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K.W. McNeer, M.G. Tucker, S.J. Goldberg, R. McClung; Anatomy & Histology of the Check Ligament and Muscle Fiber Orientation in a Human Lateral Rectus Muscle Specimen . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5721.
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Purpose: To examine the gross anatomy and histology of the classically defined check ligament (CL), anterior Tenon's capsule, and extraocular muscle layers from a non–cadaveric human specimen. Methods: Tissue was dissected from a complete orbit exenteration specimen (78 yr. male) which had been fixed in neutral buffered formalin immediately after removal. Serial 5 micron cross sections were prepared from paraffin embedded blocks of the lateral rectus muscle and its undisturbed connective tissues. The sections were stained with Masson Trichrome stain for light microscopic examination of muscle fibers (red) and surrounding connective tissues (blue). Results: Rectus muscle cross sections with Masson Trichrome stain demonstrate the CL to be a discrete dense collagenous bridge between the distal third of the rectus muscle, proximal to where it passes through Tenon's capsule, and the periosteum of the orbital wall. No smooth muscle or innervation was observed in these collagen bundles. Representative sections through the center of the muscle show it to be surrounded by a loose encasement of connective tissue with only thin bands of attachment to the periosteum. Both orbital and global muscle fibers remain parallel within their connective tissue sheaths (perimysium) and are inline with the muscle tendon. The CL attaches onto the orbital muscle fiber layer by investing itself around individual myofibers. The outer orbital layer remains parallel with the rest of the muscle at the point of CL attachment and does not extend outward into the ligament. Conclusions: There is a discrete dense collagen bundle classically called the check ligament extending from the periosteum to the distal third of the lateral rectus muscle. No smooth muscle or innervation is obvious in this ligament. The CL inserts onto the orbital or peripheral myofibers, rather than the reverse, as implied by the pulley theory. Supported by NIH Grant EY 11249, The Jeffress Memorial Trust and The Smith Kettlewell Eye Research Institute.
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