The calcaneofibular ligament groove at the inferior fibula, an ultrasonographic anatomical landmark.

PURPOSE: Calcaneofibular ligament (CFL) injuries are harder to diagnose than anterior talofibular ligament (ATFL) ones. This study aimed to clarify the fibular attachment of the CFL and verify the bony landmark for evaluating the CFL on ultrasonography. METHODS: Fifty-nine ankles were used in this anatomical study. To confirm the control function of the CFL, we performed passive movement manually using cadaveric ankles and observed the ankle positions where the CFLs were tense. Histological observation of CFL attachment of the fibula was performed using Masson's trichrome stain. The ATFL and CFL were removed, and the bone morphology of the CFL attachment and inferior fibular end was imaged using a stereomicroscope and a 3D scanner. Using ultrasonography, we evaluated the bone morphology of the fibular attachment of the CFL in short-axis images of 27 healthy adult ankles. RESULTS: The CFL was tensed according to ankle motions: supination, maximum dorsi flexion, maximum plantar flexion, and mild plantar flexion-external rotation. Below the CFL attachment of the fibula was a slight groove between the inferior tip and the obscure tubercle of the fibula. This groove was observed in 81.5% of cases using short-axis ultrasonography. CONCLUSION: The CFL was tensed in various ankle positions to control the movements of the talocrural and subtalar joints. There was a slight groove at the inferior end of the fibula where the CFL coursed downward. We called it the CFL groove and proposed that it could serve as a landmark for the short-axis image of ultrasonography.

Difference in the fibular attachment structure between the superior and inferior fascicles of the anterior talofibular ligament using ultrasonography and histological examinations.

PURPOSE: The anterior talofibular ligament (ATFL) is divided into superior (SB) and inferior bands (IB). Although the differences in length and width are known, the structure of the fibular attachment had not been elucidated. The present study aimed to clarify the differences in the fibular attachment structure between ATFL's SB and IB using cross-sectional images along the ligament. METHODS: An anatomical study using 15 formalin-fixed ankles was performed. The lateral ankle ligament complex was collected after a longitudinal image of SB/IB was visualized by ultrasonography. The specimens were decalcified and sectioned longitudinally at the center of SB/IB using a microtome. Histological evaluation of the enthesis structure at the fibular attachment of SB/IB was performed using hematoxylin-eosin and Masson's trichrome stains. RESULTS: A fibrillar pattern could not be observed in the longitudinal image at the IB level by ultrasonography. The lengths of ATFL's SB and IB were 20.6 ± 1.6 and 15.3 ± 1.3 mm, respectively, with thicknesses of 1.8 ± 0.4 and 1.0 ± 0.4 mm, respectively. The ATFL's IB was significantly shorter and thinner than the ATFL's SB. The fibular attachment of ATFL's SB had distinct enthesis structure, whereas in the attachment structure of the ATFL's IB, there were several variations including a type with a narrower enthesis structure than the ATFL's SB and a type that merged with or wrapped around the calcaneofibular ligament. CONCLUSION: The fibular attachment structure between ATFL's SB and IB differs. Our results could be useful information when performing ultrasonography and MRI diagnosis.

Relationship between inferior fascicle of anterior talofibular ligament and articular capsule in lateral ankle ligament complex.

PURPOSE: The lateral ankle ligament complex (LALC) is composed of anterior talofibular (ATFL), calcaneofibular (CFL), and posterior talofibular (PTFL) ligaments, all of which have a connection/continuous fiber. However, the structural link between the LALC and the articular capsule remains unknown. The goal of our study was to determine the connection between ATFL's inferior fascicle and the articular capsule. METHODS: In this study, we utilized 84 formalin-fixed ankles to elucidate the structure of LALC. Between ATFL and CFL, the bundle number of ATFL and arciform fiber was investigated. The specimens were decalcified and sectioned coronally using a freezing microtome, in the case of double bundles of ATFL, to study the connection between the inferior fascicle of ATFL and the articular capsule. RESULTS: ATFL had a single (25%), double (74%), and triple (1%) bundle number, respectively. The arciform fiber connecting the ATFL and the CFL was found in the superficial layer of all ankles (100%). There were two types of relationships between the inferior fascicle of ATFL and the articular capsule: 36 ankles (58%) were extracapsular, and 26 of 62 ankles (42%) were integrated with the inferior-lateral articular capsule. There are two kinds of relationships between the inferior fascicle of the ATFL and the articular capsule: extracapsular and integrated-capsular. CONCLUSIONS: The inferior fascicle of ATFL has a variant and integrated-capsular type is reinforced inferior-lateral articular capsule and enters the joint to form continuous fibers with PTFL, making LALC. These anatomical findings are helpful in ultrasonography diagnosis and arthroscopic ankle surgery.

Continuous and Connective Fibers of the Lateral Ankle Ligament Complex.

The lateral ankle ligament complex (LALC) is an intricate structure; therefore precise anatomic knowledge is required by the surgeon. However, the structural relationship of the LALC remains unclear. Here, the features of the posterior talofibular ligament (PTFL) and the relationship to the LALC at the distal fibula were clarified in a cadaver study. The lengths of most of the anterior and posterior parts, and the widths of the anterior-posterior and superior-inferior parts, were measured with a digital caliper. In addition, the relationship between the anterior talofibular ligament (ATFL) and PTFL inside of the capsule is described. The small fiber bundles of the PTFL were manually divided, and the footprint of each bundle at the fibula and talus was clarified. The relationship between the ATFL and CFL, outside of the capsule, was examined on axial slices at the inferior fibula. The lengths of the most anterior and most posterior parts of the PTFL were 9.8 ± 1.7 and 29.4 ± 1.9 mm, respectively. The widths of the anterior-posterior and superior-inferior parts were 10.0 ± 0.9 and 5.8 ± 1.1 mm, respectively. Approximately 83% of the fibers between the ATFL and PTFL were continuous. The anterior-inferior fibers of the PTFL were continuous with the inferior fibers of the ATFL inside of the capsule. The ATFL and CFL converged with connective tissue from outside of the capsule at the distal fibula. The results of this study should prove useful to further clarify the relationships of the LALC both inside and outside of the capsule at the distal fibula.

Independent Attachment of Lateral Ankle Ligaments: Anterior Talofibular and Calcaneofibular Ligaments - A Cadaveric Study.

Anatomic knowledge of lateral ligaments around the lateral malleolus is important for repair or reconstruction of ankle instability. The detailed structure of the connective fibers between the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) is unknown. To clarify the anatomic structure of ATFL and CFL and the connective fiber between the 2 ligaments, the lateral ligament was dissected in 60 ankles of formalin-fixed cadavers, and the distance was measured between bony landmarks and fibular attachment of ATFL and CFL using a digital caliper. All ankles had connective fibers between ATFL and CFL. The structure of connective fibers consisted of a thin fiber above the surface layer of ATFL and CFL; it comprised thin fibrils of the surface layer covering the lower part of ATFL and the front part of CFL. Both ATFL and CFL were independent fibers, and both attachments of the fibula were isolated. Single bands of ATFL were noted in 14 of 60 (23.3%) ankles, double bands that divided the superior and inferior bands were observed in 42 of 60 (70.0%) ankles, and multiple bands were observed in 4 of 60 (6.7%) ankles. A cord-like and a flat and fanning type of CFL was noted in 22 (36.7%) and 38 (63.3%) of the 60 ankles, respectively. Distances between ATFL/CFL and articular and inferior tips of the fibula were 4.3 ± 1.1 mm/7.6 ± 1.6 mm and 14.3 ± 1.9 mm/7.4 ± 1.7 mm, respectively (mean ± standard deviation). The results of this study suggest that knowledge of more anatomic structures of ATFL, CFL, and connective fiber will be beneficial for surgeons in the repair or reconstruction of the lateral ligament of the ankle.

Stereological estimation of olfactory receptor neurons in rats.

The total number of olfactory receptor neurons (ORNs) in the rat main olfactory epithelium (MOE) was estimated using stereological sampling. Skulls and noses of newborn (postnatal day 0), young adult (8 weeks), and adult (6 months) rats were decalcified, embedded in paraffin, cut into 10-µm thick sections serially at 100-µm intervals, and processed for immunohistochemistry for olfactory marker protein (OMP), a specific marker of mature ORNs with fiber connections to the olfactory bulb. The number of OMP (+) receptor neurons was measured using an optical fractionator with stereological software (Stereoinvestigator). The total number of OMP (+) receptor neurons in the unilateral MOE was 0.47 × 10(6) in newborns and 21 × 10(6) in young adults and adults. Our previous study showed that the corresponding unilateral total number of neurons was 5.2 × 10(6) in young adult mice. Accordingly, we concluded that rats had 4 times more OMP (+) receptor neurons than mice at the adult stage and that the number of these neurons increased approximately 45 times between birth and maturity.

Spontaneous regeneration after resection of various lengths of hypoglossal nerve in rats.

OBJECTIVES: The objective of this study was to investigate spontaneous neural regeneration and functional recovery after resection of various lengths of the hypoglossal (XII) nerve in adult rats. METHODS: Twelve weeks after XII nerve resection at lengths ranging from 0.0 to 15.8 mm, the tongue deviation angle of rats was measured to evaluate the severity of paralysis; thereafter, the XII neurons in the XII nucleus were labeled with Fluoro-Gold (FG), which was injected into the tongue to visualize regenerated XII neurons re-innervating the tongue muscles. RESULTS: In the XII nerve-resected rats, the regenerative rates, that is, the percentage of the total number of FG-positive neurons on the injured side relative to that on the uninjured side, were divided into two groups; the regenerative rates were more than 77% and less than 6%, respectively. Upon comparing the two groups, the boundary resection length was approximately 10.0 mm. Moreover, the former and latter groups demonstrated tongue deviation angles less than or greater than 15°, respectively. CONCLUSIONS: The critical nerve gap length for spontaneous neural regeneration was approximately 10.0 mm in XII nerve-resected adult rats, and nerve regeneration occurred in both morphological and functional aspects after resection at less than the critical length.

Hypoglossal nerve injury with long nerve resection leading to slow motoneuron death.

Crush injury to peripheral nerves in adult animals is considered not to trigger retrograde neuronal cell death; however, several studies reported neuronal cell death following severe injuries including nerve transection, resection, or avulsion. However, the rate of neuronal cell death varied among studies. In this study, we evaluated the outcomes of very severe nerve injury by long nerve resection in adult rats. Right hypoglossal (XII) nerve was exposed, and a 9-mm section was resected. At 4, 8, and 12 weeks after the resection, the number of XII neurons were counted in from the rostral to caudal sections. The number of XII neurons in the injured right side was reduced after the XII nerve resection compared with the uninjured left side. The mean rates of surviving neurons at 4, 8, and 12 weeks after the nerve resection were 83.5 %, 73.9 %, and 61.1 %, respectively, which were significantly lower than those of the control. The number of XII neurons after extensive XII nerve resection declined gradually over a relatively long time period, revealing that extensive nerve resection led to slow cell death of the injured neurons.

Tyrosine hydroxylase-immunoreactive fibers in the human vagus nerve.

Sympathetic catecholaminergic fibers in the vagus nerve were immunohistochemically examined in formalin-fixed human cadavers using an antibody against the noradrenalin-synthetic enzyme tyrosine hydroxylase (TH). TH-positive fibers were extensively distributed in the vagal nerve components, including the superior and inferior ganglia, the main trunk and the branches (superior and recurrent laryngeal, superior and inferior cardiac, and pulmonary branches). The inferior ganglion and its continuous cervical main trunk contained numerous TH-positive fibers with focal or diffuse distribution patterns in each nerve bundle. From these findings, we conclude that sympathetic fibers are consistently included in the human vagus nerve, a main source of parasympathetic preganglionic fibers to the cervical, thoracic and abdominal visceral organs.

Stereological assessment of the total number of hypoglossal neurons after repeated crush injuries to the hypoglossal nerve in adult rats.

OBJECTIVE: Retrograde neuronal cell death does not occur in mature motoneurons following the axonal injury of peripheral nerves. However, a previous study suggested that retrograde neuronal cell death does occur in adult rats after the creation of double lesions on the hypoglossal (XII) nerve based on a substantial decrease in the number of XII neurons. Using stereological methods, we examined neuronal apoptosis in XII neurons and the total number of XII neurons following repeated crush injuries to the XII nerve. METHODS: The right XII nerve of adult rats was crushed three times at one-week intervals with a brain aneurysm clip. At 4 weeks after the final crush, the total numbers of XII neurons on the injured right and uninjured left sides were estimated stereologically. RESULTS: After repeated crush injuries, no apoptosis was evident in XII neurons as indicated by immunostaining for cleaved caspase-3. Moreover, immunohistochemistry for the vesicular acetylcholine transporter revealed axonal elongation in the tongue 4 weeks after repeated crush injuries. At 4 weeks, the total numbers of XII neurons were 7800 ± 290 on the injured right side and 8000 ± 230 on the uninjured left side, and no significant difference was evident between the injured and uninjured sides. CONCLUSION: Neuronal cell death does not occur in XII neurons and the total number of XII neurons does not decrease after repeated crush injuries of the XII nerve in adult rats.

Quantitative analysis of survival of hypoglossal neurons in neonatally nerve-injured rats: Correlation with milk intake.

INTRODUCTION: Tongue movement innervated by the hypoglossal (XII) nerve is essential for the survival of neonatal rats. The pups with bilateral XII nerve resection failed to suckle milk and did not survive, and the pups with unilateral XII nerve resection showed disturbed suckling capability and lower survival rates. The present study was performed to investigate the relation between neuronal population and milk intake of developing rats that had received various degrees of crush injuries to the unilateral XII nerve during the neonatal period. METHODS: The right XII nerve of postnatal day 1 (P1) pups was crushed and milk intake was estimated at 3 days and 6 days after the nerve injury. As nerve injury at the neonatal stage results in death of axotomized neurons, varying degrees of crushing was estimated by the number of survived motor neurons. RESULTS: In nerve-crushed rats, the populations of XII motor neurons and amounts of milk intake were reduced in a varied manner. Statistically significant positive correlations were observed between increasing XII neuron survival and increasing milk intake at 3 (r=0.62) and 6 (r=0.71) days after the nerve injury. CONCLUSION: The results indicate that there is a strong relationship between the number of XII motor neurons and the amount of milk intake in neonatally XII nerve-injured rats.

Re-evaluation of spontaneous regeneration of the lateral olfactory tract.

Spontaneous regeneration of the lateral olfactory tract (LOT) was re-evaluated in newborn rats using a fluorescent retrograde neuronal tracer as objective indicators of complete LOT transection. Complete LOT transection was evidenced by the loss of the white myelinated band characteristic for adult LOT and the total lack of retrograde neuronal labeling of mitral cells by Fast Blue that was injected during LOT transection. In completely LOT-transected young adult rats, mitral cells were retrogradely labeled consistently only by Fluoro-Gold that was injected into the olfactory cortex at the adult stage. Moreover, an anterograde neuronal tracer, biotinylated dextran amine (BDA), was demonstrated to pass from the neonatally LOT-transected bulb, through the transected retrobulbar site, towards the olfactory cortex, far caudally at a level near the optic chiasm. The regenerated structures lacked immunoreactivity for myelin basic protein and electron-dense myelinated axon bundles, and were also characterized by the thinness of the BDA+ terminal zone within the olfactory cortex and the lack of its caudal extension. Young adult rats subjected to unilateral bulbectomy contralateral to the neonatally LOT-transected side showed perfect ability to discriminate cycloheximide solution by olfaction. From these findings, we conclude that the spontaneously regenerated olfactory system is functional despite structural incompleteness.

Determination of functionally essential neuronal population of the olfactory epithelium for nipple search and subsequent suckling behavior in newborn rats.

Neuronal population of the olfactory epithelium required for nipple search and subsequent suckling behavior was examined in newborn rats. After unilateral ablation of the olfactory bulb, different concentrations of ZnSO(4) were contralaterally injected into the nasal cavity to produce varying degrees of neuronal degeneration in the olfactory epithelium. The ZnSO(4)-treatment resulted in two populations of pups. One exhibited suckling while the other did not, and intact olfactory receptor neurons were quantified immunohistochemically using an antibody for olfactory marker protein (OMP), a marker protein for olfactory receptor neurons. The total numbers of the OMP (+) cells in the ZnSO(4)-treated pups with suckling capability ranged between 2457 and 4615, whereas those in the ZnSO(4)-treated pups without suckling capability ranged between 112 and 2398. With the mean value (4969) of the total numbers of the OMP (+) cells of the normal/control pups assumed to represent 100%, the total numbers of the OMP (+) cells accounted for 49-93% in the suckling (+) group and 2-48% in the suckling (-) group. From these findings, we conclude that approximately 50% of neuronal population of the olfactory epithelium is a critical value to distinguish between the two groups with and without suckling capability in the unilateral olfactory system of newborn rats.