-136, Lodz, Poland
| | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Narutowicza 60, 90-136, Lodz, Poland
| |
Collapse
|
49
|
The Plantaris Muscle Tendon and Its Relationship with the Achilles Tendinopathy. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9623579. [PMID: 29955614 PMCID: PMC6000875 DOI: 10.1155/2018/9623579] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/30/2018] [Indexed: 11/21/2022]
Abstract
Purpose Although the plantaris muscle (PM) is vestigial in humans, it has a significant clinical role in procedures such as grafting. However, recent reports suggest its potential involvement in the tendinopathy of the midportion of the Achilles tendon. The aim of the study is therefore to evaluate morphological variation of the PM with regard to its potential conflict with the Achilles tendon. Material and Methods Classical anatomical dissection was performed on 130 lower limbs (71 right, 59 left) fixed in 10% formalin solution. The morphology of the PM was assessed regarding the relationship between the course of the plantaris tendon and the calcaneal tendon. Results The PM was present in 89.2% of cases. The findings indicate the presence of a new type of PM tendon insertion in which the tendon is inserted into the tarsal canal flexor retinaculum, potentially affecting the tendinopathy of the tibialis posterior muscle. In 26 cases (22.4%), insertion blended with the Achilles tendon (Type II), which may increase the risk of Achilles tendinopathy. Conclusion The anatomical variation of PM tendon morphology may create a potential conflict with the Achilles tendon and the tibialis posterior tendon, thus increasing the possibility of tendinopathy.
Collapse
|
50
|
Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018. J Orthop Sports Phys Ther 2018; 48:A1-A38. [PMID: 29712543 DOI: 10.2519/jospt.2018.0302] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to midportion Achilles tendinopathy. J Orthop Sports Phys Ther 2018;48(5):A1-A38. doi:10.2519/jospt.2018.0302.
Collapse
|