The Anterior Transverse Ligament of Knee: Morphological and Morphometric Study in Formalin Fixed Human Fetuses

The objective was to study the morphology and morphometry of transverse ligament of the knee joint in south Indian population. The present study included 53 formalin fixed foetuses which were obtained from the department of Anatomy. There were 106 knee joints which were available for the present study. A vernier caliper of 0.02 mm accuracy was used to measure the length of the transverse ligament. Among our specimens, transverse ligament of the knee was observed in 87.7% of the cases. It was observed bilaterally in 81.1% of cases. The double transverse ligaments were not observed in any of our specimens. The mean length of the transverse ligament measured 3.7 ± 1.5 mm. The statistically significant difference was not observed between the right and left sided transverse ligaments or gender with regard to its length (Student's t test; p > 0.05). The morphological and morphometric data related to the transverse ligament of the knee in human foetuses have not been reported. The present study provides additional information on the morphology and morphometry of the transverse ligament in human foetuses. We believe that the data of the present study will provide support to the foetal anatomy, concerning the surgical procedures and arthroscopy of the knee joint. The findings are enlightening not only for Orthopedic Surgeons, but also for the Morphologists and Embryologists.

Higher and Bulkier Origin of the Lumbricals and their Clinical Relevance

Lumbricals are important small intrinsic muscles of the hand, which arise from the tendons of the flexor digitorum profundus in the palm distal to the flexor retinaculum and are inserted on to the dorsal digital expansion. Variations in the unipinnate/bipinnate pattern of lumbricals, absence of one or more muscles, origin from the superficial flexor tendons and flexor retinaculum have been reported earlier. In the present case, all four lumbricals were arising from the tendons of the flexor digitorum profundus, proximal to the flexor retinaculum in the anterior part of the forearm and extending into the palm through the carpal tunnel. However, there was no variation found with regard to their normal unipinnate (first two) and bipinnate (last two) pattern of origin. In the palm all the four lumbricals were found to be bulkier than their normal size, first one being the bulkiest. The bulky and high origin of lumbricals within the carpal tunnel makes the tunnel a compact space. Therefore, such variation is one of the predisposing factors for the carpal tunnel syndrome. Thus, the knowledge of such variant origin of lumbricals is helpful not only during carpal tunnel release but also during the magnetic resonance imaging (MRI) and ultrasound based diagnosis of carpal tunnel and during the flexor tendon repair and reconstruction.