A meta-analysis of the accessory left atrial appendage and the left atrial diverticulum.

Left atrial (LA) structures, including the accessory left atrial appendage (aLAA) and left atrial diverticulum, have been studied based on their prevalence, shape, and association with arrhythmia and thrombi formation. A pooled prevalence with morphometric data has not been determined in previous research. Our goal is to provide structured, clinically relevant information on said structures for clinical practitioners to use in their daily work. We propose that morphometric data of additional LA structures is necessary when considering the possible complications during cardiac interventions. We conducted a meta-analysis of all relevant studies which used electrocardiogram (ECG)-gated computed tomography (CT) imaging to determine the prevalence of LA structures and record their morphometric characteristics as well as the presence of thrombi. Data were extracted from 19 studies (n = 6643 hearts). The pooled prevalence estimate of left atrial diverticulum and/or aLAAs were reported from 14 studies and was 28.8%. The most common location noted was anterosuperior in the LA with 70.2% of structures found there. Data regarding thrombi presence in left atrial diverticulums or aLAAs were extracted from 11 studies and a thrombus was present in 0.2%. The prevalence rates of aLAAs and left atrial diverticulums are essential in performing uncomplicated cardiac interventions and reducing risk of electrophysiological procedures. Our findings show a considerable prevalence of LA structures in varying populations, provides information regarding the general characteristics of said structures, and does not support the previously theorized associated risk of thrombus formation in relation to LA structure presence.

Systematic review and meta-analysis of the prevalence of the retrotransverse foramen of the atlas.

The retrotransverse foramen (RTF) is a nonmetric variant of the atlas vertebra that can accommodate an anastomotic vertebral vein and occipital nerve. An understanding of this variation and its occurrence is crucial, as it could aid in explanation of the unidentified cause of the high prevalence of variability in this region. The aim of this meta-analysis was to obtain data on the prevalence of the RTF and its variations according to anatomy, sex, and ethnicity. A large-scale search was conducted through the major online databases to establish and determine the pool of studies reporting data relevant to the RTF. No date or language restrictions were applied. The data collection was categorized by prevalence, type (incomplete/complete), side, sex, ethnicity, laterality, and diameter. A total of 17 studies (n = 1979 subjects) were incorporated into our analysis. The overall pooled prevalence for a complete RTF was 11.4% and the overall pooled prevalence of an incomplete (partial) RTF was 9.6%. A complete RTF was most prevalent in Africa (Sub-Saharan population) (12.1%), followed by Europe (11.8%) and Asia (9.7%). As this variant occurs in a significant number of patients in all of the aforementioned populations, recognition, and awareness, especially with thorough investigation with computer tomography angiography (CTA) should be implemented, as it is the only possible way to visualize the possible contents of RTF.

Renal agenesis: A meta-analysis of its prevalence and clinical characteristics based on 15 641 184 patients.

Our objective was to analyse the newest relevant data on worldwide prevalence and associated symptoms of renal agenesis (RA). This meta-analysis builds on previous systematic reviews to include bilateral RA, its symptoms and data on gender, unilateral RA and anomaly location prevalence. Review of available data included records in English and other languages from PubMed, Embase, ScienceDirect, Web of Science, SciELO, BIOSIS, Current Content Connect Korean Journal Database and Russian Citation Index and Google. A total of 15 641 184 patients were analysed in relation to the prevalence of RA. The pooled prevalence of RA was 0.03% (95% CI: 0.03%-0.04%). Based on 500 subjects, a pooled prevalence of 47.96% (95% CI: 31.55%-64.58%) for unilateral and 52.04% (95% CI: 35.42%-68.45%) for bilateral RA has been set. Our study presents the newest generalized findings on bilateral RA. There appears to be universal disease and symptom prevalence with minor differences between world regions, although quality of future observational research should include genomic data. This will provide even further insight into the prognosis of various renal anomalies and their etiologies.

The subscapularis muscle: A meta-analysis of its variations, prevalence, and anatomy.

BACKGROUND: The subscapularis (SSC) is the largest rotator cuff muscle and is involved in the medial rotation, abduction, adduction, and anterior stabilization of the shoulder. It is anatomically variable, as is the morphology and prevalence of the accessory SSC (aSSC), a rare muscle slip attached to the SSC. There is no current review investigating the prevalence and morphometrics of the SSC and aSSC. PURPOSE: To investigate the prevalence of the morphological variants of the SSC and aSSC via meta-analysis and review the relevant literature involving cadaveric, magnetic resonance imaging, and ultrasonographic studies. STUDY DESIGN: Meta-analysis. MATERIALS AND METHODS: Literature data reporting the prevalence rates and morphometrics of the SSC and aSSC and their variants were pooled. Literature searches and data analyses were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Anatomical Quality Assurance guidelines. RESULTS: Forty-six studies, totaling 2166 shoulders, were assessed. The SSC showed an overall length, thickness, cross-sectional area, and volume of 152.2 mm (95% confidence interval, CI, 103.8-200.5 mm), 5.6 mm (95% CI, 4.6-6.6 mm), 18.1 cm2 (95% CI, 14.2-22.0 cm2 ), and 126.9 cm3 (95% CI, 87.2-166.5 cm3 ), respectively. The SSC displayed substantial variations in its origin and insertion points and in the composition of its tendon. The aSSC had an overall pooled prevalence of 24.6% (95% CI, 0.0%-76.9%). CONCLUSIONS: The SSC and aSSC have been implicated in multiple shoulder pathologies, including muscle and tendon ruptures and neurovascular compromise. A better understanding of SSC and aSSC variants when diagnosing and treating their related pathologies will reduce patient morbidity and improve treatment regimens.

Prevalence and morphometry of sternal and xiphoid foramen: a meta-analysis on 16,666 subjects.

PURPOSE: Sternal foramen is a perforation of the sternum that can be a source of misdiagnosis during radiographic imaging or life-threatening perforations during bone marrow sampling. The aim of this study was to conduct a meta-analysis on the prevalence, morphometrics, and location of foramen in the sternal body and xiphoid process, describe morphometric features of this phenomenon, and thus verify its clinical importance. Moreover, our secondary outcome was to compare effectiveness of various imaging methods in diagnosis of the sternal or xiphoid foramen. METHODS: A comprehensive search was conducted on major scientific databases to identify studies containing relevant information. Data on foramen's prevalence, location, morphometrics, and accompanying findings were extracted and pooled into a meta-analysis using MetaXL 5.0. RESULTS: Thirty-five studies (n = 16,666 subjects) were included. The overall pooled prevalence of a foramen in the sternal body and/or a xiphoid process was 8.9% (95% CI 6.5-11.7) and it equaled 6.5% (95% CI 5.6-7.6) for sternal body alone and 2.9% (95% CI 0.5-6.9) for the xiphoid process. The foramen was more prevalent in males than in females (12.2% vs. 6.8%). The prevalence of sternal foramen was higher in South American [13.9% (95% CI 11.2-16.9)] and African [13.6% (95% CI 9.7-18.0)] studies compared to North American [6.2% (95% CI 5.0-7.5)] and European populations [8.6% (95% CI 3.1-16.3)]. Mean transverse and vertical diameter of foramen equaled 4.7 mm (95% CI 3.8-5.5), and 5.6 mm (95% CI 4.2-6.9), respectively. CONCLUSION: Our analysis proves that the sternal foramina are structures of significant prevalence and size. Any physician should keep them in mind when performing punctures in this area.

Anatomy of the greater palatine foramen and canal and their clinical significance in relation to the greater palatine artery: a systematic review and meta-analysis.

PURPOSE: Accurate knowledge of greater palatine foramen (GPF) and greater palatine canal (GPC) anatomy is necessary to avoid injury to the greater palatine artery (GPA) when performing a variety of anesthesiologic, dental or surgical procedures. The aim of this paper was to perform a systematic review and meta-analysis of literature on the anatomy and localization of bony structures associated with the GPA, namely the GPF and GPC. METHODS: A systematic literature search was performed using PubMed, Embase, ScienceDirect, and Web of Science databases. Seventy-five studies were included in the meta-analysis (n = 22,202 subjects). RESULTS: The meta-analysis showed that the GPF is positioned 17.21 mm (95% CI = 16.34-18.09 mm) from the posterior nasal spine, 2.56 mm (95% CI = 1.90-3.22 mm) from the posterior border of the hard palate, 46.24 mm (95% CI = 44.30-48.18 mm) from the anterior nasal spine, 15.22 mm (95% CI = 15.00-15.43 mm) from the midline maxillary suture, 37.32 mm (95% CI = 36.19-38.45 mm) from the incisive foramen, and opposite the third maxillary molar (M3) in 64.9% (58.7-70.7%) of the total population. CONCLUSION: An up-to-date, comprehensive analysis of GPF and GPC clinical anatomy is presented. The results from this evidence-based anatomical study provides a unified set of data to aid clinicians in their practice.

Variations in human pulmonary vein ostia morphology: A systematic review with meta-analysis.

This study aimed to establish the most accurate and up-to-date anatomical knowledge of pulmonary veins (PV), ostia variations, diameters and ostial area, to provide physicians, especially heart and thoracic surgeons with exact knowledge concerning this area. The main online medical databases, such as PubMed, Embase, Scopus, Web of Science, and Google Scholar, were searched to gather all studies in which the variations, maximal diameter, and ostial area of the PVs were investigated. During the study, the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Additionally, the critical appraisal tool for anatomical meta-analysis (CATAM) was used to provide the highest quality findings. The most common ostia variation is the classical one, which contains the left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), right superior pulmonary vein (RSPV) and right inferior pulmonary vein (RIPV). The mean diameter and ostial area of each pulmonary vein were established in the general population and in multiple variations considering the method of collecting the data and geographical location. Significant variability in PV ostia is observed. Left-sided PVs have smaller ostia than the corresponding right-sided PVs, and the inferior PVs ostia are smaller than the superior. The LCPV ostium size is the largest among all veins analyzed, while the RMPV ostium is the smallest. The results of this meta-analysis are hoped to help clinicians in planning and performing procedures that involve the pulmonary and cardiac areas, especially catheter ablation for atrial fibrillation.

Innervation of the wrist joint: Literature review and clinical implications.

The aim of this study was to review the literature on the innervation of the wrist with an emphasis on pathological and therapeutic aspects. The nerves involved in wrist innervation and their mechanoreceptor endings are described. The literature over the past 30 years includes several topics that are still subjects of discussion and debate and require further research.

The persistent median artery and its vascular patterns: A meta-analysis of 10,394 subjects.

The presence of a persistent median artery (PMA) has been implicated in the development of compression neuropathies and surgical complications. Due to the large variability in the prevalence of the PMA and its subtypes in the literature, more awareness of its anatomy is needed. The aim of our meta-analysis was to find the pooled prevalence of the antebrachial and palmar persistent median arteries. An extensive search through the major databases was performed to identify all articles and references matching our inclusion criteria. The extracted data included methods of investigation, prevalence of the PMA, anatomical subtype (antebrachial, palmar), side, sex, laterality, and ethnicity. A total of 64 studies (n = 10,394 hands) were included in this meta-analysis. An antebrachial pattern was revealed to be more prevalent than a palmar pattern (34.0% vs. 8.6%). A palmar PMA was reported in 2.6% of patients undergoing surgery for carpal tunnel syndrome when compared to cadaveric studies of adult patients in which the prevalence was 8.6%. Both patterns of PMA are prevalent in a considerable portion of the general population. As the estimated prevalence of the PMA was found to be significantly lower in patients undergoing surgery for carpal tunnel syndrome than those reported in cadaveric studies, its etiological contribution to carpal tunnel syndrome is questionable. Surgeons operating on the forearm and carpal tunnel should understand the anatomy and surgical implications of the PMA and its anatomical patterns.

Neglected workforce: pharmacists and their health-related quality of life.

BACKGROUND: pharmacists remain on the frontline of public health around the globe and their performance directly impacts patients' safety. So far, to our knowledge, no European study has been dedicated to their heath-related quality of life (HQoL). Therefore, the primarily aim of our study was to evaluate HQoL of Polish pharmacists utilizing the SF-36 health survey with regard to anthropometric and lifestyle-related variables. METHODS: A total sample screened consisted of 1412 respondents, yet 765 pharmacists (mean age 40, 86.3% females) finally participated in the study. HQoL was assessed with the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). RESULTS: The lowest median scores were noted for general health (GH, 50.0) and vitality (V, 60.0) domains. No gender differences regarding physical and mental summary scores were found. Significant difference of HQoL was found among the assessed age groups in several domains, especially physical functioning (PF) and GH (p <0.001) scores, and especially in the group of 51-60-year-old-respondents. Correlations were found between PF (r = -0.29, p <0.001), GH (r = -0.25, p <0.001) and age as well PF (r = -0.27, p <0.001), GH (r = -0.21, p <0.001) and BMI. Self-assessed dietary habits were correlated with PF (r = 0.22, p <0.001), mental health (r = 0.25, p <0.001), GH (r = 0.27, p <0.001) and V (r = 0.30, p <0.001) scores. CONCLUSIONS: The analysis indicates that pharmacists tend to have similar mental and physical burden according to SF-36, with age, BMI and dietary habits as predominant factors influencing their HQoL. The study presents unique values for future comparative analyses related, for instance, to the influence of the ongoing pandemic on HQoL of health-care providers.

The Accessory Parotid Gland and its Clinical Significance.

PURPOSE: The accessory parotid gland is a collection of salivary tissue separate from the main parotid gland. When present, it may complicate parotidectomies, promote parotitis, and serve as a potential site for benign and malignant lesions to arise. The aim of this study was to provide a comprehensive and current overview of the anatomy of the accessory parotid gland, as there is a wide discrepancy in the literature regarding its prevalence. MATERIALS AND METHODS: The authors conducted a search in PubMed, Embase, ScienceDirect, Web of Science, SciELO, BIOSIS, Current Content Connect, Korean Journal Database, and Russian Citation Index to identify all studies which reported relevant data on the accessory, with no date or language restrictions applied. Data on prevalence, side of occurrence, and sex dimorphism of the accessory parotid gland were extracted and pooled into a meta-analysis. RESULTS: A total of 13 articles (n = 3115 subjects) were included in the study. The results revealed that the overall pooled prevalence of an accessory parotid gland was 32.1% (95% confidence interval: 21.2-44.0). It was more prevalent in cadaveric studies (35.8%) than in computed tomography studies (21.5%), had a higher prevalence in Asia (33.8%) as compared to North America (23.5%), and when present, it was most often found as an unilateral structure (77.8%). CONCLUSIONS: With respect to the findings presented, the accessory parotid gland may be considered an anatomical variation likely to encounter in the population. More anatomical studies on the structure and its prevalence are needed, in all regions of the world, to provide a representative global overview.

The gastrocnemiofibular ligament: A new, more anatomically accurate name for the fabellofibular ligament-An original magnetic resonance imaging study and meta-analysis.

INTRODUCTION: The fabellofibular ligament (FFL) is a component of the posterolateral corner (PLC) of the knee and is an anatomically variable static stabilizer. Several investigations have reported prevalence rates for the FFL among their subjects, but no overall prevalence rate has been reported. MATERIALS AND METHODS: We conducted a meta-analysis of all relevant studies reporting prevalence rates of the FFL according to PRISMA and AQUA guidelines and pooled prevalence data using MetaXL 5.3. We also conducted a retroactive magnetic resonance imaging (MRI) study of 100 knees to assess FFL and fabella prevalence. RESULTS: Twenty-one studies (from 18 articles) and our MRI data were used in this meta-analysis (n = 1,176 knees). The pooled prevalence estimate (PPE) for FFL absence was 37.4% (95% confidence interval [CI], 24.5-51.3%). When divided by continent, PPEs of FFL absence were 31.5% (95% CI, 1.4-72.7%), 58.2% (95% CI, 44.1-71.6%), and 29.0% (95% CI, 14.7-45.7%) for North American, European, and Asian subjects, respectively. Cadaveric and MRI studies showed PPEs of FFL absence of 31.5% and 49.7%, respectively. Our MRI results showed PPEs of FFL and fabella absences of 42.0 and 80.0%, respectively. CONCLUSIONS: Understanding prevalence rates and anatomical geometry of the FFL will assist surgeons in repairing PLC injuries. Our MRI data and previous studies suggest the FFL is frequently present in knees lacking a fabella. Based on the observations of this study, we propose the ligament be renamed the gastrocnemiofibular ligament.

The superficial temporal artery: A meta-analysis of its prevalence and morphology.

INTRODUCTION: The superficial temporal artery (STA) is a terminal branch of the external carotid artery. It supplies the regions of scalp and face. The morphometrical data concerning STAs are not consistent; therefore, in this systemic review and meta-analysis, we aimed in this to provide an up-to-date data on its anatomic features. MATERIAL AND METHODS: In order to do this, PubMed, Embase, ScienceDirect, and Web of Science were searched. We followed the Preferred Reporting Items and Review and Meta-Analyses guidelines for the meta-analysis. Studies that reported the prevalence and anatomical data regarding STA were included in further analyses. RESULTS: Out of 1,446 studies initially evaluated, 21 were included in the meta-analysis (874 patients/donors). The STA diameter was 1.5 mm (95% confidence interval [CI]: 1.47-1.53 mm). The frontal and parietal branches of the STA were present in 97.6% (95% CIs: 94.6-99.5%) and 96.4% (95% CIs: 93.5-98.5%) of the cases, respectively. The STA bifurcation point was located above the zygomatic arch in 79.1% (95% CI: 68.0-84.3), below the zygomatic arch in 6.7% (95% CI: 2.4-12.1), and on the zygomatic arch in 11.1% of the cases (95% CI: 5.4-17.5). There was no bifurcation of the STA in 3.1% of the cases (95% CI: 0.4-7.3). CONCLUSION: The most comprehensive analysis of STA morphological features is presented. The results from this evidence-based anatomical study will improve understanding of the clinical STA anatomy, which in turn has major implications for understanding the STA in clinical practice.

Prevalence, morphology, and morphometry of the pterygospinous bar: a meta-analysis.

PURPOSE: The purpose of the study was to analyze the total prevalence, morphologic, and morphometric characteristics of the pterygospinous (PS) bar and its gender and ethnic differences among populations. PS bar is an ossified anatomic structure stretching between the posterior margin of the lateral pterygoid lamina to the angular spine of the undersurface of the sphenoid, with potential clinical implications. There is no consensus in the literature on its prevalence, morphologic, and morphometric characteristics. METHODS: A thorough search of databases was conducted. Data on the prevalence, morphology, i.e., ossification type (complete and incomplete), side, gender, laterality, and morphometrics, of the PS bar were extracted and pooled into a meta-analysis. RESULTS: A total of 35 studies (n = 14,047 subjects) were analyzed. The overall pooled prevalence of a complete PS bar was 4.4% (95% CI 3.7-5.1), while the overall pooled prevalence of an incomplete PS bar was significantly higher (11.6% [95% CI 8.5-15.2]). A complete PS bar was more prevalent among males and was more commonly unilaterally, on the left side. CONCLUSION: The overall prevalence of PS bar is quite common. It could be of importance for clinicians who should consider its potential presence when planning surgical approaches to the retropharyngeal and parapharyngeal space.

Oblique incisions in hamstring tendon harvesting reduce iatrogenic injuries to the infrapatellar branch of the saphenous nerve.

PURPOSE: Iatrogenic injury to the infrapatellar branch of the saphenous nerve (IPBSN) is associated with many surgical interventions to the medial aspect of the knee, such as anterior cruciate ligament (ACL) reconstruction. Different types of surgical incisions during hamstring tendon harvesting for ACL reconstruction are related to a variable risk of IPBSN injury. This study aimed to evaluate the risk of iatrogenic IPBSN injury during hamstring tendon harvesting for ACL reconstruction with different incision techniques over the pes anserinus. METHODS: This study was performed on 100 cadavers. Vertical, horizontal, or oblique incisions were simulated on each cadaveric limb to determine the incidence of iatrogenic IPBSN injury. RESULTS: The vertical incision caused the IPBSN injury during hamstring tendon harvesting in 101 (64.7%), the horizontal incision in 78 (50.0%), and the oblique incision in 43 (27.6%) examined lower limbs. The calculated odds ratios (OR) for risk of injury in vertical versus horizontal and horizontal versus oblique incisions were 2.4 (95% CI 1.5-3.6) and 1.8 (95% 1.2-2.8), respectively. CONCLUSIONS: The vertical incision technique over the pes anserinus should be avoided during hamstring tendon harvesting for ACL reconstruction. The adoption of an oblique incision, with the shortest possible length, will allow for the safest procedure possible, thus minimizing the risk of iatrogenic IPBSN injury, and improving patient outcomes and postoperative quality-of-life.

Incidence of Foramen Tympanicum (of Huschke): Comparing Cadaveric and Radiologic Studies.

PURPOSE: The foramen tympanicum (FT) represents a developmental anomaly that forms due to incomplete fusion of processes of the tympanic ring. Its presence in the population is controversial and it has been associated with a number of otologic complications. The aim of this study was to systematically analyze the prevalence, anatomical characteristics, and ethnic variations of the FT and compare these parameters in cadaveric and radiologic studies. METHODS: An extensive search was conducted through the major electronic databases, and identified articles were separated into 2 groups based on their methodology: cadaveric and radiologic studies. Data extracted included study modality, prevalence data, ethnicity, gender, side, laterality, and diameter. RESULTS: A total of 8 studies (n = 2671 patients) were included into our meta-analysis. The main findings revealed that the prevalence of the FT in the population is 14.9%, it is more often unilateral (62.5%) than bilateral (37.5%), it is most often reported in Asia (21.4%), and it is more prevalent in cadavers (21.2%) than in radiologic studies (8.8%) (not statistically significant). CONCLUSION: As the FT is present in more than one-tenth of the population, it is important to consider the possibilities of its presence when undertaking surgical procedures in the temporomandibular joint and ear region and plan accordingly to avoid injuries. Clinicians should keep it as one of the possible diagnoses while confronted with patients presenting with otologic complications. The use of newer imaging techniques was recommended, such as cone-beam computer tomography to detect the FT prior to surgery.

Internal and external morphology of mandibular molars: An original micro-CT study and meta-analysis with review of implications for endodontic therapy.

The aim of this radiological micro-CT study and meta-analysis was to determine the morphological features of the root canal anatomy of the mandibular molars. The radiological study included micro-CT scans of 108 mandibular first, 120 mandibular second, and 146 mandibular third molars. For our meta-analysis, an extensive search was conducted through PubMed, Embase, and Web of Science to identify articles eligible for inclusion. Data extracted included investigative method (cadaveric, intraoperative, or imaging), Vertucci type of canal configuration, presence/number of canals, roots, apical foramina, apical deltas, and intercanal communications. In the mesial roots of mandibular molars, the most frequent Vertucci type of canal configuration was type IV, except for the mandibular third molar where type I was most common. Type I was most common in the distal root. There were usually two canals in the mesial root and one in the distal root. Two was the most common number of roots, and a third root was most prevalent in Asia. One apical foramen was most common in the distal root and two apical foramina in the mesial root. Intercanal communications were most frequent in the mesial root. Knowledge of the complex anatomy of the mandibular molars can make root canal therapy more likely to succeed. We recommend the use of cone-beam computed tomography before and after endodontic treatment to enable the root anatomy to be accurately described and properly diagnosed, and treatment outcome to be assessed. Clin. Anat. 31:797-811, 2018. © 2018 Wiley Periodicals, Inc.

Clinical anatomy of the human Achilles subtendons twist - meta-analysis.

PURPOSE: This study aimed to provide a comprehensive and current overview of the anatomy of the Achilles tendon (AT) twisted structure, as there is a discrepancy in the literature regarding its rotating morphology. METHODS: An extensive literature search was conducted across multiple databases to identify all studies that reported relevant data on the AT torsion, with no date or language restrictions applied. Data was extracted and assessed for this meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of the included articles was examined using the anatomical quality assessment (AQUA) tool. RESULTS: Seven articles (n=690 limbs) were pooled into this meta-analysis. The prevalence of Achilles tendon torsion types was as follows: type II was the most common (46.7%, 95% CI: 31.6-60.9%), followed by type I (44.7%, 95% CI: 29.8-59.0%), and least commonly, type III (8.6%, 95% CI: 1.8-18.8%). Additionally, morphometric analysis, utilizing the method described by van Gils et al., revealed a mean Achilles tendon torsion of 46.5° (95% CI: 25.1-67.9°). CONCLUSIONS: This meta-analysis underscores the prominent and variable twist within the Achilles tendon among individuals, emphasizing the inherent diversity in AT morphology. Furthermore, the study highlights the importance of considering torsion angle as a potential factor influencing AT pathologies and biomechanical function.

Clinical anatomy of the popliteal artery and its implications in total knee arthroplasty: a systematic review and meta-analysis.

The popliteal artery (PA) is a lower extremity arterial vessel, a continuation of the superficial femoral artery. PA may be injured in the majority of total knee arthroplasty (TKA), as well as arthroscopic surgeries which may lead to acute ischemic injury. Our objective was analyzing morphometry of PA in relation to other structures both in flexion and extension of the knee, highlighting discrepancies in the PA's location in varying positions. Literature was reviewed in regards to morphological qualities, prevalence rates, and variants of PA were pooled. Five cadaveric and 14 radiological studies were included, totalling 1473 lower limbs. We found that PA, when nearing bone, was more predictable and fixed as seen in axial plane one and two centimeters distal to joint line at 0 degrees flexion. The distance between PA and posterior tibial cortex was estimated at 3.3 mm with 95% confidence interval (CI) 2.6-4.1 and 7.8 mm (95% CI 5.1-10.5) respectively. Once PA passed over and nearing the joint it had larger discrepancies with distance comparing the knee in 0 vs 90 degree flexion. Due to rise of TKA, arthroscopic surgeries and connected vascular complications PA has been investigated more frequently, and while majority of publications describes relationships between vessels of popliteal area and specific landmarks conducted with knee in extension, our study also implemented data regarding knee flexion thus encompassing the problem in a more dynamic manner. We believe this provides superior data for identification of PA, especially during knee surgery.

The meta-analysis and systematic review of prevalence and clinical anatomy of the arc of Buhler.

The arc of Buhler (AOB) is a direct anastomosis of the celiac axis and superior mesenteric artery. This paper reviews the literature on the AOB and provides accurate and up-to-date data on its prevalence, anatomy, and clinical significance. The main scholarly online databases were carefully searched for relevant studies related to the AOB. Information was gathered and formed the basis of the analysis of this study. In total, 11 studies were used in this meta-study, consisting of 3685 total patients tested and 50 cases of the AOB presented. The pooled prevalence estimate of the AOB was determined to be 1.7% (95% CI 0.9, 2.9). By imaging type, the prevalence of the AOB was 1.8% for radiological studies (n = 3485; 95% CI 0.9, 3.0), 1.4% for computed tomography (CT) studies (n = 1417; 95% CI 0.4, 3.0), and 1.9% for angiography studies (n = 2068; 95% CI 0.5, 4.0). The AOB is sufficiently significant and should be considered when planning surgeries or radiological procedures involving the abdomen.