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Femoral Intercondylar Notch: Gross Anatomy and Histology of the Connective Tissue Lining of its Roof: A Pilot Study

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Abstract

Purpose

We have consistently observed a connective tissue lining over the intercondylar notch's roof (CTLINR) during arthroscopic surgeries of the knee joint. As there is a strong association of the intercondylar fossa with the anterior cruciate ligament (ACL), we believe that this tissue must be having some role in the functioning of the ACL. The purpose of this pilot study was to investigate the anatomic characteristics of the CTLINR.

Methods

In this observational anatomical study, we have investigated the gross anatomical and histological features of the CTLINR in four knees of two fresh frozen non-embalmed cadavers. We have also studied its ultrastructural characteristics by obtaining an arthroscopic biopsy of the tissue from a patient undergoing ACL reconstruction.

Results

At gross examination, the CTLINR had a typical glistening white surface with transversely oriented fibres. It entirely covered the roof of the intercondylar notch and was soft to touch. Histological examination with haematoxylin–eosin stain revealed fibro-collagenous tissue with intervening blood vessels. Transmission electron microscopy manifested loosely arranged collagen fibres of variable diameter.

Conclusion

The histological and electron microscopic characteristics of the tissue differentiate it from the ACL and its femoral enthesis, suggesting that it was a distinct anatomical structure. As it entirely covered the roof of the intercondylar fossa and had a smooth surface and soft consistency, it may protect the reconstructed ACL from graft abrasion. Furthermore, as it had a characteristic arthroscopic appearance, future research can investigate its role in femoral tunnel positioning.

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Acknowledgements

The authors thank Dr Tara Shankar Roy and Dr Adarsh Barwas for their guidance during the conduction of the study and for writing assistance. The authors acknowledge Dr Vijay Kumar Digge and Dr Rahul Morankar for proofreading the article.

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Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, 110049

    Hira Lal Nag, Gunjar Jain & Vivek Vijayakumar

  2. Department of Anatomy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, 110029

    Tony George Jacob

  3. Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, 110029

    Mukinkumar Sonai

  4. Department of FMT, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, 110029

    Sanjeev Lalwani

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  1. Hira Lal Nag
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  2. Gunjar Jain
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  4. Tony George Jacob
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Contributions

HLN: Protocol development and Manuscript editing, GJ: Cadaveric dissection, Review of literature, and Preparation of the draft manuscript, VV: Review of literature and Proofreading of the manuscript, TJ: Cadaveric dissection and Proofreading of the manuscript, MS: Histological analysis and Review of literature, SL: Protocol development and Manuscript editing.

Corresponding author

Correspondence to Gunjar Jain.

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The authors declare that they have no conflict of interests in respect of the research, authorship and publication of this article.

Ethics approval

Approval was obtained from the institutional Ethics Committee. The procedures applied in this study adhered to the tenets of the Declaration of Helsinki.

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Informed consent was obtained from the participant included in the study.

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Nag, H.L., Jain, G., Vijayakumar, V. et al. Femoral Intercondylar Notch: Gross Anatomy and Histology of the Connective Tissue Lining of its Roof: A Pilot Study. Surg Radiol Anat 43, 1659–1666 (2021). https://doi.org/10.1007/s00276-021-02757-y

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