Ikuo Kageyama

The twisted structure of the human Achilles tendon

The Achilles tendon (AT) consists of fascicles that originate from the medial head of the gastrocnemius (MG), lateral head of the gastrocnemius (LG), and soleus muscle (Sol). These fascicles are reported to have a twisted structure. However, there is no consensus as to the degree of torsion. The purpose of this study was to investigate the twisted structure of the AT at the level of fascicles that originate from the MG, LG, and Sol, and elucidate the morphological characteristics. Gross anatomical study of 60 Japanese cadavers (111 legs) was used. The AT fascicles originated from the MG, LG, and Sol were fused while twisting among themselves. There were three classification types depending on the degree of torsion. Further fine separation of each fascicle revealed MG ran fairly parallel in all types, whereas LG and Sol, particularly of the extreme type, were inserted onto the calcaneal tuberosity with strong torsion. In addition, the sites of Sol torsion were 3–5 cm proximal to the calcaneal insertion of the AT. These findings provide promising basic data to elucidate the functional role of the twisted structure and mechanisms for the occurrence of AT injury and other conditions.

A new, three-dimensional method for determining tooth wear

A new technique combining moiré contourography and digital image analysis allows the three-dimensional description of molar wear. It is possible to describe the amount of tooth material lost in a given time, e.g. mm3/year, and the differing amounts of wear on individual cusps. The moiré technique can be used in conjunction with more conventional quantitative techniques or by itself to assist in age determination in a population. It can be used to describe small amounts of wear that hitherto were difficult to quantify. It is not recommended where the wear includes the greatest convexity of the crown (height of contour) or affects the central fossa.

Comparative morphological studies on the stereo structure of the lingual papillae of selected primates using scanning electron microscopy.

A scanning electron microscope was used to observe the lingual papillae and their connective tissue cores (CTCs) in five primates (tupai, tamarin, crab-eating monkey, mandrill, and human). There were some slender protrusions rising from the top of the filiform papilla in all five types of primate. After removing the epithelium the filiform CTC from the tupai, tamarin and crab-eating monkey displayed a U-shaped arrangement of rod-shaped protrusions. The filiform CTC from the crab-eating monkey also had a columnar base. The human filiform CTC consisted of a primary columnar base, numerous short rod-shaped secondary protrusions from its upper periphery, and a few central protrusions. The filiform CTC from the Mandrill was fundamentally similar to that of the human, however, its base was shorter. The fungiform CTC from the tupai was column shaped, with several depressions for taste buds on the top. There were three vallate papillae in the tupai, tamarin, and mandrill, approximately four in the monkey, and between five and twelve in the human. Moderately developed foliate papillae were found in the tamarin, monkey, mandrill and human. The tupai, however, possessed a finger-like lateral organ instead. The lingual root area of the tupai, tamarin, crab-eating monkey and mandrill was relatively small with a smooth surface. Only the human had a tonsil-structure, which was located on the surface of its larger lingual root.

Light and scanning electron microscopic study on the lingual papillae and their connective tissue cores of the Cape hyrax Procavia capensis

We examined the epithelial surface and connective tissue cores (CTCs) of each lingual papilla on the Paenungulata, Cape hyrax (Procavia capensis), by scanning electron microscopy and light microscopy. The tongue consisted of a lingual apex, lingual body and lingual root. Filiform, fungiform and foliate papillae were observed on the dorsal surface of the tongue; however, fungiform papillae were quite diminished on the lingual prominence. Moreover, no clearly distinguishable vallate papillae were found on the tongue. Instead of vallate papillae, numerous dome‐like large fungiform papillae were arranged in a row just in front of the rather large foliate papillae. Foliate papillae were situated in the one‐third postero‐lateral margin of the lingual body. The epithelium of filiform papillae was covered by a keratinized layer with kerato‐hyaline granules, whereas weak keratinization was observed on the interpapillary epithelium. The external surface of the filiform papillae was conical in shape. CTCs of the filiform papillae were seen as a hood‐like core with a semicircular concavity in the anterior portion of each core. Large filiform papillae were distributed on the lingual prominence. The CTCs of large filiform papillae after exfoliation of their epithelium consisted of a concave primary core and were associated with several small protrusions. The surface of fungiform papillae was smooth and dome‐like. After removal of the epithelium, CTCs appeared as a flower bud‐like primary core and were associated with several protrusions that were arranged on the rim of the primary core. Several taste buds were found on the top of the dorsal part of the epithelium of both fungiform and large fungiform papillae. Well‐developed foliate papillae were seen and numerous taste buds could be observed in the lateral wall of the epithelium in a slit‐like groove. The morphological characteristics of the tongue of the Cape hyrax had similarities with other Paenungulata such as Sirenia. However, three‐dimensional characteristics, especially CTCs of lingual papillae, exhibited multiple similarities with rodents, insectivores and artiodactyls.

Variations in the course of the maxillary artery in Japanese adults

Many authors have studied variation in the maxillary artery but there have been inconsistencies between reported observations. The present research aimed to examine the courses and branching patterns of the trunk and branches of the maxillary artery in a large sample of Japanese adult cadavers. The course of the maxillary artery should be reclassified into seven groups as a clear relationship was found between the origin of the middle meningeal artery and the course of the maxillary artery. This indicates that conventional theory about the formation of the maxillary artery, which was considered to be a direct derivative of the stapedial artery, might be inaccurate. Many variations in the origin of the inferior alveolar artery were found. Notably, the inferior alveolar artery origin from the external carotid artery and a double origin of the inferior alveolar artery was also observed. Thus, the maxillary artery might be derived from a combination of both the external carotid and stapedial arteries.

Light and Scanning Electron Microscopic Study on the Tongue and Lingual Papillae of the Common Hippopotamus, Hippopotamus amphibius amphibius

We observed the three‐dimensional structures of the external surface and connective tissue cores CTCs, after exfoliation of the epithelium of the lingual papillae (filiform, fungiform, and foliate papillae) of the common hippopotamus (Hippopotamus amphibius amphibius) using scanning electron microscopy and conventional light microscopy. Following unique features were found; typical vallate papillae with a circumferential furrow were not observable. Instead, numerous large fungiform papillae were rather densely distributed on the posterior of the lingual prominence. Taste buds were observable only on the dorsal epithelium. Serous lingual gland was not seen in the lamina propria; however, mucous‐rich mixed lingual glands were found and in a few of orifices were seen on the large fungiform tops. Lingual prominence was diminished their width. Rather long and slender conical papillae were distributed on the lingual prominence and were similar to nonruminant herbivore, that is donkey. Beside this narrow lingual prominence, lateral slopes were situated with numerous short spine‐like protrusions. After removal of the epithelium, CTCs of lateral slopes exhibited attenuated flower bud structures. Large‐conical papillae were situated on the root of the tongue. These large conical papillae were not seen among ruminants and seen on the lingual root of omnivores and carnivores. It implies that lingual structure of common hippopotamus possessed mixed characteristics between Perissodactyls, Ruminantia, and nonherbivores such as Suiformes because of their unique evolutionally taxonomic position. Moreover, adaptation for soft grass diet and associating easier mastication may be also affecting these mixed morphological features of the tongue. Anat Rec, 292:921–934, 2009.

Gender differences of muscle and crural fascia origins in relation to the occurrence of medial tibial stress syndrome.

Although women reportedly have a higher prevalence of medial tibial stress syndrome (MTSS) than men, the possible role of gender‐based anatomical differences has not been investigated. The aim of the present study was to investigate the presence of gender‐based differences in the range of muscle attachments along the entire medial tibia, the proportion of muscle attachment at the middle and distal thirds of the medial margin of the tibia, the structure of the crural fascia, and chiasm position. The specimens were 100 legs of 55 Japanese cadavers. Statistical analysis was carried out using a chi‐square test to compare anatomical features between the sexes. The flexor digitorum longus (FDL) had a higher proportion of attachment to the middle and distal thirds of the medial margin of the tibia than the soleus (SOL; P < 0.001). The proportion of the SOL attachment to the middle and distal thirds of the medial margin of the tibia was 33.3% in men and 72.5% in women (P < 0.001). The soleal aponeurosis was not observed in any specimen. In all specimens the FDL formed the top layer of both chiasms. These results suggest that the higher prevalence of MTSS reported among women may be the result of gender‐based anatomical differences.

Structure of the Achilles tendon at the insertion on the calcaneal tuberosity

Findings on the twisting structure and insertional location of the AT on the calcaneal tuberosity are inconsistent. Therefore, to obtain a better understanding of the mechanisms underlying insertional Achilles tendinopathy, clarification of the anatomy of the twisting structure and location of the AT insertion onto the calcaneal tuberosity is important. The purpose of this study was to reveal the twisted structure of the AT and the location of its insertion onto the calcaneal tuberosity using Japanese cadavers. The study was conducted using 132 legs from 74 cadavers (mean age at death, 78.3 ± 11.1 years; 87 sides from men, 45 from women). Only soleus (Sol) attached to the deep layer of the calcaneal tuberosity was classified as least twist (Type I), both the lateral head of the gastrocnemius (LG) and Sol attached to the deep layer of the calcaneal tuberosity were classified as moderate twist (Type II), and only LG attached to the deep layer of the calcaneal tuberosity was classified as extreme twist (Type III). The Achilles tendon insertion onto the calcaneal tuberosity was classified as a superior, middle or inferior facet. Twist structure was Type I (least) in 31 legs (24%), Type II (moderate) in 87 legs (67%), and Type III (extreme) in 12 legs (9%). A comparison between males and females revealed that among men, 20 legs (24%) were Type I, 57 legs (67%) Type II, and eight legs (9%) Type III. Among women, 11 legs (24%) were Type I, 30 legs (67%) Type II, and four legs (9%) Type III. No significant differences were apparent between sexes. The fascicles of the Achilles tendon attach mainly in the middle facet. Anterior fibers of the Achilles tendon, where insertional Achilles tendinopathy is most likely, are Sol in Type I, LG and Sol in Type II, and LG only in Type III. This suggests the possibility that a different strain is produced in the anterior fibers of the Achilles tendon (calcaneal side) where insertional Achilles tendinopathy is most likely to occur in each type. We look forward to elucidating the mechanisms generating insertional Achilles tendinopathy in future biomedical studies based on the present results.

Anatomical study of toe flexion by flexor hallucis longus.

Because connections exist between the flexor hallucis longus (FHL) and flexor digitorum longus (FDL), the FHL is surmised to exert a flexion action on the lesser toes, but this has not been studied quantitatively. The objectives of this study have thus been to clarify the types of FHL and FDL connections and branching, and to deduce the toe flexion actions of the FHL. One hundred legs from 55 cadavers were used for the study, with FHLs and FDLs harvested from the plantar aspect of the foot, and connections and branches classified. Image-analysis software was then used to analyze cross-sectional areas (CSAs) of each tendon, and the proportion of FHL was calculated in relation to flexor tendons of each toe. Type I (single slip from FHL to FDL tendon) was seen in 86 legs (86%), Type II (crossed connection) in 3 legs (3%), and Type III (single slip from FDL to FHL tendon) or Type IV (no connection between muscles) in 0 legs (0%). In addition, Type V (double slip from FHL to FDL tendon) was seen in 11 legs (11%), representing a new type not recorded in previous classifications. In terms of the various flexor tendons, the proportion of FHL showing tendons to toes 2 and 3 was high, at approximately 50-70%. Consequently, considering the branching type and proportion of CSA, the FHL was conjectured to not only act to flex the hallux, but also play a significant role in the flexion of toes 2 and 3. These results offer useful information for future clarification of the functional roles of tendinous slips from the FHL.

Effective and selective stretching of the medial head of the gastrocnemius

Muscle injury frequently occurs in the medial head of the gastrocnemius (MG), and stretching is used for treatment. However, there are no studies based on anatomical considerations and biomechanics. This study therefore examined the macroscopic anatomical structure of the triceps surae muscle to design an effective and selective MG stretching method, before quantitatively verifying that method by ultrasonography. The macroscopic anatomy was analyzed in 16 Japanese cadavers (25 legs). Based on the anatomical findings and the arrangement of fascicles in the MG, we concluded that ankle inversion might be advantageous for selective stretching of the tendon fiber bundles into which the MG inserts. We devised a method in which the limb was initially positioned with the knee joint in extension and the ankle joint in plantar flexion. Then, the ankle was dorsiflexed and inverted. The proposed method was compared with standard stretching and verified by ultrasonography in eight healthy adult males. This method effectively and selectively stretched the MG, producing a significantly decreased pennation angle and increased muscle fiber length. This method may be beneficial for preventing future injuries and may enhance the effect of therapy on the MG.