Abstract
O aumento da utilização dos tendões dos músculos grácil e semitendíneo nos procedimentos de reconstrução ligamentar do joelho foi acompanhado de um aumento nas complicações provenientes da extração dos mesmos, como: lesão do ligamento colateral tibial, lesão do nervo safeno, retirada equivocada do tendão do músculo sartório, secção dos próprios tendões e aumento do tempo cirúrgico por imperícia ou desconhecimento da anatomia da região medial do joelho(1-6). Como a extração destes tendões tem sido um fator limitante em alguns procedimentos ortopédicos, realizamos este estudo dissecando 30 joelhos de cadáveres com os seguintes objetivos: localizar a inserção dos músculos grácil e semitendíneo na tíbia; verificar se existe correlação entre esta localização com a estatura do cadáver e avaliar as possíveis variações anatômicas. Observamos que a inserção do tendão do músculo grácil foi, em média, a 4,6 cm abaixo da superfície articular do joelho e a do semitendíneo foi, em média, a 7,4 cm. Existe correlação entre a estatura das pessoas e a localização destes tendões. Os músculos grácil e semitendíneo apresentam geralmente algum tipo de variação anatômica, sendo a mais frequente a inserção acessória do semitendíneo, 70%, e em segundo lugar a fusão entre eles, 56%.
Highlights
Gracile and semitendinous muscles’ tendons, secondary knee flexors, are largely used in knee ligament reconstruction procedures for treating anterior cruciate ligament (ACL), posterior cruciate ligament, collateral, tibial, and fibular ligaments injuries, and in patellar tendon’s chronic injuries reconstruction
Due to the increased use of such tendons, complication rates related to their removal have increased, such as: tibial collateral ligament injury; saphenous nerve injury; wrong removal of the sartorio muscle tendon; tendons sectioning, and; increased surgergy time due to difficulties for isolating and extracting those tendons as a result of inexpertness or unawareness of the anatomy of knee medial region(1-6)
This lack of detailed knowledge about the knee medial region anatomy by some orthopaedic doctors is partially justified by a usually superficial description of this region in most anatomy books(7-14) and in articles describing surgical techniques using those tendons in orthopaedic procedures(6,15-17)
Summary
Gracile and semitendinous muscles’ tendons, secondary knee flexors, are largely used in knee ligament reconstruction procedures for treating anterior cruciate ligament (ACL), posterior cruciate ligament, collateral, tibial, and fibular ligaments injuries, and in patellar tendon’s chronic injuries reconstruction. Due to the increased use of such tendons, complication rates related to their removal have increased, such as: tibial collateral ligament injury; saphenous nerve injury; wrong removal of the sartorio muscle tendon; tendons sectioning, and; increased surgergy time due to difficulties for isolating and extracting those tendons as a result of inexpertness or unawareness of the anatomy of knee medial region(1-6) This lack of detailed knowledge about the knee medial region anatomy by some orthopaedic doctors is partially justified by a usually superficial description of this region in most anatomy books(7-14) and in articles describing surgical techniques using those tendons in orthopaedic procedures(6,15-17). As the removal of gracile and semitendinous muscles tendons has been a limiting factor in some orthopaedic procedures(5,6) we performed this study by dissecting 30 cadaver knees with the following objectives: To find the insertion of gracile and semitendinous muscles at the tibia; to check for a relationship between that location to cadaver’s height and to assess potential anatomical changes
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