Examination of Anatomic and Morphometric Features of Kager’s Triangle

Year 2022, , 207 - 213, 30.12.2022

Rabia Solak Döner , Papatya Keleş , Burak Karip

https://doi.org/10.56150/tjhsl.1191371

Abstract

Abstract

Background/aim: In this study, it was aimed to determine the morphometric properties of the Kager’s triangle, which is located in the posterior region of the ankle where interventional procedures are frequently performed and contains fat pad.

Materials and methods: For our study, bilateral lower extremity of 4 female and 4 male cadavers were dissected. Tibia length, fibula length, foot length, intermaleolar length, intercondylar length, gastrocnemius muscle’s medial head and lateral head and tendon length, floor, anterior margin, posterior margin lengths and area of Kager’s triangle were measured in the cadavers. Descriptive and statistical analysis of the morphometric measurements we made was performed.

Results: All 3 parts of the Kager’s triangle, which are defined anatomically in the literature, have been observed. The base of the Kager’s triangle is an average of 24.33±2.05 mm in women and 31.44±3.84 mm in men. The anterior border of Kager's triangle is 60.10±6.56 mm in females and 67.19±19.05 mm in males. The posterior border of Kager's triangle was found to be 55.61±6.38 mm in women and 72.52±17.56 mm in men. The area of Kager's triangle was found to be 6.74±1.15 cm² on average in females and 9.06±1.85 cm² in males.

Conclusion: The data obtained will be a guide for the injections to be applied to the region or surgical interventions to be performed in the region, especially for the treatment of pathologies such as Achilles tendinopathy in this region. It is aimed that this study will contribute to the literature on the anatomy of the relevant region

Keywords

anatomy, retrocalcaneal bursa, Kager’s triangle, Kager’s fat pad, pre-achilles fat pad, calcaneal tendon.

References

• 1. Lin Y jing, Duan X jun, Yang L. V-Y Tendon Plasty for Reconstruction of Chronic Achilles Tendon Rupture: A Medium-term and Long-term Follow-up. Orthop Surg. 2019;11(1):109–16.
• 2. Wiegerinck JI, Somford MP, Hoornenborg D, Niek Van Dijk C. Orthopaedic forum Eponyms of the Kager Triangle. 2012;67:1–6.
• 3. Theobald P, Bydder G, Dent C, Nokes L, Pugh N, Benjamin M. The functional anatomy of Kager’s fat pad in relation to retrocalcaneal problems and other hindfoot disorders. J Anat. 2006;208(1):91–7.
• 4. Apaydın N, Ünlü S, Bozkurt M, Doral MN. Aşil tendonu’nun fonksiyonel anatomisi ve biyomekanik özellikleri Functional anatomy and biomechanical aspects of the Achilles tendon. TOTBİD Derg. 2011;10(1):61–8.
• 5. Ward ER, Andersson G, Backman LJ, Gaida JE. Fat pads adjacent to tendinopathy: More than a coincidence? Br J Sports Med. 2016;50(24):1491–2.
• 6. Taneja AK, Santos DCB. Steroid-induced Kager’s fat pad atrophy. Skeletal Radiol. 2014;43(8):1161–4.
• 7. Canoso JJ, Liu N, Traill MR, Runge VM. Physiology of the retrocalcaneal bursa. Ann Rheum Dis. 1988;47(11):910–2.
• 8. Ly JQ, Bui-Mansfield LT. Anatomy of and Abnormalities Associated with Kager’s Fat Pad. Am J Roentgenol. 2004;182(1):147–54.
• 9. Kinugasa R, Taniguchi K, Yamamura N, Fujimiya M, Katayose M, Takagi S, et al. A Multimodality Approach Towards Elucidation of the Mechanism for Human Achilles Tendon Bending during Passive Ankle Rotation. Sci Rep. 2018;8(1):1–14.
• 10. Malagelada F, Stephen J, Dalmau-Pastor M, Masci L, Yeh M, Vega J, et al. Pressure changes in the Kager fat pad at the extremes of ankle motion suggest a potential role in Achilles tendinopathy. Knee Surgery, Sport Traumatol Arthrosc. 2020;28(1):148–54.
• 11. Humphrey J, Chan O, Crisp T, Padhiar N, Morrissey D, Twycross-Lewis R, et al. The shortterm effects of high volume image guided injections in resistant non-insertional Achilles tendinopathy. J Sci Med Sport. 2010;13(3):295–8.
• 12. Basadonna P-T, Rucco V, Gasparini D, Onorato A. Plantar Fat Pad Athropy After Corticosteroid Injection For An Interdigital Neuroma: A Case Report: 1. Am J Phys Med Rehabil. 1999;78(3).
• 13. Beyzadeoglu T, Bekler H, Gokce A. Skin and subcutanous fat atrophy after corticosteroid injection for medial epicondylitis. Vol. 34, Orthopedics. 2011. p.570.
• 14. Jeon B, Yeo J, Shin J. 신발 굽 높이에 따른 Kager씨 삼각의 면적과 후종족부의 표면온도 측정. Measurement of Kager’s Triangle Area and Retrocalcaneal Surface Temperature by shoes heel height. J Korean Soc Radiol. 2012;6(6):521–9.