Accessory Ligament Research Articles

Accessory Ligament of the Deep Digital Flexor Tendon of the Horse Forelimb and Its Relationship with the Superficial Digital Flexor Tendon: A Plastination, Histological, and Morphometry Study.

The accessory ligament of the deep digital flexor tendon (AL-DDFT) plays a crucial role in the stay apparatus of the horse. This study aimed to investigate the anatomical relationship between the AL-DDFT, the superficial digital flexor tendon (SDFT), and other structures in the metacarpal region. Sixteen distal forelimbs from eight horses, aged 1 to 6 years, were evaluated through macroscopic, microscopic, and morphometric analyses, utilizing detailed dissection, E12 plastinated sections, and histological analysis. During lateral dissection, a connection was observed between the AL-DDFT and the SDFT. Histological evaluation revealed that this connection was a fibrous band (FB), extending the common synovial sheath (CSS) to the SDFT, along with associated collagen fibrils of the epiligament and peritenon. Additionally, two distinct forms of the AL-DDFT were identified, Type I and Type II, with Type II showing a greater cross-sectional area (CSA) than Type I. While numerous morphological and morphometric studies have explored the AL-DDFT and related structures, research incorporating plastination-based morphological and histological evaluations remains scarce. The findings provide valuable insights for both the morphological and clinical assessment of structures within the metacarpal region.

Retrospective study of patellar fractures and damage of accessory soft tissue based on MRI.

To better understand the pathophysiological mechanisms of patellar fractures, MRI was utilized to identify the imaging signs of various types of patellar fractures. A retrospective study was performed using MRI images of 52 patients with patellar fractures. Observing the development of patellar and femoral morphology and the imaging manifestations of different fracture types, such as fracture displacement, and damage to accessory ligaments, tendons, and meniscus, type of joint cavity effusion, and damage to surrounding accessory bones were identified. There were 21 tangential fractures (40.4%), 8 transverse fractures (15.4%), 8 longitudinal fractures (15.4%), 4 oblique fractures (7.7%), and 11 comminuted fractures (21.2%) among the 52 patients with patellar fracture. Tangential fractures begin at a younger age than the other four forms of fractures. When tangential fractures were compared to other types of fractures, medial patellar retinaculum and anterior and posterior cruciate ligament injuries were statistically significant (P< 0.05). The detection rate of trochlear dysplasia, type II and type III patellar was higher in patients with tangential fractures than in other fractures. Tangential fractures are less common to cause anterior and posterior cruciate ligament injuries than other types of fractures, but they are more likely to cause medial patellar retinaculum injuries.

Dorsal capsule release and lateral band translocation for a stiff swan neck deformity without articular involvement.

The treatment for proximal interphalangeal joint (PIP) stiffness in extension requires extensor tenolysis, concomitant procedures to restore flexion, and intensive therapy. A stiff swan neck deformity without articular involvement is rare and the treatment is always challenging. Six patients with stiff swan neck deformities were operated between 2016 and 2023, and the outcome was analyzed retrospectively. A dorsal capsule release and radial lateral band translocation volar to the PIP joint axis were done. This translocation was maintained by a sling formed by the flexor digitorum superficialis and the free margins of the accessory collateral ligament. The range of movements in the PIP joint, visual analog scale (VAS), and functional outcomes were analyzed by the Michigan Hand Outcome Questionnaire (MHOQ) score. The mean follow-up was 49.5months (range 48-52months). The mean preoperative PIP joint extension was 8 (range 5-10) degrees of extension), and the mean preoperative PIP joint flexion was 0. All patients improved after the surgery and the mean flexion of the PIP joint at follow-up was 95 degrees; extension was 1 degree (range 0-5 degrees). The mean Michigan Hand Outcomes Questionnaire (MHOQ) score was 92 (range 90-95) and the VAS was 0. Dorsal capsule contracture release and lateral band translocation to the volar axis of the PIP joint seem to be the possibilities for correcting stiff swan neck deformity. IV, retrospective case study.

Diagnostic value and interventional treatment of elbow cyst by high frequency ultrasound

To study and analyze the diagnostic value and interventional treatment value of high-frequency ultrasound for elbow cyst. From February 2018 to February 2021, the data of 60 patients with elbow cyst treated by high-frequency ultrasound interventional therapy were retrospectively analyzed, including 30 males and 30 females with an average age of (30.93±5.32) years old ranging from 20 to 54 years old. The course of disease ranged from 1 to 10 years with an average of (3.45±0.25) years. High-frequency ultrasound features of all patients were analyzed. The clinical efficacy, the occurrence of adverse events and the changes of psychological status before and after treatment were analyzed. In 60 cases of elbow cyst, the cyst size was from 6 mm×7 mm to 111 mm×60 mm. The characteristics of ultrasonic images included such as most of the morphology was regular, which was round or oval, and a few were irregular;the boundary was clear, there was a capsule wall, most of the inside of the capsule was good, no echo;when accompanied by bleeding or infection, small dense points can be seen floating;the cystic wall of the patients with long course of disease was coarser, and the internal light bands were separated, showing multilocular shape;no significant blood flow signal was observed. Final results involved olecranon bursa cysts in 19 cases, annular ligament cysts in 10 cases, radial bursa cysts in 9 cases, accessory ligament cysts in 7 cases, epidermoid cysts in 4 cases, ganglion cysts in 6 cases, nerve sheath cysts in 5 cases. After treatment, 33 cases were cured, 16 cases had obvious effect, 11 cases were improved, 0 cases were invalid. After treatment, mild adverse events occurred in 1 case, moderate adverse events in 1 case, and severe adverse events in 0 cases, with a total incidence of 3.33% (2/60). After treatment, positive affect score (38.04±1.74) was higher than that before treatment (35.92±2.34), and negative affect score (24.61±1.51) was lower than that before treatment (30.15±3.46), with statistical significance(P<0.05). High-frequency ultrasound has high diagnostic value for elbow cyst, and it has ideal effect in interventional therapy.

Desmitis of the accessory ligament of the deep digital flexor tendon in the forelimb: A retrospective case study of 91 horses.

Desmitis of the accessory ligament of the deep digital flexor tendon (ALDDFT) is a commonly reported injury. Despite the commonality of this injury, the literature is limited to small case series, with the reported success following treatment varying from 18% to 75%. To identify the prognosis and factors associated with a return to work following ALDDFT injury. Retrospective case series. Medical records of horses from four equine hospitals (January 2000 and December 2018) with a diagnosis of desmitis of ALDDFT were reviewed. Data retrieved included case detail, use, history, lameness treatment and follow-up. Success was defined as returning to work. Backward stepwise logistic regression was used to identify variables significantly associated with return to work. Ninety-one horses were included. The mean age was 13.5 years (standard deviation 4.9 years). Thirty-four percent (28/91) of horses were sound at the initial presentation. Sixty-eight percent (62/91) of horses were managed using controlled exercise alone, 28% (29/91) were treated with intra-lesional injection, therapeutic ultrasound, extracorporeal shockwave therapy or desmectomy of the ALDDFT and 3% (3/91) were euthanased without treatment. Sixty-four percent (54/85) of horses returned to work. Horses that were lame at follow-up were less likely to return to work (odds ratio [OR] 107.93, 95% confidence interval [CI] 20.06-580.61, p < 0.001) than those that returned to soundness. Identification of adhesions on ultrasonography was also associated with having reduced odds for return to work when compared to horses without adhesions (OR 0.10, 95% CI 0.01-0.76, p = 0.03). Retrospective nature of the study, the potential of selection bias with regards to follow-up. Sixty-four percent (54/85) of horses returned to work following injury of the ALDDFT. Persistence of lameness and adhesion formation were significantly associated with a poor outcome.

Anatomical and Biomechanical Characteristics of Peroneus Longus Tendon: Applications in Knee Cruciate Ligament Reconstruction Surgery.

The peroneus longus tendon is used in many orthopedic surgeries to regenerate the external ligaments of the knee. This study aims to evaluate some anatomical, biomechanical, and load-bearing properties of the peroneus longus tendon for use in cruciate ligament reconstruction. The study design is a cross-sectional description. The study subjects were 20 samples of the peroneus longus tendon from fresh carcasses. The leg is still intact, not crushed, is well preserved, and it has never been used in research. The average length of the peroneus longus tendon was 29.25 ± 2.1 cm, and the average distance from the peroneus longus tendon to the deep peroneal nerve was 71.1 ± 8.63 mm. The peroneus longus tendon did not have an accessory ligament, the maximum tension of the peroneus longus tendon was 1170.4 ± 203 N, and the maximum length at break was 14.29 ± 3.88 mm. Removing the peroneus longus tendon will not affect the surrounding anatomical components. The maximum breaking force and the diameter of the peroneus longus tendon are similar to other graft materials, such as the hamstring tendon and patellar tendon.

Ultrasound Morphometry and Mean Echogenicity of Digital Flexor Tendons, Suspensory Ligament, and Accessory Ligament of Digital Deep Flexor Tendon in Gaited Horses.

The objective of this study was to evaluate and compare the sonographic characteristics of the digital flexor tendons and ligaments of the palmar/plantar of the metacarpal and metatarsal regions in gaited horses, as well as to establish normal reference ultrasound values for Mangalarga Marchador (MM) and Campeiro breeds. Transverse sonographic images were obtained of 50 adult and healthy horses from the MM (n = 25) and Campeiro (n = 25) breeds. The images were taken in six metacarpal/metatarsal zones, and the following measurements were taken: transverse area, circumference, dorsopalmar/plantar length, lateromedial length, and mean echogenicity. Differences were observed between breeds in the fore- and hindlimbs, and, even when not significant, the Campeiro breed tended to have higher values for most variables and structures. Variations between zones and between structures in the same zone followed a similar trend in both breeds for all variables. In addition, the dimensions and variations between zones and structures were different between the fore- and hindlimbs, highlighting the need for specific values for the digital flexor tendons and ligaments of the metatarsal plantar region. In conclusion, the digital flexor tendons, suspensory ligaments, and accessory ligaments of the digital deep flexor tendon are influenced by the breed factor in gaited horses, and they are different between the fore- and hindlimbs.

A finite element analysis of different postures and intra-abdominal pressures for the uterine ligaments in maintaining the normal position of uterus

Uterine prolapse is a common gynecological disease, which seriously affects the quality of life and physical and mental health of elderly women. The aim of this study was to analyze the influence of different conditions (intra-abdominal pressure (IAP) and posture) on stress and displacement of uterine ligaments using the finite element method, and evaluate the contribution of uterine ligaments on uterus. The three-dimensional (3D) models of retroverted uterus and its accessory ligaments were established, loads and constraints were set in ABAQUS software, and the stress and displacement of uterine ligaments were calculated. The uterine displacement increased with the increase of IAP, and then the stress and displacement of each uterine ligament also increased. The uterine displacement was in the order of forward < upright < backward with different postures, and USL, CL and RL got larger values when the body was backward, while BL got a larger value when the body was forward. With the same condition, the stress of the uterine ligaments was in the order of USL > BL > CL > RL, and the displacement of the ligaments was in the order of BL > RL > USL > CL. The contribution of each uterine ligament changing with different IAP and postures was studied through finite element analysis, and the research results were consistent with the clinical data, which can provide a basis for exploring the mechanism of uterine prolapse.

Occurrence of osteochondrosis of the scapulohumeral joint in a 6-month-old filly: a case report

Osteochondrosis of the scapulohumeral joint is one of the most frequent diseases of this joint, which can cause marked discomfort, decreased athletic use, economic losses and restrictions in equine breeding. This report discusses the clinical case of a 6-month-old warmblood filly with osteochondrosis of the scapulohumeral joint. Contraction of the deep digital flexor tendon and flexural deformity on the right front limb was the primary diagnosis established by the equine practitioner. The filly was referred to the Equine clinic of the University of Veterinary Medicine and Pharmacy (UVMP) in Košice for desmotomy of the accessory ligament of the deep digital flexor tendon. The final, primary diagnosis obtained by a complex diagnostic approach was osteochondrosis of the scapulohumeral joint. Presence of multiple pathologies on the right front limb was detected, but the main source of painful clinical manifestation was the condition of the scapulohumeral joint. This report describes an uncommon, rarely diagnosed pathological condition, which can lead to unfavourable prognosis. Osteochondrosis of the scapulohumeral joint was the reason for humane euthanasia of the filly in this case. The clinical case was completed by postmortem findings.

Applicability of ARFI elastography in detecting elasticity changes of the equine superficial digital flexor tendon with induced injury.

The objectives of this prospective, experimental study were to describe changes in the stiffness of the equine superficial digital flexor tendon (SDFT) after induced injury, deep digital flexor tendon (DDFT), accessory ligament (AL-DDFT), and suspensory ligament (SL) during 90 days of healing using acoustic radiation force impulse (ARFI) elastography. Eight healthy horses were selected. Preinjury B mode and ARFI evaluations were performed bilaterally in the palmar metacarpal region. Injury was induced only on the left forelimb (G2) by a single injection of collagenase in SDFT, 15 cm distal to the accessory carpal bone. The right forelimb was used as a control (G1). Evaluations were performed at eight timepoints: one before injury (T0) and seven (T1-T7) after injury (3, 15, 30, 40, 60, 75, and 90 days post-induction). Tendinopathies were visualized as hypoechoic areas with loss of parallel tendon fiber pattern. Injured SDFTs presented mainly cool colors (soft) from T1 to T3, and from T4, there was an increase in warm colors (hard), close to the appearance of tendons of G1. In the first four timepoints, there was a decrease in stiffness compared to G1 (P < 0.001). On T1 and T2, a cutoff value <6.21 m/s to determine tendinopathy of the SDFT was established (75.8% sensitivity and 92.03% specificity). Stiffness changes in the DDFT, AL-DDFT, and SL of injured limbs occurred at different timepoints. Tendinopathy significantly altered the stiffness of the injured tendon and the adjacent tissues. ARFI made it possible to detect these changes, helping to monitor the reparation of this injury.

High-Resolution Ultrasound and Magnetic Resonance Imaging of Abnormal Ligaments in Thoracic Outlet Syndrome in a Series of 16 Cases.

IntroductionNeurogenic thoracic outlet syndrome (NTOS) is a complex entity that comprises various clinical presentations, which are all believed to result from mechanical stress to the brachial plexus. Causes for the stress can include fibrous bands, spanning from the transverse processes, stump, or cervical ribs to the pleural cupula. The aim of this case series is to document how the combined potential of high-resolution neurography, including high-resolution ultrasound (HRUS), and magnetic resonance imaging (MRI) can be used to identify, anatomical compression sites, such as stump ribs and their NTOS associated ligamentous bands.Materials and MethodsRetrospective chart and image reviews identified patients, who underwent HRUS between 2011 and 2021 and the diagnosis of NTOS caused by accessory ligaments was subsequently confirmed by radiological imaging (MRI) and/or surgical exploration.ResultsSixteen patients were included in this study. In all cases, a ligament extending from the tip of a stump rib to the pleural cupula could be depicted. In all cases, these structures led to compression of the lower trunk of the brachial plexus. All surgically explored cases confirmed the radiological findings.ConclusionThis case-series demonstrates that HRUS and MRI can directly and reliably visualize accessory costocupular ligaments and a stump rib in patients with symptoms of NTOS. HRUS may be used as the first imaging modality to diagnose suspected NTOS.

Construction of 3D model of knee joint motion based on MRI image registration

Abstract There is a growing demand for information and computational technology for surgeons help with surgical planning as well as prosthetics design. The two-dimensional images are registered to the three-dimensional (3D) model for high efficiency. To reconstruct the 3D model of knee joint including bone structure and main soft tissue structure, the evaluation and analysis of sports injury and rehabilitation treatment are detailed in this study. Mimics 10.0 was used to reconstruct the bone structure, ligament, and meniscus according to the pulse diffusion-weighted imaging sequence (PDWI) and stir sequences of magnetic resonance imaging (MRI). Excluding congenital malformations and diseases of the skeletal muscle system, MRI scanning was performed on bilateral knee joints. Proton weighted sequence (PDWI sequence) and stir pulse sequence were selected for MRI. The models were imported into Geomagic Studio 11 software for refinement and modification, and 3D registration of bone structure and main soft tissue structure was performed to construct a digital model of knee joint bone structure and accessory cartilage and ligament structure. The 3D knee joint model including bone, meniscus, and collateral ligament was established. Reconstruction and image registration based on mimics and Geomagic Studio can build a 3D model of knee joint with satisfactory morphology, which can meet the requirements of teaching, motion simulation, and biomechanical analysis.

Anatomical variants of the medioplantar oblique ligament and inferoplantar longitudinal ligament: an MRI study

PurposeThe spring ligament complex (SL) is the chief static stabilizer of the medial longitudinal foot arch. The occurrence of normal anatomical variants may influence radiological diagnostics and surgical treatment. The aim of this study was to evaluate anatomical variants of the part of SL located inferior to the talar head (i-SL), medioplantar oblique ligament (MPO) and inferoplantar longitudinal ligament (IPL).MethodsWe included 220 MRI examinations of the ankle performed on a 3.0 T engine. Only patients with a normal SL were included. Two musculoskeletal radiologists assessed the examinations and Cohen’s kappa was used to assess agreement. Differences between groups were assessed using the chi-squared test; p < 0.05 was considered as significant. The final decision was made by consensus.ResultsMost commonly, i-SL was composed of the two ligaments IPL and MPO n = 167 (75.9%); in this group, bifid ligaments occurred in 19.2%, most commonly in the MPO. A branch to the os cuboideum was seen in n = 17 (10.2%). Three ligaments were seen in n = 52 (23.6%). In this group, bifid ligaments occurred in 13.5%; most commonly, the IPL was bifid and a branch to the os cuboideum was noted in n = 6 (11.5%). In one case, n = 1 (0.04%), we identified MPO, IPL and two accessory ligaments. No significant relationship was noted between the number of ligaments, the presence of bifid ligaments and side or gender (p > 0.05). Conclusion. More than two aligaments were seen in 24.1% of examined cases, the most common variant was the presence of MPO, IPL and one accessory ligament.

Neurovascular variations in the proximal plantar metatarsal region of the horse.

Neurovascular variation may be relevant when performing surgical techniques to the proximal plantar metatarsal region. To document variations in the neurovascular anatomy of the proximal plantar metatarsal region and study the relationship of the neurovascular components to each other and other structures located in this area. Descriptive anatomical study. Paired cadaver hind limbs from 15 horses were dissected from the distal tibia to the metatarsophalangeal joint. Deep branch of the lateral plantar nerve (DBLPN) length, location of its origin from the lateral plantar nerve (LPN), individual DBLPN ramifications into the suspensory ligament (SL) and relationship of the DBLPN to the plantar arch and accessory ligament of the deep digital flexor tendon (ALDDFT) were recorded. Mean DBLPN length was 5.8±1.7cm with the nerve arising 3.7±1.5cm proximal to the head of the fourth metatarsal bone (MTIV). There was a median of three individual DBLPN ramifications (range 2-6) entering the SL. There were no significant left/right differences. In 57% (CI 39%-74%; n=17) limbs, the deep plantar arch was superficial to the DBLPN, whereas in 33% (CI 16%-50%; n=10) limbs, the DBLPN passed between the venous and arterial components of the arch. In 10% (CI 1%-20%; n=3) limbs, the deep plantar arch was deep to the DBLPN. In 67% (CI 50%-84%; n=20) limbs, the DBLPN was superficial to the ALDDFT, whereas in 33% (CI 16%-50%; n=10) limbs, the nerve ran deep to the ALDDFT. An additional branch from the LPN was noted in one limb. Limbs were used from horses with unknown clinical history. Anatomical variation, in particular the relationship of the DBLPN and deep metatarsal fascia to the deep plantar arch and the ALDDFT is an important consideration when undertaking surgical approaches to the proximal plantar metatarsal region.

Ligament deformation patterns of the craniocervical junction during head axial rotation tracked by biplane fluoroscopes

BackgroundFrequently, treatment decisions for craniocervical injuries and instability are based on imaging findings, but in vivo ligament kinematics were poorly understood. This study was to determine in vivo deformation patterns of primary ligaments in the craniocervical junction (i.e., C0–2), including the cruciform ligament, alar ligaments, and accessory ligaments, during dynamic head axial rotation. MethodsThe skulls and cervical spines of eight asymptomatic female subjects were dynamically imaged using a biplane fluoroscopic imaging system, when they performed left and right head axial rotations. Using a 3D-to-2D registration technique, the in vivo positions and orientations of cervical segments were determined. An optimization algorithm was implemented to determine ligament wrapping paths, and the resulting ligament deformations were represented by percent elongations. Using paired t-tests, ligament deformations in the end-range position were compared to those in the neutral position. FindingsNo significant differences were observed in segmental motions during left and right head rotations (p > 0.05). In general, slight deformations occurred in each component of the cruciform ligament. For the alar ligaments, the ipsilateral ligament was lengthened from −0.7 ± 13.8% to 16.6 ± 15.7% (p < 0.001*). For the accessory ligaments, the contralateral ligament was lengthened from −2.9 ± 7.5% to 10.1 ± 6.2% (p < 0.001*). InterpretationThis study reveals that there are distinct deformation patterns in craniocervical junction ligaments during dynamic axial head rotation. These ligament deformation data can enhance our understanding of the synergic function of craniocervical junction ligaments, and guide the treatment of craniocervical instability.

Long-term athletic performance in sport horses after desmotomy of the accessory ligament of the deep digital flexor tendon.

Outcome after desmotomy of the accessory ligament of the deep digital flexor tendon (AL-DDFT) to treat flexural deformity of the distal interphalangeal joint has been reported to be excellent. However, no studies have compared long-term athletic performance of sport horses exposed to desmotomy of the AL-DDFT to that of matched controls. The objective of this study is to compare long-term athletic performance in sports horses subjected to desmotomy of the AL-DDFT with the performance of matched controls. This is an observational multicentre retrospective matched cohort study. Records from horses undergoing desmotomy of the AL-DDFT between 2004 and 2015 were reviewed. Various databases were used to identify age-matched siblings as unexposed controls and data on the horses' athletic careers. Seventy-four exposed and 194 matched unexposed horses were included. Although not significantly different, the proportion of exposed horses entering competition (28%, 95% CI 16%-38%) had a substantial risk difference compared with the proportion of unexposed horses entering competition (38%, 95% CI 26%-44%) (P=.2). Career longevity was significantly better for unexposed (15.6 competitions [95% CI 10.7-22.5] over a median of 570days [IQR 210-1340]) than for exposed horses (9.7 competitions [95% CI 6.4-14.6] over a median of 219days [IQR 2-1159] for horses operated in one limb and 6.1 competitions [95% CI 3.6-9.9] over a median of 446days [IQR 23-603days] for horses operated in two limbs, P<.001). Age at surgery and whether the condition was unilateral or bilateral did not affect chance of competing. Small sample size, varying quality of medical records, stage of contraction not noted in many records and missing information on reasons for not entering into competition. Desmotomy of the AL-DDFT is associated with decreased long-term athletic performance in sport horses compared with matched unexposed horses.

An equine tendon model for studying intra-tendinous shear in tendons that have more than one muscle contribution

Human Achilles tendon is composed of three smaller sub-tendons and exhibits non-uniform internal displacements, which decline with age and after injury, suggesting a potential role in the development of tendinopathies. Studying internal sliding behaviour is therefore important but difficult in human Achilles tendon. Here we propose the equine deep digital flexor tendon (DDFT) and its accessory ligament (AL) as a model to understand the sliding mechanism. The AL-DDFT has a comparable sub-bundle structure, is subjected to high and frequent asymmetric loads and is a natural site of injury similar to human Achilles tendons. Equine AL-DDFT were collected and underwent whole tendon level (n=7) and fascicle level (n=7) quasi-static mechanical testing. Whole tendon level testing was performed by sequentially loading through the proximal AL and subsequently through the proximal DDFT and recording regional strain in the free structures and joined DDFT and AL. Fascicle level testing was performed with focus on the inter-sub-bundle matrix between the two structures at the junction. Our results demonstrate a significant difference in the regional strain between the joined DDFT and AL and a greater transmission of force from the AL to the DDFT than vice versa. These results can be partially explained by the mechanical properties and geometry of the two structures and by differences in the properties of the interfascicular matrices. In conclusion, this tendon model successfully demonstrates that high displacement discrepancy occurs between the two structures and can be used as an easy-access model for studying intra-tendinous shear mechanics at the sub-tendon level. Statement of significanceOur study provides a naturally occurring and easily accessible equine model to study the complex behaviour of sub-tendons within the human Achilles tendon, which is likely to play a critical role in the pathogenesis of tendon disease. Our results demonstrate that the difference in material stiffness between the equine AL and DDFT stems largely from differences in the inter-fascicular matrix and furthermore that differences in strain are maintained in distal parts of the tightly joined structure. Furthermore, our results suggest that distribution of load between sub-structures is highly dependent on the morphological relationship between them; a finding that has important implications for understanding Achilles tendon mechanical behaviour, injury mechanisms and rehabilitation.

Classification of the interosseous tarsometatarsal ligaments of the foot

BackgroundThe aim of this study was to clarify the anatomical features of the interosseous tarsometatarsal ligaments of foot and to classify their types based on the combinations of their ligamentous components. MethodsFifty feet from 27 adult Korean cadavers were dissected. ResultsThe interosseous tarsometatarsal ligaments were observed in the first, second, and third cuneometatarsal joint spaces. The interosseous tarsometatarsal ligament of the first cuneometatarsal space consistently connected the medial cuneiform and the second metatarsal, and was accompanied by one or two accessory ligaments above (34%) and/or below (6%) the Lisfranc ligament. The interosseous tarsometatarsal ligaments of the second and third cuneometatarsal joint spaces comprised seven and five components, and were classified into five and three types depending on the number and combination of the components, respectively. ConclusionsThese results are expected to advance the current knowledge on the tarsometatarsal joint and provide helpful information for more accurate and successful diagnosis and treatment of lesions at this joint.

A Comprehensive View into a Novel, Accessory Liver Lobe

Precise clinical knowledge of liver anatomy is required to perform a hepatectomy, in both open and laparoscopic surgery. Accessory liver lobes (ALL) are anatomical variations involving supernumerary lobes in the liver. Although their origin is not entirely understood, hypotheses for the embryological processes resulting in an ALL include hyperplastic anomaly during embryological development or formation because of increased intraabdominal tension from trauma or surgery. In most cases, the accessory lobe is located inferior to the liver. Riedel’s lobe is the best-known example of an accessory lobe, corresponding to hypertrophy of liver segments V and VI. In this report, we presented the case of an elderly female cadaver who showed an atypical ALL left variant attached through an accessory ligament. Therefore, we discuss the gross morphology, histopathology, and clinical and surgical implications to improve future patient outcomes.

Singularities of digital flexor tendons in the Catalan Pyrenean Horse

The gross anatomy of the digital flexors tendons and the distal accessory ligament of the Catalan Pyrenean Horse, an equine trait breed from Catalonia (NE Spain), is presented here. Research has been based on the dissection of isolated 10 right forelimbs, 10 left forelimbs, six right hindlimbs and five left hindlimbs (total 31 distal limbs) from clinically normal yearlings, about 12 months of age. Tendons dimensions tended to be bigger than those reported in the literature, probably due to breed, age, bodyweight, withers height and exercise programme. Distal accessory ligament was sometimes absent. Data intend to serve as standard manual data for this breed but also for other trait breeds, being the present study the first one on the subject.