Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland.
Ann Anat. 2019 Jul;224:47-53. doi: 10.1016/j.aanat.2019.03.002. Epub 2019 Mar 28.
The fibularis longus muscle (FLM) is located in the lateral compartment of the leg. Although the FLM presents high morphological variability, particularly the tendon, little is known of its insertion. Similarly, little information exists regarding the great diversity of the Frenular ligament. The main aim of the study was hence to characterize the morphology of the fibularis longus tendon (FLT) and its accessory bands, to classify it and to determine the incidence of frenular ligaments. I hypothesize that the presence of anterior/posterior frenular ligament can be closely correlated with a given type of fibularis longus tendon insertion.
Classical anatomical dissection was performed on 100 lower limbs (50 female, 50 male) fixed in 10% formalin solution. The morphology of the insertion of the FLT and of the frenular ligaments was evaluated.
The FLM was present in all specimens. Three types of insertion were observed, the most common being Type I (49%): a single distal attachment in which the tendon inserts into the lateral tubercle of the base of the I metatarsal bone. The second most common type was Type II (40%): bifurcated distal attachment, the main tendon inserts into the lateral tubercle of the base of the I metatarsal bone. This group was divided into three subtypes (A-C), subtype (A) - the accessory band inserts into the medial cuneiform bone; subtype (B) - a strong, accessory band inserts into both the base of the I metatarsal bone and the medial cuneiform bone, including the first metatarsal-cuneiform joint; subtype (C) - the accessory band inserts into the first interosseus dorsalis muscle. The rarest type was Type III (9%), characterized by a single distal tendon, which fuses with other adjacent muscle tendons before insertion. The main tendon inserts into the lateral tubercle of the base of the I metatarsal bone; this group was divided into two subtypes (IIIA - fusion with the tibialis posterior tendon and IIIB - fusion with the adductor hallucis longus). The anterior frenular ligament was present in 49% of specimens, whereas the posterior frenular ligament joined the FLT to the long calcaneo-cuboid ligament and was present in 9%.
Both the fibularis longus tendon and frenular ligament present high morphological variability. The anterior frenular ligament is closely correlated with Type I of the proposed classification, while the posterior frenular ligament is associated with Type II b. Knowledge of particular types of insertion is essential for both clinicians and anatomists.
腓骨长肌（FLM）位于小腿外侧间隔。尽管 FLM 具有很高的形态变异性，尤其是肌腱，但对其插入点知之甚少。同样，关于 Frenular 韧带的多样性也几乎没有信息。因此，本研究的主要目的是描述腓骨长肌腱（FLT）及其辅助带的形态，对其进行分类，并确定 Frenular 韧带的发生率。我假设前/后 Frenular 韧带的存在可以与腓骨长肌腱插入的特定类型密切相关。
对 100 条下肢（50 条女性，50 条男性）进行经典解剖学解剖，这些下肢固定在 10%甲醛溶液中。评估了 FLT 和 Frenular 韧带插入的形态。
所有标本均存在 FLM。观察到三种插入类型，最常见的是类型 I（49%）：单一的远端附着，肌腱插入第一跖骨基底的外侧结节。第二种最常见的类型是类型 II（40%）：分叉的远端附着，主要肌腱插入第一跖骨基底的外侧结节。该组分为三个亚型（A-C），亚型（A）-辅助带插入内侧楔骨；亚型（B）-一个强大的辅助带插入第一跖骨基底和内侧楔骨，包括第一跖楔关节；亚型（C）-辅助带插入第一骨间背侧肌。最少见的类型是类型 III（9%），其特征是单一的远端肌腱，在插入前与其他相邻肌肉肌腱融合。主要肌腱插入第一跖骨基底的外侧结节；该组分为两个亚型（IIIA-与比目鱼肌肌腱融合和 IIIB-与长屈肌跟骨融合）。前 Frenular 韧带存在于 49%的标本中，而后 Frenular 韧带将 FLT 与长跟距骨韧带连接，存在于 9%的标本中。
腓骨长肌腱和 Frenular 韧带均具有很高的形态变异性。前 Frenular 韧带与所提出分类的 I 型密切相关，而后 Frenular 韧带与 IIB 型相关。了解特定的插入类型对临床医生和解剖学家都很重要。
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