Characteristic features of the insertions of the distal tibiofibular ligaments on three-dimensional computed tomography- cadaveric study.

PURPOSE: The purpose of this study was to clarify the insertion sites of the anterior inferior tibiofibular ligament (AITFL) and posterior inferior tibiofibular ligament (PITFL) and related osseous landmarks on three-dimensional computed tomography images. METHODS: Twenty-nine non-paired, formalin-fixed human cadaveric ankles were evaluated. The tibial and fibular insertion sites of the AITFL and PITFL were identified. The morphology and location of the insertion sites and their positional relationships with osseous structures were analyzed on three-dimensional computed tomography images. RESULTS: The AITFL had a trapezoidal shape, with fibers that ran obliquely lateral from a wider insertion at the lateral distal tibia to the medial distal fibula. The PITFL had a similar shape to the AITFL; however, it ran more horizontally, with fibers running in the same direction. In the tibia, the anterior capsular ridge and the Chaput's and Volkmann's tubercles were useful osseous landmarks for the insertion sites. In the fibula, the centers of the insertion sites of the AITFL and PITFL were located on the edges of the distal anterior and posterior fibula, which were useful osseous landmarks. The mean distances between the center points of the tibial and fibular insertion sites of the AITFL and PITFL were 10.1 ± 2.4 mm and 11.7 ± 2.6 mm, respectively. CONCLUSIONS: The relationships between the characteristic features of the distal tibia and fibula and the insertions of the AITFL and PITFL were consistent. The present findings improve the understanding of the anatomy of the insertions of the distal tibiofibular syndesmotic joint.

Morphology of the patellar tendon and its insertion sites using three-dimensional computed tomography: A cadaveric study.

BACKGROUND: To clarify, with three-dimensional (3D) images, the morphological properties of the patellar tendon and both of its insertion sites. METHODS: Thirty-two human cadaveric left knees were evaluated, and 3D computed tomography images were created. These images were used to analyse the morphology of both insertion sites of the patellar tendon, and the width, length and thickness of each region of the patellar tendon. RESULTS: The insertion sites of the patellar tendon on the patellar and tibial sides were V-shaped and crescent-shaped, respectively, with the respective bony apexes located at 44.5 ±â€¯2.2% (standard deviation) and 35.5 ±â€¯2.8% of the tendon width from its medial edge. The proximal, central and distal widths of the patellar tendon were 29.9 ±â€¯2.7 mm, 27.3 ±â€¯2.5 mm and 25.0 ±â€¯2.4 mm, respectively. The length of the patellar tendon was shortest at 40.6% ±â€¯6.7% of the central width and gradually became longer toward both edges. The patellar tendon was thickest in the central portion of 40-75% and gradually became thinner toward both edges. CONCLUSIONS: The morphological properties of the patellar tendon and its insertion sites on both the patellar and tibial sides were consistent. These findings indicate that the characteristics of the bone-patellar tendon-bone graft markedly depend on the location from which it is harvested, and that these characteristics contribute to predicting the length, width and shapes of the bone plugs of the graft when performing bone-patellar tendon-bone surgery.

Morphology of the fibular insertion of the posterolateral corner and biceps femoris tendon.

PURPOSE: To clarify the fibular head insertion of the fibular collateral ligament (FCL), popliteofibular ligament (PFL), and biceps femoris tendon and related osseous landmarks on three-dimensional (3-D) images. METHODS: Twenty-one non-paired, formalin-fixed human cadaveric knees were evaluated in this study. The fibular head insertions of the FCL, PFL and biceps femoris tendon were identified and marked. 3-D images were created, and the surface area, location, positional relationships, and morphology of the fibular insertions of the FCL, PFL, and biceps femoris tendon and related osseous structures were analysed. RESULTS: The fibular head had a unique pyramidal shape, and the relationships of the fibular insertion of the FCL, PFL, and biceps femoris tendon were consistent. The fibular head consists of three aspects: lateral aspect, posterior aspect, and proximal tibiofibular facet. The insertions of the FCL, PFL, and biceps femoris tendon were attached to the centre from the distal side of the lateral aspects of the fibular head, posterior aspect of the fibular styloid process, and lateral aspect surrounding the FCL, respectively. The mean surface areas of the FCL and PFL fibular insertions were 100.1 ± 29.5 and 18.5 ± 7.2 mm2, respectively. CONCLUSION: This study showed that the relationships between the characteristic features of the fibular head and insertions of the FCL, PFL, and biceps femoris tendon were consistent. The clinical relevance of this study is that it improves understanding of the anatomy of the insertions of the PLC and biceps femoris tendon.

Morphology of the Insertions of the Superficial Medial Collateral Ligament and Posterior Oblique Ligament Using 3-Dimensional Computed Tomography: A Cadaveric Study.

PURPOSE: To describe the insertions of the superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) and their related osseous landmarks. METHODS: Insertions of the sMCL and POL were identified and marked in 22 unpaired human cadaveric knees. The surface area, location, positional relations, and morphology of the sMCL and POL insertions and related osseous structures were analyzed on 3-dimensional images. RESULTS: The femoral insertion of the POL was located 18.3 mm distal to the apex of the adductor tubercle (AT). The femoral insertion of the sMCL was located 21.1 mm distal to the AT and 9.2 mm anterior to the POL. The angle between the femoral axis and femoral insertion of the sMCL was 18.6°, and that between the femoral axis and the POL insertion was 5.1°. The anterior portions of the distal fibers of the POL were attached to the fascia cruris and semimembranosus tendon, whereas the posterior fibers were attached to the posteromedial side of the tibia directly. The tibial insertion of the POL was located just proximal and medial to the superior edge of the semimembranosus groove. The tibial insertion of the sMCL was attached firmly and widely to the tibial crest. The mean linear distances between the tibial insertion of the POL or sMCL and joint line were 5.8 and 49.6 mm, respectively. CONCLUSIONS: This study used 3-dimensional images to assess the insertions of the sMCL and POL and their related osseous landmarks. The AT was identified clearly as an osseous landmark of the femoral insertions of the sMCL and POL. The tibial crest and semimembranosus groove served as osseous landmarks of the tibial insertions of the sMCL and POL. CLINICAL RELEVANCE: By showing further details of the anatomy of the knee, the described findings can assist surgeons in anatomic reconstruction of the sMCL and POL.