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Assi C, Bonnel F, Mansour J, Daher J, Gerges B, Khoury A, Yammine K. The gracilis and semitendinosus muscles: a morphometric study on 18 specimens with clinical implications. Surg Radiol Anat 2022; 44:813-820. [PMID: 35314874 DOI: 10.1007/s00276-022-02925-8] [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: 11/18/2021] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The pes anserinus consists of the sartorius, semitendinosus, and gracilis muscles. They coalesce together with the leg fascia to form the anserine plate. The semitendinosus and gracilis both form the deep layer of this plate and are clinically relevant for ligament reconstruction. The aim of the study is to report a detailed morphometric evaluation of the semitendinosus and gracilis muscles and assess their clinical implications. METHODS Using a rigorous dissection process on 18 cadaveric hips, measurements of both the semitendinosus and gracilis muscles with bone parameters were conducted. We measured the following: (a) total femur, femoral shaft, and neck lengths, (b) total muscle lengths, and (c) intra-muscular and extra-muscular (free) tendon lengths. Correlation values between bone variables, muscle variables, and in-between muscle variables were computed. RESULTS The total muscle and the distal intra-muscular tendon length of the St and Gr are correlated with the total femur length. When compared to gracilis, the total muscle and distal intra-muscular tendon lengths of the ST are much better correlated with the total femur length. The free distal tendon length for both muscles did not show a significant correlation with any of the femoral bone lengths. CONCLUSION The variability of tendon length of the ST/Gr poses a significant challenge to surgeons. This study reports a detailed morphometric evaluation of the ST/Gr hamstring muscle and tendons. It revealed a positive correlation between the femoral length and the ST/Gr graft lengths. This could help orthopedic surgeons in predicting the graft lengths pre-operatively and develop better planning for reconstructive surgeries.
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Affiliation(s)
- Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon.,Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Beirut, Lebanon
| | - Francois Bonnel
- Anatomy Laboratory, School of Medicine, BD. Henri IV, 34000, Montpellier, France.,Department of Orthopedic Surgery, Clinique Beau Soleil, 119 Avenue de Lodeve, 34070, Montpellier, France
| | - Jad Mansour
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon.,Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Beirut, Lebanon
| | - Jimmy Daher
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon.,Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Beirut, Lebanon
| | - Bassam Gerges
- Department of Anesthesia, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon
| | - Alfred Khoury
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon. .,Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Beirut, Lebanon.
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Vadgaonkar R, Prameela MD, Kumar CG, Blossom V, Tonse M, Murlimanju BV, Pai MM, Prabhu LV. Dimensions of pes anserinus of the lower extremity, an anatomical study with its surgical implications. Anat Cell Biol 2021; 54:178-183. [PMID: 33827991 PMCID: PMC8225473 DOI: 10.5115/acb.20.275] [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: 10/22/2020] [Revised: 01/07/2021] [Accepted: 02/23/2021] [Indexed: 11/27/2022] Open
Abstract
The reconstructive surgeries utilize pes anserinus (PA) tendons, because of their lesser post-operative clinical deficits and donor site morbidity. These surgeries require anatomical knowledge about the extent of PA formation. The goal of this study was to determine the length and width of the PA formation. The objectives were to measure the distance of its upper limit, lower limit, and vertical distance from the tibial tuberosity (TT). The present descriptive cross sectional study included 53 embalmed cadaveric lower extremities. The upper and lower limits of PA were exposed with the careful dissection. Measurements of the dimensions were performed with the help of a digital vernier caliper (Mitutoyo Co., Kanagawa, Japan). The PA length, width, distance of its upper limit, lower limit, and vertical distance of it from the TT were 47.4±13.3 mm, 37.3±7.2 mm, 47.6±12.5 mm, 54.6±10.4 mm, and 39.1±14.2 mm, respectively over the right extremity. The same measurements were 46.3±14.7 mm, 39.1±9.4 mm, 39.1±5.9 mm, 49.5±8.2 mm, and 36.4±12.1 mm, respectively for the left extremity. The extent of PA was observed to be extremely variable. The preoperative knowledge about the dimensions of PA will help the plastic and orthopedic surgeon put the accurate skin incision, decreasing the donor site morbidity and biomechanical instability of the PA grafts. We suggest that, preoperative ultrasound measurement of the PA may help the operating surgeon to prevent the complications like injury to the infrapatellar branch of saphenous nerve.
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Affiliation(s)
- Rajanigandha Vadgaonkar
- Department of Anatomy, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - M D Prameela
- Department of Anatomy, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Chettiar Ganesh Kumar
- Department of Anatomy, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vandana Blossom
- Department of Anatomy, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mamatha Tonse
- Department of Anatomy, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - B V Murlimanju
- Department of Anatomy, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mangala M Pai
- Department of Anatomy, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Latha V Prabhu
- Department of Anatomy, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
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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.
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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.
| | - 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
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Albtoush OM, Taib AA, Horger M, Springer F. Avulsion fracture of an ossified pes anserinus tendon post-lateral patellar dislocation. Skeletal Radiol 2018; 47:699-702. [PMID: 29170812 DOI: 10.1007/s00256-017-2825-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 02/02/2023]
Abstract
The pes anserinus is a common tendon comprising the tendinous insertions of the sartorius, gracilis, and semitendinosus muscles. It inserts at the anteromedial aspect of the tibia and plays a significant role in stabilization of the medial side of the knee joint. The current article presents a case with recurrent lateral patellar dislocations causing chronic stress along the medial knee stabilizers and consecutive enthesophyte formation at the insertion of the pes anserinus tendon that showed a transverse fracture upon a subsequent incident of traumatic lateral patellar dislocation. Avulsion injuries of the pes anserinus tendon are rarely encountered, and to our knowledge, association with recurrent lateral patellar dislocations has not been described before.
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Affiliation(s)
- Omar M Albtoush
- Department of Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany. .,Department of Diagnostic and Interventional Radiology, University of Jordan, Queen Rania Street, Amman, 11942, Jordan.
| | - Abtehag A Taib
- Department of Radiology, Faculty of Medicine, Benghazi University, Belawon Street, Bernghazi, Libya
| | - Marius Horger
- Department of Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Fabian Springer
- Department of Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
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Vadgaonkar R, Prameela MD, Murlimanju BV, Tonse M, Kumar CG, Massand A, Blossom V, Prabhu LV. Morphometric study of the semitendinosus muscle and its neurovascular pedicles in South Indian cadavers. Anat Cell Biol 2018; 51:1-6. [PMID: 29644103 PMCID: PMC5890011 DOI: 10.5115/acb.2018.51.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/09/2017] [Accepted: 11/21/2017] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study was to determine the length of the semitendinosus muscle belly and its tendon in South Indian population and to study the topography and diameter of its neurovascular pedicles. The study included 46 formalin fixed human cadaveric lower limbs. The length of the semitendinosus muscle belly and its tendon were measured. The neurovascular pedicles of the semitendinosus muscle were identified and counted. The diameter of the neurovascular pedicle was measured just before its entrance into the semitendinosus muscle. The topographical distance of the neurovascular pedicles from the origin of the semitendinosus muscle were determined. The mean length of the semitendinosus muscle belly was 332.3±36.1 mm and its tendon measured 154.8±31.9 mm. The mean diameter of the vascular pedicle was measuring 11.4±9.1 mm, just before its entrance into the semitendinosus muscle. The neurovascular pedicles, of the semitendinosus muscle were ranging between 1 and 7. The distance of the entrance of neurovascular pedicle to the semitendinosus muscle from its origin was ranging between 46 and 272 mm. It was observed that the neurovascular pedicles were highest (31%) at the range of 151-200 mm away from the ischial tuberosity. The morphometric data obtained in the present study is enlightening to the orthopedic and plastic surgeons. The topographical knowledge of the neurovascular pedicles has its implications during the harvesting of the grafts and pedicle flaps. The diameter of vessels in the pedicles is enlightening because of new method of anterior cruciate ligament reconstruction.
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Affiliation(s)
| | - Manoor Dass Prameela
- Department of Anatomy, Kasturba Medical College, Manipal University, Mangalore, India
| | | | - Mamatha Tonse
- Department of Anatomy, Kasturba Medical College, Manipal University, Mangalore, India
| | - Chettiar Ganesh Kumar
- Department of Anatomy, Kasturba Medical College, Manipal University, Mangalore, India
| | - Amit Massand
- Department of Anatomy, Kasturba Medical College, Manipal University, Mangalore, India
| | - Vandana Blossom
- Department of Anatomy, Kasturba Medical College, Manipal University, Mangalore, India
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