The anatomy of the anconeus nerve redefined

The anconeus nerve is the longest branch of the radial nerve and suitable as a donor for the neurotization of the axillary nerve. The aim of this study was to map its topographical course with reference to palpable, anatomical landmarks. The anconeus nerve was followed in 15 cadaveric specimens from its origin to its entry to the anconeus. It runs between the lateral and the medial head of the triceps before entering the medial head and running intramuscularly further distal. Exiting the muscle, it lies on the periosteum and the articular capsule of the elbow, before entering the anconeus muscle. Two types of anconeus nerve in relation to branches innervating triceps were found: nine nerves also innervated the lateral triceps head, while the other six only contributed two branches to its innervation. The course of the anconeus nerve is important for harvesting as a donor nerve and to protect the nerve in surgical elbow approaches.

Internal Structural Connections in the Popliteal Muscle Tendon Complex and Their Clinical Significance

Background:The popliteal muscle-tendon complex (PMTC) belongs to the deep structure of the posterolateral complex (PLC) of human knee, which plays an important role in the posterolateral stability of the knee joint. At present, the anatomical relationship between the popliteal muscle and its adjacent structures remains controversial, especially the posterior cruciate ligament (PCL) and popliteal muscle. The revealation of anatomical connection between the popliteus muscle and its deep structures could provide an anatomical basis for the reconstruction of the PLC injury.Methods: To observe and analyze the relationship between popliteal muscle and the PCL, posterior meniscofemoral ligament (PMFL), lateral meniscus and articular capsule (AC). The dissection of 7 cases of adult human knee joint fixed with formalin, and 9 cases of sagittal P45 plastinated section of the knee joint were involved in this study. Results: For the popliteal muscle, the anatomical dissection showed that at the posterior edge of the platform of the lateral condyle of the tibia, at the tendon-muscle transition, from medial to lateral, separately sent out: dense connective tissue to connect with the PCL, dense fiber bundles to connect with the PMFL, and dense connective tissue band to connect the lateral meniscus. Meanwhile, the results of the P45 section revealed that the popliteal muscle fascia ran superiorly over the posterior edge of the tibialintercondylar eminence, andturned forward to be integrated into the PCL. Laterally, near the posterior edge of the lateral tibial plateau, the popliteal tendon penetrates through the articular capsule, where two dense fiberous bundleswere given off upwards by the popliteal tendon: one was the ventral fiber bundle,which ran superiorly over the posterior edge of the tibial plateau and then moved forwards to connect with the lateral meniscus; the dorsal fibersbundle ascended directly and participated in the AC.Conclusion: Popliteus muscle was connected with PCL, AC, lateral meniscus, and PMFL via the dense connective tissues near its tendon-muscle transition.

Histological and Immunofluorescence Study of Discal Ligaments in Human Temporomandibular Joint

The temporomandibular joint (TMJ) is a bilateral synovial articulation stabilized by several anatomical structures such as ligaments. The existence of articular capsule reinforcement structures have been described in the lateral and medial sides of disc which have been defined as collateral ligaments, lateral and medial. Despite that, some macroscopic observations support that these collateral ligaments do not belong to the articular capsule but they belong to the disc. By that, the aim of the present work was to evaluate morphological aspects of TMJ from cadaveric frozen heads by histological and immunofluorescence techniques in order to verify the origin and insertion of lateral and medial collateral ligaments. Results show that both lateral and medial ligaments origin from the disc and insert directly to the articular cartilage of mandibula condyle. These data open a new approach in the study of human TMJ.

Effect of articular capsule repair on postoperative dislocation after primary total hip replacement by the anterolateral approach

Objective Artificial hip dislocation is one of the most serious complications following total hip replacement. This study was performed to assess articular capsule repair in primary total hip replacement with the anterolateral approach (Watson-Jones incision) and its effect on postoperative dislocation. Methods Patients who underwent primary total hip replacement by the anterolateral approach in Tongren Hospital of Shanghai Jiao Tong University School of Medicine from June 2007 to June 2014 were retrospectively analyzed. The patients were divided into the repair and dissection groups based on the articular capsule repair status during surgery. Postoperative dislocation rates were compared between the two groups using the chi-squared test. Results The repair and dissection groups comprised 137 and 248 patients, respectively. All patients were followed up for 6 months to 5 years (average, 3.75 years). The mean age, sex, disease composition, and follow-up time were not significantly different between the two groups. Early postoperative dislocation occurred in 1 hip (0.7%) in the repair group and 13 hips (5.2%) in the dissection group. Conclusions During the anterolateral approach for primary total hip replacement, articular capsule repair may reduce the occurrence of early postoperative dislocation of the hip joint.

Comparative morphofunctional and species-specific vascularization features of of the knee capsule of some mammals

The metabolic, reparative and plastic properties, as well as the functional activity of the multiorgan synovial environment of the knee joint, are organically and functionally related to their morphology and blood supply. The aim of our research was to determine the general biological and specific features of the structural organization and vascularization of the knee joint capsule in animals with different supports, locomotion and body weight. A complex of morphological research methods is used in this work: anatomical, histological, neurohistological. Used neurohistological method of impregnation in its own algorithm. The structural organization of synovial and fibrous capsule, histotopography of intraorganic vessels was studied on 43 objects of various groups of animals. The selection of animals was carried out according to the type of limb specialization to the substrate. Animals were taking into account the ecology, types of support, the nature of locomotion and the speed of movement – phalanoid animals – a domestic horse, a domestic bull and a finger animal – a domestic dog and a domestic cat. As a result of the complex comparative-morphological study the general patterns of the structural organization of the articular capsule, the general-biological and species-specific features of the angioarchitectonics and angiotopography were established. The zones of the most intense intraorganic vascularization and the topography of the vascular fields and glomeruli of the articular capsule are shown. The zones of intensive vascularization are localized: in the domestic bull – in the medial, dorsal, lateral parts, vascular glomeruli – in the lateral; in the domestic horse – in all parts of the capsule, vascular glomeruli – in the plantar area; in the domestic dog – in the medial, dorsal, plantar parts, vascular glomeruli – in the plantar area; in a domestic cat, the same type of angioarchitectonics is observed, the vascular fields and glomeruli are absent. The more intense angioarhitectonics in the capsule of the knee joint in phalanoid animals (horse, cattle) than in the finger (dog, cat) possibly due to the different nature of the support and type of locomotion, is determined. Key words: vascular fields, vascular glomeruli, angioarchitectonics, knee joint, joint capsule, domestic horse, domestic bull, domestic dog, domestic cat.

Features of histological differential diagnostics of a tenosynovial giant cell tumor of diffuse type and non-specific inflammatory lesions of the articular capsule

Tenosynovial giant cell-tumor is a benign tumor of the synovial layer of the joints; for a long time to characterize this nosology, the term “villous- nodular synovitis” was used and considered it as a kind of inflammatory post-traumatic process in the joint capsule, and only in-depth studies of the properties of TSGCT at the molecular and cytogenetic levels proved its neoplastic nature. The purpose — to determine the peculiarities of approaches to differential diagnosis of TSGCT with exudative-proliferative syndromes, based on the clinical and morphological studies of biopsy-resection material. The study was performed on 95 cases of TSGCT of diffuse type of different localization, 56 cases of rheumatoid arthritis and 48 cases of non-specific post-traumatic pigmented synovitis. Grades of expressiveness of morphological indicators were evaluated according to the visual-analog scale from low to high with an increase of x100. Hypertrophic, hyperplastic and inflammatory changes in the articular capsule in cases of nonspecific pigmented synovitis are limited to a synovial layer. Hemosiderin is found in the cytoplasm of synovial cells and in siderophages. Nodular and solid proliferators, signs of invasion in adjacent tissues, are absent, which is an important feature in the differential diagnosis of lesions of the joint capsule, rich in clusters of macrophage siderocytes. At histological examination in isolated tissues in patients with rheumatoid arthritis signs of chronic non-specific productive-infiltrative and exudative inflammation of different activity were found — a cluster of mononuclears and plasmacites with the formation of small lymphoid follicles in its own synovial plate, hyperemia of the microcirculatory bed, and fibrin layers. The difference between the described synovitis from TSGCT is the absence of nodular proliferators, infiltrative changes in the deep departments of the capsule, hemorrhages, clumps of hemosiderin and large epithelioid synovitis, which is characteristic of tumors. TSGCT is characterized by polymorphism of histological changes and different degrees of prevalence in joint structures, which in many cases complicates its differential diagnosis.

Clinical results of capsular interposition arthroplasty for severe hallux rigidus

Category: Midfoot/Forefoot Introduction/Purpose: There is no established surgical treatment for severe hallux rigidus (HR). Hamilton suggested capsular interposition arthroplasty (CIA), performed using an articular capsule and extensor hallucis brevis as a biologic spacer, as an alternative to metatarsophalangeal (MTP) joint fixation to treat severe HR. CIA is a preservation procedure that relieves pain and maintains joint function. We present the results of CIA performed at our facility to treat severe HR. Methods: In the present study, we further divided Hattrup’s grade II HR into two subtypes on the basis of joint space narrowing of 1stMTP. We recorded the severity of patients’ condition using our modified Hattrup’s classification. In this study, we did a follow-up of 8 cases in which CIA was performed to treat severe HR. The cases were followed up for 1 year or longer. The mean age of patients at surgery was 63.8 years, and the mean follow-up period was 7.1 years. Surgery was performed using a modified Hamilton method, which involves making an incision on the dorsal instead of the medial side and a manipulating the articular capsule in a different manner. Clinical outcomes were evaluated using the Japanese Society for Surgery of the Foot standard rating system (JSSF) scale. We investigated the pre- and post-operative ROM of the MTP joints and verified the presence or absence of complications. Results: It was observed that pain had reduced significantly in all cases after surgery. Following CIA, the mean ROM at extension was noted to have improved from 27.5° to 48.8° and the mean ROM at flexion had improved from 11.9° to 21.9°. The mean JSSF scale score has improved from 59.5 to 97.5 points. No complications were observed. Conclusion: This procedure is beneficial for pain relief and acquisition or maintenance of articular ROM and is a better choice for patients desiring preservation of ROM and articular function. It is imperative that patients follow proper rehabilitation for ROM and muscular strength preservation.

MORPHOMETRIC CHARACTERISTICS OF TEMPOROMANDIBULAR JOINT IN HUMAN DURING THE SECOND TRIMESTER OF INTRAUTERINE DEVELOPMENT

The article provides data on the anatomical features of temporomandibular joint in the second trimester of fetal development, certain methods of anatomy, morphometry and craniometry. The glenoid fossa in fetuses aged 4-6 months was found to be flat. The bone substance in the glenoid fossa is thin. One can see the development of the elements of the synovial membrane in the articular capsule. In the lower and upper parts of the articular cavity, the folds and ligaments of the connective tissue plate are identified, and the capillaries grow into the synovial membrane. In some places there are connective tissue membranes between the surfaces of the temporal bone and the articular disk, the articular disk and the head of mandible. Macroscopically, the articular disk has a dense structure, it is arranged between the articular surfaces, from the back surface of the articular disk to the inner surface of the articular capsule the taenia of the connective tissue is identified. Anteriorly, the articular disk is attached in the area of the future articular tubercle. The right and lefts temporomandibular joint are of the same size. In the dynamics of the second trimester of intrauterine development, the temporomandibular joint is characterized by the presence of a flat glenoid fossa and the absence of an articular tubercle. An increase in all craniometric indices is observed, indicating an increase in the total bone mass of the skull and an increase in the size of the temporomandibular joint.