Comparison of the histological structure of the tibial nerve and its terminal branches in the fresh and fresh-frozen cadavers
Abstract
Background: The aim of this study was to compare the histological structure (cross-sectional area [CSA] and number of nerve fascicles) of the distal part of the tibial nerve (TN) and its terminal branches (medial plantar nerve [MPN], lateral plantar nerve [LPN]) in the fresh and fresh-frozen cadavers using computer assisted image analysis.
Materials and methods: The TNs with terminal branches (MPN and LPN) were dissected from the fresh and fresh-frozen cadavers. Each nerve was harvested 5 mm proximally and respectively 5 mm distally from the TN bifurcation, marked, dehydrated, embedded in paraffin, sectioned at 2 μm slices and stained with haematoxylin and eosin. Then the specimens were photographed and analysed using Olympus cellSens software.
Results: The fresh cadavers’ group comprised 60 feet (mean age 68.1 ± 15.2 years). The mean CSA and the number of nerve fascicles were respectively 15.25 ± 4.6 mm2, 30.35 ± 8.45 for the TN, 8.76 ± 1.93 mm2, 20.75 ± 7.04 for the MPN and 6.54 ± 2.02 mm2, 13.40 ± 5.22 for the LPN. The fresh-frozen cadavers’ group comprised 21 feet (mean age 75.1 ± 9.0 years). The mean CSA and the number of nerve fascicles were respectively 13.71 ± 5.66 mm2, 28.57 ± 8.00 for the TN, 7.55 ± 3.25 mm2, 18.00 ± 6.72 for the MPN and 4.29 ± 1.93 mm2, 11.33 ± 1.93 for the LPN. Only LPNs showed statistical differences in the CSA and the number of nerve fascicles between examined groups (p = 0.000, p = 0.037, respectively). A positive correlation was found between donors age and tibial nerve CSA in the fresh cadavers group (r = 0.44, p = 0.000). A statistical difference was found between the MPN and LPN both in the CSA and the number of nerve fascicles (p < 0.001, p < 0.001, respectively).
Conclusions: The CSA and the number of nerve fascicles of the tibial and medial plantar nerves were similar in the fresh and fresh-frozen cadavers whilst different in the LPN. The TN showed increasing CSA with the advanced age in the fresh cadavers. The MPN had larger CSA and more nerve fascicles than the LPN.
Keywords: tibial nervecross-sectional areamedial and lateral plantar nervesfresh cadaversfresh-frozen cadavers
References
- Abdul-Jabar HB, Bhamra J, Quick TJ, et al. Iatrogenic posterior tibial nerve division during a combined anterior ankle arthroscopy with an additional posterolateral portal. J Surg Case Rep. 2016; 2016(5): rjw097.
- András C, Josvai A, Gergely C, et al. The importance of daily fast fresh cadaver dissection (how can we organize it?). J Neurol Stroke. 2019; 9(1).
- Arnout N, Myncke J, Vanlauwe J, et al. The influence of freezing on the tensile strength of tendon grafts : a biomechanical study. Acta Orthop Belg. 2013; 79(4): 435–443.
- Bakhach J. The cryopreservation of composite tissues. Organogenesis. 2014; 5(3): 119–126.
- Bedewi MA, Abodonya A, Kotb M, et al. Estimation of ultrasound reference values for the lower limb peripheral nerves in adults: A cross-sectional study. Medicine (Baltimore). 2018; 97(12): e0179.
- Bitar AC, Santos LA, Croci AT, et al. Histological study of fresh versus frozen semitendinous muscle tendon allografts. Clinics (Sao Paulo). 2010; 65(3): 297–303.
- Boehm J, Scheidl E, Bereczki D, et al. High-resolution ultrasonography of peripheral nerves: measurements on 14 nerve segments in 56 healthy subjects and reliability assessments. Ultraschall Med. 2014; 35(5): 459–467.
- Botero SS, Honecker S, Jmal H, et al. The biomechanical properties of 44 human digital collateral nerves from fresh frozen cadavers. J Cell Immunother. 2018; 4(1): 38–40.
- Brenner E. Human body preservation - old and new techniques. J Anat. 2014; 224(3): 316–344.
- Cartner JL, Hartsell ZM, Ricci WM, et al. Can we trust ex vivo mechanical testing of fresh--frozen cadaveric specimens? The effect of postfreezing delays. J Orthop Trauma. 2011; 25(8): 459–461.
- Cartwright MS, Passmore LV, Yoon JS, et al. Cross-sectional area reference values for nerve ultrasonography. Muscle Nerve. 2008; 37(5): 566–571.
- Eisma R, Wilkinson T. From "silent teachers" to models. PLoS Biol. 2014; 12(10): e1001971.
- Freedman DM, Barron OA. Iatrogenic posterior tibial nerve division during ankle arthroscopy. Arthroscopy. 1998; 14(7): 769–772.
- Giannini S, Buda R, Di Caprio F, et al. Effects of freezing on the biomechanical and structural properties of human posterior tibial tendons. Int Orthop. 2008; 32(2): 145–151.
- Grimm A, Axer H, Heiling B, et al. Nerve ultrasound normal values - Readjustment of the ultrasound pattern sum score UPSS. Clin Neurophysiol. 2018; 129(7): 1403–1409.
- He Y, Xiang Xi, Zhu BH, et al. Shear wave elastography evaluation of the median and tibial nerve in diabetic peripheral neuropathy. Quant Imaging Med Surg. 2019; 9(2): 273–282.
- Hocking G, McIntyre O. Achieving change in practice by using unembalmed cadavers to teach ultrasound-guided regional anaesthesia. Ultrasound. 2010; 19(1): 31–35.
- Hohmann E, Keough N, Glatt V, et al. The mechanical properties of fresh versus fresh/frozen and preserved (Thiel and Formalin) long head of biceps tendons: A cadaveric investigation. Ann Anat. 2019; 221: 186–191.
- Jansen S, Kirk D, Tuppin K, et al. Fresh frozen cadavers in surgical teaching: a gelatine arterial infusion technique. ANZ J Surg. 2011; 81(12): 880–882.
- Kang S, Kim SeH, Yang SN, et al. Sonographic features of peripheral nerves at multiple sites in patients with diabetic polyneuropathy. J Diabetes Complications. 2016; 30(3): 518–523.
- Koo GB, Lee JH, Jang JH, et al. Superficial course of the medial plantar nerve: case report. Anat Cell Biol. 2019; 52(1): 87–89.
- Kronlage M, Schwehr V, Schwarz D, et al. Magnetic resonance neurography : normal values and demographic determinants of nerve caliber and T2 relaxometry in 60 healthy individuals. Clin Neuroradiol. 2019; 29(1): 19–26.
- Lee D, Dauphinée D. Morphological and functional changes in the diabetic peripheral nerve. J Am Podiatr Med Assoc. 2005; 95(5): 433–437.
- Lijoi F, Lughi M, Baccarani G. Posterior arthroscopic approach to the ankle: an anatomic study. Arthroscopy. 2003; 19(1): 62–67.
- Lothet EH, Bishop TJ, Walker FO, et al. Ultrasound-Derived nerve cross-sectional area in extremes of height and weight. J Neuroimaging. 2019; 29(3): 406–409.
- Marieswaran M, Mansoori N, Digge VK, et al. Effect of preservation methods on tensile properties of human femur-ACL-tibial complex (FATC) - a cadaveric study on male subjects. Acta Bioeng Biomech. 2018; 20(4): 31–42.
- Mizia E, Tomaszewski KA, Rutowicz B, et al. Computer-assisted assessment of the histological structure of the human sural nerve. Folia Morphol. 2014; 73(3): 292–297.
- Moore KL. Clinically Oriented Anatomy. 8th Edition, LWW 2017.
- Pallante-Kichura AL, Chen AC, Temple-Wong MM, et al. In vivo efficacy of fresh versus frozen osteochondral allografts in the goat at 6 months is associated with PRG4 secretion. J Orthop Res. 2013; 31(6): 880–886.
- Panjabi MM, Krag M, Summers D, et al. Biomechanical time-tolerance of fresh cadaveric human spine specimens. J Orthop Res. 1985; 3(3): 292–300.
- Riazi S, Bril V, Perkins BA, et al. Can ultrasound of the tibial nerve detect diabetic peripheral neuropathy? A cross-sectional study. Diabetes Care. 2012; 35(12): 2575–2579.
- Sargon MF, Ogretmenoglu O, Gunenc Beser C, et al. Quantitative analysis of the terminal branches of facial nerve in fresh frozen head and neck specimens. Folia Morphol. 2014; 73(1): 24–29.
- Seok HY, Jang JH, Won SJ, et al. Cross-sectional area reference values of nerves in the lower extremities using ultrasonography. Muscle Nerve. 2014; 50(4): 564–570.
- Sharma M, Horgan A. Comparison of fresh-frozen cadaver and high-fidelity virtual reality simulator as methods of laparoscopic training. World J Surg. 2012; 36(8): 1732–1737.
- Sharma M, Macafee D, Pranesh N, et al. Construct validity of fresh frozen human cadaver as a training model in minimal access surgery. JSLS. 2012; 16(3): 345–352.
- Singh K, Gupta K, Kaur S. High resolution ultrasonography of the tibial nerve in diabetic peripheral neuropathy. J Ultrason. 2017; 17(71): 246–252.
- Stouthandel MEJ, Vanhove C, Devriendt W, et al. Biomechanical comparison of Thiel embalmed and fresh frozen nerve tissue. Anat Sci Int. 2020; 95(3): 399–407.
- Tagliafico A, Cadoni A, Fisci E, et al. Reliability of side-to-side ultrasound cross-sectional area measurements of lower extremity nerves in healthy subjects. Muscle Nerve. 2012; 46(5): 717–722.
- Thiel W. [The preservation of the whole corpse with natural color]. Ann Anat. 1992; 174(3): 185–195.
- Tomaszewski KA, Graves MJ, Henry BM, et al. Surgical anatomy of the sciatic nerve: A meta-analysis. J Orthop Res. 2016; 34(10): 1820–1827.
- Unger S, Blauth M, Schmoelz W, et al. Effects of three different preservation methods on the mechanical properties of human and bovine cortical bone. Bone. 2010; 47(6): 1048–1053.
- Warchol Ł, Walocha JA, Mizia E, et al. Ultrasound-guided topographic anatomy of the medial calcaneal branches of the tibial nerve. Folia Morphol. 2021; 80(2): 267–274.
- Warchoł Ł, Mróz I, Mizia E, et al. Vascular density of inferior tibiofibular joint - cadaveric experimental study. Folia Med Cracov. 2017; 57(1): 47–54.
- Wong YR, Pang X, Lim ZY, et al. Biomechanical evaluation of peripheral nerves after crush injuries. Heliyon. 2019; 5(4): e01557.
- Young BH, Flanigan RM, DiGiovanni BF. Complications of ankle arthroscopy utilizing a contemporary noninvasive distraction technique. J Bone Joint Surg Am. 2011; 93(10): 963–968.
- Zarb F, McNulty J, Gatt A, et al. Comparison of in vivo vs. frozen vs. Thiel cadaver specimens in visualisation of anatomical structures of the ankle on proton density Magnetic Resonance Imaging (MRI) through a visual grading analysis (VGA) study. Radiography (Lond). 2017; 23(2): 117–124.
- Zengerink M, van Dijk CN, Zengerink M, et al. Complications in ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2012; 20(8): 1420–1431.
