Exploring consistent ratios in morphometry of the proximal tibia: insights for knee arthroplasty.

INTRODUCTION: The current study, which delves into proximal tibia morphometric parameters in a Greek sample, not only analyzes whether specific linear distance ratios are consistent but also paves the way for a potential novel metric system for knee arthroplasty imaging studies using constant ratios. These findings could have significant implications for future enlarged research and clinical practice. METHODS: A total of 38 dried tibiae were evaluated by two independent investigators. The following distances were measured with a digital Vernier sliding caliper: (1) the mediolateral distance of the proximal surface (A), (2) the anteroposterior distance of the proximal surface (B), (3) The longitudinal length of the bone (C), (4) the line connecting the anterior margin of the proximal surface with the highest peak of the tibia tuberosity (D), (5) the depth of the proximal margin of the medial articular facet (AF) (medial plateau) (E) and (6) the depth of the proximal margin of the lateral AF (lateral plateau) (F). RESULTS: The A, B, C, D, E, and F mean distances were 71.3 mm, 47.4 mm, 340.2 mm, 37.1 mm, 42 mm, and 35.9 mm. Reliability analysis for each observer on all measurements revealed an interclass correlation (ICC) score of 0.975 (observer 1) and 0.971 (observer 2). The ratio A/B was 1.5, A/C was a constant 0.2, and D/C was 0.1. The ratio E/F was 1.2. The six measurements (A-F) showed excellent inter-observer reliability (all ICC values > 0.990). CONCLUSIONS: The study established constant ratios of the studied linear distances around the proximal tibia. Considering these ratios, asymmetrical tibial components in knee arthroplasty seem to replicate the native anatomy more closely. Furthermore, the distance from the anterior margin of the proximal surface to the tibial tuberosity peak, constituting one-tenth of the longitudinal length of the tibia, shows promise as a metric system for imaging studies, especially in assessing lesions around tibial components.

Considerations for the value of three-dimensional printed (3DP) versus cadaveric specimens for anatomy education.

We enjoyed reading the Brumpt et al. paper, which showed that a three-dimensional printed model (3DPM) of the ear was more effective than conventional cadaveric models for teaching anatomy. We would like to comment on the findings of this exciting study. In this case, the 3DPM of the ear was compared with dried bone models but not with a cadaveric specimen (with all adjacent soft tissues). The better results after the first test of students who used the 3DPMs were probably attributed to the optimized 3D representation of the ear anatomy. Also, the educational outcomes will likely be better if a more complex 3DPM is used, as it permits better visualization of the structures compared to the dried bone specimens. We certainly agree that 3DPMs have a remarkable ability to represent anatomy. Still, their effectiveness has not been proven superior to cadaveric specimens teaching complex anatomy. In conclusion, although we agree that 3DPMs have a high educational potential and can contribute to complex anatomy teaching, those models were not proven significantly more effective than cadaveric specimens in the Brumpt et al. study. The better effectiveness of 3DPMs compared to dried bone specimens (at the first test) does not mean those models are superior to specimens with retained soft tissues. Such cadaveric specimens permit visualization of complex structures and have proven valuable for teaching complex anatomy. Currently, the literature does not support the educational superiority of 3DPMs to those cadaveric specimens.

A scarce combination of arterial variants: an occipital artery originating from the internal carotid artery associated with a linguofacial trunk.

The occipital artery (OA) typically originates from the external carotid artery (ECA). Variations of the ECA has been well described in the current literature, while the OA is a relatively stable vessel, and its variations are uncommon. In the current case report, an aberrant OA has been found coexisting with a linguofacial trunk (LFT) on the right hemineck of a 51-year-old male patient. The OA was identified originating from the cervical internal carotid artery (ICA) at the level of the second cervical vertebra (C2). On the ECA, the lingual and facial arteries were emanating in common, as LFT. The left hemineck of the patient was free of variations. The current coexistence of arterial variants has been reported only once previously; therefore, the current case corresponds to the second case in the English literature. The aberrant OA origin from the ICA has been estimated with a pooled prevalence of 0.37%, while the origin at the C2 level and from the anterior surface of the ICA corresponds to a very rare variation. Additionally, the LFT is one of the most common trunk that can be found on the ECA. Interventional radiologists and surgeons must be aware of common and uncommon variation to avoid iatrogenic lesion.

An ectopic thyrolingual trunk arising from the common carotid artery: a rare variant.

The common carotid artery (CCA) typically bifurcates into the external and internal carotid arteries (ECA and ICA). In the head and neck area, the ECA gives off a few anterior branches from proximal to distal: the superior thyroid artery (STA), the lingual artery (LA), and the facial artery (FA). Occasionally, these branches can fuse into trunks, with the linguofacial trunk being the most common. During a computed tomography angiography (CTA) of a 67-year-old patient, a common arterial trunk, 11.3 mm proximal (prior) to the CCA bifurcation was recorded. The trunk was formed by the STA and the LA fusion and was characterized as a thyrolingual trunk (TLT). These trunks have been reported with a prevalence ranging between 0.3 and 1% and correspond to one of the rarest variants of the ECA anterior branches. Knowledge of the typical and variant anatomy of the carotid arteries and their branches is of paramount importance to surgeons and interventional radiologists.

The coracobrachialis muscle: typical morphology, accessory forms, and the issues with terminology.

The coracobrachialis muscle (CB) represents one of the anterior arm compartment muscles. It has been defined by classic anatomy textbooks and old papers, as a muscle of one belly arising from the coracoid process tip and partially from the tendon of the biceps brachii short head, and inserted into the humeral shaft, above the bone's midpoint. However, recent cadaveric studies have confirmed that in the majority of cases, the CB is a two-headed muscle consisting of a superficial and a deep head. This finding has caused confusion regarding the terminology of CB's morphology. Typical CB morphology, according to recent data should not be considered the muscle of one belly, but the two-headed muscle. In particular, the musculocutaneous nerve's (MCN) course plays an important role in defining the CB morphological characteristics. If the MCN courses medially to the CB, with no signs of penetration after dissection, it can be concluded, that the CB is composed of one head; otherwise, if the muscle is composed of two or more heads, the MCN will courses between the CB bellies. In conclusion, it is of paramount importance to adopt common-universal terminology. Hence, considering recent findings, if the CB origin and/or the insertion differs from the typical anatomy, an "atypical CB" is the proper definition of the muscle, while if this "atypical CB" coexists with a typical CB, the terminology "accessory CB" may be used.

Fenestration of the anterior and posterior cerebral arteries in coexistence with a contralateral posterior cerebral artery of fetal origin.

PURPOSE: The present case report aims to describe the rare coexistence of three variants of the cerebral arterial system diagnosed by computed tomography angiography (CTA). METHODS: A retrospective study on head and neck CTAs was performed on a Greek adult population from the Department of Radiology, University Hospital of Larissa. An interesting case of an 80-year-old male was further investigated. RESULTS: The cerebral arterial circle presented with a combination of three variations. The left anterior cerebral artery (ACA) was fenestrated 1.4 mm proximally to the anterior communicating artery formation. The left posterior cerebral artery (PCA) was also fenestrated, 5.5 mm distally to its origin from the basilar artery. Lastly, the right PCA originated from the ICA supraclinoid segment. CONCLUSIONS: This case report highlights an unusual coexistence of A1 and P1 segments fenestration with a fetal PCA, resulting in a unique cerebral circle. A1 segment fenestration has been previously reported as rare, while the PCA fenestration as extremely rare variant. Awareness of these rare variations could aid interventionists in their preoperative assessments.

The superior thyroid artery origin pattern: a systematic review with meta-analysis.

PURPOSE: The current systematic review with meta-analysis aimed to investigate the pooled prevalence of the superior thyroid artery (STA) pattern of origin (distinct or fused-common origin with adjacent arteries in the form of a common trunk). The standard and uncommon variants were also studied, considering the STA's exact surface of origin and the relationship with the upper border of the thyroid cartilage (TC, reference point), considering the laterality effect. Thus, the STA topographical anatomy was considered. METHODS: An evidence-based systematic review with meta-analysis was performed according to the PRISMA 2020 guidelines. A literature search was conducted in four online databases using specific keywords, the pooled prevalence was calculated using statistical analysis in the R programming language, and multiple subgroup analyses were performed. RESULTS: The most common distinct origin of the STA was from the external carotid artery (ECA) (56.94% pooled prevalence, 95%CI: 50.89-62.89), and the rarest one was from the internal carotid artery (ICA) (< 0.01%, 95%CI: 0.00-0.00). Common trunks were also investigated, with the thyrolingual trunk emanating from the ECA estimated at 0.61% (95%CI: 0.21-1.14), representing the most common. Subgroup analysis based on the nationality, type of study, and sample size, as well as a comparison between left and right sides and males and females, were investigated. CONCLUSIONS: The most common STA origin was estimated as the ECA, the medial surface of origin, and above the TC upper border. Adequate knowledge of STA origin is paramount for surgeons, especially during thyroidectomy, not to cause iatrogenic injury to the external branch of the superior laryngeal nerve.

A bilateral four-headed brachialis muscle with a variant innervation: a cadaveric report with possible clinical implications.

PURPOSE: Anterior compartment muscles of the arm present high morphological variability, with possible clinical significance. The current cadaveric report aims to describe a bilateral four-headed brachialis muscle (BM) with aberrant innervation. Emphasis on the embryological background and possible clinical significance are also provided. METHODS: Classical upper limb dissection was performed on an 84-year-old donated male cadaver. The cadaver was donated to the Anatomy Department of the National and Kapodistrian University of Athens. RESULTS: On the left upper limb, the four-headed BM was supplied by the musculocutaneous and the median nerves after their interconnection. On the right upper limb, the four-headed BM received its innervation from the median nerve due to the musculocutaneous nerve absence. A bilateral muscular tunnel for the radial nerve passage was identified, between the BM accessory heads and the brachioradialis muscle. CONCLUSION: BM has clinical significance, due to its proximity to important neurovascular structures and frequent surgeries at the humerus. Hence, knowledge of these variants should keep orthopedic surgeons alert when intervening in this area. Further dissection studies with a standardized protocol are needed to elucidate the prevalence of BM aberrations and concomitant variants.

The anterior communicating artery variants: a meta-analysis with a proposed classification system.

Morphological and morphometric variants of the anterior communicating artery (AComA) have been described by multiple studies; however, a complete classification system of all possible morphological variants with their prevalence is lacking. The current systematic review with meta-analysis combines data from different databases, concerning the AComA morphological and morphometric variants (length and diameter). Emphasis was given to the related clinical implications to highlight the clinical value of their knowledge. The typical AComA morphology occurs with a pooled prevalence (PP) of 67.3%, while the PP of atypical AComA is 32.7%. The identified AComA morphological variants (artery's hypoplasia, absence, duplication, triplication, differed shape, fenestration, and the persistence of a median artery of the corpus callosum- MACC) were classified in order of frequency. The commonest presented variants were the AComA hypoplasia (8%) and the anterior cerebral artery (ACA) fusion (5.9%), and the rarest ones were the MACC persistence (2.3%), and the AComA triplication (0.7%). The knowledge of those variants is essential, especially for neurosurgeons operating in the area. Given the high prevalence of AComA aneurysms, an adequate and complete classification of those variants is of utmost importance.

Muscle interconnections in the anterior and posterior arm compartment: a cadaveric case series with possible clinical implications.

PURPOSE: The report describes four cases of accessory bundles (ABs) or fibers connecting the muscles of the anterior with the posterior arm compartment. The ABs morphology (pure muscular or musculofascial or musculoaponeurotic) is described emphasizing their attachment points, characterized as muscles' interconnections. MATERIALS AND METHODS: Four formalin-embalmed donated male cadavers were dissected. RESULTS: The muscles' interconnections were unilaterally identified. In the first case, the two ABs originated from the coracobrachialis muscle (CB), received fibers from the biceps brachii (BB), and were inserted into the triceps brachii (TB) medial head. The ABs created an arch over the brachial vessels and the median nerve (MN). In the second case, an accessory musculoaponeurotic structure was identified between CB and TB medial head and extended over the brachial vessels. In the third case, the myofascial ABs between the BB short head and the upper arm fascia, coursed anterior to the MN, the brachial artery, and the ulnar nerve, with direction to the TB medial head. In the fourth case, the three muscular ABs originating from the CB superficial and deep heads, in common with the BB short head, joined the upper arm fascia and the TB medial head and possibly entrapped the musculocutaneous nerve, the MN, and the brachial artery. CONCLUSION: ABs or musculoaponeurotic extensions may predispose to complications due to their potential compression on nerves and vessels. Clinicians should consider the possible existence of such bridging variants between muscles, in the differential diagnosis of a patient presenting with ischemia, edema, or MN palsy symptoms.

The sphenoidal emissary foramina prevalence: a meta-analysis of 6,369 subjects.

PURPOSE: To estimate the prevalence of the sphenoidal emissary foramina (SEF), and the effect of possible moderators on it. METHODS: A systematic online literature search was conducted. The pooled prevalence with 95% confidence intervals was estimated. Outlier and influential analyses were performed. The presence of small-study effect and publication bias were evaluated. Moderator analyses were executed to investigate the effect of the specimens' continent of origin, type of study (dried skull or imaging), probing for the evaluation of SEF patency (conduction and instruments used), side dominance (bilateral or unilateral), morphometric data [SEF diameter, distances SEF-Foramen ovale (FO) and SEF-Foramen spinosum (FS)], and the methodology used for the morphometric measurements (caliper, DICOM Viewer, and image analysis software) on the estimated prevalence. RESULTS: In total, 6,460 subjects from 26 studies were included in the meta-analysis. The overall SEF prevalence was estimated as 38.1%. The heterogeneity was high and statistically significant. No indications of publication bias and small-study effect were identified. The conducted subgroup analyses did not yield statistically significant differences in the SEF prevalence between groups, except of the type of side dominance. Both results of the univariable and multivariable regression analyses showed the association of the unilateral dominance with a decrease in the reported SEF prevalence. CONCLUSION: The identification of more unilateral than bilateral foramina in a given cohort is associated with a decrease in the reported crude SEF prevalence. Laterality-specific estimates should be established for a precisive estimation of the emissary foramina prevalence.

Median artery persistence in coexistence with a bifid median nerve and interconnections of the median with the ulnar nerve and vice versa.

PURPOSE: This report describes a bilateral persistent median artery (PMA) originating from the ulnar artery and terminating at different levels of the upper limb. The PMA coexisted with a bilateral bifid median nerve (MN) and two bilateral interconnections (ICs characterized with the symbol -) of the MN with the ulnar nerve (UN) (MN-UN) and a unilateral reverse IC (UN-MN). Emphasis was given to the artery's developmental background. METHODS: The PMA was identified in an 80-year-old formalin-embalmed donated male cadaver. RESULTS: The right-sided PMA terminated at the wrist, posterior to the palmar aponeurosis. Two neural ICs were identified: the UN joined the MN deep branch (UN-MN), at the forearm's upper third, and the MN deep stem joined the UN palmar branch (MN-UN), at the lower third (9.7 cm distally to the 1st IC). The left-sided PMA ended in the palm giving off the 3rd and 4th proper palmar digital arteries. An incomplete superficial palmar arch was identified by the contribution of the PMA, radial, and ulnar arteries. After the MN bifurcation into superficial and deep branches, the deep branches formed a loop, that was penetrated by the PMA. The MN deep branch communicated with the UN palmar branch (MN-UN). CONCLUSIONS: The PMA should be evaluated as a causative factor of carpal tunnel syndrome. The modified Allen's test and the Doppler ultrasound may detect the arterial flow and the angiography may depict the vessel thrombosis in complex cases. PMA could also be a "salvage" vessel for the hand supply, in radial and ulnar artery trauma.

An unusual combination of a bilateral aberrant suprascapular artery with neurovascular structures variants.

PURPOSE: The report describes a bilateral suprascapular artery (SPSA) of atypical origin in coexistence with neurovascular aberrant structures. METHODS: The variants were identified in a 91-year-old formalin-embalmed male cadaver, derived from a body donation program after a signed informed consent. RESULTS: The left-sided SPSA emanated from the 1st part of the axillary artery, coursed between the brachial plexus lateral and medial cords, accompanied by the suprascapular nerve, and passed below the superior transverse scapular ligament. Ipsilateral coexisted variants were the lateral thoracic artery multiplication, the subscapular trunk formation, and the musculocutaneous nerve duplication. In the right supraclavicular area, a SPSA duplication was identified. The main artery emanated from the thyrocervical trunk in common with the transverse cervical artery and the accessory SPSA emanated from the dorsal scapular artery. Both SPSAs coursed over the superior transverse scapular ligament, while the suprascapular nerve ran below the ligament. CONCLUSIONS: The current study reported a bilateral aberrant SPSA, originating from the AA 1st part (left side) and from the dorsal scapular artery (right side), which coexisted with adjacent neurovascular structures' variants. The left SPSA atypically coursed below the superior transverse scapular ligament. Such an unusual combination of variations, present bilaterally in the current study, may be challenging for radiologists and surgeons.

Coracobrachialis muscle morphology and coexisted neural variants: a cadaveric case series.

PURPOSE: The current cadaveric case series evaluates the coracobrachialis muscle morphology, the related musculocutaneous nerve origin, course, and branching pattern, as well as associated adjacent neuromuscular variants. MATERIALS AND METHODS: Twenty-seven (24 paired and 3 unpaired) cadaveric arms were dissected to identify the coracobrachialis possible variants with emphasis on the musculocutaneous nerve course and coexisted neural variants. RESULTS: Four morphological types of the coracobrachialis were identified: a two-headed muscle in 62.96% (17/27 arms), a three-headed in 22.2% (6/27), a one-headed in 11.1% (3/27), and a four-headed in 3.7% (1 arm). A coracobrachialis variant morphology was identified in 37.04% (10/27). A three-headed biceps brachii muscle coexisted in 23.53% (4/17). Two different courses of the musculocutaneous nerve were recorded: 1. a course between coracobrachialis superficial and deep heads (in cases of two or more heads) (100%, 24/24), and 2. a medial course in case of one-headed coracobrachialis (100%, 3/3). Three neural interconnections were found: 1. the lateral cord of the brachial plexus with the medial root of the median nerve in 18.52%, 2. the musculocutaneous with the median nerve in 7.41% and 3. the radial with the ulnar nerve in 3.71%. Duplication of the lateral root of the median nerve was identified in 11.1%. CONCLUSIONS: The knowledge of the morphology of the muscles of the anterior arm compartment, especially the coracobrachialis variant morphology and the related musculocutaneous nerve variable course, is of paramount importance for surgeons. Careful dissection and knowledge of relatively common variants play a significant role in reducing iatrogenic injury.

A rare bilateral variant of the coracobrachialis muscle with supernumerary heads and coexisted variant branching patterns of the brachial plexus and the axillary artery.

PURPOSE: The study report describes a rare bilateral variant of a six- and five-headed coracobrachialis muscle (CB). The musculocutaneous nerve (MCN) (bilaterally) and the median nerve (MN) lateral root (unilaterally) pierced CB heads, separating superficial from deep heads. METHODS: The variant bilateral CB was identified in a 78-year-old formalin-embalmed male cadaver, derived from a body donation program after a signed informed consent. RESULTS: At the right side: The 6-headed CB was pierced by the MCN, while the MN lateral root pierced the one superficial and deep head. CB was supplied by the lateral cord and the MCN. At the left side: A 5-headed CB was identified with three superficial distinct origins that fused into a common superficial head coursing anterior to MCN. The variant CB bilaterally (with 11 heads in total) coexisted with a MN variant formation, an atypical course of the MN lateral root through CB (right side), a connection of the MN lateral root with the MCN (left side) and a variant axillary artery branching pattern (bilaterally). CONCLUSIONS: Course and direction of the accessory CB heads may occasionally entrap the MCN and/or adjacent structures (brachial artery and MN). The MCN compression results in problems in the glenohumeral joint flexion and adduction, and tingling or numbness of the elbow joint, the forearm lateral parts and the hand.

A morphological study on the sphenoid bone ligaments' ossification pattern.

PURPOSE: The sphenoid bone (SB) extracranial ligaments (ECRLs) are the pterygoalar and pterygospinous ligaments (PTAL and PTSL) that are located at the SB lateral pterygoid plate, and inferior to the foramen ovale (FO). Their ossification may affect the mandibular nerve's distribution. The intracranial ligaments' (ICRLs) ossification (the caroticoclinoid ligament-CCLL, the anterior and posterior interclinoid ligaments-AICLL and PICLL) may impede the approaches to the sella. This study highlights the incidence of the ossified ECRLs and ICRLs location, their type (partial, or complete), considering laterality, gender, age, and ligaments' simultaneous presence. METHODS: The sample consisted of 156 Greek adult dried skulls of both genders and variable age. RESULTS: Ossified ligaments were identified in 57.05%, predominantly extracranially (42.31%, P = 0.003). ECRLs were predominantly identified unilaterally (30.13%, P < 0.001). The majority of the ossified ICRLs were predominantly identified in male skulls (31.1%, P = 0.048) and the majority of the ECRLs (52.8%, P = 0.028) were predominantly identified at the age of 60 years and above. The PTAL was the most ossified (32.69%), followed by the CCLL (24.36%), the PTSL (16.03%), the PICLL (6.41%), and the AICLL (4.49%). CONCLUSIONS: Detailed knowledge of the SB morphology and ligaments' ossification extent is essential to improve the technique of the FO percutaneous approach, and sellar approaches, to minimize complications.

Reduplicated medial parapatellar plica: a case of a medial plica anatomical variation recalcitrant to conservative treatment.

PURPOSE: The current study aims to report the radiologic and clinical appearance of a rare anatomical variation of the knee medial synovial plica along with its response to conservative and surgical treatment. CASE PRESENTATION: This report portrays a 29-year-old male patient with anteromedial gradual onset right knee pain, aggravated when descending stairs or prolonged sitting. Physical examination revealed medial parapatellar local tenderness, a palpable click in this area when the knee was extended, and hamstring tightness. Magnetic resonance imaging showed a duplicated medial plica, characterized by a high-intensity signal of the infrapatellar fat pad medial portion, after which a presumptive diagnosis of medial plica syndrome was proposed. After conservative treatment failure, the patient underwent standard knee arthroscopy that revealed a superior low profile and an inferior high profile medial plica, and hypertrophy of the medial portion of the infrapatellar fat pad. Both plicae and fat pad were resected with a mechanical shaver until no contact between the femoral trochlea and the fat pad was observed during full range of motion. At 4 weeks postoperatively, symptoms completely resolved, and the patient was allowed to return to full activity with no recurrences at 1 year follow-up. CONCLUSIONS: The current study presented a rare anatomical variation of the knee medial synovial plica that was symptomatic and recalcitrant to conservative treatment. This case report may be useful for radiologists and orthopaedic surgeons to differentiate this special plica type and consider its response to conservative and surgical treatment during patient management.

Are extended reality technologies (ERTs) more effective than traditional anatomy education methods?

PURPOSE: Reviews and meta-analyses concerning the effectiveness of extended reality technologies (ERTs) (namely virtual, augmented, and mixed reality-VR, AR, and MR) in anatomy education (AE) have resulted in conflicting outcomes. The current review explores the existing evidence provided by reviews of AE literature regarding the effectiveness of ERTs after their comparison with traditional (either cadaveric or two-dimensional) anatomy teaching modalities and sheds light on the factors associated with the conflicting outcomes. METHODS: PubMed, SCOPUS, ERIC, and Cochrane databases were searched for review articles with the purpose to investigate the effectiveness of ERTs in AE. RESULTS: Nine (four systematic with or without meta-analysis and five non-systematic) reviews were included. A lack of robust evidence provided by those reviews was noted, mainly due to a remarkable confusion in the definition of each ERT, along with confusion when authors referred to traditional AE (TAE) methods. CONCLUSIONS: To clarify to what extent VR, AR, or MR can replace or supplement TAE methods, there is a primary need for addressing issues regarding the definition of each technology and determining which specific TAE methods are used as comparators.

Three-dimensional printing in anatomy teaching: current evidence.

PURPOSE: The critical literature review investigates the extent to which the current evidence supports that three-dimensional printing (3DP) could play an important role in human anatomy education. METHODS: PubMed, ERIC, and Cochrane databases were searched for papers dealing with the outcomes of 3DP implementation in human undergraduate anatomy education. The following data were extracted from each paper: authors, year of publication, type of study (comparative or not), number of participants, level of outcome according to Kirkpatrick hierarchy, influence of 3DP on acquisition of anatomical knowledge and skills, as well as perceptions about the 3DP use in anatomy teaching. RESULTS: Eight papers were eligible for analysis. All of them comprised comparison of 3DP with other anatomy teaching tools. Two papers evaluated only students' perceptions about 3DP, while six papers explored its impact on students' knowledge. The 3DP was statistically significantly superior to two-dimensional images in terms of the investigated parameters. However, comparison between 3DP and cadavers' dissection by students did not take place in any study. CONCLUSION: The 3DP implementation in anatomy education showed promising outcomes. However, the lack of studies which compared the educational effectiveness of 3DP with that of cadavers' dissection is highlighted. It seems that 3DP could certainly be used as an adjunct to cadavers' dissection. Further research could clarify if 3DP could obtain a more prominent role in anatomy pedagogy compared to other anatomy teaching modalities.

Outcomes of the use of plastination in anatomy education: current evidence.

PURPOSE: We aimed to evaluate the quantity and quality of current evidence concerning the outcomes of use of plastinated specimens in anatomy education. METHODS: We performed a narrative literature review, searching for papers dealing with the use of plastination in anatomy education. PubMed, Scopus, ERIC, Cochrane, Web of Science and CINAHL complete electronic databases were searched. The following data were extracted: author(s), year of publication, type of study (comparative or not), number of participants, evaluation of statistical significance, educational outcomes and their level according to Kirkpatrick hierarchy. RESULTS: Six studies were eligible for analysis. Five of them evaluated only students' reactions about plastination and one study also assessed their examinations results. There were four non-comparative and two comparative studies. Only a study evaluated statistical significance (p < 0.05) with higher score of perception in 2nd year undergraduate medical students, who were more familiar with plastination in comparison to 1st year students. Although the use of plastination was accompanied by positive outcomes in the majority of studies (five out of six), this method was not proved superior to traditional cadavers dissection. CONCLUSIONS: The existing evidence about the outcomes of the use of plastination in anatomy education is relatively limited and lacks comparative studies with statistical significant results. Positive students' reactions were generally noted, but further research is needed to clarify if plastination could be of benefit to students' attitude and anatomy knowledge.