Anatomical relationship between the anterior arm of the semimembranosus tendon and the medial collateral ligament: A cadaveric study

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Purpose: Despite its close anatomical relationship with the superficial medial collateral ligament (sMCL) and deep medial collateral ligament (dMCL), the primary stabilisers of the medial knee, the anterior arm of the semimembranosus (SM) tendon has been scarcely studied anatomically. In addition, there is concern about potential damage to the anterior arm during the tibial cut in total knee arthroplasty (TKA). This study aimed to quantitatively evaluate the anatomical location of the SM's anterior arm and clarify the anatomical relationship with the MCL using gross and histological evaluation. Methods: Twenty-two formalin-fixed cadaveric knees were used. The distance from the joint line to the anterior arm, the anterior arm's length, and the entry ratio of the anterior arm underneath the sMCL were measured. Four equal-thickness sections were harvested from the medial tibial condyle, including the anterior arm and MCL, and stained with Masson's trichrome, hematoxylin, and eosin. The anatomical relationship between the anterior arm, sMCL, and dMCL was evaluated. Result: The vertical distances from the joint line to the proximal and distal margin of the anterior arm are 8.9 ± 1.5 mm and 16.8 ± 1.5 mm, respectively. The entry ratio of the anterior arm underneath the sMCL was 0.53 ± 0.21. The anterior arm fibres intersected with distally extending dMCL fibres. The loose connective tissue was located at the junction of the sMCL, anterior arm, and dMCL. Conclusion: Anterior arm of the SM tendon shares a common attachment area with the dMCL tibial attachment and is connected to the sMCL via loose connective tissue. The measurements obtained in the present study may serve as useful indicators for avoiding damage to the anterior arm during tibial cut in TKA. Level of Evidence: Level Ⅳ.

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