Anatomy, biomechanics, and surgical approach to synovial folds within the joints of the foot

Distal tibiofibular syndesmosis: A meta-analysis of cadaveric studies

Though injuries to the distal tibiofibular (DTF) syndesmosis are commonly encountered in orthopedic and trauma settings, its anatomical structures have been poorly researched. The commonly overlooked DTF ligament injuries are known to cause chronic ankle pain, instability and post-traumatic osteoarthritis. Quantitative and morphological evidence synthesis has not been yet conducted. A meta-analysis was conducted to collect data from morphological studies to document more accurate details on the prevalence, size, and insertion sites of its components. The Checklist for Anatomical Reviews and Meta-Analyses (CARMA) was followed. Ten studies met the inclusion criteria with a total of 265 investigated ankles. The analysis demonstrated that the anterior and posterior tibiofibular ligaments along with the interosseous ligament were present in 100% of joints. The inferior transverse tibiofibular and the distal fascicle of the anterior tibiofibular ligament were the least prevalent with frequencies of 96% and 86.5%, respectively. The inferior transverse ligament was recorded as the longest ligament. The widest ligament was found to be the interosseous tibiofibular ligament at its fibular attachment. The thickest of the ligamentous components was the posterior tibiofibular ligament. While more cadaveric research is warranted, these results would help directing future biomechanical investigations and planning new research to further aid in diagnostic and therapeutic approaches to the injuries of the distal tibiofibular syndesmosis.

Incidence, location and classification of glenoid labrum meniscoid folds

INTRODUCTION

The purpose of the present study was to arthroscopically investigate the incidence and location of labral meniscoid folds of the shoulder joint, as well as to classify them into types and detect any possible correlation with gender, side and age of patients.

MATERIALS AND METHODS

The shoulder joint of 59 patients who underwent arthroscopic surgery for different reasons was examined for meniscoid folds. We classified all meniscoid folds into slim or thick and large or small. The location and area of labral folds were assessed according to o'clock position and were defined by the center of the fold.

RESULTS

The incidence of labral meniscoid folds in shoulder joint was 62.7 %. Meniscoid folds were more frequently found at 2-o'clock position in right shoulders and at 10-o'clock position in left shoulders. Most of them were located in anterior and superior rim of labrum. Statistically significant difference (p = 0.018) was only detected between location of meniscoid folds and gender. In male patients meniscoid folds were mostly located in a more anterior position than women, whose meniscoid folds were found more superiorly. Older patients presented a higher rate of meniscoid folds.

CONCLUSION

Meniscoid folds are quite common in shoulder joint. Labral meniscoid folds are located more often at an anterosuperior position of shoulder joints and their incidence tends to be higher in older patients, while in male ones they are located in a more anterior position in comparison to female patients where they are located more superiorly.

Examination and treatment of cuboid syndrome: a literature review

Context:

Cuboid syndrome is thought to be a common source of lateral midfoot pain in athletes.

Evidence Acquisition:

A Medline search was performed via PubMed (through June 2010) using the search terms cuboid, syndrome, subluxed, locked, fault, dropped, peroneal, lateral, plantar, and neuritis with the Boolean term AND in all possible combinations. Retrieved articles were hand searched for additional relevant references.

Results:

Cuboid syndrome is thought to arise from subtle disruption of the arthrokinematics or structural congruity of the calcaneocuboid joint, although the precise pathomechanic mechanism has not been elucidated. Fibroadipose synovial folds (or labra) within the calcaneocuboid joint may play a role in the cause of cuboid syndrome, but this is highly speculative. The symptoms of cuboid syndrome resemble those of a ligament sprain. Currently, there are no definitive diagnostic tests for this condition. Case reports suggest that cuboid syndrome often responds favorably to manipulation and/or external support.

Conclusions:

Evidence-based guidelines regarding cuboid syndrome are lacking. Consequently, the diagnosis of cuboid syndrome is often based on a constellation of signs and symptoms and a high index of suspicion. Unless contraindicated, manipulation of the cuboid should be considered as an initial treatment.

Anatomical evaluation and clinical importance of the tibiofibular syndesmosis ligaments

The aim of this study was to describe the detailed anatomical arrangement of ligaments of the tibiofibular syndesmosis and to highlight the clinical aspects of fracture dislocations. This study was performed on 42 legs of adult human embalmed cadavers. Tibiofibular syndesmosis ligaments attachments and their mutual relationships were described and their dimensions were measured. The anterior tibiofibular ligament is usually composed of three parts. This ligament runs obliquely at laterodistaly direction making 35 degrees angle with horizontal plane and posteriorly 65 degrees angle with sagittal plane. The posterior tibiofibular ligament runs almost horizontally 20 degrees angle with horizontal plane. The mean thicknesses of tibial and fibular attachments are 6.38+/-1.91 mm and 9.67+/-1.74 mm, respectively. The inferior transverse ligament originates from just below the posterior tibiofibular ligament, which has variations on the shape and dimensions due to its attachment points. The average length is 36.60+/-9.51 mm. The network between the fibular notch and the distal fibula has been filled with the interosseous tibiofibular ligament whose fibers follow the laterodistal and anterior direction from the tibia to the fibula. It lies proximally 30-40 mm from the mortise. At the inferior view of the tibiofibular syndesmosis a pyramidal shaped cartilaginous facet was observed which was attached to the fibula. The length of this cartilage was variable. Some of synovial plicas from the ankle joints synovial membrane were observed at this view. We conclude that the results of this study may be useful to both orthopedic surgeons and radiologists for anatomic evaluation of the tibiofibular syndesmosis area.