Variation of plantaris muscle: a case report with clinical significance / Variación del músculo plantar: reporte de un caso con significado clínico

SUMMARY: The plantaris muscle is located between the soleus and gastrocnemius muscles, within the posterior calf group. Due to degeneration and its loss of plantar-flexion function, the muscle is vestigial in human beings, but it retains clinical significance. Few cases of variation in the plantaris muscle have been reported, and this, therefore, appears to be rare. Nonetheless, absence of this muscle was identified via the dissection of a left lower limb (male), which also indicated the absence of an attachment in the usual position. The present report, which addresses such variation, may provide both inspiration and reference points for the clinical treatment of so-called "tennis leg", and for the use of plantaris muscle for the purposes of clinical, autologous graft repair.

RESUMEN: El músculo plantar se ubica entre los músculos sóleo y gastrocnemio, dentro del grupo posterior de la pierna. Debido a la degeneración y la pérdida de la función de flexión plantar, el músculo es un vestigio en los seres humanos, pero conserva su importancia clínica. Se han informado pocos casos de variación en el músculo plantar y, por lo tanto, esto parece ser raro. No obstante, se observó la ausencia de este músculo durante la disección de un miembro inferior izquierdo (masculino). El presente informe, que aborda dicha variación, puede proporcionar puntos de referencia para el tratamiento clínico de la llamada "pierna de tenista" y para el uso del músculo plantar con fines de reparación clínica con injerto autólogo.

Morphology of plantaris longus with special reference to its clinical importance

Background: Plantaris is small fusiform muscle, with its long, slender tendon. Actually it’s a vestigial muscle inhuman beings hence its rupture does not result in any significant loss of function. Muscle tear associated withbleeding and swelling leads to a posterior compartment syndrome. It can mimic other serious conditions likeDVT, ruptured baker’s cyst and calf neoplasms.The present study aims to find out the various patterns of proximal and distal attachment of plantaris muscle,which will help the clinician deciding in diagnosis and the plastic & orthopaedic surgeons for different types ofreconstructive surgeries.Materials and Methods: Forty-eight limbs from 24 embalmed cadavers of known sex(male) & age (40-75 years)were dissected in the department of anatomy of Lady Harding medical college, New Delhi during 2016-2017.Plantaris muscle identified with its proximal and distal attachment. Length of muscle belly & tendon wererecorded.Result: In the present study out of 48 limbs specimens, Plantaris muscle was absent in 12.5%. Its proximalattachment to lateral supracondylar ridges observed in 29% & with lateral head of gastrocnemius muscle &fibrous capsule in 58.3%. Its distal attachment deep to tendocalcaneus was noted in 25% and superficial totendocalcaneus in 62.4%. Length of muscle belly was 7- 9 cm in 37% and tendon length was 34- 36cm in 37.5%.Conclusion: The Morphological aspects of the attachment of plantaris play a significant role in the Pathologiesassociated with Calf & knee region. Their exact attachment is importance for reconstructive surgeries to therepair of ankle joint injury and flexor tendon replacement in hand.

Anatomical popliteal artery entrapment syndrome

PURPOSE: The aim of this study was to analyze anatomical popliteal artery entrapment syndrome (PAES) and to individualize the treatment of this condition according to the anatomical status of the artery and the adjacent structure. METHODS: A total of 35 anatomical PAES legs in 23 consecutive patients treated within the Asan Medical Center, Seoul, Korea between 1995 and 2011 were analyzed retrospectively. Anatomical PAES was diagnosed by MRI and/or CT scans of the knee joint, and CT or conventional transfemoral arteriography of the lower extremities. RESULTS: We noted a type II gastrocnemius medial head (GNM) anomaly, a type III GNM anomaly, or an aberrant plantaris muscle in 51.4%, 20%, and 28.6% of PAES legs, respectively. In assessments of the arterial lesions, popliteal or tibial artery occlusion was noted in 19 of 26 symptomatic PAES legs. For cases without popliteal artery lesions, myotomy of the anatomically deranged muscle was performed in 5 of 7 symptomatic and 4 of 9 asymptomatic PAES legs. For occluded popliteal arteries, we performed ten direct repairs of the pathological popliteal artery and 4 femoro-below the knee popliteal bypass surgeries. As a result of the arterial Surgery, 9 direct procedures with myotomy yielded a patent artery, while 3 graft failures were noted in the bypass group. The median follow-up period was 84 months (range, 12–206 months). CONCLUSION: We recommend that treatment of PAES should be individualized based on pathology, symptoms, and various imaging studies.

Anatomical Popliteal Artery Entrapment Syndrome Caused by an Aberrant Plantaris Muscle

PURPOSE: We report on cases of anatomical popliteal artery entrapment syndrome (PAES) caused by an aberrant plantaris muscle and highlight the involvement of this muscle in PAES. MATERIALS AND METHODS: Seven symptomatic PAES legs in six patients treated at The Division of Vascular Surgery, Asan Medical Center, Seoul, Korea, between 1995 and 2011 were included in this study. We retrospectively analyzed patient records, magnetic resonance imaging (MRI) and/or computed tomography (CT) scans of the knee joint, Doppler pressure studies, CT angiographies, and conventional femoral arteriographies. RESULTS: Five males and one female patient with a median age of 32 (18-53) years old were enrolled in the study. All patients complained of intermittent claudication of the affected leg. All aberrant plantaris muscles were higher and more medially located than normal plantaris muscles, causing occlusion of the popliteal artery upon forced plantar flexion of the ankle. For arterial lesions, five occlusions of the popliteal artery and two patent popliteal arteries with positive provocation were noted. As for treatment, myotomy of the aberrant plantaris muscle was done for two non-occlusive PAES legs. For occlusive PAES legs, one thrombectomy, one saphenous vein graft interposition of the popliteal artery followed by myotomy, and two below-knee femoro-popliteal bypasses were performed. The median follow-up period was 88 (7-148) months. CONCLUSION: An aberrant plantaris muscle can cause anatomical PAES. Classification or diagnosis of PAES should be based on axial studies using CT scans or MRI using various reconstruction methods. Treatment, including myotomy of the plantaris muscle, should be individualized.

Morphological Variations of Muscle Plantaris: Anatomical and Clinical Insight.

Background: Plantaris is the largest muscle in mammals other than primates. Plantaris muscle has been a subject of much confusion and Evolutionists have speculated on its phylogenetic significance, as a vestigial organ, while surgeons have removed it ‘useless vestige’ to employ its tendon as a spare part for the surgical repair. In humans it is reduced greatly in size, power, and function and may even be absent. Aim: With this background the aim of the present work is to study morphology, describe the observed variations of the Plantaris muscle, and to discuss the functional significance of Plantaris muscle. Methodology: For the present work 84 limbs available in the department of Anatomy were dissected. The posterior aspect of the knee was dissected using standard surgical equipment and dissection techniques. The Plantaris muscle was isolated and length of fleshy belly and tendon were measured. Any variations in origin, insertion and size were recorded. Result: Variation in insertion of the Plantaris has observed like insertion along medial margin of tendocalcaneus on to calcaneus, in front of tendocalcaneus on to calcaneus, fused to tendocalcaneus and insertion of the Plantaris on deep fascia of leg at the level of ankle. Other variations noted were two bellies of the Plantaris one from lateral supracondylar ridge and other from deep surface of Gastrocnemius, two heads of Plantaris: Both bellies were fused in the lower part producing bipennate arrangement, thin & thick belly of the Plantaris muscle. Variations also observed in relation to origin that the muscle is originating from deep surface of lateral head of Gastrocnemius & in other case origin from capsule. Bicipital Plantaris was seen where one head was originating from capsule of knee joint and other from lateral condyle. Conclusion: In order to avoid any inadvertent injury during surgical operations, variation of the Plantaris must be borne in mind. Awareness of the insertion pattern of the Plantaris tendon is also important for clinicians in the diagnosis of muscle tears and for surgeons performing reconstructive procedures. Considering the above facts, the existence and importance of the Plantaris muscle cannot be undermined.

Intramuscular Baker's Cyst in Plantaris: A Case Report / 대한골관절종양학회지

Baker's cyst is found as most frequent cystic mass around the knee occurring between medial head of gastrocnemius muscle and semimembranosus muscle. The proximal or posterolateral extension of the cyst had been rarely reported and the cyst into the surrounding muscular tissue extremely rare. Intramuscular Baker's cyst that we report was found between lateral head of gastrocnemius muscle and popliteus tendon, and then extended into the plantaris muscle. With review of the literature, we here report a very rare case of plantaris muscular extension of Baker's cyst.

Unilateral double plantaris muscle: a rare anatomical variation / Músculo plantar doble unilateral: una rara variación anatómica

The occurrence of a unilateral second plantaris muscle was discovered during the anatomical dissection of a 47 year old female with Huntington Chorea Disease. The cadaver was found to possess bilateral plantaris muscles and a distinct anomalous muscle morphologically resembling a second plantaris on the medial right leg. The inner and outer bellies of the anomalous plantaris arose proximally from the medial condyle of the femur and formed a short tendon that fused distally with the tendon of the lateral plantaris muscle.

Un segundo músculo plantar unilateral fue descubierto durante una disección anatómica de rutina, en una mujer de 47 años de edad con Enfermedad de Huntington Chorea. En la cara medial de la piena derecha, el cadáver presentaba, bilateralmente, el músculo plantar y un músculo anómalo, morfológicamente distinto, que se asemejaba a un segundo músculo plantar. Los vientres medial y lateral del músculo plantar anómalo se originaban del cóndilo medial del fémur y formaban un tendón corto que se fusionaba con el tendón del músculo plantar lateral.

The occurrence of the plantaris muscle and its muscle-tendon relationship in adult human cadavers / Presencia de músculos plantares y su relación musculotendinosa en cadáveres humanos adultos

Twenty legs from adult male cadavers were examined to analyze the anatomical relationships between the component parts of the plantaris muscle. This muscle was present in all of the cadavers and it was found that the length of the muscle in relation to its belly was approximately three times greater than in relation to the tendon.

Se estudiaron 20 miembros inferiores de cadáveres de adultos do sexo masculino con el fin de analizar la relación anatómica de los músculos plantares y sus partes constitutivas. En todos las piezas estudiadas este músculo estaba presente y fue observado que la longitud del músculo en relación a su vientre era aproximadamente tres veces superior a la del tendón.

Changes in myosin heavy chain isoform composition of rat skeletal muscles as a result of running and jumping trainings / 体力科学

Four myosin heavy chain (MHC) isoforms were detected in rat hind-limb fast muscles. MHC isoforms are particularly good candidates for fiber type-specific markers in myofibril proteins. We studied the effect of running or jumping training on MHC isoform composition in 18, 6 month-old female rats. The animals were divided into three groups : sedentary (S; n=6), running (R; n=5) and jumping (J; n=7) at 4 months of age. Animals in group R were trained with treadmill running (30 m/min, 60 min/day and 5 days/wk) for 8 weeks. Animals in group J were trained with vertical jumping (40 cm high, 100 repetitions/day, 5 days/wk) for 8 weeks.<BR>There was no significant difference in body weight among the groups. Muscle weight and muscle weight/body weight for the plantaris were significantly increased in both trained groups, but there was no significant difference in the protein concentration. With regard to MHC isoform composition, there was no significant difference in the compositions of the type I and type ha MHC isoforms. In the type lid MHC isoform, the values for both trained groups were significantly higher than that of group S (p<0.05) . The values for both trained groups in the type lib MHC isoform were lower than that of group S. In particular, there was a significant difference between groups S and J (p<0.05) .<BR>These results indicate that a relative increment of the type lid MHC isoform is a typical adaptation phenomenon of the olantaris muscle in rats riven runninr and iumoinr training.

Effects of local muscle activity on glut 4 concentration in skeletal muscle / 体力科学

In the present study, we examined whether GLUT4 concentration in rat skeletal muscle is dependent on local muscle activity level or not. In ten male Sprague-Dawley rats, one side of gastrocnemius muscle was tenotomized, and the other side contralateral muscle was treated sham operation as a control. Gastrocnemius and plantaris muscles were excised from both legs at the five weeks after surgery. After the muscles were weighed, GLUT 4 concentration and citrate synthase (CS) activity were measured. The results are summarized as follows:<BR>In gastrocnemius muscle, tenotomy induced decreases of 25% in muscle weight, 16% in CS activity, and 25% in GLUT 4 concentration as compared with the control muscle. These data suggest that although extramuscular environment is similar, different GLUT 4 concen-tration in both muscles is induced by different muscle activity level. Therefore, it is con-cluded that muscle activity level regulates GLUT 4 concentration in skeletal muscle. In over-loaded synergistic plantaris muscle, muscle weight and GLUT 4 content per whole muscle were increased by 18% and 17%, respectively, but GLUT 4 concentration and CS activity were not changed as compared with the control muscle. These data could be interpreted that GLUT 4 concentration and mitochondrial oxidative enzyme activity in skeletal muscle are coregulated.