Standardized statement for the ethical use of human cadaveric tissues in anatomy research papers: Recommendations from Anatomical Journal Editors-in-Chief.

Human cadaveric donors are essential for research in the anatomical sciences. However, many research papers in the anatomical sciences often omit a statement regarding the ethical use of the donor cadavers or, as no current standardized versions exist, use language that is extremely varied. To rectify this issue, 22 editors-in-chief of anatomical journals, representing 17 different countries, developed standardized and simplified language that can be used by authors of studies that use human cadaveric tissues. The goal of these editor recommendations is to standardize the writing approach by which the ethical use of cadaveric donors is acknowledged in anatomical studies that use donor human cadavers. Such sections in anatomical papers will help elevate our discipline and promote standardized language use in others non anatomy journals and also other media outlets that use cadaveric tissues.

Three-dimensional reconstruction of the orbital retrobulbar vasculature.

PURPOSE: The retrobulbar orbital vasculature is known to be complex and variable between individuals. This study aimed to produce a method to map the retrobulbar vessels, to generate 3D reconstructions, to visualise and to improve our understanding of their complexity. METHODS: Five human orbits donated under the Human Tissue Act (2004) were fixed in formalin, decalcified in 10% formic acid, and dehydrated in acetone at -20°C. Specimens were impregnated with epoxy resin, cured, and cut into 0.3 mm sections. Sections were stained with Gomori's trichrome stain, imaged, and reconstructed using 3D reconstruction software (BioVis3D, version 3.1). RESULTS: The arterial system was reconstructed in all five specimens. The superior ophthalmic vein (SOV) and the central retinal vein (CRV) were reconstructed in four specimens. E12 sheet plastination showed excellent results for histological analysis at a macroscopic level; however, anatomical topology was not entirely preserved on a microscopic level. Gomori's trichrome stain gave excellent results in highlighting axial sections of the arterial walls and their tunics, including finer calibre vessels, thus allowing detailed reconstruction of the arterial vasculature. Miller's stain for elastin showed poor results in differentiating vessels from soft tissue; venous vasculature was poorly identified with both stains. CONCLUSIONS: This study provided a detailed anatomical model of the retrobulbar orbital vascular system, a method that can be used for further studies to form a database relating to the topography of the arterial system. These models may be employed for teaching, and possible surgery planning, for both trainees and ophthalmic surgeons.

The effect of stretching exercises on the fibre angle of the vastus lateralis and vastus medialis oblique: an ultrasound study.

[Purpose] To investigate the effects of a seven-week quadriceps stretching program on the muscle fibre orientation of the vastus medialis oblique and vastus lateralis in the lower limbs by ultrasound imaging. [Participants and Methods] Twenty-seven healthy, physically fit, asymptomatic females and males (age 21.5 ± 1.3, Tegner activity level score ≥4) were recruited. Their initial vastus medialis oblique and vastus lateralis fibre angles were determined using ultrasound. They then undertook a seven-week quadriceps stretching program, 3 sets of stretches to be performed on both lower limbs, 3 times a week on 3 separate days. One volunteer was assigned as an intra-rater control and did not take part in the stretching program. The vastus lateralis and vastus medialis oblique fibre angles were measured again on completion of the exercise regime. [Results] A statistically significant decrease in muscle fibre angle was observed in both the right and left vastus medialis oblique, and the right and left vastus lateralis. [Conclusion] A 7-week stretching program can result in a significant decrease in muscle fibre angle in both the vastus medialis oblique and the vastus lateralis. This can help in understanding the effects of prescribed stretching exercises on athletic patients with PFP.

The innominate tubercle of the femur is a consistent surgical landmark and shows no variation between sex and side: An osteological study.

INTRODUCTION: During direct anterior approach hip arthroplasty, the innominate tubercle (IT) of the femur is used as a reference point for femoral neck osteotomy. A recent study found that IT dimensions are unaffected by femoral length, neck-shaft angle, and neck length. This study investigated the position of the tubercle relative to femoral side, sex and femoral neck dimensions. MATERIALS AND METHODS: One hundred and ninety femora (95 pairs, complete with biographical data) from St. Bride's Church, London, were photographed with the apex of the tubercle marked. Using imaging software, axes were superimposed onto the image, allowing the X and Y co-ordinates of the tubercle apex to be derived. Statistical analysis was carried out. RESULTS: The position of the tubercle did not vary significantly and did not correlate with femoral side (p > .05). P values for variation of the X and Y coordinates were 0.351 and 0.996 in left and right femora, respectively. The tubercle position did not vary significantly with sex (p > .05). p Values for variation of the X and Y coordinates were 0.254 and 0.634 in males and females, respectively. There was little variation between tubercle position and femoral neck dimensions: correlation coefficient -0.20 (x coordinate) and -0.12 (y coordinate). CONCLUSIONS: The data showed that the position of the IT did not vary significantly with either sex or side and that, therefore, the tubercle can be considered a reliable surgical landmark during arthroplasty surgery.

Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors.

Research within the anatomical sciences often relies on human cadaveric tissues. Without the good will of these donors who allow us to use their bodies to push forward our anatomical knowledge, most human anatomical research would come to a standstill. However, many research papers omit an acknowledgement to the donor cadavers or, as no current standardized versions exist, use language that is extremely varied. To remedy this problem, 20 editors-in-chiefs from 17 anatomical journals joined together to put together official recommendations that can be used by authors when acknowledging the donor cadavers used in their studies. The goal of these recommendations is to standardize the writing approach by which donors are acknowledged in anatomical studies that use human cadaveric tissues. Such sections in anatomical papers will not only rightfully thank those who made the donation but might also encourage, motivate, and inspire future individuals to make such gifts for the betterment of the anatomical sciences and patient care.

Ultrasound investigation into the relationship between hip adduction and the patellofemoral joint.

[Purpose] Patellofemoral pain (PFP) is a common musculoskeletal complaint. It has been suggested that hip adduction creates a load on the iliotibial band and causes lateral displacement of the patella (patella tilt). However, data gathered in a previous study were derived from a small sample of males, while the condition predominantly affects females. We assessed the relationship between hip adduction and patellar position with a larger sample size, including males and females. [Participants and Methods] Forty healthy, asymptomatic females and males (age 21.5 ± 1.3 years) were recruited. Their knees were passively flexed by 20°. Using ultrasound, the distance between the lateral edge of the patella and the lateral condyle of the femur was measured in the neutral position and at 20° adduction. [Results] Hip adduction produced a smaller patella-lateral femoral condyle measurement than in the neutral position. The mean difference in the patella-condyle distance between the neutral position and 20° hip adduction was 0.18 cm. No statistically significant difference was found between the right and left limbs, genders, Tegner scores, or BMI of the study participants. [Conclusion] The results of the study showed that hip adduction causes lateral displacement of the patella. Ultrasound is an effective means of assessing patella tilt.

Rare Variant of Vastus Medialis Detected in vivo by Ultrasound and Confirmed by High-resolution MRI.

[Purpose] This report describes an unusual incidental finding during ultrasound investigation of the vastus medialis muscle. Volunteers underwent ultrasound scanning as part of an on-going investigation into the architecture of the vastus medialis muscle. [Subjects and Methods] The distal thighs of forty-one subjects were scanned using the Philips iU22 US system. An unusual muscle morphology was detected bilaterally in one subject, who then underwent a 3T Magnetic Resonance Imaging (MRI) scan in order to further investigate the muscle morphology. The subject in question was a 32 year-old female who suffers from recurrent bilateral patellar dislocations. [Results] The MRI scan confirmed the ultrasound findings, and indicated the presence of the vastus medialis in two layers, with the VML continuing deep, separate from the VMO. [Conclusion] Although this rare variant has been been reported in previous cadaveric studies, we believe this to be the first report in the literature of this morphology in vivo. The biomechanical implications of this muscle arrangement are unknown, but it may not be without significance that this individual suffers from recurrent patellar dislocations.

Supraorbital notch and foramen: positional variation and relevance to direct brow lift.

PURPOSE: Forehead paresthesia after brow lift is well-documented with rates as high as 40.7%. The authors describe an anatomical study to identify the variation in position of the supraorbital notch/foramen to define safe limits for deep dissection during this procedure. METHODS: Sixty-six orbits from 23 dry skulls and 9 formalin-fixed cadavers were analyzed photographically using ImageJ software. The cadaveric specimens were dissected using a coronal incision, which allowed the inferior resection of the frontalis muscle and periosteum. The exit point of the supraorbital neurovascular bundle was noted as a foramen or notch. The position of the supraorbital notch or foramen was recorded in relation to the midline as defined by the sagittal suture at the level of the highest point of the supraorbital rim. The distance and angle for each foramen/notch were calculated. RESULTS: Thirty-three percent of orbits had a foramen. The average distance from the midpoint to the foramen was 25.24 mm (standard deviation 3.78 mm) and to the notch was 22.69 mm (22.69 mm). The range of distance between the midpoint and the foramen/notch was 17.62 to 32.35 mm. The average angle between the horizontal meridian and the foramen was 81/57° (standard deviation 4.69°). CONCLUSIONS: A wide variation in anatomy was seen. Greater caution is required when performing deep dissection around the supraorbital notch because of the variation in position of the supraorbital foramen.

Lessons from the past: cribra orbitalia, an orbital roof pathology.

AIMS: To define a computed tomography protocol that may be used in future clinical practice for the reliable detection and analysis of cribra orbitalia. MATERIALS AND METHODS: Two osteological assemblages from the Museum of London were used to select 13 cribratous skulls and 5 non-cribratous skulls. Area of cribra orbitalia was measured using image analysis. Morphology of cribra orbitalia, orbital roof density and the associated optic canal diameter was analysed using computed tomography reconstructions. RESULTS: The presence of cribra orbitalia was associated with changes in the internal diploë layer as well as the cortical bone table. A novel radiological grading system and protocol was developed to identify the pathology. A decrease in the orbital roof density by 210 Hounsfield units and a reduction in the optic canal diameter, up to 1 mm, were found to be associated with the presence of cribra orbitalia. CONCLUSIONS: The occurrence of cribra orbitalia is found to be associated with stenosis of the optic canal, and could explain a proportion of cases ofoptic nerve entrapment. This study provides a guideline for radiologists and oculoplastic surgeons to help detect the presence of cribra orbitalia in suspected patients.

A cadaveric study of the morphometric relationships and bony composition of the caucasian nasolacrimal fossa.

AIMS: To describe the morphometric relationships and bony composition of the nasolacrimal fossa in a Caucasian population with particular reference to the lacrimo-maxillary suture (LMS). METHODS: Forty-seven orbits from 24 formalin fixed cadavers were exenterated. Morphometric measurements were taken between anatomical landmarks forming the lacrimal fossa on the medial orbital wall. RESULTS: The mean recorded distance from the anterior lacrimal crest (ALC) to the posterior lacrimal crest (PLC) and the LMS were 8.8 mm (± 1.6) and 4.3 mm (± 1.1), respectively. In 25.5% of the orbits the LMS was at the mid-vertical line (MVL), defined as a line equidistant from the ALC and PLC. In 42.5% the LMS was located anterior to the MVL toward the ALC. In 66% of the orbits the LMS was at or within one standard deviation (SD) of the MVL. The LMS was >1 SD away from the MVL toward the ALC and PLC in 19% and 15% of orbits, respectively. CONCLUSIONS: In a quarter of the orbits in our Caucasian population the nasolacrimal fossa was formed equally by the maxillary and lacrimal bones. However, in nearly a third of the cases the LMS was located closer to the PLC, indicating predominance of the thicker maxillary bone. This may result in greater difficulty in initiating the surgical osteotomy when performing a dacryocystorhinostomy. These data contribute to our understanding of the variation in lacrimal fossa anatomy and encourage further studies in different racial groups.

Ultrasound Measurement of Lateral Patellar Displacement: A Cadaveric Validation Study.

Background: Patellofemoral pain syndrome (PFPS) is one of the most common musculoskeletal complaints seen in outpatient settings. It has been suggested that hip adduction creates loads on the iliotibial band and causes lateral displacement of the patella (patellar tilt), which can lead to uneven patellofemoral joint loading, and hence, cause patellofemoral pain. In previous studies in the literature, ultrasound has been used to measure lateral patellar displacement. However, the method lacks validity data. Purpose/Hypothesis: The aim of this study was to validate the use of ultrasound to measure lateral displacement of the patella, by comparing the position of the patella as measured first by ultrasound, and then by direct measurement. Study Design: Descriptive Laboratory Study. Methods: Nine soft-fixed cadavers were used in this study. The cadavers had been donated for anatomical examination and research under the Human Tissue Act (2004). The distance between the lateral femoral condyle and the lateral edge of the patella were measured by B-mode real-time ultrasound, and then by direct measurement, in two positions, neutral and at 20° hip adduction. Results: The mean difference in the patella-to-lateral femoral condyle distance in the neutral position and at 20° adduction was 0.27 cm (ultrasound), and 0.34 cm (direct measurement), respectively. There were no significant differences between the measurements obtained by US and by direct measurement (Pearson correlation= 0.97, p=0.83). Conclusion: Ultrasound is a valid and reliable method for measuring patellar position relative to the femoral condyle, and the validity data reported here suggest that it can be used with confidence in clinic to assess lateral patellar displacement. Level of Evidence: 3.

The Effect of Self-Myofascial Release on the Pennation Angle of the Vastus Medialis Oblique and the Vastus Lateralis in Athletic Male Individuals: An Ultrasound Investigation.

Background: Maintenance of patellar stability requires a balance between the vastus medialis oblique (VMO) and the vastus lateralis (VL). The imbalance between these muscles is thought to be implicated in the etiology of patellofemoral pain (PFP). Where there is hypertrophy of the VL in PFP patients, self-myofascial release (SMR) may be utilized for its management. However, there is no current evidence regarding SMR and its effects on VMO and VL architecture. The aim of this study, therefore, was to use ultrasound to gain further understanding of the effects of a program of SMR on the fiber angles of the VMO and VL. Hypothesis: There will be a significant decrease in the pennation angles of the VMO and VL after seven weeks of SMR using a foam roller. Study Design: Cohort Study. Methods: Twenty-five young, athletic, male participants were recruited to use a foam roller, along the full length of both anterior thighs, three times weekly, on three separate days, for seven weeks. Ultrasound was used to determine the initial and final VMO and VL pennation angles on both limbs. One eligible participant was chosen as an intra-rater control and did not partake in the SMR regimen. Results: There was a statistically significant (p < 0.001) decrease in the pennation angles of the VMO and VL after the SMR regime. Mean combined right and left VL angle change was -6.65° (-18% mean change) and the mean combined right and left VMO angle change was -7.65° (-11.5% mean change). A weak negative correlation was found between initial VMO fiber angle and the angle change (Rsquared = -0.21), as well as moderate negative correlation for the VL (Rsquared = -0.51). Conclusion: A program of SMR on the anterior thighs of young, asymptomatic males resulted in changes to the fiber angles of both the VMO and VL. There was a significant decrease in pennation angle after seven weeks of SMR using a foam roller.

A cadaveric study of the morphometric and geometric relationships of the orbital apex.

INTRODUCTION: To define the morphometric and geometric relationships which exist at the orbital apex. MATERIALS AND METHODS: Forty-seven orbits from twenty-four formalin-fixed Caucasian cadavers were exenterated and the relevant sutures, fissures and foramina identified. Measurements were taken from the optic canal to anatomical landmarks located along the medial wall, inferior wall and lateral wall of each orbit. Based on the mean results the geometric angles between the different anatomical structures were calculated and used to create three-dimensional models. RESULTS: The mean distances from the midpoint of the optic canal to the superior orbital fissure, inferior orbital fissure and anterior ethmoidal foramen were 10.22 mm, 29.56 mm and 21.65 mm, respectively. The mean distances from the anterior ethmoidal foramen to the superior and inferior orbital fissures were 24.27 mm and 31.93 mm, respectively. The mean distance between the tips of the superior and inferior orbital fissures was 27.70 mm. The mean distances directly from the tips of the superior and inferior orbital fissures and the anterior ethmoidal foramen to the orbital rim were 39.23 mm, 17.11 mm and 18.94 mm, respectively. These values were used to calculate geometric values and create three-dimensional models. DISCUSSION: The orbital apex is a congested structure and the practicing orbital surgeon must have an intimate knowledge of its contents. We have presented novel data, which in conjunction with radiology may be used as both a navigational aid to plan orbital surgery and to guide the surgeon intraoperatively to assess proximity to key anatomical structures.

Morphometric and geometric anatomy of the caucasian orbital floor.

INTRODUCTION: To describe the morphometric and geometric relationships of the orbital floor in a Caucasian population. MATERIALS AND METHODS: Exenterations of 47 orbits from 24 formalin fixed cadavers were performed. Morphometric measurements were taken between anatomical landmarks located along the orbital floor and the orbital apex. The mean measurements were used to calculate geometric data. These results were analysed according to sex and side and compared to results from other ethnic populations. RESULTS: The average distances from the infraorbital foramen to the nasolacrimal fossa, inferior orbital fissure, optic canal and inferior orbital rim were 20.67 mm (± 2.42), 25.40 mm (±2.70), 43.23 mm (±3.35) and 8.95 mm (± 1.53), respectively. The average distances from the tip of the infraorbital groove to the tip of the inferior orbital fissure, lateral aspect of the inferomedial strut, optic canal and the intersection with the inferior orbital fissure were 14.08 mm (±2.41), 12.12 mm (±2.42), 35.02 mm (±3.17) and 20.05 mm (± 2.87), respectively. The distances from the tip of the inferior orbital fissure to the optic canal and the intersection with the inferior orbital groove were 29.56 mm (±2.73) and 13.37 mm (±2.76), respectively. DISCUSSION: Orbital surgeons should be aware of the morphometric relationships of the orbital floor due to the degree of variation that exists between different ethnic groups. Geometric data may be used to provide orbital surgeons with a navigational template that can be used to plan surgery and as a guide intraoperatively.

Anatomical basis of the support of fibula to tibial plateau and its clinical significance.

BACKGROUND: The fibula is only indirectly involved in the composition of the human knee joint and has therefore been neglected in the research on knee osteoarthritis. Nonuniform settlement of the proximal tibia plateau is clinically defined as when the height of the medial tibial plateau is lower than that of the lateral side in medial compartment knee osteoarthritis (KOA). The non-uniform settlement of the proximal tibia plateau may be caused by fibular support on the lateral side. Orthopedic surgeons practice partial fibulectomy based on the clinical manifestation of nonuniform settlement, and this technique has been shown to reduce pain and improve function in patients with medial compartment KOA. However, this hypothesis of the mechanism of nonuniform settlement lacks an anatomical basis. METHODS: The P45 polyester plastination technique was used to prepare sections of the proximal tibiofibular joint to investigate the distribution of the bone trabeculae in the region of the lateral tibial plateau. RESULTS: There was uneven distribution of trabeculae in the lateral condyle of the tibia and the head and neck of the fibula. The fibula and the posterolateral cortex of the shaft of the tibia united to form an arch beam via the tibiofibular joint. Many thick, dense trabeculae were present in a longitudinal direction above the tibiofibular arch. CONCLUSIONS: The fibula supports the lateral tibial plateau, and the trabeculae were concentrated above the tibiofibular arch.

The celebrated écorchés of Honoré Fragonard, part 1: The classical techniques of preparation of dry anatomical specimens in the 18th century.

The écorchés that Honoré Fragonard created between 1766 and 1771 have miraculously survived the ravages of time due to a technique of preparation which Fragonard never revealed. The present paper and a subsequent article aim to explain the classical methods used by anatomists of the 18th century (Part 1) and to throw light on the details of Fragonard's method (Part 2). Anatomists of the 18th century who wished to preserve their dissections used a method of mummification, which has now fallen into disuse: drying after immersion in alcohol. This article explains the stages of the classical method utilized by French anatomists of the Age of Enlightenment. The cadaver was selected with care before the vascular system was injected with a colored mixture of wax, animal fat, and plant resins. The body was then dehydrated by immersion in a bath of alcohol, after which it was removed and positioned by means of a wooden framework, which held the body in the desired pose while the alcohol evaporated. The vessels were painted, and finally the body was varnished.

The celebrated écorchés of honoré Fragonard, part 2: The details of the technique used by Fragonard.

It is remarkable that the famous écorchés of Honoré Fragonard have survived the centuries to reach us today. Studies carried out by several teams have established details of the technique used by Fragonard that help to explain their longevity. The injection of the vessels was achieved by means of a mixture of mutton tallow and pine resin diluted in essence of turpentine and essential oils. This gave Fragonard a very high success rate. Above all, he did not add pigments to his mixture while injecting the veins, and this facilitated the procedure. The vessels were painted after preservation to give them the vivid colors that we can still see today. Another detail that explains their exceptional conservation is that the varnish used by Fragonard was composed of Venice turpentine, made from larch resin and known to repel insects.

The International Society for Plastination.

The International Society for Plastination (ISP) was conceived as a means of defining plastination as an area of professional activity and serving as an agency for disseminating information relative to the art and science of plastination. In this paper, we present the purpose of ISP, the Journal of Plastination, the Plastination Index and the different international meetings organised by ISP.

The medial and lateral bellies of gastrocnemius: a cadaveric and ultrasound investigation.

It is commonly reported that the medial belly (MG) of the gastrocnemius muscle extends further distally than the lateral belly (LG). This observation is made in several standard anatomy texts with no explanation or quantitative data. In this study, the medial and lateral bellies of gastrocnemius in 45 embalmed cadavers were measured. The observed difference in length of the two bellies was found to be highly significant (mean difference in length = 1.74 cm, P < 0.001). In 8 out of 84 legs examined (9.5%), however, the MG was found to be shorter than the LG (three right legs, five left legs, bilateral in two individuals). Surprisingly, there was no correlation between the difference in muscle belly length in any individual and ipsilateral leg length or total body length, suggesting that the difference in belly length may be unrelated to biomechanical function. An ultrasound investigation into the activity pattern of the two bellies was carried out on five volunteers. Muscle activity was monitored during passive and active movements of the ankle and knee joints at different leg positions. During knee flexion and ankle plantarflexion, the LG contracted first in four of the five subjects, followed by the MG, then a period of either LG predomination or equal contraction. The fifth subject, who showed a reversed pattern of activity, had previously suffered an inversion injury of the ankle. We suggest that the initial activation of the LG may help to stabilize the ankle during plantarflexion. We found no evidence that gastrocnemius acts as a shunt muscle during distraction of the knee.