Morphological description of the temporomandibular joint ligaments in domestic pigs.

The temporomandibular joint (TMJ) ligaments play crucial roles in its function or dysfunction. The objective of this study was to describe the macro and microscopic morphology of these ligaments in domestic pigs, aiming to: (1) expand knowledge about the species; (2) provide anatomical references for advancing veterinary therapy and utilizing pigs as animal models in craniofacial research. Heads of young Sus scrofa domesticus were dissected to identify TMJ ligaments. Fragments of these ligaments were collected and processed for subsequent histological analysis with Haematoxylin and eosin staining. The results were qualitatively described. Pigs exhibited a TMJ reinforced by three individualized capsular ligaments: a lateral ligament, attaching to the ventral margin of the zygomatic process of the temporal bone and the lateral margin of the mandibular neck; a caudomedial ligament, attaching to the retroarticular process of the squamous part of the temporal bone and the caudomedial margin of the mandibular neck and a caudolateral ligament, attaching to the ventral margin of the base of the zygomatic process of the temporal bone and the caudal margin of the mandibular neck. The lateral ligament exhibited a greater constitution of dense irregular connective tissue, while the caudomedial and caudolateral ligaments showed a greater constitution of dense regular connective tissue. It is concluded that the TMJ of pigs presents one more ligament than horses, cattle, dogs, cats and what has been described for pigs themselves. We believe these results may contribute to the improvement of veterinary clinical and surgical therapy overall, as well as provide essential morphological information for a better interpretation and application of interspecies results in craniofacial research using pigs as an experimental model, as in the case of humans.

Cone beam computed tomography and cross-sectional anatomy of the region of the fetlock in the horse (Equus caballus).

This study aimed to delineate the detailed anatomy of the metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints in healthy horses using cone beam computed tomography (CBCT). The fetlock region of 15 cadaveric forelimbs and 14 cadaveric hindlimbs from nine adult horses without orthopaedic disease underwent CBCT scanning. Additionally, arthrography CBCT scans were conducted following intra-articular injection of a radiopaque contrast medium containing blue epoxy resin dye. Subsequently, limbs were frozen and sectioned to visualize anatomical structures in sectional planes corresponding to selected CBCT images. CBCT proved suitable for detailed visualization of the bony components of the fetlock region. Furthermore, the common digital extensor tendon, superficial and deep digital flexor tendons, suspensory ligament, and straight and oblique sesamoidean ligaments were identifiable on CBCT images. However, certain ligaments, such as the collateral sesamoidean ligaments and intersesamoidean ligaments, were not clearly identified. The hyaline cartilage of the MCP and MTP joint facets was assessable on the post-contrast sequence. In cases where a radiographic or ultrasound examination cannot provide a definitive diagnosis and determine the extent of disease, CBCT can provide additional valuable data on the equine MCP and MTP joint. The images obtained in this study can serve as a reference for CBCT examination of the equine MCP and MTP joint.

Does ponticulus posticus affect vertebral artery diameter.

PURPOSE: Ponticulus Posticus, atlantooccipital ligament ossification-induced anomaly, surrounds the vertebral artery and the first cervical nerve root. It is believed to wrap around the first cervical nerve root and the vertebral artery, causing compression. We hypothesized that it would also reduce the diameter of the vertebral artery. METHODS: Between January 1, 2022, and December 31, 2022, cervical spine CT scans taken for any reason were retrospectively reviewed. The images of 1365 patients suitable for evaluation were evaluated by two expert radiologists in 3 dimensions. Among patients with PP, those who underwent cervical angiography were identified for vertebral artery diameter measurement. RESULTS: The average age of the 1365 individuals included in the study (732 males, 633 females) was 55.78 (± 18.85) with an age range of 1-96. Among this group, PP was detected in 288 individuals, resulting in a total prevalence of 21.1%. Right and left vertebral artery diameters were significantly lower in patients with complete PP compared to the absent group (p < 0,001, p < 0,001, respectively). Additionally, it was observed that width and height diameters and artery diameters were positively correlated in patients with Complete PP. CONCLUSIONS: Ponticulus posticus can cause vertebrobasilar insufficiency by reducing the diameter of the vertebral artery. Therefore, imaging and detailed evaluation of this region are important in symptomatic patients.

Sexual dimorphism in articular tissue anatomy - Key to understanding sex differences in osteoarthritis?

OBJECTIVE: Osteoarthritis (OA) prevalence and incidence varies between women and men, but it is unknown whether this follows sex-specific differences in systemic factors (e.g. hormones) and/or differences in pre-morbid joint anatomy. We recognize that classifications of sex within humans cannot be reduced to female/male, but given the lack of literature on non-binary individuals, this review is limited to the sexual dimorphism of articular morphotypes. METHODS: Based on a Pubmed search using relevant terms, and input from experts, we selected articles based on the authors' judgment of their relevance, interest, originality, and scientific quality; no "hard" bibliometric measures were used to evaluate their quality or importance. Focus was on clinical rather than pre-clinical studies, with most (imaging) data being available for the knee joint. RESULTS: After introducing "sexual dimorphism", the specific literature on articular morphotypes is reviewed, structured by: radiographic joint space width (JSW), meniscus, ligaments, articular cartilage morphology, articular cartilage composition and deformation, and articular tissue response to treatment. CONCLUSIONS: Sex-specific differences were clearly observed for JSW, meniscus damage, ligament size, and cartilage morphometry (volume, thickness, and surface areas) but not for cartilage composition. Ligament and cartilage measures were smaller in women even after matching for confounders. Taken together, the findings indicate that female (knee) joints may be structurally more vulnerable and at greater risk of OA. The "one size/sex fits all" approach must be abandoned in OA research, and all observational and interventional studies should report their results for sex-specific strata, at least in pre-specified secondary or post-hoc analyses.

Anatomical analysis of ligaments surrounding calcaneocuboid joint; implications for role in foot stability.

PURPOSE: The calcaneocuboid joint is located in the lateral part of the foot and acts as a major stabilizer for the foot. Injuries to this joint often occur in association with ankle or foot injuries and are frequently overlooked, subsequently causing chronic pain or osteoarthritis. However, the relationship between ligaments surrounding the joint and joint instability remains unclear. Therefore, this study aimed to clarify the morphology and position of the ligaments surrounding the calcaneocuboid joint, and to reveal the relationship between the ligament structure. METHODS: The position and morphology of the bifurcate ligament (subdivided into calcaneonavicular and calcaneocuboid ligaments), dorsal calcaneocuboid ligament, lateral calcaneocuboid ligament, long plantar ligament, and short plantar ligament were measured (N = 11 feet in 6 Japanese cadavers). The circumference of the joint was quartered, while the ligament-uncovered area and the estimated cross-sectional area of each ligament were compared between the four sides. Furthermore, the estimated cross-sectional area of each ligament was calculated as an index for the ligament strength. RESULTS: The inferolateral side of the calcaneocuboid joint had the most uncovered area (54.63%) by the ligaments. In addition, the cross-sectional area of the ligaments on the lateral side was considerably smaller than that on the medial side. CONCLUSION: Our results suggest that ligament weakness on the inferolateral side may cause instability of the calcaneocuboid joint, especially after an inversion sprain injury, and may decrease the lateral longitudinal arch function, which results in chronic foot pain.

Morphological and morphometric analysis of oblique popliteal ligament in North Indian population: a cadaveric study.

PURPOSE: To study the morphology and the morphometry of the oblique popliteal ligament (OPL). METHODS: Thirty cadaver knees were dissected to study the morphology and morphometry of the OPL. For the measurement of the morphology of the OPL a standard tape and the vernier callipers were used. RESULT: Out of 30 specimens 14 were Y shaped, 10 were band shaped, and 6 were Z shaped observed. Total length was measured on both the limbs, on the right side it was 4.5 ± 0.4 cm and on the left side 4.5 ± 0.5 cm was recorded. Width at the medial attachment was also measured on both the limbs, on the right side it was 4.6 ± 0.5 cm and on the left side 4.7 ± 0.5 cm was recorded. And width at the lateral attachment was recorded too, on the right side it was 4 ± 0.3 cm and on the left side it was 4 ± 0.3 cm. Width at the midpoint was recorded as on the right side 3.5 ± 0.2 cm and on the left side 3.5 ± 0.2 cm. CONCLUSION: The OPL is a thick ligament that arises as an extension of the semimembranosus, and it exists in various morphology which includes band, Y, Z, complex shapes.

An anatomic study of the morphologic characteristics of the dorsal capitolunate ligament.

PURPOSE: There is consensus in favor of a description of the dorsal ligaments of the carpus as not including a direct ligament between the lunate and capitate. On the other hand, there is an anatomical formation which, according to the currently accepted description, corresponds to the dorsal midcarpal capsule, itself thickened by the dorsal intercarpal ligament. The question is whether the capsule at this point deserves to be called an individualizable ligament. In our operative experience of the dorsal carpus, we have encountered a stout structure adherent to the lunate and capitate. In this article, we present the anatomic evidence of this structure's existence. METHODS: Seven adult fresh frozen upper extremities were dissected. Three wrists were longitudinally sectioned in line with the middle finger metacarpal. The remaining 4 were dissected dorsally. Two representative samples of the stout structure connecting the lunate to the capitate were sent to pathology for histologic analysis and staining. RESULTS: In all 3 of the longitudinally sectioned wrists, a thick band of tissue could clearly be seen, originating on the lunate, spanning the dorsal interval between the lunate and the capitate, and inserting on the capitate. With this structure intact, dorsal dislocation of the capitate was not possible, but preliminary sectioning of the structure allowed dislocation. In the 4 dorsally dissected wrists, the same connection was observed, palmar to the dorsal intercarpal ligament, in every specimen. The average dimensions of the dorsal capitolunate were: 15.25 ± 1 mm long, 8.75 ± 1 mm wide at the midpoint, and 1.75 ± 1 mm thick. The two specimens sent to pathology after sectioning showed longitudinally oriented collagen fibers. This structure also stained positive for elastin and contained intrasubstance vascular structures. CONCLUSION: There is a stout ligamentous structure connecting the lunate to the capitate, palmar to the dorsal intercarpal ligament. Disruption of this structure appears to be necessary for dorsal dislocation of the capitate. Clinical studies are needed to gain better understanding of the exact function and importance of this structure.

Editorial Commentary: When Managing Patellofemoral Instability, Mind Your P's and Q's: Medial Patellofemoral Ligament Versus Medial Quadriceps Tendon Femoral Ligament Versus Medial Patellofemoral Complex.

Our understanding of patellar instability and the medial patellofemoral complex (MPFC) has evolved over the past 15 years. Despite advancements and appreciation of the anatomy and biomechanics of the MPFC, the best surgical treatment for recurrent patellar instability has yet to be determined. The goals of medial patellofemoral ligament (MPFL), medial quadriceps tendon femoral ligament (MQTFL), or MPFC reconstructions (with grafts from both the patella and quad to the femur) are to return patients back to activity and avoid complications such as recurrent instability, overconstraint, secondary arthrosis, and potential patellar fracture from surgical drill holes. Other considerations when managing recurrent instability include patella alta, hypermobility, and whether an osteotomy procedure is indicated. Although we always need to make good choices and mind our P's and Q's, the big question remains: Is MPFL, MQTFL, or MPFC the best choice for our patients?

Medial Patellofemoral Reconstruction Techniques for Patellar Instability.

The medial patellofemoral complex (MPFC) is the term used to describe the primary soft tissue stabilizer of the patella, which consists of fibers that attach to the patella (medial patellofemoral ligament, or MPFL), and the quadriceps tendon (medial quadriceps tendon femoral ligament, or MQTFL). Despite the variability of its attachment on the extensor mechanism, the midpoint of this complex is consistently at the junction of the medial quadriceps tendon with the articular surface of the patella, indicating that either patellar or quadriceps tendon fixation can be used for anatomic reconstruction. Multiple techniques exist to reconstruct the MPFC, including graft fixation on the patella, quadriceps tendon, or both structures. Various techniques using several graft types and fixation devices have all reported good outcomes. Regardless of the location of fixation on the extensor mechanism, elements critical to the success of the procedure include anatomic femoral tunnel placement, avoiding placing undue tension on the graft, and addressing concurrent morphological risk factors when present. This infographic reviews the anatomy and techniques for the reconstruction of the MPFC, including graft configuration, type, and fixation, while addressing common pearls and pitfalls in the surgical treatment of patellar instability.

Anatomy and morphology of iliolumbar ligament.

PURPOSE: To address limited amount of available data and contradictory statements in published works 60 Iliolumbar ligaments extracted from 30 cadavers were examined to describe their insertions and morphology. METHODS: The ligaments were removed during the standard autopsy procedures with a use of an oscillating saw, a chisel and a scalpel. The specimens were photographed before the extraction and measured alongside their anterior margin. Next, they were preserved in formaldehyde, stripped of other soft tissues and then examined, photographed and described. RESULTS: The mean length of the ligaments was 31.7 mm. 44 specimens were described as single-banded, 13 as double-banded and 3 as other. In 24 cases costal process of LV has been fixed to the iliac plate by short ligamentous bands. In 38 cases there was a thick fibrous membrane connected to the ligament. No legitimate insertions on LIV vertebra were observed. CONCLUSIONS: Typical iliolumbar ligament consists of a single ligamentous band. Most common variability of the ligament consist of two bands. In approximately 40% of cases the costal process of LV can be additionally stabilized to the iliac plate by short, strong ligamentous bands. In 63% of cases a connection between the iliolumbar ligament and a fibrous membrane placed in the frontal plane, superiorly to the ligament, has been observed. There seems to be no convincing proof of existence of the insertion of the iliolumbar ligament on the LIV vertebra.

Anatomical description of the perforating cutaneous nerve.

BACKGROUND: The perforating cutaneous nerve/perforating nerve of the sacrotuberous ligament is rarely observed. It usually arises from the posterior division of the sacral plexus or the pudendal nerve and perforates the sacrotuberous ligament. The anatomy of this nerve and its variants is poorly described in the literature, but there are data indicating its role in pudendal neuralgia. MATERIALS AND METHODS: Herein, we present an anatomical study of six formalin-fixed cadavers with descriptions of the topography of spinal nerves S2-S4, the pudendal bundle, the perforating cutaneous nerve and the sacrotuberous ligament. RESULTS: We found three perforating cutaneous nerves and described each of them in detail, with measurements of length and width, and point of perforation of the sacrotuberous ligament. CONCLUSIONS: We distinguished three types of perforating cutaneous nerve on the basis of our findings and previous publications; two of the three types were observed in our study.

Bony structures at the attachment areas of the cruciate ligaments in human knee joints and their clinical significance-studied using the P45 plastination technique / Estructuras óseas en las áreas de inserción de los ligamentos cruzados en las articulaciones de la rodilla humana y su importancia clínica, estudiadas mediante la técnica de plastinación P45

SUMMARY: For treating cruciate ligament injuries, especially for characterizing the mechanics of the tunnel in cruciate ligament reconstruction, correctly understanding the bony information of the attachment area of the cruciate ligaments is significant. We studied 31 knee joints of middle-aged Chinese adults using the P45 sheet plastination technique, focusing on the attachment areas of the cruciate ligaments, especially the bony structures. The trabeculae at the attachment area were distributed radially and extended deep into the medial wall of the lateral condyle of the femur. However, in the anterior part of the intercondylar eminence, the trabeculae of the anterior group were parallelly arranged along the tendinous fibers of the anterior cruciate ligament, while the trabeculae of the posterior group were parallelly arranged along the perpendicular direction of the anterior cruciate ligament fibers. Similarly, at the attachment area of the lateral wall of the medial condyle of the posterior cruciate ligament, the trabeculae extended radially toward the deep medial condyle. Deep in the posterior part of the intercondylar eminence, the trabeculae were arranged longitudinally. In the anterior part of the intercondylar eminence, the trabeculae were parallelly arranged along the perpendicular directions of ligament fibers. The distribution patterns of the trabecular at the attachment areas of the cruciate ligaments at the ends of the femur and tibia were different. This difference should be considered when orthopedic surgeons reconstruct anterior cruciate ligaments.

Para el tratamiento de lesiones de los ligamentos cruzados, especialmente para caracterizar la mecánica del túnel en su reconstrucción, es importante comprender correctamente la información ósea del área de inserción de estos ligamentos. Estudiamos 31 articulaciones de rodilla de individuos chinos, adultos, de mediana edad, utilizando la técnica de plastinación de láminas P45, centrándonos en las áreas de unión de los ligamentos cruzados, especialmente en las estructuras óseas. Las trabéculas en el área de inserción se distribuyeron radialmente y se extendieron profundamente en la pared medial del cóndilo lateral del fémur. Sin embargo, en la parte anterior de la eminencia intercondílea, las trabéculas del grupo anterior estaban dispuestas paralelamente a lo largo de las fibras tendinosas del ligamento cruzado anterior, mientras que las trabéculas del grupo posterior estaban dispuestas paralelamente a lo largo de la dirección perpendicular de las fibras del ligamento cruzado anterior. De manera similar, en el área de inserción en la cara lateral del cóndilo medial del ligamento cruzado posterior, las trabéculas se extendían radialmente y profundas hacia el cóndilo medial. Profundamente en la parte posterior de la eminencia intercondílea, las trabéculas estaban dispuestas longitudinalmente. En la parte anterior de la eminencia intercondílea, las trabéculas estaban dispuestas paralelamente a lo largo de las direcciones perpendiculares de las fibras del ligamento. Los patrones de distribución del tejido óseo trabecular en las áreas de unión de los ligamentos cruzados en los extremos del fémur y la tibia eran diferentes. Estas diferencias deben tenerse en consideración cuando los cirujanos ortopédicos reconstruyen los ligamentos cruzados anteriores.

Medial Ankle Instability: Review of Anatomy, Evaluation, and Treatment.

The medial ankle ligamentous complex, which includes the deltoid, talocalcaneal, and calcaneonavicular ligaments, functions to provide stability to the medial ankle. Injuries to the deltoid ligament can lead to medial-sided ankle pain, subsequent instability, and posttraumatic osteoarthritis given the altered biomechanics of the ankle joint. After completing a thorough physical examination, imaging modalities such as stress radiographs and magnetic resonance imaging can be used to confirm the diagnosis. Acute injuries to the deltoid ligament should be managed conservatively with a short course of immobilization. For patients with continued pain and instability following a regimen of nonoperative management, surgical intervention can be considered. Primary repair using suture anchor fixation to the medial malleolus can be utilized if sufficient tissue remains. However, if reconstruction is necessitated, autograft or allograft can be utilized in several described techniques.Levels of Evidence: Therapeutic.

Surgical Anatomy for Fibular Free Flap Focusing on the Inferior Tibiofibular Syndesmotic System: A Cadaveric Study and Case Series of 3-Dimensional Prefabricate Cutting Guided Fibular Free Flap.

ABSTRACT: Even though there are many options for mandibular reconstruction, a free fibula osteocutaneous flap is regarded as the most frequently used flap. Despite having some previous anatomical studies pertaining to syndesmotic ligaments, there is no study pointing out that surgical landmarks can be used while free fibula osteocutaneous flaps are performed and used for surgical landmarks in order to avoid syndesmotic ligament injuries. Therefore, this study investigates the characteristics and relationship between inferior syndesmotic ligaments and fibula in cadavers. A total of 140 legs were obtained from 83 embalmed cadavers as well as other soft ones, which were donated for the inferior tibiofibular syndes- motic system's study. Detailed dissection and measurement of each ligament's distance to the end of the fibula and lateral malleolus were performed. Distances from the distal end of the fibula to anterior inferior tibiofibular ligament, posterior inferior tibiofibular, and inferior transverse ligament, and the lower border of the interosseous membrane are 3.5 ±â€Š0.4 cm, 3.4 ±â€Š0.5 cm, 1.9 ±â€Š0.4 cm, and 5 ±â€Š1 cm (mean ±â€ŠSD), respectively. Distance from the most distal part of the fibula to lateral malleolus is 1.6 ±â€Š0.4 cm (mean ±â€ŠSD). Thus, the remaining distance of the fibular should be left at least 4 cm without disrupting the syndesmotic ligament complex. It is argued that the lateral malleolus can be applied as a surgical landmark while harvesting fibula.

New insights into the musculotendinous and ligamentous attachments at the pubic symphysis: A systematic review.

OBJECTIVE: Collection and meta-analysis of all relevant anatomical studies related to the pubic symphysis to provide a state of the art review of its musculotendinous and ligamentous attachments from 2010 to date. METHODS: A systematic search of published literature databases (PubMed, Web of Science and Embase) was conducted according to the PRISMA guidelines from January 2010 up until now. All papers investigating the anatomy of the musculotendinous attachments of the pubis and the pubic ligaments were eligible. Methodological quality was assessed using the Quality Appraisal for Cadaveric Studies (QUACS scale). A narrative analysis approach was adopted to synthesize the findings. RESULTS: After screening and review of 1313 papers, a total of six studies investigating the anatomy of the pubic ligaments and tendons were included. Of the six articles included in this systematic review, five articles performed a macroscopic anatomical dissection, three articles performed a microscopic (histological) study, and one article combined microscopic examination with an MRI imaging examination. The anatomy of the pubic symphysis was examined in 76 anatomical cadavers (60 embalmed, 16 fresh frozen). In total 44 male cadavers (58%), 28 female cadavers (37%) and four cadavers whose gender was not stated were dissected. CONCLUSION: The age-old accepted concept of the fusion of the rectus abdominis with the adductor longus via the aponeurotic plate is outdated. New anatomical concepts like the pyramidalis-anterior pubic ligament-adductor longus complex (PLAC), recto-gracilis tendon, fusion of adductor brevis with gracilis, etc. are recently introduced. The awareness of anatomy and morphology of the pubic ligaments plays a significant role in understanding the diagnosis and treatment of groin pain.

Anatomic Navigation Using the Transverse Acetabular Ligament for Acetabular Component Positioning in Total Hip Arthroplasty Through the Direct Anterior Approach.

The transverse acetabular ligament (TAL) is a reliable native anatomic landmark that can be used to guide accurate acetabular implant positioning during total hip arthroplasty through the direct anterior approach. The accurate acetabular implant position is defined by the preoperative plan, which corresponds to the Lewinnek safe zone. This article describes the anatomy of the TAL , exposure of the TAL, and pearls and pitfalls for exposure of the acetabulum during total hip arthroplasty through the direct anterior approach. This article discusses how the TAL is used to guide acetabular implant positioning and describes pilot data from our single surgeon case series (n = 31).

Anatomical and biomechanical evaluation of the lateral calcaneo-cuboid and bifurcate ligaments.

BACKGROUND: This study aims to analyze the ligaments of the dorso-lateral calcaneo-cuboid joint and to assess the biomechanical relevance of the bifurcate ligament. METHODS: 16 specimens were analyzed for their ligamentous anatomy of the dorso-lateral calcaneo-cuboid joint and side-alternating assigned to two groups with varying ligamentous dissection order. The Chopart joint was stressed in plantar, medial, and lateral direction measuring the displacement by an 3D motion tracker for every dissection step. RESULTS: 37.5% of specimens had all ligaments (lateral calcaneo-cuboid, dorsal calcaneo-cuboid, bifurcate calcaneo-cuboid, bifurcate calcaneo-navicular), 37.5% were lacking bifurcate´s calcaneo-cuboid-portion, and 25% presented without dorsal calcaneo-cuboid. Biomechanical testing revealed no significant displacement within the calcaneo-cuboid or talo-navicular joint for any stressed state except for axial compression with dissected dorsal talo-navicular joint capsule in Group 2. CONCLUSION: Broad morphological variability and missing significant displacement regardless of its integrity, make the bifurcate ligament appear of limited biomechanical relevance.

Medial patellofemoral ligament is a part of the vastus medialis obliquus and vastus intermedius aponeuroses attaching to the medial epicondyle.

PURPOSE: This study aimed to investigate the bony surface characteristic of the femoral attachment of the medial patellofemoral ligament (MPFL) and the correlation between the relevant layered structures, including muscular aponeurosis and the joint capsule, which contribute to patellofemoral joint (PFJ) stability. METHODS: The morphology of the medial aspect of the medial condyle using micro-computed tomography and analysed cortical bone thickening in 24 knees was observed. For the macroscopic and histological analyses, 21 and 3 knees were allocated, respectively. The Kruskal-Wallis one-way analysis of variance test with Dunn post hoc testing was performed for statistical analysis. RESULTS: At the level of the adductor tubercle, there were no significant differences in cortical bone thickness. At the level of the medial epicondyle (MEC), cortical bone thickness was considerably greater than that in other areas of the medial condyle (mean ± standard deviation, 0.60 ± 0.20 mm; p < 0.0001). Macroscopic analysis revealed that the deep aponeurosis of the vastus medialis obliquus and the tendinous arch of the vastus intermedius distally formed the composite membrane and adjoined to the joint capsule to firmly attach to MEC, which was located at 41.3 ± 5.7 mm posterior and 14.2 ± 3.1 mm superior to the joint cartilage. Histological analysis showed a composite membrane and adjoining capsule attached to MEC via fibrocartilage. CONCLUSION: MPFL could be interpreted as part of the deep aponeurosis of the vastus medialis obliquus (VMO) and the tendinous arch of the vastus intermedius, which combined with the joint capsule to attach to MEC. The cortical bone thickening indicated that the tensile stresses were loaded on MEC in aged cadavers. Involvement of VMO and vastus intermedius aponeuroses in restored graft of MPFL could utilise the dynamic stability of surrounding muscles to mimic a native structure.

A Morphologic Analysis of the Pubic Symphysis Using CT and MRI.

INTRODUCTION: The goal of this study was to investigate prevalence and morphometric parameters of pubic ligaments and the interpubic disk and its cavity using imaging methods for use in clinical medicine. METHODS: Pubic symphysis morphology was investigated in 652 patients (348 women and 304 men), from which 449 CT scans and 203 MR scans were available. The average age of men was 48 years and women 39 years. Investigated parameters included dimensions of the interpubic disk, visibility and width of the reinforcing ligaments, and visibility, dimensions, and location of the symphysial cavity. The results were compared with MR scans of 20 healthy volunteers and 21 dissected anatomic specimens. RESULTS: The craniocaudal, ventrodorsal, and mediolateral diameters of the pubic disk were 36 to 37.7, 14.8 to 15.2, and 2.2 to 4.2 mm in women and 42 to 42.3, 18.6 to 19, and 2.4 to 4.5 mm in men, respectively. Higher age correlated with shorter mediolateral diameter and larger craniocaudal and ventrodorsal diameters. The superior pubic ligament was visible in 93.1% of men (1.44 mm thick) and in 100% of women (1.7 mm); the inferior pubic ligament in 89.7% of men (1.74 mm) and 88% of women (1.95 mm), the anterior pubic ligament in 96.6% of men (1.5 mm) and 82% of women (1.34 mm); and the posterior pubic ligament in 65.5% of men (1.18 mm) and 63.7% of women (0.83 mm). A symphysial cavity was found in 24% of men and 22.9% of women, with craniocaudal, ventrodorsal, and mediolateral dimensions of 13, 10.7, and 3.2 mm in men and 9.5, 10.7, and 3 mm in women, respectively. CONCLUSION: The presented morphologic parameters provide an anatomic reference for diagnostics of pathologic conditions of the pubic symphysis. The following anatomic structures should be added to the official anatomic terminology: symphysial cavity (cavitas symphysialis), retropubic eminence (eminentia retropubica), anterior pubic ligament (ligamentum pubicum anterius), and posterior pubic ligament (ligamentum pubicum posterius). LEVEL OF EVIDENCE: II-III.

A Comprehensive Description of the Lateral Patellofemoral Complex: Anatomy and Anisometry.

BACKGROUND: The lateral patellofemoral complex (LPFC) is an important stabilizer of the patella composed of the lateral retinacular structures including the lateral patellofemoral ligament (LPFL), the lateral patellomeniscal ligament (LPML), and the lateral patellotibial ligament (LPTL). While the isolated anatomy of the LPFL has been previously described, no previous study has investigated the entirety of the LPFC structure, length changes, and radiographic landmarks. An understanding of LPFC anatomy is important in the setting of LPFL injury or previous lateral release resulting in iatrogenic medial instability requiring LPFC reconstruction. PURPOSE: To both qualitatively and quantitatively describe the anatomy and length changes of the LPFC on gross anatomic dissections and standard radiographic views. STUDY DESIGN: Descriptive laboratory study. METHODS: Ten nonpaired cadaveric specimens were utilized in this study. Specimens were dissected to identify distinct attachments of the LPFL, LPML, and LPTL. Ligament lengths, footprints, and centers of each attachment were described with respect to osseous landmarks using a 3-dimensional coordinate measuring device. Ligament length changes were also assessed from 0° to 90° of flexion. Radiopaque markers were subsequently utilized to describe attachments on standard anteroposterior and lateral radiographic views. RESULTS: The individual elements of the LPFC were identified in all specimens. The LPFL patellar attachment had an average total length of 22.5 mm (range, 18.3-27.5 mm), involving a mean of 59% (range, 50%-75%) of the sagittal patella. Based on the average patellar size, a mean of 63% of the LPFL attached to the patella, and the remainder (11.1 ± 1.4 mm) inserted into the patellar tendon. The femoral attachment of the LPFL had a mean maximum length of 24.4 ± 4.3 mm. The center of the LPFL femoral attachment was a mean distance of 13.5 ± 3.2 mm anterior and distal to the lateral epicondyle. The LPFL demonstrated significant shortening, especially in the first 45° of flexion (7.5 ± 5.1 mm). In contrast, the LPTL (5.5 ± 3.0 mm) and LPML (10.0 ± 3.3 mm) demonstrated significant shortening from 45° to 90°. On lateral radiographs, the center of the femoral attachment of the LPFL was a mean total distance of 19.2 ± 7.2 mm from the lateral epicondyle. CONCLUSION: The most important findings of this study were the correlative anatomy of 3 distinct lateral patellar ligaments (LPFL, LPML, and LPTL) and their anisometry through flexion. All 3 components demonstrated significant shortening during flexion. The quantitative and radiographic measurements detailed the LPFL osseous attachment on the patella; soft tissue attachment on the patellar tendon; and finally, the osseous insertion on the femur distal and anterior to the lateral epicondyle. Similarly, the authors documented the meniscal insertion of the LPML and defined a patellar insertion of the LPTL and LPML as a single attachment. These data allow for reproducible landmarks to aid in the understanding and reconstruction of the lateral patellar restraints. CLINICAL RELEVANCE: The data produced from this investigation provide a comprehensive description of these 3 lateral patellar stabilizers (LPFL, LPML, LPTL). These data can be used intraoperatively to facilitate anatomic reconstructions of the lateral patellar stabilizers.