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Winter P, Klos K, Lambert L, Paulsen F, Landgraeber S, Wagener J. Indications and possible limitations using medio-plantar plate systems in tarsometatarsal 1 fusions - A cadaveric study. Ann Anat 2023; 250:152145. [PMID: 37597823 DOI: 10.1016/j.aanat.2023.152145] [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: 07/07/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND The tarsometatarsal 1 arthrodesis is an adequate treatment for moderate to severe hallux valgus deformity and instability of the first ray. Plantar plating arthrodesis has been shown to provide better mechanical stability and fewer postoperative complications than screw fixation or medial plating. The medio-plantar plate is a new plate design for Lapidus arthrodesis. It could combine the biomechanical advantages of the plantar plate and the anatomical overview of a medial plate. However, the implanted material can cause irritation of the tibialis anterior, which in some cases may require removal of the material. The purpose of this study was to examine the possibility of tendon irritation following medio-plantar first tarsometatarsal joint arthrodesis using cadaveric specimens. METHODS The study involved the simulated surgical procedure of medio-plantar plate arthrodesis on 30 lower extremities. After the plates were fixed, a thorough examination of the feet was conducted to assess any tendon irritation and to determine a recommendation for placement of the medio-plantar plate based on the Olewnik classification. RESULTS Irritation of the tibialis anterior tendon components with the medio-plantar plate depends mainly on the anatomic norm variant, classified according to Olewnik et al. A medio-plantar plate is particularly recommended in TA tendon Olewnik type 3 and type 5. The positioning of a medio-plantar plate in Olewnik type 1 and type 2 tendons depends on the anatomic fit of the medio-plantar plate and the bony configuration of the TMT 1 joint. A large portion of the TA tendon must be detached, so a different plate design may be preferred in these patients. CONCLUSIONS TMT 1 arthrodesis with medio-plantar plating of the first tarsometatarsal joint should be performed considering the anatomic TA tendon variations. LEVEL OF EVIDENCE Level V, Expert Opinion includes Case Reports and Technique Tips.
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Affiliation(s)
- Philipp Winter
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany.
| | - Kajetan Klos
- Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; Gelenkzentrum Rhein-Main, Fuß- Und Sprunggelenkschirurgie, Frankfurter Straße 94, 65239 Hochheim, Germany
| | - Laura Lambert
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Stefan Landgraeber
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany
| | - Joe Wagener
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany; Department of Orthopaedic Surgery, Hôpital Kirchberg, L-2540 Luxembourg, Germany
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Ruzik K, Gonera B, Podgórski M, Zielinska N, Balcerzak A, Olewnik Ł. Anatomical variations of the calcaneofibular ligament in human foetuses. Sci Rep 2023; 13:11016. [PMID: 37419905 PMCID: PMC10328930 DOI: 10.1038/s41598-023-37799-2] [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: 02/12/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023] Open
Abstract
Ligaments anatomy often show a huge anatomy variations between species and individuals. For example calcaneofibular ligaments (CFL) characterize the great variability of morphological shape or presence of additional bands. The aim of this study was to propose first anatomical classification of CFL concerning on human fetuses. We investigated thirty spontaneously-aborted human fetuses aged 18-38 weeks of gestation at death. Sixty lower limbs (30 left and 30 right) fixed in 10% formalin solution were examined. The morphological variability of CFL was assessed. Four types of CFL morphology were observed. Type I was characterized by a band shape. This was the most common type, occurring in 53% of all cases. Based on our study we are proposing a classification based on four morphological types of CFL. Types 2 and 4 are further divided into subtypes. Present classification may be useful to better understand the anatomical development of ankle joint.
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Affiliation(s)
- K Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - B Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - M Podgórski
- Department of Interventional Radiology, Medical University of Lodz, Lodz, Poland
| | - N Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - A Balcerzak
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Ł Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
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Gonera B, Wysiadecki G, Kurtys K, Brzeziński P, Borowski A, Olewnik Ł. Immunohistochemical Analysis of the Ligamentum Mucosum is the Key to Understand its Clinical Usefulness. Ann Anat 2023; 249:152106. [PMID: 37207849 DOI: 10.1016/j.aanat.2023.152106] [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: 10/10/2022] [Revised: 04/04/2023] [Accepted: 05/10/2023] [Indexed: 05/21/2023]
Abstract
Ligamentum Mucosum(LM) is a ligamentous structure within the synovial layer of the knee joint capsule. For a long time LM was perceived as the vestigial remnant from the embryological development of the knee. Being treated as an irrelevant structure LM was often the first victim of shaver during arthroscopy. However, last years have shown increased interest in this structure due to its potentially significant clinical role. Our aim was to classify LM based on its morphological characteristics and examine its microanatomy using immunohistochemical analysis to reveal the potential clinical value for surgeons. We have examined sixteen fresh frozen lower limbs, 6 females (mean age 83.1 ± 3.4 years) and 10 males (mean age 84.2 ± 6.8 years). Classical histological H+E stain was routinely conducted. Subsequently, CD31 antibody (DAKO, Monoclonal Mouse Anti-Human, Clone JC70A) was used to mark vascular epithelium. Monoclonal Mouse Anti-Human Neurofilament Protein (NFP) antibody (DAKO, Clone 2F11) was used to expose the nerves. Moreover, we have conducted arthroscopic visualizing and suturing LM to the torn ACL during routinely performed arthroscopic suturing of the ACL. The dissection process has revealed that LM was present only in 75% of cases. Histological examination confirmed the presence of longitudinal collagen fiber bundles in all samples. Tiny nerves were confirmed by NFP, along the subsynovial layer in all samples. CD-31 immunostain revealed the presence of many vascular vessels along the entire ligament, especially well developed at its distal end. Our study has revealed that LM contains rich vascular network. Thus, it may be a donor for the revascularization process after ACL tear or reconstruction which may improve the recovery. Another great advantage of the LM is the presence of nerves along the subsynovial layer, hopefully they may serve as the source of reinnervation and hence better clinical outcome. Based on our results we believe that seemingly irrelevant LM may be very useful during surgical procedures in the knee region. Suturing LM to the ACL may not only prevent the infrapatellar fat pad from subluxation but also improve the blood flow and reinnervation of the injured ACL. Until now there are only a few studies examining microanatomy of the LM. This basic knowledge may serve as the foundation for surgical procedures. Hopefully our findings may be useful for surgeons while planning surgical procedures or clinicians while diagnosing patients who suffer anterior knee pain.
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Affiliation(s)
- B Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - G Wysiadecki
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz
| | - K Kurtys
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - P Brzeziński
- Department of Histology and Embryology, Chair of Anatomy and Histology, Medical University of Lodz
| | - A Borowski
- Clinic of Orthopaedic and Paediatric Orthopaedics, Medical University of Lodz, Poland
| | - Ł Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
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Gonera B, Kurtys K, Wysiadecki G, Podgórski M, Olewnik ŁH. The ligamentum mucosum: A new classification. Clin Anat 2023; 36:242-249. [PMID: 36199212 DOI: 10.1002/ca.23963] [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: 05/09/2022] [Revised: 10/02/2022] [Accepted: 10/02/2022] [Indexed: 11/08/2022]
Abstract
The ligamentum mucosum (LM) is a ligamentous structure within the synovial layer of the knee joint capsule. For a long time LM was perceived as the vestigial remnant from the embryological development of the knee. However, last years have shown increased interest in this structure due to its potentially significant clinical role. Fifty-one, 12 females (mean age 83.1 ± 3.4 years) and 39 males (mean age 84.2 ± 6.8 years) fixed in 10% formalin were examined. Upon dissection, the following morphological features of the LM were assessed: the types of LM, morphometric measurement and histological analysis of each type. The LM was present in 66.7% of all examined specimens. Three different types were recognized: Type I (55.9%)-single band with attachment to the intercondylar notch, Type IIa-bifurcated ligament with attachment to the anterior cruciate ligament, Type IIb-bifurcated ligament with both attachments to the intercondylar notch, Type III-double ligament with two independent bands and attachments to the intercondylar notch and to the knee joint capsule. The LM is variable and probably evolutionary changes are the reason. In our study we propose the new clinically useful classification supported by its anatomical and histological characteristics. Type IIa seems to be the most important from the clinical point of view, as it may be responsible for clinical issues and should be paid attention while diagnosing patients suffering from anterior cruciate ligament torn or anterior knee pain.
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Affiliation(s)
- 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
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Medical University of Lodz, Lodz, Poland
| | - Michał Podgórski
- Deparment of Interventational Radiology, Medical University of Lodz, Lodz, Poland
| | - Łukasz Hubert Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
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Kurtys K, Gonera B, Zielinska N, Podgórski M, Karauda P, Olewnik Ł. Localization of the gracilis muscle motor points - key considerations for botulinum neurotoxin injection and electrical stimulation. Ann Anat 2023; 248:152072. [PMID: 36863619 DOI: 10.1016/j.aanat.2023.152072] [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: 10/26/2022] [Revised: 01/31/2023] [Accepted: 02/05/2023] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Muscle motor points are considered the best sites for electrode positioning in electrical stimulation and, by some researchers, for botulinum neurotoxin injections. The aim of this study is to locate the motor points in the gracilis muscle to improve muscle function maintenance and treatment of spasticity. MATERIAL AND METHODS Ninety-three gracilis muscles (49 right, 44 left), fixed in 10% formalin solution, were subjected to the research. All nerve branches running towards the muscle were precisely traced to each motor point. Specific measurements were collected. RESULTS The gracilis muscle presents multiple motor points (median of 12), all of which were localized on the deep (lateral) side of the muscle belly. Generally, motor points of this muscle were spread between 15% and 40% of the reference line length. CONCLUSION Our findings may help clinicians identify appropriate locations for electrode placement during electrical stimulation of the gracilis muscle; they also deepen our understanding of the correlation between motor points and motor end plates and improve the application of botulinum neurotoxin injections.
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Affiliation(s)
- Konrad Kurtys
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Bartosz Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Michał Podgórski
- Department of Diagnostic Imaging and Interventional Radiology, Veteran's Memorial Hospital, Medical University of Lodz, 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.
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A Proposal for a New Classification of the Supernumerary Heads of the Biceps Brachii Muscle. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1510363. [PMID: 35496043 PMCID: PMC9054453 DOI: 10.1155/2022/1510363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 11/18/2022]
Abstract
Introduction The anterior compartment of the arm consists of three muscles: the biceps brachii (BB), brachialis, and coracobrachialis muscle. The aim of the present study was to characterize possible variations in the supernumerary heads of the biceps brachii and use these to prepare an accurate classification of the area that could be used for planning surgical procedures in the region. Material and Methods. One hundred (51 left and 49 right, 52 females and 48 males) upper limbs fixed in 10% formalin solution were examined. Results Four types of supernumerary BB heads were identified, with subtypes. Type I was the most common type, characterized by the two heads (64%); this was subdivided into Type IA, with a single muscle belly, and Type IB with two muscle bellies. The second most common type was Type II, which was characterized by the three BB heads (26%). This type was divided into four subtypes (A-D): Type IIa characterized by attachment to the middle part of the shaft of the humerus; Type IIb characterized by the origin to the coracoid process together with the short head of the BB; Type IIc characterized by origin to the tendon of the pectoralis major muscle; and Type IId characterized by the attachment to the capsule of the humeral joint. The third most common type was Type III, which was characterized by four heads (6%); this was divided into Type IIIa, where two heads originated from the humerus bone, and Type IIIb, where one head originated from the short heads and the second from the long head of the BB. The rarest type was Type IV (4%) which was characterized by five heads: the short head originated from the coracoid process and the long head originated from the supraglenoid tubercle, the third and fourth head originated from the shaft of the humerus, while the fifth head originated from the pectoralis major muscle. Conclusion The biceps brachii is characterized by very high morphological variability. The new classification proposes four types of supernumerary head arrangement (I-IV), divided into subtypes. This classification has both clinical and anatomical significance.
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Olewnik Ł, Ruzik K, Szewczyk B, Podgórski M, Aragonés P, Karauda P, Tubbs RS, Sanudo JR, Pires MB, Polguj M. The relationship between additional heads of the quadriceps femoris, the vasti muscles, and the patellar ligament. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9569101. [PMID: 35224103 PMCID: PMC8866009 DOI: 10.1155/2022/9569101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The quadriceps femoris consists of four muscles: the rectus femoris, vastus medialis, vastus intermedius, and vastus lateralis. However, the effect of additional quadriceps femoris heads on the vasti muscles and patellar ligaments is unknown. The aims of the present study are to determine the relationship between additional quadriceps femoris heads and the vasti muscles and patellar ligaments and to review the morphology of the vastus lateralis, vastus medialis, and vastus intermedius. MATERIALS AND METHODS One hundred and six lower limbs (34 male and 19 female cadavers) fixed in 10% formalin were examined. RESULTS On all lower extremities, the vastus lateralis consisted of superficial, intermediate, and deep layers. The vastus medialis, on the other hand, consisted of only the longus and obliquus layers. The quadriceps head had one or more supplementary heads in 106 dissected limbs from 68 cadavers (64.1%). The distal portion of the patella was wider in lower limbs without supplementary heads than in type IA but narrower than in type IIIA. In general, the distal portion of the patella was narrower in specimens with a supplementary head than in those without (19.03 SD 3.18 mm vs. 20.58 SD 2.95 mm, p = 0.03817). Other patellar ligament dimensions did not differ significantly. CONCLUSION The quadriceps femoris muscle is characterized by high morphological variability. Occurrence of extra heads is at the level of 64.1%. The vastus lateralis consists of three parts (superficial, intermediate, and deep), and vastus medialis consists of two (longus and oblique).
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Affiliation(s)
- Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Kacper Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Bartłomiej Szewczyk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Michał Podgórski
- Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Paloma Aragonés
- Department of Orthopedics Surgery, Hospital Santa Cristina, Madrid, Spain
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jose Ramon Sanudo
- Department of Human Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | | | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
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Olewnik Ł, Gonera B, Kurtys K, Zielinska N, Ruzik K, Aragonés P, Sanudo JR, Danowska-Klonowska D, LaPrade RF. Classification of the popliteofibular ligament. Clin Anat 2022; 35:375-382. [PMID: 35119143 DOI: 10.1002/ca.23842] [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: 10/04/2021] [Revised: 01/03/2022] [Accepted: 01/26/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE The purpose of this study was to characterize the morphological variations in the distal attachment of the popliteofibular ligament (PFL) and create an accurate classification for use in planning surgical procedures in this area and in evaluating radiological imaging. METHODS One hundred and thirty-seven lower limbs of body donors fixed in 10% formalin solution were examined for the presence and course of the popliteofibular ligament. RESULTS The PFL was present in 88.3% of cases. We propose the following three-fold classification: type I (72.3%), the most common type, characterized by the attachment onto the apex of the head of the fibula, type II (8.7%), characterized by a bifurcation, with the dominant band inserting on the anterior slope of the styloid process of the fibula and the smaller band onto the posterior surface of the styloid process of the fibula and type III (7.3%), characterized by a double PFL: the first PFL (main) originated from the popliteus tendon and inserted onto the anterior slope of the styloid process of the fibula, while the second originated from the musculotendinous junction of the popliteus muscle and inserted on the posterior surface of the styloid process of the fibula. CONCLUSION The PFL was characterized by high morphological variation, as reflected in our proposed classification. This variation may present clinical and biomechanical issues for both medical personnel and researchers. Our proposed classification may be valuable for clinicians who evaluate and perform surgical procedures within the knee joint area.
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Affiliation(s)
- Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - 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
| | - 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
| | - Paloma Aragonés
- Department of Orthopedics Surgery, Hospital Santa Cristina, Madrid, Spain.,Department of Human Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - J Ramón Sanudo
- Department of Human Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Spain
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Nerve and Arterial Supply Pattern of the Popliteus Muscle and Clinical Implications. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6980471. [PMID: 35047639 PMCID: PMC8763497 DOI: 10.1155/2022/6980471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/12/2021] [Accepted: 12/04/2021] [Indexed: 11/17/2022]
Abstract
Introduction. The aim of this study was to investigate the nerve and artery supply and the tibial attachment of the popliteus muscle using anatomical methods. Methods. Forty-four nonembalmed and embalmed extremities were dissected for this study. To measure the attachment area of the popliteus, the most prominent points of the medial epicondyle of the femur and the medial malleolus of the tibia were identified before dissection. A line connecting these two prominent points was used as the reference line, with the most prominent point of the medial epicondyle of the femur as the starting point. This study also investigated the area where the popliteus attaches to the bone and the points where nerves and arteries enter the popliteus muscle when it is divided into three equal parts in the coronal plane. Results. The mean length of the reference line was
. The origin of the popliteus was found to be at a distance of 16.6% to 35.2% on the tibial bone from the proximal region. The popliteus was innervated by only the tibial nerve in 90% of the cases and by the tibial and the sciatic nerves in the remaining 10% of the cases. The inferior medial genicular artery and the posterior tibial artery supplied blood to the popliteus in 90% and 65% of the cases, respectively. When the popliteus muscle was divided into three equal parts in the coronal plane, the nerve and the artery were found to enter the muscle belly in zones II and III and zones I and II in 92% and 98% of the specimens, respectively. Discussion. The anatomical investigation of the popliteus in this study will help identify patients with clinically relevant syndromes.
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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.
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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.
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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
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Szewczyk B, Polguj M, Paulsen F, Podgórski M, Duparc F, Karauda P, Olewnik Ł. A proposal for a new classification of coracobrachialis muscle morphology. Surg Radiol Anat 2021; 43:679-688. [PMID: 33564931 PMCID: PMC8105249 DOI: 10.1007/s00276-021-02700-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The coracobrachialis muscle (CRM) originates from the apex of the coracoid process, in common with the short head of the biceps brachii muscle, and from the intermuscular septum. It inserts to the medial part of the humerus between the attachment of the medial head of the triceps brachii and the brachial muscle. Both the proximal and distal attachments of the CRM, as well as its relationship with the musculocutaneus nerve, demonstrate morphological variability. MATERIAL AND METHODS One hundred and one upper limbs (52 left, and 49 right) fixed in 10% formalin solution were examined. RESULTS Three main types, with subtypes, were identified. The most common was Type I (49.5), characterized by a single muscle belly with a classical origin from the coracoid process, medially and posteriorly to the tendon of the biceps brachii. Type II (42.6%), characterized by two heads, was divided into two subtypes (A-B) depending on its origin: Type IIA, where one head originated from the coracoid process posteriorly to the tendon of the biceps brachii and the second head from the short head of the biceps brachii, and Type IIB, in which both heads originated from the coracoid process; however, the superficial head fused with the insertion of a short head of the biceps brachii, while the deep head was directly originating. Finally, Type III (7.9%) was characterized by three heads: two originated from the coracoid process (superficial and deep), and the third from a short head of the biceps brachii. Two types of insertion and two types of musculocutaneous nerve (MCN) relative to CRM could be distinguished. CONCLUSION An adapted classification is needed for all clinicians working in this area, as well as for anatomists. The CRM demonstrates morphological variability in both its proximal and distal attachments, as well as the variable course of the MCN relative to the CRM. WHAT IS KNOWN ABOUT THIS SUBJECT "AND" WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE: Not much is known about the variability of coracobrachialis muscle. The present paper introduces a completely new classification, both clinical and anatomical.
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Affiliation(s)
- Bartłomiej Szewczyk
- 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
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Erlangen, Germany
- Department of Topographic Anatomy and Operative Surgery, Sechenov University, Moscow, Russia
| | - Michał Podgórski
- Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Fabrice Duparc
- Laboratory of Anatomy, Faculty of Medicine, Rouen University, Mont-Saint-Aignan, France
| | - Piotr Karauda
- 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
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Morphological variability of the extensor hallucis longus in human fetuses. Ann Anat 2021; 234:151627. [DOI: 10.1016/j.aanat.2020.151627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023]
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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.
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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
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15
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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.
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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.
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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
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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.
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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
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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: 11] [Impact Index Per Article: 2.8] [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.
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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
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Olewnik Ł, Podgórski M, Ruzik K, Polguj M, Topol M. New classification of the distal attachment of the fibularis brevis - Anatomical variations and potential clinical implications. Foot Ankle Surg 2020; 26:308-313. [PMID: 31031151 DOI: 10.1016/j.fas.2019.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/04/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although the lateral compartment of the leg is characterized by a high degree of morphological variation, very little information exists on the morphological variability of the fibularis brevis muscle (FBM) and fibularis digiti quinti (FDQ). The main aim of the study was to characterize the morphology of the FBM tendon and its accessory bands, to classify them and to determine the incidence of FDQ. The work attempts to determine the relationship between the types of the insertion of the FBM tendon and the occurrence of FDQ. METHODS Classical anatomical dissection was performed on 102 lower limbs fixed in 10% formalin solution. The morphology of the insertion of the FBM and of the FDQ was evaluated. RESULTS The FBM was present in all specimens. Two types of insertion were observed, the most common being Type I (70.6%): a single distal attachment in which the tendon inserts into the tuberosity at the base of the fifth metatarsal bone. The second most common was Type II (29.4%); this group was divided into three subtypes (A-C). The FDQ was present in 17.7% of specimens and always with Type I FBM. CONCLUSION Both the FBM tendon and FDQ present significant morphological variation. Two main types of the FBM tendon determine the presence of the FDQ. LEVEL OF EVIDENCE II Basic Science Research.
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Affiliation(s)
- Łukasz Olewnik
- 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
| | - Kacper Ruzik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of 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
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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.
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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
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Olewnik Ł, Karauda P, Gonera B, Kurtys K, Haładaj R, Tubbs RS, Paulsen F, Ramón Sanudo J, Polguj M. Intramuscular innervation of plantaris muscle evaluated using a modified Sihler's staining protocol - Proposal for a new classification. Ann Anat 2020; 230:151504. [PMID: 32173561 DOI: 10.1016/j.aanat.2020.151504] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE The plantaris muscle is a morphologically variable structure with regard to both its origin and insertion, and the course of the tendon. We here determined the pattern of branching and distribution of intramuscular nerves of the plantaris muscle to determine its usability for autologous transplantation. No information exists on the innervation of the plantaris muscle using Sihler's staining technique, and hence its intramuscular nerves. The main purpose of the work is to determine the pattern of branching and distribution of the intramuscular nerves of the plantaris muscle. Is the plantaris muscle a good transplant candidate? MATERIALS AND METHODS Eighty lower limbs from cadavers (40 left, 40 right, 40 male, 40 female, age range 41-94 years) were fixed in 10% formalin solution and examined macroscopically as well as morphometrically with regard to the innervation pattern of the respective plantaris muscle. Afterwards Sihler's staining was used in all 80 plantaris muscles to identify the exact distribution of the muscular branch originating from the main nerve trunk in the muscle belly. RESULTS Two patterns of branching and nerve distribution could be intensified in the plantaris muscle: Type I, with a single pattern entire up to the muscle and then divided into superior and inferior intramuscular branches.; type II with a double innervation pattern (superior and inferior). The superior and inferior pattern were not connected to each other. CONCLUSION The plantaris muscle reveals variability with two different innervation patterns. Type II is ideally suited for autologous transplantation. New classifications of innervation are desirable for individual muscles rather than a generalized approach.
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Affiliation(s)
- Ł Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
| | - P Karauda
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - B Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - K Kurtys
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - R Haładaj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of 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, Grenada
| | - 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
| | - J Ramón Sanudo
- Department of Human Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - M Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
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Olewnik Ł, Podgórski M, Polguj M, Ruzik K, Grzelak P. Is ultrasound effective in determining variation of the insertion of the extensor hallucis longus tendon? Clin Anat 2020; 33:1235-1239. [DOI: 10.1002/ca.23572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Łukasz Olewnik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology Medical University of Lodz Łódź Poland
| | - Michał Podgórski
- Polish Mother's Memorial Hospital Research Institute Lodz Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology Medical University of Lodz Łódź Poland
| | - Kacper Ruzik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology Medical University of Lodz Łódź Poland
| | - Piotr Grzelak
- Polish Mother's Memorial Hospital Research Institute Lodz Poland
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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.
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Affiliation(s)
- Łukasz Olewnik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Łódź, Poland
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Urban S, Pretterklieber B, Pretterklieber ML. The anterolateral ligament of the knee and the lateral meniscotibial ligament - Anatomical phantom versus constant structure within the anterolateral complex. Ann Anat 2019; 226:64-72. [PMID: 31330303 DOI: 10.1016/j.aanat.2019.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/21/2019] [Accepted: 06/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Concerning the ongoing controversy about the existence and nature of the anterolateral ligament (ALL) of the knee joint, we reinvestigated the formation of the anterolateral part of its fibrous capsule in anatomic specimens. Furthermore, we wanted to clarify if the lateral meniscus has established a constant anchoring to the lateral tibial condyle via a lateral meniscotibial ligament (lmtl). METHODS Forty paired embalmed lower extremities taken from 20 human body donors (15 men and five women) underwent exact macroscopic dissection. For the detailed evaluation of the lmtl, additionally 12 specially dissected joint specimens were used. In two of these specimens, the lmtl underwent further histological examination. RESULTS In all specimens, the anterolateral part of the knee joint fibrous capsule was established by the iliotibial tract and the anterior arm of the aponeurosis of the biceps femoris muscle. According to their close connection and the fact that the anterolateral part of the fibrous capsule is exclusively assembled by these two aponeuroses, they do not leave any space for a distinct ALL connecting the lateral femoral epicondyle and the lateral tibial condyle. The constantly present lmtl was identified as a flat, rectangular bundle of collagen and also elastic fibers reinforcing the inner aspect of the fibrous capsule. Following an oblique direction, it connected the lateral face of the lateral meniscus with the superolateral margin of the lateral tibial condyle. The lmtl measured, on average, 17.1mm in longitudinal and 13mm in anteroposterior direction. CONCLUSION Our results show that there is no evidence for the existence of an ALL in human knee joints. It is represented either by the iliotibial tract or - most likely - by the anterior arm of the short head of the biceps femoris muscle. On the other hand, the lmtl was found to be a constantly present structure.
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Affiliation(s)
- Stefanie Urban
- Medical University of Vienna, Center for Anatomy and Cell Biology, Division of Anatomy, Waehringer Strasse 13, Vienna 1090, Austria
| | - Bettina Pretterklieber
- Medical University of Vienna, Center for Anatomy and Cell Biology, Division of Anatomy, Waehringer Strasse 13, Vienna 1090, Austria
| | - Michael L Pretterklieber
- Medical University of Vienna, Center for Anatomy and Cell Biology, Division of Anatomy, Waehringer Strasse 13, Vienna 1090, Austria.
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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.
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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
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Ali AA, Abdelwahab MB. Short-Term Outcome of Multi-Ligament Knee Injury among Sudanese Patients. Open Access Maced J Med Sci 2019; 7:1486-1493. [PMID: 31198460 PMCID: PMC6542394 DOI: 10.3889/oamjms.2019.282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND: Multi-ligament knee injury is the state of having two or more of the major knee ligaments, namely: the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), the lateral collateral ligament (LCL), the posteromedial corner (PMC), and the posterolateral corner (PLC). The knee is a hinge joint; this dictates two direction movements on the y-axis plane. The knee joints carry the weight load of the body uniquely. The role of the knee ligaments is not conserved only to maintain knee in a rigid position while standing, but also orchestrates the biomechanics of knee motion in harmony. Multi-ligament knee injury is very rare (incidence < 10:10,000 of trauma cases). Patients with multiple ligaments injuries of the knee become disabled for a long period. This disability rises from the pain and stiffness of the knee joint. A disability that might be associated with increased frequencies of sick leave from work, or much more dire consequences, such as quitting a job or being relieved of duty. AIM: To assess the functional outcome of the knee of patients with a multi-ligament knee injury after treatment using a standard scoring system and to determine the recovery rates of each treatment option to a multi-ligament knee injury. METHODS: it is a cross-sectional study conducted from January 2018 to January 2019. All patients with multi-ligament knee injuries that were diagnosed by MRI, and underwent reconstruction surgeries or on the waiting list, at Ribat University Hospital and Alyaa Specialized Hospital, Alkuwiti specialised hospital, and Haj Alsafi Hospital for the past 2 years were included. Lyshlome knee scoring scale was used to assess the functional outcome of each patient. RESULTS: 24 patients were enrolled in this study (16 had reconstruction surgery, 8 did not). 3 had excellent outcome (LKSS = 95 – 100), 8 of them had good score (LKSS = 84-94), 5 had fair outcome (LKSS = 65-83). All those who did not have reconstruction had a poor score (LKSS < 64). CONCLUSION: Reconstruction of multi-ligament knee injury shows a good outcome than it was left alone. Post-operative physiotherapy increases the potential of reconstruction. While our data is limited because of the rare condition, we plan to expand our study area to include a larger sample size. We also recommend extending the post-operative physiotherapy to improve the outcome of a multi-ligament knee injury.
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Olewnik Ł. Is there a relationship between the occurrence of frenular ligaments and the type of fibularis longus tendon insertion? Ann Anat 2019; 224:47-53. [PMID: 30930196 DOI: 10.1016/j.aanat.2019.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/11/2019] [Accepted: 03/14/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE The fibularis longus muscle (FLM) is located in the lateral compartment of the leg. Although the FLM presents high morphological variability, particularly the tendon, little is known of its insertion. Similarly, little information exists regarding the great diversity of the Frenular ligament. The main aim of the study was hence to characterize the morphology of the fibularis longus tendon (FLT) and its accessory bands, to classify it and to determine the incidence of frenular ligaments. I hypothesize that the presence of anterior/posterior frenular ligament can be closely correlated with a given type of fibularis longus tendon insertion. METHODS Classical anatomical dissection was performed on 100 lower limbs (50 female, 50 male) fixed in 10% formalin solution. The morphology of the insertion of the FLT and of the frenular ligaments was evaluated. RESULTS The FLM was present in all specimens. Three types of insertion were observed, the most common being Type I (49%): a single distal attachment in which the tendon inserts into the lateral tubercle of the base of the I metatarsal bone. The second most common type was Type II (40%): bifurcated distal attachment, the main tendon inserts into the lateral tubercle of the base of the I metatarsal bone. This group was divided into three subtypes (A-C), subtype (A) - the accessory band inserts into the medial cuneiform bone; subtype (B) - a strong, accessory band inserts into both the base of the I metatarsal bone and the medial cuneiform bone, including the first metatarsal-cuneiform joint; subtype (C) - the accessory band inserts into the first interosseus dorsalis muscle. The rarest type was Type III (9%), characterized by a single distal tendon, which fuses with other adjacent muscle tendons before insertion. The main tendon inserts into the lateral tubercle of the base of the I metatarsal bone; this group was divided into two subtypes (IIIA - fusion with the tibialis posterior tendon and IIIB - fusion with the adductor hallucis longus). The anterior frenular ligament was present in 49% of specimens, whereas the posterior frenular ligament joined the FLT to the long calcaneo-cuboid ligament and was present in 9%. CONCLUSION Both the fibularis longus tendon and frenular ligament present high morphological variability. The anterior frenular ligament is closely correlated with Type I of the proposed classification, while the posterior frenular ligament is associated with Type II b. Knowledge of particular types of insertion is essential for both clinicians and anatomists. LEVEL OF EVIDENCE - II basic science research.
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Affiliation(s)
- Łukasz Olewnik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland.
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Olewnik Ł. A proposal for a new classification for the tendon of insertion of tibialis posterior. Clin Anat 2019; 32:557-565. [PMID: 30758860 DOI: 10.1002/ca.23350] [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: 12/28/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 01/11/2023]
Abstract
Although the tendon of the tibialis posterior muscle (TPM) is high morphological variability, its insertion is not well defined in anatomy discussions. The aim of the work is to systematize the classification of tibialis posterior tendon insertion by anatomical dissection. Classical anatomical dissection was performed on 80 lower limbs (40 female, 40 male) fixed in 10% formalin solution. The morphology of the insertion of the tendon was evaluated, and the muscle was subjected to appropriate morphometric measurements. Four types of insertion were observed, the most common being Type III (35 cases - 43.75%): a triple distal attachment where the main tendon inserts to the navicular bone and the medial cuneiform bone, and two accessory bands insert to the medial, lateral, or intermediate cuneiform bone or to the metatarsal bones (II, III, IV, V) depending on subtypes (A-C). The second most common type was Type II (18 cases: 22.5%): a double distal attachment. Type IV (14 cases: 17.5%) was characterized by quadruple distal attachment and was also divided into three subtypes (A-B). The rarest type was Type I (13 cases: 16.25%), which was characterized by a single band: the main tendon inserts to the navicular bone and the medial cuneiform bone. The tendon of the TPM presents high morphological variability. Knowledge of the four particular types of insertions is essential for both clinicians and anatomists. Clin. Anat. 32:557-565, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Łukasz Olewnik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
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Olewnik Ł, Podgórski M, Polguj M, Topol M. A cadaveric and sonographic study of the morphology of the tibialis anterior tendon - a proposal for a new classification. J Foot Ankle Res 2019; 12:9. [PMID: 30733832 PMCID: PMC6359855 DOI: 10.1186/s13047-019-0319-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/27/2019] [Indexed: 01/11/2023] Open
Abstract
Background The tibialis anterior tendon (TAT) presents little morphological variation. The tibialis anterior muscle originates at the lateral condyle of the tibia, the proximal one-third to two-thirds of the lateral surface of the tibia shaft, and the anterior surface of the interosseous membrane and inserts to the medial cuneiform bone and first metatarsal. The aim of our work is to classify types of TAT insertion by two complimentary methods - anatomical dissection and ultrasound examination. Methods In the first part, classical anatomical dissection was performed on 100 lower limbs (50 right, 50 left) fixed in 10% formalin solution. The morphology of the insertion of the tendon was evaluated and the muscle was subjected to the appropriate morphometric measurements. In the second part, the morphology of the TAT insertion was evaluated in 50 volunteers with ultrasound. Results The tibialis anterior muscle was present in all specimens. In the cadavers, five types of insertion were observed, the most common being Type V: a single band attaching to the medial cuneiform bone (32%). In the sonographic part, Type IV was not observed; however, an additional insertion type was recognised (Type VI), which was characterized by two identical bands attached only to the medial cuneiform bone. The most common type identified by ultrasound was Type II (35%). Conclusion The tibialis anterior tendon presents high morphological variability that can be observed both in cadavers and in vivo by ultrasound examination. Level of evidence II Prospective Comparative Study Electronic supplementary material The online version of this article (10.1186/s13047-019-0319-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Łukasz Olewnik
- 1Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Michał Podgórski
- 2Department of Diagnostic Imaging Lodz, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Michał Polguj
- 3Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Mirosław Topol
- 1Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
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