open access

Vol 81, No 1 (2022)
Original article
Submitted: 2020-12-08
Accepted: 2021-01-04
Published online: 2021-01-22
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Paratenon of the cruciate ligaments of the knee: a macroscopic and histological study of human foetuses

J. H. Kim1, N. Sugai2, D. Suzuki3, G. Murakami4, H. Abe5, J. F. Rodríguez-Vázquez6, M. Yamamoto7
DOI: 10.5603/FM.a2021.0003
·
Pubmed: 33511626
·
Folia Morphol 2022;81(1):134-143.
Affiliations
  1. Department of Anatomy, Jeonbuk National University Medical School, Jeonju, Korea
  2. Department of Rehabilitation and Physical Therapy, Hitshuji-ga-oka Hospital, Sapporo, Japan
  3. Division of Common Curriculum, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
  4. Division of Internal Medicine, Cupid Clinic, Iwamizawa, Hokkaido, Japan
  5. Emeritus Professor of Akita University School of Medicine, Akita, Japan
  6. Department of Anatomy and Embryology, School of Medicine, Complutense University, Madrid, Spain
  7. Department of Anatomy, Tokyo Dental College, Tokyo, Japan

open access

Vol 81, No 1 (2022)
ORIGINAL ARTICLES
Submitted: 2020-12-08
Accepted: 2021-01-04
Published online: 2021-01-22

Abstract

Background: The paratenon is a sheath-like connective tissue that allows the tendon to move with minimal friction. The careful removal of the paratenon along the cruciate ligaments is a critical step of knee surgery. Thus, orthopaedic surgeons and interventional radiologists consider the paratenon as a basic anatomical tissue along a ligament, not along a tendon.
Materials and methods: We performed macroscopic and histological observations of cruciate ligament-associated paratenons in 43 human foetuses.
Results: This tissue usually had a thick armour-like appearance that was distant from the infrapatellar fat pad. The anterior cruciate ligament, rather than the posterior ligament, was deeply embedded in the paratenon. The paratenon contained abundant arteries and veins and, at and near the crossing between the cruciate ligaments, had a well-developed venous plexus. Notably, there were abundant fused veins in the paratenon venous plexus, and prenatal knee movements (especially rotation) seemed to restrict its blood supply, leading to the development of a large cavity by way of advancing fusion of veins in the degenerating plexus. This unique manner of cavitation likely expanded the joint cavity.
Conclusions: Differences in knee movements in utero seemed to cause differences in the thickness of the paratenon among foetuses. New-borns might have limited knee flexion due to a mass-effect of the thick paratenon around the cruciate ligaments. A slight twisting or rotation at the knee may help to release the knee, because it can break the foetal paratenon and accelerate cavitation.

Abstract

Background: The paratenon is a sheath-like connective tissue that allows the tendon to move with minimal friction. The careful removal of the paratenon along the cruciate ligaments is a critical step of knee surgery. Thus, orthopaedic surgeons and interventional radiologists consider the paratenon as a basic anatomical tissue along a ligament, not along a tendon.
Materials and methods: We performed macroscopic and histological observations of cruciate ligament-associated paratenons in 43 human foetuses.
Results: This tissue usually had a thick armour-like appearance that was distant from the infrapatellar fat pad. The anterior cruciate ligament, rather than the posterior ligament, was deeply embedded in the paratenon. The paratenon contained abundant arteries and veins and, at and near the crossing between the cruciate ligaments, had a well-developed venous plexus. Notably, there were abundant fused veins in the paratenon venous plexus, and prenatal knee movements (especially rotation) seemed to restrict its blood supply, leading to the development of a large cavity by way of advancing fusion of veins in the degenerating plexus. This unique manner of cavitation likely expanded the joint cavity.
Conclusions: Differences in knee movements in utero seemed to cause differences in the thickness of the paratenon among foetuses. New-borns might have limited knee flexion due to a mass-effect of the thick paratenon around the cruciate ligaments. A slight twisting or rotation at the knee may help to release the knee, because it can break the foetal paratenon and accelerate cavitation.

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Keywords

paratenon, tendon sheath, cruciate ligament of the knee, histology, human foetus

About this article
Title

Paratenon of the cruciate ligaments of the knee: a macroscopic and histological study of human foetuses

Journal

Folia Morphologica

Issue

Vol 81, No 1 (2022)

Article type

Original article

Pages

134-143

Published online

2021-01-22

Page views

1102

Article views/downloads

541

DOI

10.5603/FM.a2021.0003

Pubmed

33511626

Bibliographic record

Folia Morphol 2022;81(1):134-143.

Keywords

paratenon
tendon sheath
cruciate ligament of the knee
histology
human foetus

Authors

J. H. Kim
N. Sugai
D. Suzuki
G. Murakami
H. Abe
J. F. Rodríguez-Vázquez
M. Yamamoto

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