Abstract
PurposeSeemingly a well-known, weak, and vestigial plantaris muscle should not be a revelation. However, recent studies have shown that this structure is incredibly underestimated and perceived only as an infirm flexor of the talocrural joint, the knee joint or a great source of graft tissue. Usually, the origin of this inconspicuous muscle begins at the lateral supracondylar line of the femur and the knee joint capsule. It continues distally, forming a long and slender tendon. In most cases, it inserts onto the calcaneal tuberosity on the medial side of the Achilles tendon. However, many morphological variations have been discovered during anatomical dissections and surgical procedures. Nevertheless, according to the present literature, no other studies presented such a complex insertion variant, with indisputable clinical value and significant proof of development of this forgotten muscle.MethodsThe dissection of the right thigh, knee, crural and talocrural region was performed using standard techniques according to a strictly specified protocol.ResultsFour different insertion points were observed. The first band (A) inserted near to the tarsal canal flexor retinaculum. The second band (B) bifurcates into two branches—B1 and B2. B1 is located on the medial side and B2 is located on the lateral side of the calcaneal tuberosity. The third band (C) is inserted into the superior nonarticular calcaneal surface of the calcaneus anteriorly to the Achilles tendon.ConclusionA differently shaped plantaris tendon could be considered a cause of harvesting procedure failure. In the light of new case reports perhaps what we are now witnessing is remodeling and transformation of the Plantaris muscle. If so, the awareness of the influence on the onset of Achilles midportion tendinopathy or a potential role in tibialis posterior conflict can be crucial for every clinician.
Highlights
The plantaris muscle (PM) is typically described as a small, short and fusiform muscle in a part of the superficial posterior compartment of the lower limb
PM originates from the lateral supracondylar line of the femur and the knee joint capsule
The aim of this study is to present a unique and complex insertion of the plantaris muscle which has never been described before
Summary
The plantaris muscle (PM) is typically described as a small, short and fusiform muscle in a part of the superficial posterior compartment of the lower limb. PM originates from the lateral supracondylar line of the femur and the knee joint capsule. It may arise from the inferior division of linea aspera; fascia covering the popliteus. According to comprehensive studies [6, 9, 26], four more types of insertion could be described: three with their insertion point at the calcaneal tuberosity and one with its insertion into the deep crural fascia. When the Plantaris tendon (PT) is developed independently of the Achilles tendon, it remains intact when the Achilles tendon ruptures [8]
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