open access

Vol 83, No 1 (2024): Folia Morphologica
Case report
Submitted: 2022-10-09
Accepted: 2022-12-15
Published online: 2023-02-16
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Very rare arrangement of the pes anserinus: potential clinical significance

Nicol Zielinska1, Richard Shane Tubbs234567, Piotr Karauda1, Teresa Vazquez8, Łukasz Olewnik1
·
Pubmed: 36811137
·
Folia Morphol 2024;83(1):239-243.
Affiliations
  1. Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
  2. Department of Anatomical Sciences, St. George’s University, Grenada, West Indies
  3. Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, United States
  4. Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, United States
  5. Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, United States
  6. Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, United States
  7. Department of Neurosurgery, Ochsner Medical Centre, New Orleans, Louisiana, United States
  8. Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Spain

open access

Vol 83, No 1 (2024): Folia Morphologica
CASE REPORTS
Submitted: 2022-10-09
Accepted: 2022-12-15
Published online: 2023-02-16

Abstract

The pes anserinus superficialis is composed of the semitendinosus, gracilis and sartorius tendons. Normally, they all insert to the medial side of the tibial tuberosity, and the first two are attached superiorly and medially to the tendon of the sartorius muscle. During anatomical dissection, a new pattern of arrangement of tendons creating the pes anserinus was found. The pes anserinus comprised three tendons; the semitendinosus tendon was located superiorly to the gracilis tendon, and they both had distal attachments on the medial side of the tibial tuberosity. This seemed like the normal type, but the tendon of the sartorius muscle created an additional superficial layer, its proximal part lying just below the gracilis tendon and covering the semitendinosus tendon and a small part of the gracilis tendon. After crossing the semitendinosus tendon it is attached to the crural fascia significantly below the tibial tuberosity. Good knowledge of the morphological variations of the pes anserinus superficialis is necessary during surgical procedures in the knee region, especially anterior ligament reconstruction.

Abstract

The pes anserinus superficialis is composed of the semitendinosus, gracilis and sartorius tendons. Normally, they all insert to the medial side of the tibial tuberosity, and the first two are attached superiorly and medially to the tendon of the sartorius muscle. During anatomical dissection, a new pattern of arrangement of tendons creating the pes anserinus was found. The pes anserinus comprised three tendons; the semitendinosus tendon was located superiorly to the gracilis tendon, and they both had distal attachments on the medial side of the tibial tuberosity. This seemed like the normal type, but the tendon of the sartorius muscle created an additional superficial layer, its proximal part lying just below the gracilis tendon and covering the semitendinosus tendon and a small part of the gracilis tendon. After crossing the semitendinosus tendon it is attached to the crural fascia significantly below the tibial tuberosity. Good knowledge of the morphological variations of the pes anserinus superficialis is necessary during surgical procedures in the knee region, especially anterior ligament reconstruction.

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Keywords

pes anserinus, superficialis, semitendinosus, gracilis, sartorius, autograft, anterior cruciate ligament reconstruction, hamstring tendon graft, patellar tendon graft

About this article
Title

Very rare arrangement of the pes anserinus: potential clinical significance

Journal

Folia Morphologica

Issue

Vol 83, No 1 (2024): Folia Morphologica

Article type

Case report

Pages

239-243

Published online

2023-02-16

Page views

502

Article views/downloads

381

DOI

10.5603/FM.a2023.0013

Pubmed

36811137

Bibliographic record

Folia Morphol 2024;83(1):239-243.

Keywords

pes anserinus
superficialis
semitendinosus
gracilis
sartorius
autograft
anterior cruciate ligament reconstruction
hamstring tendon graft
patellar tendon graft

Authors

Nicol Zielinska
Richard Shane Tubbs
Piotr Karauda
Teresa Vazquez
Łukasz Olewnik

References (14)
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  2. Bernicker JP, Haddad JL, Lintner DM, et al. Patellar tendon defect during the first year after anterior cruciate ligament reconstruction: appearance on serial magnetic resonance imaging. Arthroscopy. 1998; 14(8): 804–809.
  3. Curtis BR, Huang BK, Pathria MN, et al. Pes anserinus: anatomy and pathology of native and harvested tendons. Am J Roentgenol. 2019; 213(5): 1107–1116.
  4. Freedman KB, D'Amato MJ, Nedeff DD, et al. Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med. 2003; 31(1): 2–11.
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  6. Iwanaga J, Singh V, Takeda S, et al. Standardized statement for the ethical use of human cadaveric tissues in anatomy research papers: Recommendations from Anatomical Journal Editors-in-Chief. Clin Anat. 2022; 35(4): 526–528.
  7. Järvinen TLN, Järvinen TAH, Penttilä T, et al. Failed regrowth of the harvested semitendinosus tendon: a rare complication of tendon harvest after anterior cruciate ligament reconstruction. Arthroscopy. 2003; 19(4): E31.
  8. LaPrade RF, Engebretsen AH, Ly TV, et al. The anatomy of the medial part of the knee. J Bone Joint Surg Am. 2007; 89(9): 2000–2010.
  9. Lee JH, Kim KJ, Jeong YG, et al. Pes anserinus and anserine bursa: anatomical study. Anat Cell Biol. 2014; 47(2): 127–131.
  10. Mochizuki T, Akita K, Muneta T, et al. Pes anserinus: layered supportive structure on the medial side of the knee. Clin Anat. 2004; 17(1): 50–54.
  11. Olewnik Ł, Podgórski M, Polguj M. An unusual insertion of an accessory band of the semitendinosus tendon: case report and review of the literature. Folia Morphol. 2020; 79(3): 645–648.
  12. Olewnik Ł, Gonera B, Podgórski M, et al. A proposal for a new classification of pes anserinus morphology. Knee Surg Sports Traumatol Arthrosc. 2019; 27(9): 2984–2993.
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  14. Snoeck O, Beyer B, Rooze M, et al. Anatomical study of paratenons and fascia lata connections in the posteromedial knee region. Surg Radiol Anat. 2022; 44(6): 821–827.

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