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Zielinska N, LaPrade RF, Olewnik Ł. Morphological variations of the calcaneal tendon: clinical significance. J Orthop Surg Res 2023; 18:275. [PMID: 37016428 PMCID: PMC10074894 DOI: 10.1186/s13018-023-03748-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/24/2023] [Indexed: 04/06/2023] Open
Abstract
The calcaneal tendon, the largest and strongest in the human body, is created by the common junction of tendons of the gastrocnemius and soleus muscles. It is not a homogenous structure, being represented by layers in various arrangements. Morphological variability can be seen in the connection between the aponeurosis of the gastrocnemius muscle and the soleus muscle. Some types of plantaris tendon can be associated with a higher possibility of Achilles tendinopathy. Moreover, the presence of accessory structures, such as an accessory soleus muscle or additional gastrocnemius muscle heads may result in symptomatic pathologies. The main aim of this review is to summarize the current state of knowledge regarding the calcaneal tendon. Another aim is to present morphological variations of the calcaneal tendon and their clinical significance. Such information may be useful for clinicians, especially orthopedists, and surgeons. This review also provides an overview of embryological development and morphological variation among fetuses. Materials and methods: review was conducted according to PRISMA guidelines. An electronic search was conducted in five databases. Top quality tools were used to assess the quality of evidence in the studies reviewed. Research papers that made up the database of this review were analyzed, selected and assessed by two independently working researchers.
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Affiliation(s)
- Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | | | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
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Ishii T, Kawagishi K, Hayashi S, Yamada S, Yoshioka H, Matsuno Y, Mori Y, Kosaka J. A bilateral third head of the gastrocnemius which is morphologically similar to the plantaris. Surg Radiol Anat 2021; 43:1095-1098. [PMID: 33423145 DOI: 10.1007/s00276-020-02670-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/26/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE An extra muscle was observed on both sides of the popliteal fossa in the cadaver of a 78-year-old Japanese male during dissection. The aim of this case report was to identify whether this variant is a double plantaris or a third head of the gastrocnemius according to its morphological characteristics and innervation. METHODS The muscles were displayed by careful dissection and delineation of surrounding structures. The size of each of the muscle bellies and tendons of those extra muscles were measured manually by the vernier caliper. RESULTS The origin of each extra muscle was lateral to the tibial nerve and superior to the plantaris, and each extra muscle which transitioned to a descending tendon parallel to the plantaris had a cone-shaped belly. However, the tendon of the extra muscles was fused into the investing fascia of the gastrocnemius with a tendon length of 4.5 cm on the left and 4.6 cm on the right. The extra muscles were innervated by the branch of the tibial nerve to the medial head of the gastrocnemius on both sides. CONCLUSION Although they had an origin and shape similar to that of the plantaris, we identified the extra muscles in this case as a third head of the gastrocnemius, because of innervation to the plantaris arises directly from the tibial nerve. This case highlighted that the innervation is essential to understanding the myogenesis of extra muscles, especially in cases which are difficult to categorize based on the morphological features of the muscle.
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Affiliation(s)
- Takaya Ishii
- Department of Basic Medical Science, Graduate School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan.,Department of Anatomy, Faculty of Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba, 286-8686, Japan
| | - Kyutaro Kawagishi
- Department of Basic Medical Science, Graduate School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan. .,Department of Anatomy, Faculty of Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba, 286-8686, Japan.
| | - Shogo Hayashi
- Department of Anatomy, Division of Basic Medical Science, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Shinnosuke Yamada
- Department of Anatomy, Faculty of Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba, 286-8686, Japan
| | - Hirotaka Yoshioka
- Department of Anatomy, Faculty of Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba, 286-8686, Japan
| | - Yoshiharu Matsuno
- Center for Basic Medical Research, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan
| | - Yasutake Mori
- Department of Basic Medical Science, Graduate School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan.,Department of Anatomy, Faculty of Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba, 286-8686, Japan
| | - Jun Kosaka
- Department of Basic Medical Science, Graduate School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan.,Department of Anatomy, Faculty of Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba, 286-8686, Japan
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Rodrigues V, Rao MK, Nayak S. Multiple Heads of Gastrocnemius with Bipennate Fiber Arrangement- A Clinically Significant Variation. J Clin Diagn Res 2016; 10:AD01-2. [PMID: 27656426 DOI: 10.7860/jcdr/2016/20094.8340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/16/2016] [Indexed: 11/24/2022]
Abstract
It is common to have additional muscles or muscle slips in the extremities. Some of them may compress the nerves and vessels or restrict the movements, while others may enhance the muscular activity. However, a small number of them may go unnoticed. Knowledge of such variant muscles becomes important for plastic surgeons while performing various reconstructive surgeries and for clinicians while managing the pain. A case of multiple heads of gastrocnemius muscle was observed during routine dissection of the right lower limb of about 70-year-old male cadaver. It was observed that the medial head of gastrocnemius was attached to the femur with 3 thick heads and lateral head was arising from the lateral condyle of femur by 3 thick heads. All the heads of the muscles remained separate till they formed tendocalcaneus. Some of these heads showed bipinnate fiber arrangement. All the heads were innervated by the branches of tibial nerve. As the muscle heads passed down from their origin, they entrapped the sural nerve and sural nerve was seen emerging at the beginning of tendocalcaneus. Further, detailed literature and the clinical and surgical importance of the case are discussed.
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Affiliation(s)
- Vincent Rodrigues
- Senior Lecturer, Department of Preclinical Sciences, Faculty of Medical Sciences, University of the West Indies , St. Augustine, Trinidad and Tobago, West Indies
| | - Mohandas Kg Rao
- Professor, Department of Anatomy, Melaka Manipal Medical College, Manipal University , Manipal, Karnataka, India
| | - Shivananda Nayak
- Professor, Department of Preclinical Sciences, Faculty of Medical Sciences, University of the West Indies , St. Augustine, Trinidad and Tobago, West Indies
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Ashaolu JO, Oni-orisan OA, Ukwenya VO, Opabunmi OA, Ajao MS. The quadriceps gastrocnemius muscle. Surg Radiol Anat 2013; 36:1101-3. [PMID: 24337388 DOI: 10.1007/s00276-013-1248-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 12/10/2013] [Indexed: 11/29/2022]
Abstract
The gastrocnemius muscle forms the belly of calf muscles in the posterior compartment of the leg. This paper reports a four-headed gastrocnemius (named quadriceps gastrocnemius) muscle as a new variant and when present can alter the anatomy and/or the boundaries of the popliteal fossa. The four heads are named as medial, intermedio-medial, intermedio-lateral and medial. The newly identified heads, intermedio-medial and intermedio-lateral heads form the inferior boundaries of the popliteal fossa. Clinical conditions like popliteal entrapment syndrome may arise because of distal fossa congestion created by the intermedio-medial and intermedio-lateral heads. This supernumerary heads may also be useful for grafting and they also provide bulkier mass for gastrocnemius proximal attachment. The knowledge of anatomical variants presented is useful to surgeons, prosectors and radiologists.
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Affiliation(s)
- J O Ashaolu
- Department of Anatomy, Faculty of Basic Medical Sciences, Bowen University, Iwo, Osun State, Nigeria,
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