ESSKA Academy. MALAGELADA F. May 11, 2018; 218060; FP32-707
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Objectives: The Kager fat pad (KFP) is one of the largest soft tissue structures local to the ankle joint, yet it is poorly understood. It has been hypothesised to have a role in Achilles tendinopathy. This study aimed to clearly define KFP anatomy and perform a preliminary investigation into its biomechanical function.

Methods: Eight fresh frozen cadaveric ankles (mean age=44 , range:38-51 ) were mounted in a customized testing rig, to allow plantarflexion and dorsiflexion of the ankle. A needle tipped pressure sensor was inserted in three areas of the KFP under ultrasound guidance. Pressure readings were recorded with the ankle in 5 ranges of ankle plantarflexion, including terminal range. Following testing, specimens were dissected. A cutaneous window to expose the tendo Achilles (TA) and the crural fascia were created. The KFP was then visible and dissected from the muscles of the deep posterior compartment of the leg. This allowed the TA to be reflected enabling clear visualization of the KFP. The KFP was freed of all attachments and its dimensions and volume recorded. The total length of the KFP adherence to the TA was recorded.

Results: Mean pressures rose in all specimens in terminal ankle motion. Anatomically the KFP is adherent to the TA at its posterior part for a mean length of 9.3 cm (91% of KFP length). The most distal part of the KFP is an exception and it dettaches from the TA to give way to the retrocalcaneal bursa for a mean length of 0.88 cm (9% of KFP length). The bursal space is partially occupied by a constant 'wedge' of KFP. The mean dimensions of the extension were 0.9 cm length (from its base to the tip) and 1cm width at its base. The wedge consistency is smoother than adipose fat present in the rest of the KFP. The mean volume of the whole KFP is of 12.6cc. The KFP contacting the TA is displaced upwards and the wedge is introduced into the retrocalcaneal bursal space during plantarflexion as evidenced in video and ultrasound images.

Conclusions: The retrocalcaneal bursa and the KFP wedge seem to be an important part of the KFP and they may have a proprioceptive role giving feedback. The KFP structure may be more important than currently understood, which could have implications for posterior ankle arthroscopy as well as the pathophysiology and surgical management of Achilles tendinopathy. Further investigations are warranted.

ankle, kager's fat pad, biomechanics, anatomy
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