Cidambi Krishna R, Pennock Andrew T, Dwek Jerry R, Edmonds Eric W
Department of Orthopedic Surgery, University of California San Diego, San Diego, California.
Department of Radiology, Rady Children's Hospital, San Diego, California.
J Knee Surg. 2016 Jan;29(1):80-3. doi: 10.1055/s-0034-1398372. Epub 2015 Jan 3.
The purpose of this study was to identify the frequency and characteristics of anomalous pes anserinus tendon morphology in an adolescent population undergoing knee anterior cruciate ligament (ACL) reconstruction surgery. The records of all children who underwent ACL reconstruction surgery at our tertiary care children's hospital from June 2008 through February 2012 were reviewed. Operative reports were reviewed for any indication that an anomaly existed in the pes anserinus or that there was difficulty harvesting the required tendons. Magnetic resonance imaging (MRI) studies were then reviewed for these patients looking for evidence of any anomaly within the pes anserinus structures. Retrospective review was performed on 123 children (mean age, 16.1 years). Three girls (mean age, 16.2 years) were identified as having a low-lying muscle belly and accessory tendon when attempting to harvest the gracilis tendon. Proximal exploration of this short tendon conjoining the gracilis insertion revealed a muscle belly approximately 5 cm from its insertion in the pes anserinus. This anomaly was present in 2.4% of the cases. Based on previous literature, the anomalous muscle present in our cohort could be sartorius or semimembranosus. MRI analysis suggests that the accessory muscle and tendon could be an aberrant strip of the semimembranosus tendon, an anomalous tendon and muscle belly of the gracilis, or a thickening and separation of the sartorius tendon. Anomalous pes anserinus tendons were found to exist in 2.4% of our adolescent study population. At the time of surgery, if a tendon is harvested with a very low-lying muscle belly (with less than 6 cm of tendon), then the presence of an aberrant tendon should be considered. Preoperative MRI may provide evidence of an anomalous tendon if that information is sought.
本研究的目的是确定接受膝关节前交叉韧带（ACL）重建手术的青少年人群中鹅足肌腱形态异常的频率和特征。回顾了2008年6月至2012年2月期间在我们三级护理儿童医院接受ACL重建手术的所有儿童的记录。查阅手术报告，以寻找任何表明鹅足存在异常或获取所需肌腱有困难的迹象。然后对这些患者的磁共振成像（MRI）研究进行回顾，以寻找鹅足结构内任何异常的证据。对123名儿童（平均年龄16.1岁）进行了回顾性研究。在试图获取股薄肌腱时，三名女孩（平均年龄16.2岁）被确定为有低位肌腹和副腱。对这条连接股薄肌止点的短肌腱进行近端探查，发现其肌腹距鹅足止点约5厘米。这种异常在2.4%的病例中存在。根据以往文献，我们队列中存在的异常肌肉可能是缝匠肌或半膜肌。MRI分析表明，副肌和副腱可能是半膜肌腱的异常条带、股薄肌的异常肌腱和肌腹，或者是缝匠肌腱的增厚和分离。在我们的青少年研究人群中，发现2.4%存在鹅足肌腱异常。在手术时，如果获取的肌腱肌腹位置非常低（肌腱长度小于6厘米），则应考虑存在异常肌腱。如果寻求该信息，术前MRI可能提供异常肌腱的证据。
