Edie Benedito Caetano

Importance of anatomically locating the infrapatellar branch of the saphenous nerve in reconstructing the anterior cruciate ligament using flexor tendons

Objective To describe the path of the infrapatellar branch of the saphenous nerve (IBSN) using the medial joint line, anterior tibial tuberosity (ATT), tibial collateral ligament and a horizontal line parallel to the medial joint line that passes over the ATT, as reference points, in order to help surgeons to diminish the likelihood of injuring this nerve branch during reconstruction of the anterior cruciate ligament (ACL) using flexor tendons. Methods Ten frozen knees that originated from amputations were examined. Through anatomical dissection performed with the specimens flexed, we sought to find the IBSN, from its most medial and proximal portion to its most lateral and distal portion. Following this, the anatomical specimens were photographed and, using the ImageJ software, we determined the distance from the IBSN to the medial joint line and to a lower horizontal line going through the ATT and parallel to the first line. We also measured the angle of the direction of the path of the nerve branch in relation to this lower line. Results The mean angle of the path of the nerve branch in relation to the lower horizontal line was 17.50 ± 6.17°. The mean distance from the IBSN to the medial joint line was 2.61 ± 0.59 cm and from the IBSN to the lower horizontal line, 1.44 ± 0.51 cm. Conclusion The IBSN was found in all the knees studied. In three knees, we found a second branch proximal to the first one. The direction of its path was always from proximal and medial to distal and lateral. The IBSN was always proximal and medial to the ATT and distal to the medial joint line. The medial angle between its direction and a horizontal line going through the ATT was 17.50 ± 6.17°.

Estudio del Ángulo del Cuello del Fémur en Cadáveres del Departamento de Anatomía de la Facultad de Medicina - PUC-SP

En la literatura brasilena los trabajos sobre el angulo del cuello del femur (CDA) son escasos, asi como de las otras medidas que pueden adquirirse en la porcion proximal del hueso, como la longitud del cuello del femur (FAL), anchura de cuello del femur (FNW), y el diametro de la cabeza del femur (FHD). Este estudio tiene el proposito de aumentar los datos de individuos brasilenos, proporcionando principios anatomicos que permitan una mejor comprension de estados clinicos y patologicos que involucran la articulacion de la cadera. Todas estas medidas se consiguieron en milimetros (mm) a traves de un paquimetro y un goniometro, por un mismo investigador. Se analizaron 87 huesos, siendo 40 (46%) femures derechos y 47 (56%) femures. Los huesos estaban enteros y eran de individuos adultos. Para analizar las medidas se uso Analisis de Varianza de Friedman para comparar, separadamente, los lados derecho y izquierdo, los valores de las cinco medidas efectuados por los mismos investigadores; la prueba t-Student para las muestras independientes, con el objetivo de comparar, para cada cadaver, los valores del angulo observado en los lados derecho e izquierdo. Los resultados fueram: derecho-CDA 128.23° ± 4.43 e izquierdo-CDA 128.04° ± 4.36, derecho-FAL 90.14mm ± 5.53 e izquierdo-FAL 91.08mm ± 5.48, derecho-FNW 28.69mm ± 2.58 e izquierdo-FNW 28.81mm ± 3.28, y derecho-FHD 41.80mm ± 3.10 e izquierdo-FHD 42.11 ± 3.42. En conclusion, son importantes los datos de geometria femoral de huesos brasilenos obtenidos en este estudio, para poder compararlos con valores obtenidos en individuos de otros estados brasilenos, debido el tamano continental de Brasil, que causa variaciones en su poblacion. Tambien es importante la posibilidad de aplicar en el futuro geometria de la porcion proximal del femur en la practica medica, sobre todo cuando existe riesgo de fractura del hueso

ESTUDIO ANATÓMICO DE LAS INSERCIONES DE LOS MÚSCULOS EXTENSORES RADIALES LARGO Y CORTO DEL CARPO

En el analisis de los tendones de los musculos extensores radiales largo y corto del carpo, basados en la diseccion anatomica de 60 miembros superiores de cadaveres adultos de raza blanca y sexo masculino, registramos que las variaciones anatomicas no son muy frecuentes. La presencia de tendones accesorios ocurrio en apenas 3 manos disecadas, todas del musculo extensor radial largo del carpo. La presencia de vinculos tendinosos uniendo los tendones, fue registrada en 17 piezas. La presencia de un tendon intermedio uniendo los dos tendones, fue verificada en 4 piezas. La insercion del tendon del musculo extensor radial largo del carpo ocurrio, invariablemente, en el lado radial de la base del segundo metacarpiano y del musculo extensor radial corto en el lado radial de la base del tercer metacarpiano. Basados en nuestras disecciones podemos afirmar que la conformacion anatomica normal de los musculos extensores radiales largo y corto del carpo, es la presencia de un cuerpo muscular y un tendon de cada uno de los musculos extensores radiales que son cubiertos por los musculos abdutor largo y extensor corto; pasan por el segundo compartimiento dorsal del puno y se insertan, el musculo extensor radial largo en el lado radial de la base del segundo metacarpiano y el musculo extensor radial corto en el lado radial de la base del tercer metacarpiano, invariablemente

GANTZER MUSCLE. AN ANATOMICAL STUDY

OBJECTIVE: The relationship of Gantzer muscle to the median and anterior interosseous nerve is debated. METHODS: Ìn an anatomical study with 80 limbs from 40 cadavers the incidence, origin, insertion, nerve supply and relations of Gantzer muscle have been documented. RESULTS: The muscle was found in 54 forearms (68% of limbs) and was supplied by the anterior interosseous nerve. It arose from the deep surface of the flexor digitorum superficialis muscle, (42 limbs), coronoid process (eight limbs) and medial epicondyle (seven limbs). Its insertion was to the ulnar part of flexor pollicis longus muscle. The Gantzer muscle always lay posterior to both the median and anterior interosseous nerve. CONCLUSION: The Gantzer muscle may contribute to the median nerve and anterior interosseous nerve compression. The muscle was found in 68% of limbs and should be considered a normal anatomical pattern rather than an anatomical variation. Level of Evidence IV, Case Series .

Estudo anatômico das inserções distais do tendão extensor longo do polegar

Registramos pelo presente estudo que o musculo (ELP) e seu tendao apresentaram poucas variacoes anatomicas. Nao registramos a presenca de tendoes acessorios e nem a ausencia desse musculo ou de seu tendao. Verificamos em todas as preparacoes a passagem do tendao pelo terceiro compartimento osteofibroso, cruzando sobre os extensor radial curto (ERCC) e longo (ERLC) do carpo e dirigindo-se ao polegar. A alteracao no trajeto tendinoso, desviando-se no sentido radial foi verificada em uma das preparacoes (1,6%). A duplicacao parcial do tendao proximal a articulacao metacarpofalângica (AMFP) foi verificada em 3 observacoes (4,8%), sendo 1 bilateral, e distal a articulacao em 5 (8,3%), 2 bilateralmente. A insercao ossea na base da falange distal (BFD) foi encontrada em todas as observacoes. Durante sua passagem pela articulacao metacarpofalângica, registramos sua insercao na capsula articular em 14 observacoes (23,3%), porem nao registramos a insercao ossea nesse local. O padrao mais comum em relacao ao musculo ELP foi a presenca constante de 1 tendao, passando pelo terceiro compartimento osteofibroso dorsal do punho com insercao ossea na base da falange distal do polegar.

Clinical repercussions of Martin-Gruber anastomosis: anatomical study

Objective The main objective of this study was to describe Martin-Gruber anastomosis anatomically and to recognize its clinical repercussions. Method 100 forearms of 50 adult cadavers were dissected in an anatomy laboratory. The dissection was performed by means of a midline incision along the entire forearm and the lower third of the upper arm. Two flaps including skin and subcutaneous tissue were folded back on the radial and ulnar sides, respectively. Results Nerve communication between the median and ulnar nerves in the forearm (Martin-Gruber anastomosis) was found in 27 forearms. The anastomosis was classified into six types: type I: anastomosis between the anterior interosseous nerve and the ulnar nerve (n = 9); type II: anastomosis between the anterior interosseous nerve and the ulnar nerve at two points (double anastomosis) (n = 2); type III: anastomosis between the median nerve and the ulnar nerve (n = 4); type IV: anastomosis between branches of the median nerve and ulnar nerve heading toward the flexor digitorum profundus muscle of the fingers; these fascicles form a loop with distal convexity (n = 5); type V: intramuscular anastomosis (n = 5); and type VI: anastomosis between a branch of the median nerve to the flexor digitorum superficialis muscle and the ulnar nerve (n = 2). Conclusion Knowledge of the anatomical variations relating to the innervation of the hand has great importance, especially with regard to physical examination, diagnosis, prognosis and surgical treatment. If these variations are not given due regard, errors and other consequences will be inevitable.

INTRAMUSCULAR MARTIN-GRUBER ANASTOMOSIS

Objective : This paper reports the incidence, origin, course and anatomical relationships of intramuscular Martin-Gruber anastomosis. Methods : Anatomical dissection of 100 limbs from 50 adults cadavers was performed. The intramuscular Martin-Gruber anastomosis was found in five forearms, three in the right and two in the left side, one was bilateral. All communication were located between the anterior interosseous nerve and the ulnar nerve. Conclusion : The purpose of intramuscular Martin-Gruber anastomosis, which we found in 5% of dissected limbs, is to supply the flexor digitorum profundus muscle and it is unlikely to have any influence on the innervation of the intrinsic muscles of the hand. Level of Evidence IV, Cases Series.

ANATOMIC STUDY OF THE NERVOUS COMMUNICATION BETWEEN THE MEDIAN AND MUSCULOUCUTANEOUS NERVE

ABSTRACT Objective: The aim of this study was to analyze the incidence of nerve communication between the musculocutaneous and median nerve. Methods: Anatomical dissection of 40 limbs from 20 fetal cadavers was performed at the Laboratory of Anatomy, Faculdade de Ciências Médicas e da Saúde da Pontifícia Universidade Católica de São Paulo. Results: A communicating branch was found in 10 upper limbs. In nine limbs there was a musculocutaneous-median anastomosis (type I); and in one limb there was a median-musculocutaneous anastomosis (type II). Conclusion: It is very important to know these anatomical variations, especially when considering clinical examination, diagnostic, prognostic and surgical treatment. Level of Evidence IV, Case Series.

O comprimento dos túneis femorais varia com a flexão do joelho na reconstrução anatômica do ligamento cruzado anterior

OBJECTIVE: The objective of our study was to evaluate the effect that knee flexion angle while femoral tunnels are being drilled may have on the length of these tunnels, in anatomical reconstruction of the anterior cruciate ligament. METHODS: We measured the lengths of anteromedial and posterolateral tunnels for the anterior cruciate ligament in 20 unpaired anatomical knee specimens (10 right and 10 left knees), all with the cartilage and cruciate ligaments intact. Tunnels were drilled with the knees flexed at 90o, 110o and 130o, through the accessory anteromedial portal, with a 2.5 mm drill. The statistical analysis was done by means of Friedmans variance analysis and the Mann-Whitney U test. RESULTS: The mean anteromedial femoral tunnel lengths measured with the knees flexed at 90o, 110o and 130o were 33.7 (± 3.72) mm, 37.4 (± 2.93) mm and 38.8 (± 3.31) mm, respectively. For the posterolateral femoral tunnel lengths, the results were 32.1 (± 4.24) mm, 37.3 (± 4.85) mm and 38.4 (± 2.51) mm, respectively. Friedmans variance analysis showed that there was a significant difference between the lengths of the tunnels drilled with 90o and 110o of flexion angle, but showed that there was no significant difference between the tunnels drilled with flexion of 110o and 130o (P < 0.05). CONCLUSIONS: It is possible to drill the femoral tunnels through the accessory anteromedial tunnel with the knee flexed at 110o in such a way as to produce a tunnel of sufficient length for a good bone-graft interface.

O ultra-som na artropatia hemofílica subaguda do joelho

Here we present 4 cases of Knee Sub-Acute Hemophilic Arthropathy according to clinical, X-ray and ultrasound aspects. The X-ray images show subtle changes in the early phases of Hemophilic Arthropathy (HA). Ultrasound aspects are emphasized, which provided direct image of the synovial membrane at the knee anterior capsular recess. We discuss the potential ultrasound use as a marker of inflammatory activity.