Thickness and width of the menisci of adult knee joint: a descriptive cross-sectional observational study in cadavers.

Background: The goal was to determine the thickness and width of the knee joint meniscus at their different regions. The objective was to compare the dimensions at these regions and over the right- and left-sided specimens. Methods: The present study included 50 adult cadaveric knee joints, and 100 menisci (50 medial menisci and 50 lateral menisci) were studied. The meniscus was distributed into anterior, middle and posterior parts. Thickness and width at the mid-point of these three parts were determined by using the Vernier caliper. Results: The breadth of the medial meniscus was 8.38 ± 1.64 mm, 7.68 ± 1.92 mm and 13.93 ± 2.69 mm at the anterior, middle and posterior one-third regions. Same measurements for the lateral menisci at these regions were 9.84 ± 1.78 mm, 8.82 ± 2.01 mm and 10.18 ± 2.23 mm, respectively. The thickness of the medial meniscus was 4.49 ± 0.78 mm, 4.07 ± 0.81 mm and 4.79 ± 0.93 mm at these regions. The lateral meniscus thickness was 3.82 ± 0.69 mm, 4.43 ± 0.98 mm and 4.36 ± 0.8 mm, respectively. Conclusion: It is believed that this data is enlightening to the arthroscopic surgeon during the meniscus transplantation either by using synthetic material or allograft as the proper sizing of the meniscus is important to prevent complications due to inaccurate sizing.

Dimensions of pes anserinus of the lower extremity, an anatomical study with its surgical implications.

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.

Exploring the Morphology of Anterior Interosseous Nerve and Relating It to Its Clinical Conditions.

AIM: To study topography and variability in the origin of anterior interosseous nerve; to identify the branching pattern of the anterior interosseous nerve supplying the flexor digitorum profundus, flexor pollicis longus, and pronator quadratus muscles. MATERIAL AND METHODS: The present study included 70 formalin-fixed upper limbs of adult human cadavers. The origin of the anterior interosseous nerve was categorized into 3 types. The morphometric data obtained in this study were represented as mean± SD and the dimensions were given in millimeter. The measurements were compared statistically by using 'EZR software, version 1.38, 2019'. The 'paired t-test' was applied and the 'p' value less than 0.05 was considered as statistically significant. RESULTS: It was observed that the origin of the anterior interosseous nerve was extremely variable. It was ranging from the midepicondylar point of the elbow joint up to as below as 86mm from it. The distance of its origin from the midpoint of the pronator teres muscle ranged between 70 mm above the pronator teres muscle to 22 mm below it. In one of the forearms, the median nerve supplied the medial two tendons of the FDP, instead of the ulnar nerve. CONCLUSION: The present study provided additional information about the origin, topography, and distribution of the anterior interosseous nerve. The data will provide further insight into the causes of nerve compression syndromes. It will also help in planning the surgical approach into the distal humerus, elbow joint, and proximal ends of radius and ulna, without causing any nerve injury.

Anatomical dimensions of the typical cervical vertebrae and their clinical implications

The aim of the present study was to study the dimensions of various parts of the typical cervical vertebrae in anatomical samples. This study included 100 cadaveric dried typical cervical vertebrae, which were obtained at the osteology sec-tion. This study lacks the information on sex and chronological number of cervical vertebrae being studied. The dimensions of different parts of vertebrae like the body, pedicle, spinous process, laminae and articular facets were measured. The data of the right and left sides were statistically analysed by using the software 'EZR' (version 1.38, 2019). The shapes of the superior and inferi-or articular facets were macroscopically observed. The mean height of the typical cervical vertebra was 10.92 ± 1.35 mm; the vertebral body antero-posterior length was 14.79 ± 1.96 mm and 15.56 ± 1.95 mm at the superior and inferior borders; the vertebral body transverse length was 23.22 ± 2.16 mm and 19.88 ± 2.38 mm at the superior and inferior borders respectively; the spinous process length was 15.25 ± 4.25 mm; the vertebral fora-men anteroposterior and transverse length were 12.33 ± 1.68 mm and 21.98 ± 1.82 mm respectively. The pedicle length was more (p > 0.05) at the right side than the left. In the remaining parameters of the paired structures, there was no statistically significant difference observed (p < 0.05). The morphometric data of the present study will enlighten the operating spine surgeon during procedures like internal fixation and decom-pression procedures of fracture spine. We believe that the surgical implants should be devised as per the morphometric data of the particular population

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Anatomical variations of the arrangement of structures at the pulmonary hilum: a cadaveric study.

PURPOSE: The aim was to study the anatomical variations of the arrangement of structures at the hilum of the lung. METHODS: The present study examined the hila of 110 cadaveric lung specimens of south Indian population. The anatomical variations of the arrangement of structures at the hilum were macroscopically observed. RESULTS: It was observed that the variations were higher in the left lung than in the right lung. The variations were observed in 16.1 % of right lungs and 48.2 % of the left lungs. There were some interesting anatomical variations like the two upper pulmonary veins, two pulmonary artery, two bronchi in the hilum of the left lung, three bronchi, four pulmonary veins and four bronchi. The present study was compared with a similar study from the same geographical location. It was observed that the frequency of variations and the hilar morphology of the arrangement of structures differ among the two separate studies from south India. CONCLUSIONS: The observations of the present study suggest that the pulmonary hilar morphology is extremely variable.

Assessment of craniometric traits in South Indian dry skulls for sex determination.

The skeleton plays an important role in sex determination in forensic anthropology. The skull bone is considered as the second best after the pelvic bone in sex determination due to its better retention of morphological features. Different populations have varying skeletal characteristics, making population specific analysis for sex determination essential. Hence the objective of this investigation is to obtain the accuracy of sex determination using cranial parameters of adult skulls to the highest percentage in South Indian population and to provide a baseline data for sex determination in South India. Seventy adult preserved human skulls were taken and based on the morphological traits were classified into 43 male skulls and 27 female skulls. A total of 26 craniometric parameters were studied. The data were analyzed by using the SPSS discriminant function. The analysis of stepwise, multivariate, and univariate discriminant function gave an accuracy of 77.1%, 85.7%, and 72.9% respectively. Multivariate direct discriminant function analysis classified skull bones into male and female with highest levels of accuracy. Using stepwise discriminant function analysis, the most dimorphic variable to determine sex of the skull, was biauricular breadth followed by weight. Subjecting the best dimorphic variables to univariate discriminant analysis, high levels of accuracy of sexual dimorphism was obtained. Percentage classification of high accuracies were obtained in this study indicating high level of sexual dimorphism in the crania, setting specific discriminant equations for the gender determination in South Indian people.

The Paracondylar Skull Base: Anatomical Variants and Their Clinical Implications.

AIM: The knowledge of the vasculature around the paracondylar region is important in neurosurgical procedures such as the paracondylar and lateral supracondylar approaches. The objectives of the present study were to determine the prevalence of paracondylar emissary foramina in the adult skull bases and to study the morphology of condylar canals and hypoglossal canals. MATERIAL AND METHODS: The present study included 48 adult human skulls that were obtained from the gross anatomy laboratory of our institution. The paracondylar region was macroscopically observed for the variant foramina, canals and grooves. RESULTS: It was observed that the paracondylar emissary foramen was present in 16 skulls (33.3%). The foramen was found bilaterally in 7 skulls (14.6%) and unilaterally in 9 skulls (18.7%). The hypoglossal canal was single in 35 (72.9%) skulls, double in 11 skulls (22.9%), and triple in 2 skulls (4.2%). The paracondylar process (2.1%) and the paracondylar groove (2.1%) were seen in 1 skull each. The posterior condylar canal was found to be patent in 19 (39.6%) skulls. CONCLUSION: The present study observed that, the paracondylar emissary vein is not rare in occurrence as it is observed in 33.3% of cases. The identification of the paracondylar emissary veins and accessory vessels is important to avoid dangerous bleeding during the surgery. The morphological knowledge of the foramina around the paracondylar region is enlightening to the chiropractors, neurosurgeons and radiologists.

Morphological study of styloid process of the temporal bone and its clinical implications.

The objective of this study was to study the morphometry of the styloid process of temporal bone and prevalence of elongated styloid process. The morphology of elongated styloid process along with its embryological and clinical importance are discussed. The present study included 110 human dry skulls which were procured from the bone collections of the department of anatomy. The styloid process was observed macroscopically on both sides of all the skulls, the elongations if any were noted. All the styloids were measured for their length, thickness at different levels and interstyloid distance at various levels. Out of 110 specimens, only 5 skulls (4.5%) exhibited the elongated styloid process. Among them, 3 skulls (2.7%) had unilateral elongation and 2 skulls (1.8%) had bilateral elongation of the styloid process. The mean length of the styloid process was 17.8±9.3 mm and 18.2±5.6 mm for the right and left sides, respectively. The prevalence of elongated styloid process in the present study was 4.5%. The clinical anatomy of this congenital variant is important to the neurosurgeon and radiologist, while interpreting the computed tomogram and magnetic resonance image scans. The morphological knowledge of elongated styloid process is clinically important since the course of the vertebral artery may be distorted in such situations.

Arterial supply to the soleus muscle: an anatomical study with emphasis on its application in the pedicle flap surgery.

PURPOSE: To study the various patterns in the extra muscular part of arterial supply to the soleus muscle. METHODS: The study was carried out using 38 adult cadaveric lower limbs which were available from the Department of Anatomy of our institution. The vascular branches to the soleus were identified and traced till their point of entry into the soleus. These were considered as extramuscular branches (EMB) to the soleus. The distances of first and last branches from each artery were measured from the apex of head of fibula to their point of entry into the soleus and were expressed as proportion to the length of soleus. RESULTS: The present study observed that the soleus muscle is supplied by EMB of popliteal, posterior tibial and peroneal arteries. In 42.1% cases, there was no direct EMB from the popliteal artery to the soleus. The EMB of popliteal artery were located between 3.2 and 24.6% of the length of soleus. The EMB from the posterior tibial and peroneal arteries were located between 6.8-97.1% and 5.7-94.9% of the length of soleus, respectively. The proximal 25% of length of soleus received EMB from all the three arteries. CONCLUSIONS: The present study has provided additional information on the various patterns in the extra muscular part of arterial supply to the soleus muscle. This knowledge is important to the plastic and orthopedic surgeons while performing the pedicle flap surgeries. Our opinion is that the proximally based soleal muscle flaps are more beneficial in the surgical practice.

The anatomical variations in the neurovascular relations of the sphenoid sinus: an evaluation by coronal computed tomography.

AIM: The sphenoid sinus is deeply situated in the skull and is the least accessible paranasal sinus. The sphenoid sinus is surrounded by vital structures such as the optic nerve and internal carotid artery, and therefore additional radiological assessment of the sphenoid sinus and the related neurovascular structures is inevitable before surgery. The aim of this study was to note the anatomic variations in the relationship of these structures with the sphenoid sinus by analyzing the coronal computed tomography (CT) scans. MATERIAL AND METHODS: The consecutive coronal CT scans of 100 patients that included 43 males and 57 females were evaluated. RESULTS: Variations in the neurovascular boundaries of the sphenoid sinus were a common finding in the present study and were seen in as many as 66% of the cases. Variations involving the Vidian canal were the commonest in our study and were seen in around 42%, followed by those involving the bony canal for internal carotid artery, 33%; maxillary nerve, 21 % and optic nerve, 9%. CONCLUSION: These variations do not represent disease as such, but may increase the risk of endoscopic mishaps. CT of the paranasal sinus region is therefore an essential prerequisite prior to sinonasal and trans-sphenoidal surgeries.

Morphometric study of the medial orbital wall emphasizing the ethmoidal foramina.

PURPOSE: Ethmoidal foramina on the medial orbital wall show a higher incidence of variation. Surgeons performing endonasal, anterior cranial fossa and medial orbital wall surgeries must be aware of these variations as they are a source of hemorrhage and also serve as landmark in proximity to the orbital apex. AIM: The present study aims to describe the morphometric distances of various ethmoidal foramina between anterior lacrimal crest to optic canal in south Indian dry human skulls. MATERIALS AND METHOD: The study was done on 44 adult dry human skulls. The occurrence of Ethmoidal foramina was noted by direct inspection. The distance of Ethmoidal foramina from anterior lacrimal crest to optic canal was measured with the help of ruler, probe and magnifying glass. RESULTS: The Posterior ethmoidal foramina were found in all 44 skulls bilaterally. Middle ethmoidal foramen was present in 12 and 13 skulls on right and left, respectively. Anterior ethmoidal foramen was found in 38 and 37 skulls on right and left, respectively. The distance between anterior lacrimal crest (ALC) and posterior lacrimal crest (PLC) was in the range of 3-8 mm and that of ALC to anterior ethmoidal foramen was in the range of 24-30 mm. The range of distance between anterior ethmoidal foramen to posterior ethmoidal foramen was 9-17 mm and that between posterior ethmoidal foramen to optic canal was 5-13 mm. CONCLUSION: These observations would help to predict the anatomical variations in the position of ethmoidal foramina with respect to anterior and posterior lacrimal crest and ensure the safe and precise performance of medial orbital wall surgeries to avoid injuries to the important neurovascular bundles passing through various foramina and fissures.

Morphology and topography of the parietal emissary foramina in South Indians: an anatomical study.

The objectives of the present study were to study the prevalence of the parietal emissary vein in adult South Indian population and to study the distance of foramen from the sagittal suture. There were 58 adult human skulls in the present study which were available at the anatomy department of our institution. The study included 116 parietal bones which have been observed macroscopically for the number, prevalence and topography of the emissary foramen. The emissary foramen was present in 83 parietal bones (71.5%) of the present study. It was present at the junction between the middle 1/3 and posterior 1/3 region of the parietal bone. The foramen was observed solitary in 73 parietal bones (62.9%), double in 8 bones (6.9%), and triple in 2 parietal bones (1.7%). The foramen was not observed in 33 parietal bones (28.4%). The bilateral absence of parietal emissary foramen was seen in 7 skulls (12.1%). It was absent unilaterally in 19 skulls (32.7%). The accessory foramina were seen in only 8 skulls (13.8%). The mean distance of the foramen from the sagittal suture was 6.7±2.9 mm and 6.8±2.8 mm on the right and left sides respectively. The prevalence of parietal emissary vein in the present study was 71.5%. The present study has observed important data about the morphology and morphometry of the parietal emissary vein in South Indian population. The identification of parietal emissary veins and accessory veins is important in the operation room to prevent the blood loss.

Mastoid emissary foramina: an anatomical morphological study with discussion on their evolutionary and clinical implications.

The identification of mastoidal emissary veins is of importance in the neurosurgical practice to diagnose abnormal and normal structures. In the present study, the objectives were to estimate the prevalence rate of mastoidal emissary foramina in the temporal bones of the adult skull and to study their number and morphology. The present study included 48 adult human skulls which were obtained from the gross anatomy laboratory of our institution. The mastoid parts of 96 temporal bones were macroscopically observed for the prevalence, number and morphology of the emissary foramina. It is observed that, the mastoidal emissary foramen was present in 88 temporal bones (91.7%) of our specimens. The foramen was observed single in 60 temporal bones (62.5%), double in 22 bones (22.9%), and triple in 6 temporal bones (6.2%). The mastoidal emissary foramen was absent in 8 (8.3%) temporal bones. The foramen was bilaterally absent in 3 (3.1%) skulls. It was unilaterally absent in 2 (2.1%) skulls and both were on the left side. The mastoidal emissary vein is prevalent in a large number (91.7%) of cases. It was observed that the accessory mastoidal emissary foramina were present in 29.1% of cases. Recognition of the mastoid emissary veins and accessory mastoid emissary veins during the otologic surgery is critical to avoid the significant bleeding. In the neurosurgical practice, the knowledge is important due to variability in the number of mastoidal emissary veins and their connection to the venous sinuses.

Morphometric parameters of the human adult kidney: an anatomical study / Parámetros morfométricos del riñon humano adulto: un estudio anatómico

The purpose of this study was to determine the anatomic parameters of the kidney in adults. The Renal lengths, width at superior and inferior poles, thickness at the superior and inferior poles were measured in 151 adult cadaver kidneys. A digital vernier caliper was used for performing the measurements. The data were statistically analyzed. The mean renal length was 8.9 ± 0.9 cm on the right side and 9.1 ± 0.9 cm on the left side. The mean width of the superior pole of the right kidney was 4.9 ± 0.6 cm and the left kidney was 5 ± 0.7 cm. The width of inferior pole of the right and left kidneys were 4.8 ± 0.6 cm and 4.5 ± 0.7 cm respectively. The mean thickness of the superior pole of the right kidney was 3 ± 0.4 cm and left kidney was 3.2 ± 0.5 cm. The mean thickness of the inferior pole of the right and left kidneys were 3.1 ± 0.4 cm and 3.2 ± 0.5 cm respectively. There was no statistical significance with respect to the length of both the kidneys. However there was some data on width and thickness among the right and left side showed the difference which was significant statistically. The present study has provided additional information on the renal morphometry which will be of use to the surgeons and radiologists.

El propósito de este estudio fue determinar los parámetros anatómicos del riñon en los adultos. La longitud renal, ancho de los polos inferior y superior, y grosor de los polos superior e inferior se midieron en riñones de 151 cadáveres adultos. Se utilizó un caliper vernier digital para realizar las mediciones y los datos fueron analizados estadísticamente. La longitud media renal fue 8,9±0,9 cm en el lado derecho y 9,1±0,9 cm en el lado izquierda. El ancho promedio del polo superior del riñón derecho fue 4,9±0,6 cm y del riñón izquierdo fue 5±0,7 cm. El ancho promedio del polo inferior del lado derecho e izquierdo riñones fueron 4,8±0,6 cm y 4,5±0,7 cm, respectivamente. El grosor promedio del polo superior en el riñón del lado derecho fue 3±0,4 cm y el izquierdo 3,2±0,5 cm. El grosor promedio del polo inferior del riñon del lado derecho e izquierdo fueron 3,1±0,4 cm y 3,2±0,5 cm, respectivamente. No hubo diferencia significativa en relación con la longitud de los riñones. Sin embargo hubo algunos datos en ancho y grosor entre el lado derecho e izquierdo que mostraron diferencia significativa. El presente estudio ha proporcionado información adicional sobre la morfometría renal que puede ser de utilidad para los cirujanos y radiólogos.

In vivo morphometry of menisci of the knee in South Indians: a preliminary study.

BACKGROUND: Since the in vivo morphometric data on the menisci of the knee joint of Indian subjects are scarce, we hereby studied the width and thickness of the menisci using Magnetic Resonance Imaging (MRI) to establish standard dimensions of the normal medial and lateral meniscus as an aid to orthopaedic surgery. METHODS: Eighty menisci from 40 knee joints were analysed in each of three regions, the anterior horn, the mid body and the posterior horn. The thickness and width of the menisci were measured in sagittal and coronal T1-weighted and T2-weighted MRI images and analysed statistically. RESULTS: The mean thickness of medial meniscus at the anterior horn, mid body, and posterior horn were 6.3 ± 1.1 mm, 5.2 ± 1.3 mm, and 6.9 ± 1.1 mm, respectively. The respective values for the lateral meniscus were 4.8 ± 0.7 mm, 6.4 ± 1.1 mm, and 7.0 ± 0.9 mm. The mean width of medial meniscus at the anterior horn, mid body, and posterior horn were 10.5 ± 1.2 mm, 7.8 ± 1 mm and 13.9 ± 0.9 mm, respectively. The widths of lateral meniscus at the same regions were 11.8 ± 1.4 mm, 8.6 ± 1.2 mm, and 12.0 ± 0.9 mm, respectively. The lateral meniscus was significantly wider than medial at the anterior horn and mid body (p = 0.00). In contrast, the posterior horn of medial meniscus was significantly wider than lateral meniscus. Both menisci were significantly wider at their posterior horn, followed by the anterior horn and were significantly narrower at their mid body. CONCLUSION: The present study provides new information on the meniscal thickness and width in South Indians that can be used in planning of orthopaedic and arthroscopic surgeries of the knee joint. However, the study needs to be analyzed with a large sample size for the better interpretation.