scholarly journals GASTROCNEMIUS TUBERCLE IN INDIAN POPULATION: A NEW ANATOMICAL ENTITY?. Tubérculo gastrocnemio en la población india: Una nueva entidad anatómica?

2016 ◽  
Vol 7 (2) ◽  
pp. 107-111
Author(s):  
Shilpa Gosavi ◽  
Rajendra Garud ◽  
Surekha Jadhav
Keyword(s):  
Gastrocnemius Muscle ◽  
Indian Population ◽  
Knee Injuries ◽  
Medial Epicondyle ◽  
Anatomical Entity ◽  
Medial Condyle ◽  
Posterior Oblique Ligament ◽  
Adductor Tubercle ◽  
Bony Prominence ◽  
Bilateral Differences

Los libros de texto comunes de anatomía describen dos protuberancias óseas presentes en el cóndilo medial del fémur. A parte del tubérculo aductor (TA) y del epicóndilo medial (EPM) del fémur también se ha observado una tercera protuberancia ósea en muchos huesos. En la literatura publicada previamente se lo denomina tubérculo gastrocnemio. La cabeza medial del músculo gastrocnemio y el ligamento oblicuo posterior están adheridos al mismo. Hemos observado 396 (derecha-204 e izquierda-192) fémures secos de pacientes indios. Se observó la presencia en el cóndilo medial de la tercera protuberancia ósea, es decir, el tubérculo gastrocnemio (TGC) junto con el tubérculo aductor y el epicóndilo medial. Se advirtió la presencia o ausencia de TGC. Se comparó el tamaño del TGC y del TA. Se midió la distancia entre TA y TGC y se midió asimismo la distancia entre TGC y EPM utilizando un calibre vernier digital con un grado de precisión de hasta 0,01 mm. Para la elaboración de datos se calculó el porcentaje, la distancia media, el rango y la desviación estándar. Se comprobó la presencia de TGC en 207 huesos, es decir 52,27% (derecha-109 e izquierda-98). En la mayoría de los fémures (80,7%) el TA es de tamaño mayor que el TGC. La distancia media entre TGC y TA en el lado derecho es 10,8 ± 2,4 mm y en el lado izquierdo es 10,9 ± 2,3.  Se observó una distancia entre TGC y EPM de 14,8 ± 0,5 mm en el lado derecho y de 14,9 ± 2.9 mm en el lado izquierdo. Las diferencias bilaterales no son significativas en términos estadísticos. Es importante para los clínicos identificar el TGC para evitar la reparación no anatómica de lesiones del ligamento medial de la rodilla. The standard textbooks of anatomy describe two bony prominences on the medial condyle of femur. In addition to adductor tubercle (AT) and medial epicondyle (MEP) of femur a third bony prominence was also observed in many bones. In previously published literature it was named as gastrocnemius tubercle. The medial head of gastrocnemius muscle and posterior oblique ligament were attached close to it. We observed three hundred and ninety six (right-204 and left-192) dry femora belonging to Indian population. The medial condyle was observed for the presence of third bony prominence - gastrocnemius tubercle (GCT) along with adductor tubercle and medial epicondyle. The presence or absence of GCT was noted. The size of GCT and AT was compared. The distance between the most prominent point on AT and GCT and between GCT and MEP was measured using digital Vernier caliper accurate up to 0.01 mm. The percentage, mean, range and standard deviation was calculated for the data. Presence of GCT was noted in 207 bones (52.27%) (right-109 and left-98). In majority (80.7%) of the femora AT was larger than GCT. Mean distance between GCT and AT on right side was 10.8 ± 2.4 mm and on left side it was 10.9 ± 2.3.  Distance between GCT and MEP on right side was observed as 14.8 ± 0.5 mm and on left side 14.9 ± 2.9. The bilateral differences were not significant statistically. It is important for clinicians to identify GCT to avoid non-anatomical repair of medial knee injuries.

scholarly journals The third osseous ambiguous tubercle-A study on Indian population

2018 ◽  
Vol 07 (01) ◽  
pp. 041-046
Author(s):  
Sudha R. ◽  
Sasikala P.
Keyword(s):  
Gastrocnemius Muscle ◽  
Indian Population ◽  
Average Distance ◽  
Medial Epicondyle ◽  
Knee Joints ◽  
The Third ◽  
Adductor Tubercle ◽  
Medial Head ◽  
Medial Side ◽  
The Right

Abstract Background & Aim: Bony prominences on the medial side of the lower end of femur include the adductor tubercle and the medial epicondyle. A third osseous ambiguous tubercle or the Gastrocnemius tubercle is often noted about which there is not much mention in standard textbooks of Anatomy. This tubercle gives attachment to the medial head of gastrocnemius muscle. Its clinical relevance cannot be under estimated particularly in cases of treatment of rupture of medial head of gastrocnemius [Tennis leg] and while raising of Gastrocnemius flaps. Materials and Methods: This study was conducted in150 dry femora and in 10 dissected knee joints [Total femora 160 : 150 dry bones+ 10 cadaveric femora] gross specimens. The presence of gastrocnemius tubercle, supracondylar tubercle, the distances between gastrocnemius tubercle and adductor tubercle, medial epicondyle and condylar margin were measured. Results: The incidence of gastrocnemius tubercle was 55% and was predominantly noted on the right side [63%]. The average distance between the gastrocnemius tubercle and the adductor tubercle was 6 mm, and the average distance between the gastrocnemius tubercle and medial epicondyle was 15 mm. The incidence ofsupracondylartubercle was 71% and in 95% of the bones it was noted above the medial condylar margin. Conclusion: The awareness of the presence of gastrocnemius tubercle and supracondylar bony prominences in the medial side of lower end of femur will be of much use to the Orthopaedic surgeons and Plastic surgeons

scholarly journals Gastrocnemius tubercle: attachment point of the gastrocnemius muscle tendon and posterior oblique ligament

2019 ◽  
Vol 6 (6) ◽  
Author(s):  
José Aderval Aragão ◽  
Julia Dória Fontes ◽  
Iapunira Catarina Sant’ Anna Aragão ◽  
Felipe Matheus Sant’ Anna Aragão ◽  
Francisco Prado Reis
Keyword(s):  
Gastrocnemius Muscle ◽  
Posterior Oblique Ligament ◽  
Attachment Point

scholarly journals Single-Stage Arthroscopic Anterior and Posterior Cruciate Ligament Repairs and Open Medial Collateral Ligament Repair for Acute Knee Dislocation

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ryo Murakami ◽  
Eisaburo Honda ◽  
Atsushi Fukai ◽  
Hiroki Yoshitomi ◽  
Takaki Sanada ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Knee Dislocation ◽  
Single Stage ◽  
Lateral Condyle ◽  
Ligament Repair ◽  
Collateral Ligament ◽  
Medial Condyle

Till date, there are no clear guidelines regarding the treatment of multiple ligament knee injuries. Ligament repair is advantageous as it preserves proprioception and does not involve grafting. Many studies have reported the use of open repair and reconstruction for multiple ligament knee injuries; however, reports on arthroscopic-combined single-stage anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) repairs are scarce. In this report, we describe a case of type III knee dislocation (ACL, PCL, and medial collateral ligament (MCL) injuries) in a 43-year-old man, caused by contact while playing futsal. On the sixth day after injury, arthroscopic ACL and PCL repairs were performed with open MCL repair. The proximal lesions in the three ligaments that were injured were sutured using no. 2 strong surgical sutures. The ACL was pulled out to the lateral condyle of the femur and fixed using a suspensory fixation device. The PCL was pulled out to the medial condyle of the femur, and the MCL was pulled towards the proximal end of the femur; both were fixed using suture anchors. Early mobilization was performed, and both, clinical and imaging outcomes, were good two years after surgery.

scholarly journals Morphometric Analysis of Proximal End of the Tibia

2019 ◽  
Vol 08 (02) ◽  
pp. 082-086
Author(s):  
Nadia Ahmad ◽  
Deepa Singh ◽  
Aksh Dubey ◽  
S. L. Jethani
Keyword(s):  
Knee Arthroplasty ◽  
Knee Prosthesis ◽  
Knee Injuries ◽  
Morphometric Parameters ◽  
P Value ◽  
Lateral Condyle ◽  
Medial Condyle ◽  
Tibial Condyle ◽  
Knee Deformity ◽  
Total Knee

Abstract Background Total knee arthroplasty and unicompartmental knee arthroplasty are frequently done procedures for the treatment of various forms of arthritis and knee injuries. The knee prosthesis, which is used for these procedures, requires adequate sizing specific to the population. Morphometric parameters of upper end of the tibia can be used to guide treatment and monitor outcome of total knee replacement surgeries. Information regarding morphometry of upper end of the tibia is important as it provides reliable method of assessing knee deformity. This article assesses different morphometric parameters of condylar and intercondylar surface of the tibia and to compile the results, analyze, and formulate a baseline data for future studies with relevance to Indian population. Materials and Methods The study group comprised of 60 adult human dry and processed tibia of both sides which are grossly normal and complete, obtained from the Department of Anatomy, Himalayan Institute of Medical Sciences. Morphometric measurements of the medial condyle, lateral condyle, and intercondylar area of tibia were recorded with vernier calipers with a least count of 0.01 mm. The dimensions were summarized as mean ± standard deviation. A p-value of < 0.05 was considered significant. Result Mediolateral and anteroposterior length were 66.33 and 42.52 mm, respectively. Conclusion Anatomical profile of tibial condyle for Indians is smaller, hence highlighting the need for sizing of prosthesis specific to the population in question.

scholarly journals Morphometric Study of upper end of Tibia : a study done at SKIMS medical college Srinagar

2019 ◽  
pp. 9-10
Author(s):  
Nowsheeba Khurshid ◽  
Rohul Afza
Keyword(s):  
Indian Population ◽  
Current Data ◽  
Morphometric Study ◽  
Lateral Condyle ◽  
Base Line ◽  
Morphometric Measurements ◽  
Medial Condyle ◽  
Medical College ◽  
Total Knee ◽  
Base Line Data

Introduction: Upper end of tibia is an important component of knee joint. The aim of present study is to analyse different morphometric parameters of condylar and intercondylar surface of tibia, so as to formulate a baseline data for future studies with relevance to Indian population and to compare the current data with previous literature. Morphometric study of upper end of tibia can be used to guide treatment and monitor outcome of total knee replacement surgeries. Material and Method: 30 dried human adult tibia were obtained from Dept. of anatomy SKIMS Medical College bemina Srinagar. Morphometric measurements of medial condyle, lateral condyle and intercondylar area of tibiae were measured with Vernier caliper. Result: Anteroposterior measurements were found to be greater than transverse measurements for both medial and lateral condyles. Furthermore, both anteroposterior and transverse measurements were greater in medial condyle than in lateral condyle.Racial differences were observed. Conclusion: The present study is to provide a base line data pertaining to morphometric details of upper end of tibia in Indian population, which aims to provide help for anatomists, anthropologists, and orthopedics, in knee arthroplasty procedures, and meniscal transplantation

scholarly journals Accuracy of Ultrasound-Guided Genicular Nerve Block: A Cadaveric Study

2015 ◽  
Vol 5;18 (5;9) ◽  
pp. E899-E904
Author(s):  
Dr. Serdar Kesikburun
Keyword(s):  
Knee Pain ◽  
Nerve Block ◽  
Medial Collateral Ligament ◽  
Medial Epicondyle ◽  
Cadaveric Study ◽  
Ultrasound Guided ◽  
Collateral Ligament ◽  
Anatomic Landmarks ◽  
Adductor Tubercle ◽  
Chronic Knee Pain

Background: Genicular nerve block has recently emerged as a novel alternative treatment in chronic knee pain. The needle placement for genicular nerve injection is made under fluoroscopic guidance with reference to bony landmarks. Objective: To investigate the anatomic landmarks for medial genicular nerve branches and to determine the accuracy of ultrasound-guided genicular nerve block in a cadaveric model. Study Design: Cadaveric accuracy study. Setting: University hospital anatomy laboratory. Methods: Ten cadaveric knee specimens without surgery or major procedures were used in the study. The anatomic location of the superior medial genicular nerve (SMGN) and the inferior medial genicular nerve (IMGN) was examined using 4 knee dissections. The determined anatomical sites of the genicular nerves in the remaining 6 knee specimens were injected with 0.5 mL red ink under ultrasound guidance. The knee specimens were subsequently dissected to assess for accuracy. If the nerve was dyed with red ink, it was considered accurate placement. All other locations were considered inaccurate. Results: The course of the SMGN is that it curves around the femur shaft and passes between the adductor magnus tendon and the femoral medial epicondyle, then descends approximately one cm anterior to the adductor tubercle. The IMGN is situated horizontally around the tibial medial epicondyle and passes beneath the medial collateral ligament at the midpoint between the tibial medial epicondyle and the tibial insertion of the medial collateral ligament. The adductor tubercle for the SMGN and the medial collateral ligament for the IMGN were determined as anatomic landmarks for ultrasound. The bony cortex one cm anterior to the peak of the adductor tubercle and the bony cortex at the midpoint between the peak of the tibial medial epicondyle and the initial fibers inserting on the tibia of the medial collateral ligament were the target points for the injections of SMGN and IMGN, respectively. In the cadaver dissections both genicular nerves were seen to be dyed with red ink in all the injections of the 6 knees. Limitations: The small number of cadavers might have led to some anatomic variations of genicular nerves being overlooked. Conclusions: The result of this cadaveric study suggests that ultrasound-guided medial genicular nerve branch block can be performed accurately using the above-stated anatomic landmarks. Key words: Knee pain, genicular nerve, nerve block, osteoarthritis, ultrasonography, cadaver study, injection, accuracy

scholarly journals Morphological and topographic study of diaphyseal nutrient foramen of femur and its clinical implications in North Indian population

2017 ◽  
Vol 5 (9) ◽  
pp. 4036
Author(s):  
Shweta Jha ◽  
Renu Chauhan
Keyword(s):  
Surgical Procedures ◽  
Indian Population ◽  
North Indian Population ◽  
Medial Condyle ◽  
Nutrient Foramen ◽  
Common Location ◽  
Nutrient Foramina ◽  
Distal Aspect ◽  
Linea Aspera ◽  
Upper Third

Background: Nutrient foramen of long bones defines the extent of bone vascularisation. Information regarding nutrient foramen is necessary to conserve circulation during orthopaedic and surgical procedures. The present study was conducted to examine the position, number and calibre of nutrient foramina in 100 dry femora belonging to North Indian population.Methods: The total length (TL) of each femur was measured by taking the measurement between the most proximal aspect of the head of the femur and the most distal aspect of the medial condyle. Number of nutrient foramina was determined by using a magnifying lens. Distance of nutrient foramen from upper end was measured. Direction and obliquity of nutrient foramina were noted. Position of nutrient foramina was determined in relation to length of femur and linea aspera. Caliber of nutrient foramen was measured using 18, 20, 22 and 24-gauge needles.Results: Length of femur on right side was 435.2 mm (Range 393-523 mm). Length of femur on left side was 437 mm (range 369-524). 78 (78%) femora had single nutrient foramen, 11 (11%) had double nutrient foramen and 11 (11%) had no nutrient foramen. All foramina were directed upwards. Maximum foramina were located in middle third of femur (84%) followed by upper third of femur (8%). Most common location was on the intermediate area between two lips of linea aspera (42%) followed closely by medial lip of linea aspera (36%).Conclusions: This study has provided additional data on the subject which will help in resection, surgical procedures and transplantation techniques by orthopedician in North Indian population.

scholarly journals Differential anatomy within the femoral origin of the medial patellofemoral complex: Implications or reconstruction

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0044
Author(s):  
Miho Tanaka
Keyword(s):  
Patellar Instability ◽  
Femoral Tunnel ◽  
Graft Function ◽  
Femoral Shaft ◽  
Quadriceps Tendon ◽  
Medial Epicondyle ◽  
Distal Margin ◽  
Proximal Margin ◽  
Adductor Tubercle ◽  
Medial Patellofemoral Complex

Objectives: The medial patellofemoral complex (MPFC) includes the medial patellofemoral ligament (MPFL) and medial quadriceps tendon femoral ligament (MQTFL). Recent reports have described reconstruction of this fan-shaped ligament to treat patellar instability using a double stranded technique to recreate both components of the complex, with a common origin on the medial femur. Much effort has been placed on accurately identifying the “point” of femoral origin during reconstruction due to the influence of femoral tunnel position on MPFC graft function, however, the MPFC origin is elongated in nature. Therefore, the purpose of this study was to describe the shape and orientation of the MPFC origin and identify the difference between the most proximal and distal margins of the elongated femoral footprint. Methods: 20 paired fresh frozen cadaveric knees were dissected. From an intraarticular approach, the MPFC was exposed and followed to its footprint on the medial femur. All other soft tissue was removed from the distal femur, and the footprint of the MPFC, the adductor tubercle and medial epicondyle were marked. Images of the medial femur were analyzed using Image J software. The length and width of the MPFC footprint was described to the nearest 0.1mm, as well as the angle of the long axis of the footprint relative to the axis of the femoral shaft (0.1 degrees). The position of the footprint’s most proximal and distal margins were identified and described in relation to the adductor tubercle and medial epicondyle. The positions for each were compared using paired t tests. Results: 17 knees from 10 cadavers (7M, 3F, mean age 73.1) were included in this study. The MPFC femoral footprint had a length of 11.7mm+/-1.8mm (Range 9.6,15.7) and a width of 1.7mm+/-0.4mm (Range, 0.9, 2.2). The long axis of the footprint was found to lie at an angle 14.6+/-16.6 degrees anterior to the axis of the femoral shaft. The most proximal fibers originated 7.4mm+/-3.8mm anterior and 1.8mm+/-4.7mm distal to the adductor tubercle, and 4.1mm+/-2.6mm posterior and 8.4mm+/-5.6mm proximal to the medial epicondyle. The most distal fibers originated 4.9mm+/-4.2mm anterior and 1.3mm+/-4.3mm and distal to the adductor tubercle, as well as 7.1mm+/-2.4mm posterior and 0.5mm+/-5.6mm distal to the medial epicondyle. Overall, the distal margin of the footprint was 10.9mm+/-1.7mm distal (p<0.001) and 2.6mm+/-3.2mm more posterior (p=0.005) than the proximal margin of the MPFC origin. Conclusions: The femoral footprint of the MPFC is ribbon shaped, with the distal margin being 10.9 mm distal and 2.6 mm posterior to the proximal margin. This differential anatomy of the femoral origin suggest that MPFL and MQTFL reconstruction may require separate placements of the femoral tunnels to anatomically recreate these fibers. Further biomechanical studies are needed to determine the optimal femoral tunnel placement in the setting of double-limbed MPFC reconstruction, as well as the long term benefit of this technique in the treatment of patellar instability.

scholarly journals Isokinetic profile of subjects with the ruptured anterior cruciated ligament

2016 ◽  
Vol 73 (7) ◽  
pp. 631-635 ◽  
Author(s):  
Miodrag Drapsin ◽  
Damir Lukac ◽  
Predrag Rasovic ◽  
Patrik Drid ◽  
Aleksandar Klasnja ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Peak Torque ◽  
Acl Rupture ◽  
Thigh Muscle ◽  
Thigh Muscles ◽  
Significant Difference ◽  
Bilateral Differences ◽  
High Level

Background/Aim. All changes in the knee that appear after anterior cruciate ligament (ACL) lesion lead to difficulties in walking, running, jumping especially during sudden changes of the line of movement. This significantly impairs quality of life of these subjects and leads to decrease in physical activity. Knee injuries make 5% of all most severe acute sport injuries. The aim of the study was to determine strength of the thigh muscles in persons with unilateral rupture of the ACL and to evaluate potential bilateral differences between healthy and injured leg. Methods. This study involved 114 male athletes of different sport specialities with the clinical diagnosis of ACL rupture. Each subject had unilateral ACL rupture and the other leg was actually the control for this research. An isokinetic device was used to evaluate the muscle strength of thigh muscles. Testing was performed for two testing speeds, 60?/s and 180?/s. Results. Data analysis showed a statistically significant difference (p < 0.01) between the ACL and the healthy leg in the following parameters: peak torque for thigh extensors (Ptrq_E), angle to peak torque during extension (Ang_E), power of extension (Pow_E) and work during extension (Work_E). Analysing hamstrings to quadriceps (H/Q) ratio we found the unilateral disbalance of thigh muscle strength in ACL leg. Conclusion. A high level of validity makes isokinetic dynamometry the method for evaluation of thigh muscles strength and leaves this field of research open for new studies in order to improve both diagnostic and rehabilitation of patients with the insufficient ACL.

scholarly journals The bone attachments of the medial collateral and posterior oblique ligaments are defined anatomically and radiographically

2020 ◽  
Vol 28 (12) ◽  
pp. 3709-3719 ◽  
Author(s):  
K. K. Athwal ◽  
L. Willinger ◽  
S. Shinohara ◽  
S. Ball ◽  
A. Williams ◽  
...  
Keyword(s):  
Medial Collateral Ligament ◽  
Knee Flexion ◽  
Tibial Plateau ◽  
Medial Epicondyle ◽  
Collateral Ligament ◽  
Posterior Cortex ◽  
Posterior Oblique Ligament ◽  
Medial Knee ◽  
Knee Ligaments ◽  
Bony Landmarks

Abstract Purpose To define the bony attachments of the medial ligaments relative to anatomical and radiographic bony landmarks, providing information for medial collateral ligament (MCL) surgery. Method The femoral and tibial attachments of the superficial MCL (sMCL), deep MCL (dMCL) and posterior oblique ligament (POL), plus the medial epicondyle (ME) were defined by radiopaque staples in 22 knees. These were measured radiographically and optically; the precision was calculated and data normalised to the sizes of the condyles. Femoral locations were referenced to the ME and to Blumensaat’s line and the posterior cortex. Results The femoral sMCL attachment enveloped the ME, centred 1 mm proximal to it, at 37 ± 2 mm (normalised at 53 ± 2%) posterior to the most-anterior condyle border. The femoral dMCL attachment was 6 mm (8%) distal and 5 mm (7%) posterior to the ME. The femoral POL attachment was 4 mm (5%) proximal and 11 mm (15%) posterior to the ME. The tibial sMCL attachment spread from 42 to 71 mm (81–137% of A-P plateau width) below the tibial plateau. The dMCL fanned out anterodistally to a wide tibial attachment 8 mm below the plateau and between 17 and 39 mm (33–76%) A-P. The POL attached 5 mm below the plateau, posterior to the dMCL. The 95% CI intra-observer was ± 0.6 mm, inter-observer ± 1.3 mm for digitisation. The inter-observer ICC for radiographs was 0.922. Conclusion The bone attachments of the medial knee ligaments are located in relation to knee dimensions and osseous landmarks. These data facilitate repairs and reconstructions that can restore physiological laxity and stability patterns across the arc of knee flexion.

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