Objectives

Accurate characterisation of fractures is essential in fracture management trials. However, this is often hampered by poor inter-observer agreement. This article describes the practicalities of defining the fracture population, based on the Neer classification, within a pragmatic multicentre randomised controlled trial in which surgical treatment was compared with non-surgical treatment in adults with displaced fractures of the proximal humerus involving the surgical neck.

Introduction: Arthroscopic A.C.L. reconstruction using Semitendinosus (S.T.) and Gracilis (Gr.) tendons is a popular technique for the treatment of ACL deficient knees. It is common to find accessory tendinous bands (vinculae) arising from these two tendons when harvesting them. The implications are that extra care must be taken with the use of the tendon stripper if one is to avoid cutting the main tendon. Our clinical experience reveals that these connections are highly variable and, contrary to popular thinking, may be present beyond 10cm. proximally.

Aim: Our aim was to map these intertendinous connections and assess their variability using a cadaveric model. In particular we were interested to identify the presence of vinculae arising proximally beyond 10cm.

Procedure: We dissected the tendons of Gr. and S.T. of ten embalmed adult human cadaveric legs. Various vinculae from both tendons were identified and their origin and insertion mapped. All measurements were done using the tibial crest as a reference.

Results: We found that vinculae have a high variability. Bands were seen between tendons, connecting them to the popliteal fascia, sartorius, gastrognemis, pretibial and superficial fascia. Vinculae originated more than 10cm proximally from Semitendinosus and Gracilis in eight and two occasions respectively. There was a constant connection band between S.T. and the grastrocriernius fascia.

Conclusion: Our results confirm that vincular anatomy is more variable than previously reported. Surgeons should be aware of our new finding of vinculae commonly originating beyond 10cm. proximally. This work has prompted us to investigate the role of MRI for pre-operatively templating vinculae.