Capsular Complex Research Articles

Microstructural analysis on the innervation of the anterior, medial, and lateral human hip capsule: Preliminary evidence on its neuromechanical contribution

Capsular repair aims to minimize damage to the hip joint capsular complex (HJCC) and subsequent dislocation risk following total hip arthroplasty (THA). Numerous explanations for its success have been advocated, including neuromuscular feedback loops originating from within the intact HJCC. This research investigates the hypothesis that the HJCC contributes to hip joint stability by analyzing HJCC innervation. Twenty-nine samples from the anterior, medial, and lateral aspects of the midportion HJCC of 29 individuals were investigated stereologically and immunohistochemically to identify encapsulated mechanoreceptors according to a modified Freeman and Wyke classification, totaling 11,745 sections. Consecutive slices were observed to determine the nerve course within the HJCC. Few encapsulated mechanoreceptors were found in the HJCC subregions and overlying tissues across the cohort studied. Of regions studied, no significant regional differences in the density of mechanoreceptors were found. No significant difference in mechanoreceptor density was found between sides (left, 10.2×10-4/mm3, 4.0×10-4 - 19.0×10-4/mm3; right 12.9×10-4/mm3, 5.0×10-4 - 22.0×10-4/mm3; mean, 95% confidence intervals) sexes (female 10.4×10-4/mm3, 4.0×10-4 - 18.0×10-4/mm3; male 11.6×10-4/mm3, 5.0×10-4 - 20.0×10-4/mm3; mean, 95% confidence intervals), nor in correlation with age demographics. Myelinated nerves coursed consistently within the HJCC in various orientations. Sparse mechanoreceptor density suggests that the HJCC contributes to a limited extent to hip joint stabilization. HJCC nerve terminals may potentially contribute to neuromuscular feedback loops with associated muscles to mediate joint stability in tandem with the active and passive components of the joint.

Four-Point Refixation for In-the-Bag Intraocular Lens Dislocation Into Vitreous Cavity With Implantable Capsular Hooks.

Four-Point Refixation for In-the-Bag Intraocular Lens Dislocation Into Vitreous Cavity With Implantable Capsular Hooks.

Anatomic Repair of a Lateral Collateral Ligament and Anterolateral Capsular Complex Injury With Internal Brace Augmentation

Background: Lateral collateral ligament (LCL) injuries are implicated in varus instability of the knee. Often, these accompany other ligamentous injuries including anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) tears, and injury to the anterolateral capsular complex (ALCC). Use of internal brace augmentation with anatomic repair is an alternative to reconstruction to improve patient outcomes and facilitate early range of motion and weight bearing. Indications: We present a case of an anatomic repair of a LCL and an ALCC injury with internal brace augmentation. Technique Description: A curvilinear incision centered over the lateral epicondyle is used. The avulsed LCL and biceps tendon was exposed and a placed #5 FiberWire was placed into the distal LCL, biceps tendon, and the popliteofibular ligament. A split was made in the iliotibial (IT) band and a second #5 FiberWire was placed proximally in the LCL/biceps tendon for additional fixation. A tunnel was made in the fibular head and tibia using a 2.4-mm beath pin and the two #5 FiberWires were passed to the anteromedial tibia. The FiberWires were fixed to the tibia using a 14-mm attachable button system (ABS) manhole cover for suspensory fixation. Repair and internal bracing of the anterolateral capsular complex was accomplished with 2 interlocked TightRopes and a #2 FiberTape. This fixation method achieved repair by compressing the anterolateral capsular complex onto its tibial origin. The suture devices also served to augment the repair and were fixed proximally to the femur using another 14-mm ABS manhole cover. The FiberTape was fixed to the anterolateral tibia distally with a 4.5 mm SwiveLock. The TightRopes were passed through a tunnel to the anterolateral tibia and secured using an ABS Dog Bone. The construct was tensioned in near full extension and gapping was matched fluoroscopically to the contralateral knee. Results: Patient was cleared for full return to sports 9 months postoperatively. At the final follow up visit, the patient had excellent strength, stability, and 135° range of motion on the operative knee. Patient had returned to exercise at home but was unable to return to sports due to COVID-19 restrictions. Conclusion: Anatomic repair of the LCL and the ALCC with internal brace augmentation can serve as an effective alternative to reconstruction and demonstrates excellent patient outcomes regarding restoring stability, ROM, and return to preoperative sports.

Capsular Contraction Syndrome. Review. Methods of Prevention and Treatment. Part 2

The article describes the existing methods of preventing the occurrence and progression of capsule bag fibrosis. The types of used treatment are listed and structured. Key aspects of the principles of surgical treatment are highlighted. They are aimed to eliminate the dislocation of the IOL-fibrous capsular bag complex. Special attention is paid to the methods of suture and sutureless fixation of the IOL to the sclera or iris. The author’s techniques are given. Variants of fixing devices were used. The risks of possible complications were analyzed. Conclusion: capsular syndrome is an actual problem that requires attention and search for optimal treatment methods, depending on comprehensive assessment of the initial condition.

Surgical technologies of sutured iris fixation of the dislocated IOL — fibrosed capsular bag complex

Purpose. To present various techniques of surgical treatment with the dislocation of the IOL — fibrosed capsular bag complex, and to analyze their clinical and functional results.Material and methods. 50 patients (mean age 75.7 ± 1.3 years) who received surgery with IOL-capsular bag complex (ICBC) were divided into 2 groups according to the applied treatment tactics. Tactics 1 consisted in suturing ICBC to the iris on the support needle without manipulations with the capsular bag (26 eyes). Tactic 2 involved IOL suturing to the iris in combination with various manipulations on the capsular bag, aimed at partial or complete removal of fibrous tissue (24 eyes). The follow-up period ranged from 4 to 6 years.Results. The criteria affecting the choice of the treatment technique were determined: integrity of the Zinn ligament, manifestation of capsular bag fibrosis (phimosis of the anterior capsulorhexis, fibrosis of the posterior capsule); impact of changes in the capsular bag structure on the correct position of the IOL (frontal inclination of the IOL, inversion of haptic elements to the optic zone); presence of a prolapse of the vitreous body; Semmering's ring with a high risk of the release of lens masses. A frequency occurrence analysis of the proposed criteria showed their importance in the choice of surgical treatment technique in patients with mixed type ICBC dislocation. Remote functional results of the operations are presented.Conclusion. The proposed low invasive methods of surgical treatment of patients with the dislocation of the IOL — fibrosed capsular bag complex are reliable and technically simple. Relative indications to choosing the treatment method with dislocation of the IOL-fibrosed capsular bag complex have been determined for various combinations of the proposed criteria.

The Pronator Quadratus Muscle – its Morphology and Functions

Knowledge of the architecture and nerve supply of the human pronator quadratus muscle (MPQ) appears to be rather scarce and is insufficient for a surgical approach of the muscle. In older French and more recent clinical studies it is stated that the MPQ consists of two or even three parts, each of them with an individual nerve supply and function. Former studies have described a superficial part that is active during pronation, and a deeper part which acts during supination. Furthermore, other authors described that the MPQ regulates the tension of the capsular complex at the distal radio‐ulnar joint.We studied the existence of subdivisions of the MPQ and their pattern of nerve supply from the anterior interosseous nerve in 15 cadaver forearms (8 M, 7 F, mean age 80 years). The dissection was carried out using a surgical microscope. In all 15 forearms the MPQ consisted of three parts: a superficial (pars superficialis; PQs), a deep proximal (pars profunda proximalis; PQpp) and a deep distal part (pars profunda distalis; PQpd).Three primary nerve branches were identified (ramus proximalis, ramus intermedius and ramus distalis) as they originated from the anterior interosseous nerve and at entry of the individual parts of the MPQ.We have not been able to conclude whether the ramus proximalis or the ramus intermedius supplies the superficial (PQs) or the deep proximal (PQpp) part of the MPQ. However, it could be established that the ramus distalis goes to the deep distal (PQpd) part of the MPQ. We could also confirm that only fibers of the deep distal part insert into the distal radio‐ulnar joint.On the basis of the existing division of the MPQ in three different parts, functional considerations can be made with regard to the complex functions of MPQ, i.e. pronation by the superficial part of the MPQ, fine‐tuning of motion of the radius during pronation and supination by the deep proximal part and capsular tension (stabilization) of the distal radio‐ulnar joint by the deep distal part of the MPQ.

Optimisation of the ankle sprain recovery process for junior footballers by computerised dynamometers

A sprained ankle is one of the most common joint injuries. This traumatic and painful injury is caused by abnormal stress on the capsular ligament complex and occurs secondary to a movement that forces it to stretch beyond its normal range without losing permanent contact between the joint surfaces. In the United States, the incidence of ankle sprain in the general population (between 2002 and 2006) was 2.15 per 1000 person-years, the highest rates being associated with the age of 10 to 19 years. For people aged 15-24, the incidence was considerably higher in men compared to women, while for those over 30, the incidence was higher in women than men. Epidemiological statistics showed that almost half of all ankle sprains occurred during athletic activities. The motivation for choosing this topic is to highlight the benefits of using the Biodex System 4 Pro in the recovery program for junior footballers with grade II ankle sprains. The assessment made by this device provides information on joint mobility and muscle strength; therefore, the programs used in the recovery process can be performed without putting pressure on the joint and within the range and speed parameters set by the physiotherapist (especially passive, isotonic, isometric and isokinetic ones in the eccentric or concentric mode). The study has shown that the Biodex System 4 Pro is very helpful in optimising the recovery process because it offers the possibility to work in the isokinetic mode, which reduces the functional recovery period and ensures the return to sport in a minimum time

Superior capsule reconstruction: anatomy, biomechanics, indications, and graft treatment.

Superior capsule reconstruction: anatomy, biomechanics, indications, and graft treatment.

Trocar blade-assisted scleral fixation for an incomplete dislocated intraocular lens.

An incomplete dislocated intraocular lens (IOL) is often treated with IOL exchange because the IOL subluxates posteriorly during surgery and makes it difficult to fixate the IOL in situ. A trocar blade used for 23-gauge vitrectomy was used to lift and stabilize the IOL-capsular complex. The IOL can then be fixated using a suture loop fixation technique, which was originally limited to patients with decentered IOL. The advantage of this technique is that it allows the remaining zonular fibers and IOL to be preserved. The modified technique using a trocar blade to assist scleral fixation allows the incomplete dislocated IOL to be retrieved and fixated with a simplified surgical procedure.

Ultrasonographic Measurement of Elbow Varus Laxity With a Sequential Injury Model of the Lateral Collateral Ligament-Capsular Complex.

Background:There is no consensus how to determine the varus laxity due to the LCL injury using the ultrasonography. There is a risk of lateral collateral ligament injury during or after arthroscopic extensor carpi radialis brevis release for tennis elbow. The equator of the radial head has been suggested as a landmark for the safe zone to not increase this risk; however, the safe zone from the intra-articular space has not been established.Hypothesis:Increased elbow varus laxity due to lateral collateral ligament–capsular complex (LCL-cc) injury could be assessed reliably via ultrasound.Study Design:Descriptive laboratory study.Methods:Eight cadaveric elbows were evaluated using a custom-made machine allowing passive elbow flexion under gravity varus stress. The radiocapitellar joint (RCJ) space was measured via ultrasound at 30° and 90° of flexion during 4 stages: intact elbow (stage 0), release of the anterior one-third of the LCL-cc (stage 1), release of the anterior two-thirds (stage 2), and release of the entire LCL-cc (stage 3). Two observers conducted the measurements separately, and the mean RCJ space in the 3 LCL-cc injury models (stages 1-3) at both flexion angles was compared with that of the intact elbow (stage 0). We also compared the measurements at 30° versus 90° of flexion.Results:At 30° of elbow flexion, the RCJ space increased 2 mm between stages 0 and 2 (95% confidence interval [CI], 1-3 mm; P < .01) and 4 mm between stages 0 and 3 (95% CI, 2-5 mm; P < .01). At 90° of elbow flexion, the RCJ space increased 1 mm between stages 0 and 2 (95% CI, 1-2 mm; P < .01) and 2 mm between stages 0 and 3 (95% CI, 2-3 mm; P < .01).Conclusion:Elbow varus laxity under gravity stress can be reliably assessed via ultrasound by measuring the RCJ space.Clinical Relevance:Because ultrasonographic measurement of the RCJ space can distinguish the increasing varus laxity seen with release of two-thirds or more of the LCL-cc, the anterior one-third of the LCL-cc, based on the diameter of the radial head, can be considered the safe zone in arthroscopic extensor carpi radialis brevis release for tennis elbow.

Новые подходы к лечению детей с посттравматическими контрактурами локтевого сустава

Abstract. Introduction Post-traumatic elbow contracture is a severe disabling condition of childhood that interferes with both physical and psychic aspects for the child. A high rate of poor results encourages surgeons seek for better surgical treatments. Current diagnostic modalities were practical to get the clinical picture of the contracture mechanogenesis and determine the treatment strategy. The goal of the study was to review long-term results of new surgical techniques developed for post-traumatic elbow contractures in children. Material and methods The inpatient records of 102 pediatric patients with post-traumatic elbow contractures operated on with the technique offered were reviewed. All patients underwent conventional radiological, ultrasound and MSCT examinations. Results Based on the pathobiomechanics of the injured elbow a mobilization technique was developed to ensure complete bone realignment, relieve pain and allow early exercises for the joint. Postoperative lavage of the joint cavity, intra-articular administration of corticosteroids and polyvalent enzymes in the early postoperative period facilitated improved long-term outcomes of elbow contractures. All patients reported good results. Discussion Tenotomies of the lateral ligaments can be added to arthrotomy and reconstruction of articular surfaces for temporary instability of the joint to restore movement in the elbow joint in severe cases. Post-traumatic elbow contractures are accompanied by impaired biomechanics. MSCT and 3D reconstruction of bone structures is the gold standard in the diagnosis of post-traumatic elbow contractures. Conclusion Bone impingements are to be addressed and an extended mobilization of the capsular ligamentous complex be provided for complete movement recovery through partial elbow instability to be temporarily ensured. Prolonged lavage of the elbow joint can be used to prevent adhesions and allow early elbow exercises and provide improved outcomes.

Locating the rotator cable during subacromial arthroscopy: bursal- and articular-sided anatomy.

The rotator cable (RCa) is an important articular-sided structure of the cuff capsular complex that helps prevent suture pull out during rotator cuff repairs (RCRs) and plays a role in force transmission. Yet, the RCa cannot be located during bursal-sided RCRs. The purpose of this study is to develop a method to locate the RCa in the subacromial space and compare its bursal- and articular-sided dimensions. In 20 fresh-frozen cadaveric specimens, the RCa was found from the articular side, outlined with stitches, and then evaluated from the bursal side using an easily identifiable reference point, the intersection of a line bisecting the supraspinatus (SS) tendon and posterior SS myotendinous junction (MTJ). Four bursal-sided lengths were measured on the SS-bisecting line as well as the RCa's outside anteroposterior base. For the articular-sided measurements, the rotator cuff capsular complex was detached from bone and optically scanned creating 3D solid models. Using the 3D models, 4 articular-sided lengths were made, including the RCa's inside and outside anteroposterior base. The RCa's medial arch was located 9.9 ± 5.6 mm from the reference point in 10 intact specimens and 4.1 ± 2.4 mm in 10 torn specimens (P = .007). The RCa's width was 10.9 ± 2.1 mm, and the distance from the lateral edge of the RCa to the lateral SS insertion was 13.9 ± 4.8 mm. The bursal- and articular-sided outside anteroposterior base measured 48.1 ± 6.4 mm and 49.6 ± 6.5 mm, respectively (P = .268). The average inside anteroposterior base measurement was 37.3 ± 5.9 mm. The medial arch of the RCa can be reliably located during subacromial arthroscopy using the reference point, analogous to the posterior SS MTJ. The RCa is located 10 mm in intact and 4 mm in torn tendons (P = .007) from the posterior SS MTJ. If the above 6-mm shift in location of the RCa is not taken into consideration during rotator cuff suture placement, it could negatively affect time zero repair strength. The inside anteroposterior base of the RCa measures on average 37 mm; therefore, rotator cuff tears measuring >37 mm are at risk of rupturing part or all of the RCa's 2 humeral attachments, which if not recognized and addressed could impact postoperative function.

Assessment of Risk Factors for the Development of Late Intraocular Lens Dislocation

Dislocation of intraocular lens is a serious complication of phacoemulsification with implantation of intraocular lens. Among the causes of early dislocation of intraocular lens intraoperative complications predominate, as well as various form of their mixed fixation. In the late postoperative period, dislocation of the capsular bag-intraocular lens complex mainly occurs, the main reasons for which are the zonular weakness and the failure of the capsular bag support or its fibrosis.Purpose: to assess the influence of various factors on the development of late IOL dislocation (both in the capsular bag and without it) requiring surgical correction.Patientes and methods. The study included 78 patients (78 eyes) who were underwent surgical treatment of varying degree of IOL dislocation from October 2018 to April 2020. The control group consisted of 62 patients recruited for surgical treatment of cataract at the same period. The main factors for assessment were the following: axial myopia (≥26 mm), previous vitreoretinal surgery, recurrent uveitis, primary glaucoma, retinitis pigmentosa, and the use of the capsular tension ring during phacoemulsification.Results. Among the factors studied, the following risk factors of late IOL dislocation were revealed: age, gender, the presence of pseudoexfoliation syndrome, axial myopia, primary glaucoma, implantation of the capsular tension ring. Conclusion. Phacoemulsification is the standard surgical treatment of cataract. However, in patients with potential risk factors of developing IOL dislocation, surgeons should consider the use of additional IOL fixation.

Management of Bigbag capsular complex dislocation of intraocular lens in high myopia patients

Management of Bigbag capsular complex dislocation of intraocular lens in high myopia patients

High Valging Tibial Osteotomy in the Complex Treatment of Anterior Cruciate ligament Ruptures in Patients With Varus Gonarthrosis of the Knee

MATERIALS AND METHODS. We observed 164 patients from 2013 to 2019 (mean age 39.8 ± 5.1 years) who underwent anatomical antegrade ACLR ВТВ autograft . Group 1 (43 people, 31.1%) and Group 2 (48 patients, 29.3%) included patients with isolated medial GA of 2-3 degree and/or varus deformity of at least 5º. Group 3 (73 people or 44.5%) included patients with normal articular cartilage and the correct axis of the limb. In Group 1, ACLR was supplemented with an “open wedge” HVTO. The assessment was carried out according to Lysholm Knee Scoring Scale, 2000 IKDC, KOOS.RESULTS. The simultaneous performance of HVTO and ACLR shows good clinical and radiological results in 93% in the first year, and three years after surgery keeps it in 88.4%. The results of treatment of patients of Group 1 turned out to be significantly better in comparison with Group 2 (p&lt;0.01). In Group 1, the anteroposterior and rotational hypermobility of the knee joint was 16.3%, less commonly we observed pain, synovitis, atrophy of the muscles of the thigh and contracture (p &lt;0.01), some dysfunctions (C according 2000 IKDC scale) were determined in 11.6% (p&lt;0.05), and significant impairment of the knee joint function (D according to 2000 IKDC scale) were not observed (p&lt;0.001). In the first 5 years after surgery, a much larger number of patients of the 1st group were able to fully return to their work, domestic and sports activities, compared with Group 2 (p&lt;0.05).CONCLUSION. The combined ACLR and HVTO allow reliable technology in the treatment of anterior instability in patients with GA (p&lt; 0.05%). This approach is effective in young active middle-aged patients, with anterior instability of the knee joint and varus GA or prerequisites for its development, as well as with revision ACLR, posterior tibial plateau tilt of more than 12º. Performing HVTO simultaneously with ACLR is not practical for patients with valgus deviation of the lower leg, failure of the posterolateral capsular ligamentous complex, or changes in the external joint.

Частота спонтанной дислокации комплекса «интраокулярная линза – капсульный мешок» в различные сроки послеоперационного периода факоэмульсификации возрастной катаракты

Purpose . To study frequency of spontaneous dislocation of intraocular lens – capsular bag complex in various periods after phacoemulsification (PE) of age-related cataracts, develop its clinical classification based on objective criteria for gradation of degrees of severity. Material and methods . All cases of intraocular lens – capsular bag complex dislocation occurred in our clinic in different periods after PE of age-related cataract in 2010–2018 were selected. 24231 PE of agerelated cataract were performed in our clinic during this period. The proportion of spontaneous dislocations of intraocular lens – capsular bag complex having non-traumatic origin was at least 0.26%. We carried out retrospective analysis of the possible causes of spontaneous dislocation of intraocular lens – capsular bag complex in these patients. Results . All 63 patients with dislocation of intraocular lens – capsular bag complex presented themselves to the clinic. There were 39 men and 24 women. Their age ranged from 50 to 89. The time of formation of intraocular lens – capsular bag complex dislocations was conditionally estimated according to the data presented by the patients. It varied widely from 3 months to 14 years, averaging 5.45±3.6 years. In the course of time after performing PE, the frequency of dislocation progressively increased. Conclusion . The criteria for the presence and severity of spontaneous dislocation of intraocular lens – capsular bag complex was: 1) severity of dislocation of intraocular lens – capsular bag complex from its correct anatomical position, based on biomicroscopy, 2) uncorrected visual acuity, 3) intraocular pressure, 4) risk of intraocular complications. Our in-depth clinical analysis of the severity of postoperative dislocation of intraocular lens – capsular bag complex allowed us to create simple and affordable clinical classification of this condition.

The effects of soft tissue lateral release on the stability of the ligament complex of the knee

PurposeValgus deformity presents a particular challenge in total knee arthroplasty. This condition regularly leads to contractures of the lateral capsular ligament complex and to overstretching of the medial ligamentous complex. Reconstruction of the knee joint kinematics and anatomy often requires lateral release. However, data on how such release weakens the stability of the knee are missing in the literature. This study investigated the effects of sequential lateral release on the collateral stability of the ligament complex of the knee in vitro.MethodsTen knee prostheses were implanted in 10 healthy cadaveric knee joints using a navigation device. Soft tissue lateral release consisted of five release steps, and stiffness and stability were determined at 0, 30, 60 and 90° flexion after each step.ResultsSoft tissue lateral release increasingly weakened the ligament complex of the lateral compartment. Because of the large muscular parts, the release of the iliotibial band and the M. popliteus had little effect on the stability of the lateral and medial compartment, but release of the lateral ligament significantly decreased the stability in the lateral compartment over the entire range of motion. Stability in the medial compartment was hardly affected. Conversely, further release of the posterolateral capsule and the posterior cruciate ligament led to the loss of stability in the lateral compartment only in deep flexion, whereas stability decreased significantly in the medial compartment.ConclusionOur study shows for the first time the association between sequential lateral release and stability of the ligamentous complex of the knee. To maintain the stability, knee surgeons should avoid releasing the entire lateral collateral ligament, which would significantly decrease stability in the lateral compartment.

Innervation of the hip joint capsular complex: A systematic review of histological and immunohistochemical studies and their clinical implications for contemporary treatment strategies in total hip arthroplasty.

The hip joint capsule contributes to the stability of the hip joint and lower extremity, yet this structure is incised and often removed during total hip arthroplasty (THA). Increasing incidence of osteoarthritis is accompanied by a dramatic rise in THAs over the last few decades. Consequently, to improve this treatment, THA with capsular repair has evolved. This partial restoration of physiological hip stability has resulted in a substantial reduction in post-operative dislocation rates compared to conventional THA without capsular repair. A further reason for the success of this procedure is thought to be the preservation of the innervation of the capsule. A systematic review of studies investigating the innervation of the hip joint capsular complex and pseudocapsule with histological techniques was performed, as this is not well established. The literature was sought from databases Amed, Embase and Medline via OVID, PubMed, ScienceDirect, Scopus and Web of Science; excluding articles without a histological component and those involving animals. A total of 21 articles on the topic were identified. The literature indicates two primary outcomes and potential clinical implications of the innervation of the capsule. Firstly, a role in the mechanics of the hip joint, as mechanoreceptors may be present in the capsule. However, the nomenclature used to describe the distribution of the innervation is inconsistent. Furthermore, the current literature is unable to reliably confirm the proprioceptive role of the capsule, as no immunohistochemical study to date has reported type I-III mechanoreceptors in the capsule. Secondly, the capsule may play a role in pain perception, as the density of innervation appears to be altered in painful individuals. Also, increasing age may indicate requirements for different strategies to surgically manage the hip capsule. However, this requires further study, as well as the role of innervation according to sex, specific pathology and other morphometric variables. Increased understanding may highlight the requirement for capsular repair following THA, how this technique may be developed and the contribution of the capsule to joint function and stability.

The discomallear ligament: anatomical, microscopical, and radiologic analysis.

Several anatomic relationships between the ear and the temporo-mandibular joint have been proposed to account for the presence of tinnitus during temporo-mandibular disorders. Among the otomandibular structures, the discomallear ligament (DML) is interposed between the malleus and the retrodiscal capsular complex. The aim of present paper was to study through dissection the frequency and morphology of DML, to characterize its type of collagen, and to evaluate the DML on routine computed tomography (CT). The study has been conducted on five un-embalmed adult cadavers, and in all cases, the DML was present (100%). It was constituted mainly by fibers of collagen I, with abundant elastic fibers. On CT exams of 40 patients with no reported pathology of the ear, on axial images, a dense structure, going from the upper end of the petrotympanic fissure to the neck of the malleus, was present in all the cases. In 90%, it showed a triangular shape, in 5% a rectangular shape, and in 5% a curved course. The mean length of the antero-medial side was 2 ± 0.6mm and that of the antero-lateral side was 1.63 ± 0.5, and the mean area was 1.29 ± 0.83 mm2. The DML could represent an anatomical structure that joining the temporo-mandibular joint and the malleus may play a role in the otologic symptoms during temporo-mandibular disorders.

New insight into the iliofemoral ligament based on the anatomical study of the hip joint capsule.

The iliofemoral ligament, which plays an important role in hip joint stability, is formed on the anterosuperior region of the hip joint capsule. Although the tendon and deep aponeurosis of the gluteus minimus and iliopsoas are partly connected to the same region of the capsule, the precise location of the connections between the joint capsule and the tendons and deep aponeuroses remains unclear. The locations of the tendinous and aponeurotic connections with the joint capsule may clarify whether the iliofemoral ligament can be regarded as the dynamic stabilizer. This study investigated the relationships between the anterosuperior region of the joint capsule and the tendon and deep aponeurosis of the gluteus minimus and iliopsoas. Fourteen hips from nine cadavers (five males; four females; mean age at death 76.7 years) were analyzed. Ten hips were macroscopically analyzed, and four were histologically analyzed. During macroscopic analysis, the joint capsule was detached from the acetabular margin and the femur, and its local thickness was measured using microcomputed tomography (micro‐CT). The gluteus minimus tendon was connected to the joint capsule, and the lateral end of this connection was adjoined with the tubercle of the femur at the superolateral end of the intertrochanteric line. The deep aponeurosis of the iliopsoas was also connected to the joint capsule, and the inferomedial end of its anterior border corresponded with the inferomedial end of the intertrochanteric line. In the micro‐CT analysis, capsular thickening was observed at the base of the connection to the gluteus minimus tendon and at the anterior border of the deep aponeurosis of the iliopsoas. A histological study showed that the gluteus minimus tendon and the deep aponeurosis of the iliopsoas were continuous with the hip joint capsule. Based on the morphology of the tendinous and aponeurotic connections, local capsular thickening and histological continuity, the transverse and descending parts of the iliofemoral ligament were the joint capsules, with fibers arranged according to the connection with the gluteus minimus tendon and the deep aponeurosis of the iliopsoas, respectively. Therefore, the so‐called iliofemoral ligament could be regarded as the dynamic stabilizer, with the ability to transmit the muscular power to the joint via the capsular complex. This anatomical knowledge provides a better understanding of the hip stabilization mechanism.