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Kakegawa A, Sumitomo N, Nagira A, Ichinose Y, Fukushima N. The calcaneofibular ligament groove at the inferior fibula, an ultrasonographic anatomical landmark. Surg Radiol Anat 2024; 46:739-747. [PMID: 38573504 DOI: 10.1007/s00276-024-03346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Calcaneofibular ligament (CFL) injuries are harder to diagnose than anterior talofibular ligament (ATFL) ones. This study aimed to clarify the fibular attachment of the CFL and verify the bony landmark for evaluating the CFL on ultrasonography. METHODS Fifty-nine ankles were used in this anatomical study. To confirm the control function of the CFL, we performed passive movement manually using cadaveric ankles and observed the ankle positions where the CFLs were tense. Histological observation of CFL attachment of the fibula was performed using Masson's trichrome stain. The ATFL and CFL were removed, and the bone morphology of the CFL attachment and inferior fibular end was imaged using a stereomicroscope and a 3D scanner. Using ultrasonography, we evaluated the bone morphology of the fibular attachment of the CFL in short-axis images of 27 healthy adult ankles. RESULTS The CFL was tensed according to ankle motions: supination, maximum dorsi flexion, maximum plantar flexion, and mild plantar flexion-external rotation. Below the CFL attachment of the fibula was a slight groove between the inferior tip and the obscure tubercle of the fibula. This groove was observed in 81.5% of cases using short-axis ultrasonography. CONCLUSION The CFL was tensed in various ankle positions to control the movements of the talocrural and subtalar joints. There was a slight groove at the inferior end of the fibula where the CFL coursed downward. We called it the CFL groove and proposed that it could serve as a landmark for the short-axis image of ultrasonography.
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Affiliation(s)
- Akira Kakegawa
- Faculty of Human Care, Teikyo Heisei University, 2-51-4 Higashi-Ikebukuro, Toshimaku, Tokyo, Japan.
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan.
| | - Norimi Sumitomo
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Ayata Nagira
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Yuko Ichinose
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Nanae Fukushima
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
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2
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Li Y, Tong J, Wang H, Ji X, Hua Y, Cheng CK. Investigation into the effect of deltoid ligament injury on rotational ankle instability using a three-dimensional ankle finite element model. Front Bioeng Biotechnol 2024; 12:1386401. [PMID: 38751867 PMCID: PMC11094218 DOI: 10.3389/fbioe.2024.1386401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
Background Injury to the lateral collateral ligament of the ankle may cause ankle instability and, when combined with deltoid ligament (DL) injury, may lead to a more complex situation known as rotational ankle instability (RAI). It is unclear how DL rupture interferes with the mechanical function of an ankle joint with RAI. Purpose To study the influence of DL injury on the biomechanical function of the ankle joint. Methods A comprehensive finite element model of an ankle joint, incorporating detailed ligaments, was developed from MRI scans of an adult female. A range of ligament injury scenarios were simulated in the ankle joint model, which was then subjected to a static standing load of 300 N and a 1.5 Nm internal and external rotation torque. The analysis focused on comparing the distribution and peak values of von Mises stress in the articular cartilages of both the tibia and talus and measuring the talus rotation angle and contact area of the talocrural joint. Results The dimensions and location of insertion points of ligaments in the finite element ankle model were adopted from previous anatomical research and dissection studies. The anterior drawer distance in the finite element model was within 6.5% of the anatomical range, and the talus tilt angle was within 3% of anatomical results. During static standing, a combined rupture of the anterior talofibular ligament (ATFL) and anterior tibiotalar ligament (ATTL) generates new stress concentrations on the talus cartilage, which markedly increases the joint contact area and stress on the cartilage. During static standing with external rotation, the anterior talofibular ligament and anterior tibiotalar ligament ruptured the ankle's rotational angle by 21.8% compared to an intact joint. In contrast, static standing with internal rotation led to a similar increase in stress and a nearly 2.5 times increase in the talus rotational angle. Conclusion Injury to the DL altered the stress distribution in the tibiotalar joint and increased the talus rotation angle when subjected to a rotational torque, which may increase the risk of RAI. When treating RAI, it is essential to address not only multi-band DL injuries but also single-band deep DL injuries, especially those affecting the ATTL.
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Affiliation(s)
- Yuandong Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
| | - Jiahui Tong
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Huizhi Wang
- Center for Intelligent Medical Equipment and Devices, Institute for Innovative Medical Devices, University of Science and Technology of China, Hefei, China
- Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, China
| | - Xiaoxi Ji
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Cheng-Kung Cheng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
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Dalmau-Pastor M, El-Daou H, Stephen JM, Vega J, Malagelada F, Calder J. Clinical Relevance and Function of Anterior Talofibular Ligament Superior and Inferior Fascicles: A Robotic Study. Am J Sports Med 2023; 51:2169-2175. [PMID: 37232327 DOI: 10.1177/03635465231172196] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Ankle lateral ligament sprains are common injuries in sports, and some may result in persistent ankle pain and a feeling of instability without clinical evidence of instability. The anterior talofibular ligament (ATFL) has 2 distinct fascicles, and recent publications have suggested that injury isolated to the superior fascicle might be the cause of these chronic symptoms. This study aimed to identify the biomechanical properties conferred by the fascicles in stabilizing the ankle in order to understand potential clinical problems that may follow when the fascicles are injured. PURPOSE/HYPOTHESIS The aim of this study was to determine the contribution of superior and inferior fascicles of the ATFL in restraining anteroposterior tibiotalar resistance, internal external tibial rotation resistance, and inversion eversion talar rotation resistance. It was hypothesized that an isolated injury of the ATFL superior fascicle would have a measurable effect on ankle stability and that the superior and inferior fascicles would restrain different motions of the ankle. STUDY DESIGN Descriptive laboratory study. METHODS A robotic system with 6 degrees of freedom was used to test ankle instability in 10 cadavers. Serial sectioning following the most common injury pattern (from superior to inferior fascicles) was performed on the ATFL while the robot ensured reproducible movement through a physiological range of dorsiflexion and plantarflexion. RESULTS Sectioning of only the ATFL superior fascicle had a significant and measurable effect on ankle stability, resulting in increased internal rotation and anterior translation of the talus, especially in plantarflexion. Sectioning of the entire ATFL resulted in significantly decreased resistance in anterior translation, internal rotation, and inversion of the talus. CONCLUSION Rupture of only the superior fascicle of the ATFL may lead to minor instability or microinstability of the ankle joint, without objective clinical findings of gross clinical laxity. CLINICAL RELEVANCE Some patients develop chronic symptoms after an ankle sprain without overt signs of instability. This may be explained by an isolated injury to the ATFL superior fascicle, and diagnosis may require careful clinical evaluation and magnetic resonance imaging examination looking at the individual fascicles. It is possible that such patients may benefit from lateral ligament repair despite having no gross clinical instability.
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Affiliation(s)
- Miki Dalmau-Pastor
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
| | - Hadi El-Daou
- Medical Engineering Group, Department of Mechanical Engineering, Imperial College London, London, UK
| | - Joanna M Stephen
- Medical Engineering Group, Department of Mechanical Engineering, Imperial College London, London, UK
| | - Jordi Vega
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
- Foot and Ankle Unit, iMove Tres Torres, Barcelona, Spain
| | - Francesc Malagelada
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
- Foot and Ankle Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - James Calder
- Medical Engineering Group, Department of Mechanical Engineering, Imperial College London, London, UK
- Fortius Clinic, London, UK
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Astolfi RS, da Silva DS, Guedes IS, Nascimento CS, Damaševičius R, Jagatheesaperumal SK, de Albuquerque VHC, Leite JAD. Computer-Aided Ankle Ligament Injury Diagnosis from Magnetic Resonance Images Using Machine Learning Techniques. SENSORS (BASEL, SWITZERLAND) 2023; 23:1565. [PMID: 36772604 PMCID: PMC9919370 DOI: 10.3390/s23031565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/16/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
Ankle injuries caused by the Anterior Talofibular Ligament (ATFL) are the most common type of injury. Thus, finding new ways to analyze these injuries through novel technologies is critical for assisting medical diagnosis and, as a result, reducing the subjectivity of this process. As a result, the purpose of this study is to compare the ability of specialists to diagnose lateral tibial tuberosity advancement (LTTA) injury using computer vision analysis on magnetic resonance imaging (MRI). The experiments were carried out on a database obtained from the Vue PACS-Carestream software, which contained 132 images of ATFL and normal (healthy) ankles. Because there were only a few images, image augmentation techniques was used to increase the number of images in the database. Following that, various feature extraction algorithms (GLCM, LBP, and HU invariant moments) and classifiers such as Multi-Layer Perceptron (MLP), Support Vector Machine (SVM), k-Nearest Neighbors (kNN), and Random Forest (RF) were used. Based on the results from this analysis, for cases that lack clear morphologies, the method delivers a hit rate of 85.03% with an increase of 22% over the human expert-based analysis.
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Affiliation(s)
- Rodrigo S. Astolfi
- Graduate Program in Surgery, Federal University of Ceará, Fortaleza 60455-970, CE, Brazil
| | - Daniel S. da Silva
- Department of Teleinformatics Engineering, Federal University of Ceará, Fortaleza 60455-970, CE, Brazil
| | - Ingrid S. Guedes
- Graduate Program in Surgery, Federal University of Ceará, Fortaleza 60455-970, CE, Brazil
| | - Caio S. Nascimento
- Department of Teleinformatics Engineering, Federal University of Ceará, Fortaleza 60455-970, CE, Brazil
| | - Robertas Damaševičius
- Department of Software Engineering, Kaunas University of Technology, 51368 Kaunas, Lithuania
| | - Senthil K. Jagatheesaperumal
- Department of Electronics and Communication Engineering, Mepco Schlenk Engineering College, Sivakasi 626005, TN, India
| | | | - José Alberto D. Leite
- Graduate Program in Surgery, Federal University of Ceará, Fortaleza 60455-970, CE, Brazil
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He L, Xu Y, Duan D, Ouyang L. The anterior talofibular ligament: A thin-slice three-dimensional magnetic resonance imaging study. Foot Ankle Surg 2022; 28:1202-1209. [PMID: 34920953 DOI: 10.1016/j.fas.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/19/2021] [Accepted: 11/28/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to provide an accurate and improved understanding of anterior talofibular ligament (ATFL) anatomy, and to determine the exact positioning and diameter of the bony tunnel during ATFL repair and/or reconstruction surgery. METHOD A total of 58 healthy asymptomatic volunteers were examined, wherein 38 underwent bilateral ankle 3D MRI, and 20 underwent unilateral ankle 3D MRI (10 left and 10 right ankles). Data from a total of 96 MRI datasets were collected. The MRI data from these cases were exported into Mimics to enable reconstruction of 3D ATFL models. The resulting image quality was evaluated using a 5-point subjective scoring system. In addition, the length, width, thickness, and positioning of each ATFL and the area of the ATFL footprints were identified within the 3D model using Mimics and SolidWorks. RESULTS The image quality score was 4.48 ± 0.50. The ATFL formed one (65.6%), two (31.3%), or three (3.1%) bundles forms. The footprint area was 31.25 ± 6.29 mm2 on the fibular side, and 17.48 ± 4.49 mm2 on the talar side. CONCLUSION Thin-slice 3D MRI aids in the reconstruction of the 3D ATFL model, and it provides reference for the accurate anatomy of the area and location of the ATFL. This technology will facilitate diagnosis of ATFL injuries and choice of surgical methods. LEVEL OF EVIDENCE level IV.
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Affiliation(s)
- Lei He
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Yan Xu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Deyu Duan
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Liu Ouyang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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Kim JH, Jin ZW, Hayashi S, Murakami G, Rodríguez-Vázquez JF, Abe H. Major change in morphology of the talofibular ligaments during fetal development and growth. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1121-1129. [PMID: 35857084 DOI: 10.1007/s00276-022-02987-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/08/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND PURPOSE Ankle sprain is often attributed to damage of the anterior and posterior talofibular ligaments (ATFL, PTFL). We compared the morphology of these ligaments in fetuses of different gestational ages (GAs) with the horizontal configuration in adults. MATERIALS AND METHODS Histological sections of unilateral ankles were examined in 22 fetuses, 10 at GA of 9-12 weeks and 12 at GA of 26-39 weeks. RESULTS At a GA of 9 to 10 weeks, the ATFL and PTFL consisted of horizontally running straight fibers. The initial ATFL appeared as a thickening of the capsule of the talocrural joint, although the initial PTFL was distant from this joint. Until a GA of 12 weeks, the talus and fibula were separated by an expanding joint cavity. Thus, the initial horizontal ligaments were "pulled" in a distal direction. The distal parts of the ligaments consisted of thin collagenous fibers that had an irregular array, whereas the short proximal parts had thick fibers and a horizontal array. In near-term fetuses, the ligaments contained no horizontal fibers. The ATFL had a wavy course around the thick synovial fold, and was exposed to the joint cavity along the entire course; the distal part was thinner than the proximal part. The PTFL was bulky and consisted of fibers with an irregular array. Therefore, the morphology in a near-term fetus was quite different from that in adults. CONCLUSION The horizontal and straight composite ankle fibers in adults apparently result from postnatal reconstruction, depending on mechanical demand.
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Affiliation(s)
- Ji Hyun Kim
- Department of Anatomy, Jeonbuk National University Medical School, Geunji-ro 20, Deukjin-gu, Jeonju, 54907, Korea.
| | - Zhe-Wu Jin
- Department of Anatomy, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Shogo Hayashi
- Department of Anatomy, Division of Basic Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Gen Murakami
- Division of Internal Medicine, Cupid Clinic, Iwamizawa, Japan
| | | | - Hiroshi Abe
- Emeritus Professor of Akita University School of Medicine, Akita, Japan
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Su T, Jiang YF, Hou ZC, Zhao YQ, Chen W, Hu YL, Guo QW, Jiang D, Jiao C. The L-shaped tunnel technique showed favourable outcomes similar to those of the Y-graft technique in anatomic lateral ankle ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:2166-2173. [PMID: 35217882 DOI: 10.1007/s00167-022-06880-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/13/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE To compare the mid- to long-term clinical and radiological outcomes of the confluent L-shaped tunnel technique with the Y-graft technique for anatomic lateral ankle ligament reconstruction. METHODS This retrospective study involved 41 patients who underwent lateral ankle ligament reconstruction between 2013 and 2018. Based on the tunnel direction and tendon fixation method at the fibula side, patients were divided into two groups, with 17 patients in the L-shaped tunnel group and 24 patients in the Y-graft group. The American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) pain score, Tegner score, and Karlsson score were evaluated and compared preoperatively and at follow-up. Anterior talar translation and talar tilt at stress radiographs, postoperative sprain recurrence, range of motion (ROM) restriction, sensory disturbance, etc., were also collected and compared. RESULTS The mean follow-up times were 72 and 42 months for the L-shaped group and Y-graft group, respectively. The median VAS pain score, Tegner score, AOFAS score, Karlsson score significantly improved from a preoperative level in both groups (all with p < 0.01). No significant difference was found between the two groups regarding the changes from preoperatively to postoperatively except for the VAS pain score reduction (1.58 ± 1.58 in the L-shaped group vs. 2.53 ± 1.29 in the Y-graft group, p = 0.035). The incidence of flexion-extension ROM restriction (≥ 5°) was significantly higher in the Y-graft group (41.2%) than in the L-shaped group (12.5%) (p = 0.035). CONCLUSIONS Both the confluent L-shaped tunnel technique and the Y-graft technique significantly improved symptoms, ankle function, and radiographic outcomes in patients with chronic lateral ankle instability (CLAI) at mid- to long-term follow-up. The confluent L-shaped tunnel technique resulted in lower rates of flexion-extension ROM restriction, while the Y-graft technique showed better VAS pain reduction. This result could provide further evidence for the surgical treatment of CLAI. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tong Su
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China
| | - Yan-Fang Jiang
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China
| | - Zong-Chen Hou
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China
| | - Yu-Qing Zhao
- Department of Radiology, Peking University Third Hospital, No. 49 North Garden Road, Beijing, China
| | - Wen Chen
- Department of Radiology, Peking University Third Hospital, No. 49 North Garden Road, Beijing, China
| | - Yue-Lin Hu
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China
| | - Qin-Wei Guo
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China.
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China.
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Yang H, Su M, Chen Z, Qu R, Yuan Z, Yuan J, He S, Li Z, Liu C, Xiao Z, Liang H, Ouyang J, Dai J. Anatomic Measurement and Variability Analysis of the Anterior Talofibular Ligament and Calcaneofibular Ligament of the Ankle. Orthop J Sports Med 2021; 9:23259671211047269. [PMID: 34820459 PMCID: PMC8607490 DOI: 10.1177/23259671211047269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/16/2021] [Indexed: 12/26/2022] Open
Abstract
Background: The anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL)
contribute greatly to the overall stability of the ankle joint; however,
ATFL and combined ATFL-CFL sprains are common. Anatomic reconstruction of
the lateral collateral ligament with grafts has been proposed for patients
with poor tissue quality or inadequate local tissue. Anatomic reconstruction
of the lateral ankle ligaments requires a good understanding of their
anatomic location. Purpose: To describe the anatomy of the ATFL and CFL ligaments quantitatively and
qualitatively and explore the relationship of some morphological
parameters. Study Design: Descriptive laboratory study. Methods: A total of 66 adult ankle specimens were analyzed for ATFL band type, origin,
length, width, thickness, and angle between the ATFL and CFL, and 73 adult
ankle specimens were used for measuring the origin of the CFL. The
coefficient of variation was used to describe and compare the respective
variability of angle, length, width, and thickness. The origin of the ATFL
was labeled as point A, and the leading edge of the CFL
intersection with the articular surface of the calcaneus was considered
point B. Results: The ATFL had a variable number of bands. A high degree of variability
(coefficient of variation >0.2) was seen for most morphological
measurements of the ATFL. In addition, the length of distance
AB also varied. The CFL originated at the tip of the
fibula in only 9% of specimens. It was found more commonly at the anterior
border of the lateral malleolus (4.94 ± 1.70 mm from the tip). The angle
between the ATFL and CFL was consistent at 100° to 105º. Conclusion: A fair amount of variability of ATFL length, width, and thickness were found
in our study, with less variability in the ATFL-CFL angle. Most CFLs
attached anterior to the tip of the fibula. Clinical Relevance: Providing relevant anatomic data of ATFL and CFL is important in ensuring
proper surgical treatment of ankle joint injuries.
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Affiliation(s)
- Han Yang
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Minghao Su
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Zhimin Chen
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Rongmei Qu
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Zhirong Yuan
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Jiajie Yuan
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Shanli He
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Zeyu Li
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Chang Liu
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Zhaoming Xiao
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Haibin Liang
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Jun Ouyang
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China.,Investigation performed at the Guangdong Provincial Medical Biomechanical Key Laboratory, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Jingxing Dai
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China.,Investigation performed at the Guangdong Provincial Medical Biomechanical Key Laboratory, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
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Szaro P, Ghali Gataa K, Solidakis N, Pękala P. Morphometric relationships between dimensions the anterior talofibular ligament and calcaneofibular ligament in routine magnetic resonance imaging. J Exp Orthop 2021; 8:90. [PMID: 34633561 PMCID: PMC8505565 DOI: 10.1186/s40634-021-00406-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/17/2021] [Indexed: 08/30/2023] Open
Abstract
Purpose This study aimed to test the hypothesis that routine MRI ankle can be used to evaluate dimensions and correlations between dimensions of single and double fascicular variants of the ATFL and the CFL. Methods We reviewed ankle MRIs for 251 patients. Differences between the length, thickness, width, and length of the bony attachments were evaluated twice. P < .05 was considered as significant. Results For the ATFL, we observed a negative correlation between thickness and width, with a positive correlation between thickness and length (p < 0.001). The average values for the ATFL were thickness, 2.2 ± 0.05 mm; length, 21.5 ± 0.5 mm; and width, 7.6 ± 0.6 mm. The average values for the CFL were thickness, 2.1 ± 0.04 mm; length, 27.5 ± 0.5 mm; and width, 5.6 ± 0.3 mm. A negative correlation was found between length and width for the CFL (p < 0.001). Conclusions Routine MRI showed that most dimensions of the ATFL and CFL correlate with each other, which should be considered when planning new reconstruction techniques and developing a virtual biomechanical model of the human foot. Level of evidence III
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Affiliation(s)
- Pawel Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Gothenburg, Sweden. .,Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland.
| | - Khaldun Ghali Gataa
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Gothenburg, Sweden.,Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Nektarios Solidakis
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Gothenburg, Sweden.,Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Przemysław Pękala
- Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
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Edama M, Takabayashi T, Yokota H, Hirabayashi R, Sekine C, Maruyama S, Syagawa M, Togashi R, Yamada Y, Otani H. Number of fiber bundles in the fetal anterior talofibular ligament. Surg Radiol Anat 2021; 43:2077-2081. [PMID: 34379153 DOI: 10.1007/s00276-021-02816-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE For the anterior talofibular ligament (ATFL), a three-fiber bundle has recently been suggested to be weaker than a single or double fiber bundle in terms of ankle plantarflexion and inversion braking function. However, the studies leading to those results all used elderly specimens. Whether the difference in fiber bundles is a congenital or an acquired morphology is important when considering methods to prevent ATFL damage. The purpose of this study was to classify the number of fiber bundles in the ATFL of fetuses. METHODS This study was conducted using 30 legs from 15 Japanese fetuses (mean weight, 1764.6 ± 616.9 g; mean crown-rump length, 283.5 ± 38.7 mm; 8 males, 7 females. The ATFL was then classified by the number of fiber bundles: Type I, one fiber bundle; Type II, two fiber bundles; and Type III, three fiber bundles. RESULTS Ligament type was Type I in 5 legs (16.7%), Type II in 21 legs (70%), and Type III in 4 legs (13.3%). CONCLUSION The present results suggest that the three fiber bundles of the structure of the ATFL may be an innate structure.
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Affiliation(s)
- Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan.
| | - Tomoya Takabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Mayuu Syagawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Ryoya Togashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Yuki Yamada
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Hiroki Otani
- Department of Developmental Biology, Faculty of Medicine, Shimane University, Izumo, Japan
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11
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Karahan N, Kaya M, Yılmaz B, Kurdal DP, Keskinoz EN, Çiçek EED. Hamstring autograft and anatomical footprint evaluation for anterior talofibular ligament reconstruction: Cadaveric study. J Orthop Surg (Hong Kong) 2021; 28:2309499020974830. [PMID: 33272074 DOI: 10.1177/2309499020974830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of the study was to evaluate whether or not there was any incompatibility between two-strand hamstring tendons taken from the same knee and the ATFL and it was the determination of suitable footprint points in the fibula and talus for anatomical ATFL reconstruction. METHODS 16 fresh frozen cadaver specimens were dissected to gracilis and semitendinosus tendons and the anterior talofibular ligament. The origins, insertions, distances from osseous landmarks of fibular talus of ATFL were determined. The diameters of gracilis, semitendinosus and ATFL were calculated. There was a moderate correlation between body height and the distance between the distal of inferior lateral malleolus and the fibular adhesion site of ATFL (r: 36.5 p: 0.036). There was a weak correlation between body height and the distance between the apex of the lateral talar process and the talus adhesion site of ATFL in a single bundle (r: 28.4 p: 0.002). There was no correlation between the distance from proximal and distal adhesion side of ATFL and body height in the double bundle (p: 0.241). RESULTS There was no significant relationship between ATFL diameter and gracilis, semitendinosus and both hamstring in women. A significant relationship at 80.5% was determined between the ATFL and the gracilis diameter in man. A significant relationship at 92.6% was determined between the ATFL and the semitendinosus diameter in man. CONCLUSION It was determined that there is not compatibility between the gracilis tendons, the semitendinosus tendon and ATFL in women. It should be supported by biomechanical and clinical studies whether this incompatibility has a clinical effect or not.
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Affiliation(s)
- Nazım Karahan
- Department of Orthopaedics and Traumatology, Corlu State Hospital, Çorlu/Tekirdağ, Turkey
| | - Murat Kaya
- Department of Orthopaedics and Traumatology, Marmara University, Pendik/İstanbul, Turkey
| | - Barış Yılmaz
- Department of Orthopaedics and Traumatology, Fatih Sultan Mehmet Research and Training Hospital, Ataşehir/İstanbul, Turkey
| | - Demet Pepele Kurdal
- Department of Orthopaedics and Traumatology, Fatih Sultan Mehmet Research and Training Hospital, Ataşehir/İstanbul, Turkey
| | | | - Esma Esin Derin Çiçek
- Deparment of Radiology, Fatih Sultan Mehmet Research and Training Hospital, Ataşehir/İstanbul, Turkey
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12
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The double fascicular variations of the anterior talofibular ligament and the calcaneofibular ligament correlate with interconnections between lateral ankle structures revealed on magnetic resonance imaging. Sci Rep 2020; 10:20801. [PMID: 33247207 PMCID: PMC7695848 DOI: 10.1038/s41598-020-77856-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022] Open
Abstract
The anterior talofibular ligament and the calcaneofibular ligament are the most commonly injured ankle ligaments. This study aimed to investigate if the double fascicular anterior talofibular ligament and the calcaneofibular ligament are associated with the presence of interconnections between those two ligaments and connections with non-ligamentous structures. A retrospective re-evaluation of 198 magnetic resonance imaging examinations of the ankle joint was conducted. The correlation between the double fascicular anterior talofibular ligament and calcaneofibular ligament and connections with the superior peroneal retinaculum, the peroneal tendon sheath, the tibiofibular ligaments, and the inferior extensor retinaculum was studied. The relationships between the anterior talofibular ligament's and the calcaneofibular ligament's diameters with the presence of connections were investigated. Most of the connections were visible in a group of double fascicular ligaments. Most often, one was between the anterior talofibular ligament and calcaneofibular ligament (74.7%). Statistically significant differences between groups of single and double fascicular ligaments were visible in groups of connections between the anterior talofibular ligament and the peroneal tendon sheath (p < 0.001) as well as the calcaneofibular ligament and the posterior tibiofibular ligament (p < 0.05), superior peroneal retinaculum (p < 0.001), and peroneal tendon sheath (p < 0.001). Differences between the thickness of the anterior talofibular ligament and the calcaneofibular ligament (p < 0.001), the diameter of the fibular insertion of the anterior talofibular ligament (p < 0.001), the diameter of calcaneal attachment of the calcaneofibular ligament (p < 0.05), and tibiocalcaneal angle (p < 0.01) were statistically significant. The presence of the double fascicular anterior talofibular ligament and the calcaneofibular ligament fascicles correlate with connections to adjacent structures.
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13
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Kobayashi T, Suzuki D, Kondo Y, Tokita R, Katayose M, Matsumura H, Fujimiya M. Morphological characteristics of the lateral ankle ligament complex. Surg Radiol Anat 2020; 42:1153-1159. [PMID: 32227271 DOI: 10.1007/s00276-020-02461-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/19/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE The relevance of each ligament comprising the lateral ankle ligament complex, including the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL), has not been sufficiently elucidated; therefore, we aimed to clarify the morphological characteristics and relevance of these ligaments. METHODS Total 152 legs from 152 Japanese cadavers were investigated. The lengths and widths of the ATFL, CFL, and PTFL were measured using a caliper. The ATFL was classified according to the number of fiber bundles (Types I, II, and III corresponded to one, two, and three fiber bundles, respectively), and the lengths and widths of the three ligaments were compared between the Type groups. In addition, the ratio of each ligament's length and width to the tibial length was calculated, and the correlation of the ratio of ligament length and width between the ATFL, CFL, and PTFL was examined about 34 legs. RESULTS The ATFL, CFL, and PTFL were found to connect at the anterior/inferior tip of the lateral malleolus each other. The Type II group of the ATFL was most common (54.6%) in our investigated specimens. However, there were no significant inter-group differences in the lengths and widths of the CFL and PTFL. CONCLUSIONS This study demonstrates that the lateral ankle ligaments may stabilize the ankle joint through interconnections.
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Affiliation(s)
- Takumi Kobayashi
- Department of Rehabilitation, Hokkaido Chitose College of Rehabilitation, Chitose, Japan.
| | - Daisuke Suzuki
- Department of Rehabilitation, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
| | - Yu Kondo
- Department of Rehabilitation, Sapporo Maruyama Orthopaedic Hospital, Sapporo, Japan
| | - Ryo Tokita
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Masaki Katayose
- Department of Physical Therapy, Sapporo Medical University, School of Health Science, Sapporo, Japan
| | - Hirofumi Matsumura
- Department of Physical Therapy, Sapporo Medical University, School of Health Science, Sapporo, Japan
| | - Mineko Fujimiya
- Department of Anatomy, Sapporo Medical University of Medicine, Sapporo, Japan
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14
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Dalmau-Pastor M, Malagelada F, Calder J, Manzanares MC, Vega J. The lateral ankle ligaments are interconnected: the medial connecting fibres between the anterior talofibular, calcaneofibular and posterior talofibular ligaments. Knee Surg Sports Traumatol Arthrosc 2020; 28:34-39. [PMID: 31754730 DOI: 10.1007/s00167-019-05794-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE A deep knowledge of lateral ankle ligaments is necessary to understand its function, pathophysiology and treatment options. The ankle lateral collateral ligament is formed by the anterior talofibular ligament (ATFL), the calcaneofibular (CFL) and the posterior talofibular ligament (PTFL). Although previous studies have reported connections between these ligaments on its lateral side, no studies have specifically assessed connections on the medial side. The aim of this study was to assess the morphology and consistency of the medial connections between the components of the lateral collateral ligament complex of the ankle. METHODS Forty fresh-frozen ankle specimens were dissected to look for connections between the three lateral ankle ligaments. After visualization of the lateral ligaments was achieved, the fibula was amputated and ligament insertions were released at the talar and calcaneal insertion points. Observation of the connections and video analysis of the dynamic relationships of ligament connections were performed. RESULTS Connections were found in all cases between the ATFL and PTFL, the ATFL and CFL, and the CFL and PTFL. Connections between ATFL and PTFL were not homogeneous. Although connections between the ATFLif and PTFL were noted in all cases (40), only 17 ankles (42.5%) had connections between the ATFLsf and PTFL. The amount of fibres of connection was also variable. CONCLUSION Connections between the three components of the lateral collateral ligament of the ankle may be observed from the medial aspect of the ankle, and this may have important implications for arthroscopic lateral ligament repair.
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Affiliation(s)
- M Dalmau-Pastor
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, University of Barcelona, Barcelona, Spain. .,GRECMIP, MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied, Minimally Invasive Foot and Ankle Society), Merignac, France. .,Vilamèdic Medical Center, Santa Coloma de Gramanet, Barcelona, Spain.
| | - F Malagelada
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, University of Barcelona, Barcelona, Spain.,Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - J Calder
- Trauma and Orthopaedics, Chelsea and Westminster Hospital, London, UK
| | - M C Manzanares
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, University of Barcelona, Barcelona, Spain
| | - J Vega
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, University of Barcelona, Barcelona, Spain.,GRECMIP, MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied, Minimally Invasive Foot and Ankle Society), Merignac, France.,Foot and Ankle Unit, iMove Tres Torres, Barcelona, Spain
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15
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Li HY, Li WL, Chen SY, Hua YH. Increased ATFL-PTFL angle could be an indirect MRI sign in diagnosis of chronic ATFL injury. Knee Surg Sports Traumatol Arthrosc 2020; 28:208-212. [PMID: 30413859 DOI: 10.1007/s00167-018-5252-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 10/22/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRI) has relatively low accuracy in diagnosing chronic anterior talofibular ligament (ATFL) injury. This study's purpose was to evaluate the angle between the ATFL and posterior talofibular ligament (PTFL) as a new indirect MRI sign of chronic ATFL injury in patients with mechanical ankle instability (MAI). METHODS This study included 200 participants: 105 patients with MAI and 95 patients seen at our institution for reasons unrelated to ankle instability. MR images of all 200 participants were reviewed. The ATFL-PTFL angle in the axial plane was measured and compared between groups. Receiver operating characteristic curves (ROC) were used to analyze ATFL-PTFL angles in participants with and without ATFL injury. The sensitivity and specificity of this method for diagnosing ATFL injury were calculated. RESULTS The mean ATFL-PTFL angle was significantly larger among MAI patients than among control patients (81.5° ± 9.8° vs 75.2° ± 8.9°, respectively; P < 0.01). The area under the ROC was 0.789 (P < 0.01). The optimal cut-off point for diagnosing ATFL injury on the basis of the ATFL-PTFL angle was 79.0° (sensitivity 0.89, specificity 0.67). CONCLUSION The ATFL-PTFL angle was significantly larger among MAI patients than among those without MAI. Increased ATFL-PTFL angle offers a new indirect MRI sign for diagnosing chronic ATFL injury. The ATFL-PTFL angle can be used not only to improve the accuracy of diagnosis of chronic ATFL injury, but also to evaluate the restoration of normal ankle joint geometry after lateral ligament reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hong-Yun Li
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Sports Medicine Center of Fudan University, No. 12 Urumq Middle Road, Shanghai, 200040, China
| | - Wen-Long Li
- Department of Orthopaedics, Penglai Traditional Chinese Medicine Hospital, Yantai, 265600, Shandong, China
| | - Shi-Yi Chen
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Sports Medicine Center of Fudan University, No. 12 Urumq Middle Road, Shanghai, 200040, China
| | - Ying-Hui Hua
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Sports Medicine Center of Fudan University, No. 12 Urumq Middle Road, Shanghai, 200040, China.
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16
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Kakegawa A, Mori Y, Tsuchiya A, Sumitomo N, Fukushima N, Moriizumi T. Independent Attachment of Lateral Ankle Ligaments: Anterior Talofibular and Calcaneofibular Ligaments - A Cadaveric Study. J Foot Ankle Surg 2019; 58:717-722. [PMID: 31130481 DOI: 10.1053/j.jfas.2018.12.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Indexed: 02/03/2023]
Abstract
Anatomic knowledge of lateral ligaments around the lateral malleolus is important for repair or reconstruction of ankle instability. The detailed structure of the connective fibers between the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) is unknown. To clarify the anatomic structure of ATFL and CFL and the connective fiber between the 2 ligaments, the lateral ligament was dissected in 60 ankles of formalin-fixed cadavers, and the distance was measured between bony landmarks and fibular attachment of ATFL and CFL using a digital caliper. All ankles had connective fibers between ATFL and CFL. The structure of connective fibers consisted of a thin fiber above the surface layer of ATFL and CFL; it comprised thin fibrils of the surface layer covering the lower part of ATFL and the front part of CFL. Both ATFL and CFL were independent fibers, and both attachments of the fibula were isolated. Single bands of ATFL were noted in 14 of 60 (23.3%) ankles, double bands that divided the superior and inferior bands were observed in 42 of 60 (70.0%) ankles, and multiple bands were observed in 4 of 60 (6.7%) ankles. A cord-like and a flat and fanning type of CFL was noted in 22 (36.7%) and 38 (63.3%) of the 60 ankles, respectively. Distances between ATFL/CFL and articular and inferior tips of the fibula were 4.3 ± 1.1 mm/7.6 ± 1.6 mm and 14.3 ± 1.9 mm/7.4 ± 1.7 mm, respectively (mean ± standard deviation). The results of this study suggest that knowledge of more anatomic structures of ATFL, CFL, and connective fiber will be beneficial for surgeons in the repair or reconstruction of the lateral ligament of the ankle.
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Affiliation(s)
- Akira Kakegawa
- Associate Professor, Faculty of Health Care, Teikyo Heisei University, Tokyo, Japan; Lecturer, Department of Anatomy, Shinshu University School of Medicine, Nagano, Japan.
| | - Yusuke Mori
- Orthopedic Surgeon, Toyohashi Ezaki Orthopedic Hospital, Aichi, Japan
| | | | - Norimi Sumitomo
- Technological Assistant, Department of Anatomy, Shinshu University School of Medicine, Nagano, Japan
| | - Nanae Fukushima
- Professor, Department of Anatomy, Shinshu University School of Medicine, Nagano, Japan
| | - Tetsuji Moriizumi
- Professor, Department of Anatomy, Shinshu University School of Medicine, Nagano, Japan
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17
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Relationships between differences in the number of fiber bundles of the anterior talofibular ligament and differences in the angle of the calcaneofibular ligament and their effects on ankle-braking function. Surg Radiol Anat 2019; 41:675-679. [PMID: 30993419 DOI: 10.1007/s00276-019-02239-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/08/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim was to clarify the relationships between differences in the number of fiber bundles of the anterior talofibular ligament (ATFL) and differences in the angle of the calcaneofibular ligament (CFL) with respect to the long axis of the fibula and their effects on ankle braking function. METHODS The study sample included 110 Japanese cadavers. ATFLs were categorized as: Type I with one fiber bundle; Type II with two fiber bundles with incomplete separation and complete separation; and Type III with three fiber bundles. The CFLs were categorized according to the angles of the CFLs with respect to the long axis of the fibula and the number of fiber bundles. Six categories were established: CFL10° (angle of the CFL with respect to the long axis of the fibula from 10° to 19°); CFL20° (range 20°-29°); CFL30° (range 30°-39°); CFL40° (range 40°-49°); CFL50° (range 50°-59°); and CFL2 (CFLs with two crossing fiber bundles). RESULTS ATFL was Type I in 34 legs (31%), Type II in 66 legs (60%), and Type III in 10 legs (9%). Five CFL categories were identified: CFL10° in 4 feet (3.7%); CFL20° in 23 feet (20.9%); CFL30° in 34 feet (30.9%); CFL40° in 33 feet (30%); CFL50° in 15 feet (13.6%); and CFL2 in one foot (0.9%). Type III contained mainly CFL40° and CFL50° (7 of 10 feet). CONCLUSIONS ATFL and CFL appear to cooperate in the ankle joint braking function.
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18
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Morphological evaluation of the calcaneofibular ligament in different ankle positions using a three-dimensional MRI sequence. Surg Radiol Anat 2018; 41:307-311. [PMID: 30539208 DOI: 10.1007/s00276-018-2152-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Evaluating images of the lateral ligament of the ankle is not easy, and evaluation of the calcaneofibular ligament (CFL) in particular is difficult. We prospectively conducted morphological measurements of the CFL in different ankle positions and obtain basic data for use in functional assessment of the CFL, diagnosis of CFL injury, and determination of treatment effects. METHODS The subjects were ten healthy volunteers (ten ankles) with a mean age of 27.8 years and no history of ankle disease. Imaging was done using a 3-T magnetic resonance imaging (MRI) machine and fast imaging employing steady-state acquisition cycled phases (FIESTA-C), a three-dimensional (3D) sequence, with the ankle in a neutral position, maximum dorsiflexion, and maximum plantar flexion. 3D images of the CFL, peroneal muscle tendons, fibula, and calcaneus were prepared at a workstation, and morphological measurements of the CFL were made. RESULTS In all positions, the CFL showed a gently curving course with the peroneal muscle tendons as a fulcrum. The tortuosity angle was significantly smaller in plantar flexion (30.0° ± 7.4°) than in the neutral position (41.7° ± 8.3°). CONCLUSIONS 3D MRI sequences showed that, in all positions, the CFL curved due to the influence of the peroneal muscle tendons. With maximum plantar flexion, the CFL tortuosity angle was small, which was thought to have been due to the tension in the CFL.
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19
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Yoshizuka H, Shibata K, Asami T, Kuraoka A. Anatomical variation in the form of inter- and intra-individual laterality of the calcaneofibular ligament. Anat Sci Int 2018; 93:495-501. [PMID: 29679362 PMCID: PMC8241744 DOI: 10.1007/s12565-018-0440-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/10/2018] [Indexed: 10/25/2022]
Abstract
The lateral ligament complex of the ankle is involved in a large proportion of ankle sprains. The calcaneofibular ligament (CFL) is often involved in severe injuries. The purpose of this study was to evaluate the anatomical variation and laterality of the CFL to improve our understanding of the mechanisms of CFL-related injuries. This study utilized 110 paired ankles from 55 formalin-fixed Japanese cadavers (33 male and 22 female). The length and width of the CFL and the angle created by the CFL and long axis of the fibula (CF angle) were measured after exposing the CFL by careful dissection from the surrounding tissues. The results revealed that each parameter exhibited a wide range of values and showed unique patterns of frequency distribution, among which only the length was normally distributed. Among the parameters, only the CF angle showed no significant correlation with the other parameters. Analysis of laterality revealed that the mean left CF angle was significantly greater than the value on the opposite side (p < 0.05) and that the values of the bilateral CF angle showed no significant correlation at the individual level. The present results revealed not only detailed information regarding the CFL morphology, but also inter- and intra-individual laterality regarding the CFL traveling angle. It is likely that the differences in the quality and quantity of mechanical stress against each leg may have caused this morphologic laterality of the CFL.
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Affiliation(s)
- Hisayoshi Yoshizuka
- Department of Anatomy and Physiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan. .,Department of Rehabilitation Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan.
| | - Kentaro Shibata
- Department of Anatomy and Physiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Toyoko Asami
- Department of Rehabilitation Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
| | - Akio Kuraoka
- Department of Anatomy and Physiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga, 849-8501, Japan
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Edama M, Kageyama I, Kikumoto T, Nakamura M, Ito W, Nakamura E, Hirabayashi R, Takabayashi T, Inai T, Onishi H. Morphological features of the anterior talofibular ligament by the number of fiber bundles. Ann Anat 2017; 216:69-74. [PMID: 29196235 DOI: 10.1016/j.aanat.2017.11.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/06/2017] [Accepted: 11/08/2017] [Indexed: 11/26/2022]
Abstract
The aims of this study have been to clarify differences in morphological features based on the number of fiber bundles in the anterior talofibular ligament (ATFL), and to investigate the relationship between the ATFL and the calcaneofibular ligament (CFL). This study used 81 legs from 43 cadavers. The ATFL was classified according to differences in the number of fiber bundles as: Type I, with one fiber bundle; Type II-a, with two fiber bundles that were incompletely separated; Type II-b, with two fiber bundles that were completely separated; and Type III, with three fiber bundles. The morphological features measured were fiber bundle length, fiber bundle width, and fiber bundle angle. For the relationship between the ATFL and CFL, the positional relationship and attachment sites of the two ligaments were examined. Type I was present in 33%, Type II-a in 17%, Type II-b in 40%, and Type III in 10%. The morphological features of superior fiber bundles and inferior fiber bundles were significantly different within each type. Among types, there were significant differences in the morphological features of Type II-a and Type III inferior fiber bundles. In the relationship between the ATFL and CFL, there was a connection between the ATFL and CFL in all specimens. Various types were present in the positional relationship and attachment sites of the two ligaments. The results of this study suggest that, among different ligament types with two or three fiber bundles, the control function of the ankle may differ within each type and among types.
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Affiliation(s)
- Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan; Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata 951-8580, Japan.
| | - Ikuo Kageyama
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata 951-8580, Japan
| | - Takanori Kikumoto
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Masatoshi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Wataru Ito
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Emi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Tomoya Takabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Takuma Inai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
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21
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Matsui K, Takao M, Tochigi Y, Ozeki S, Glazebrook M. Anatomy of anterior talofibular ligament and calcaneofibular ligament for minimally invasive surgery: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25:1892-1902. [PMID: 27295109 DOI: 10.1007/s00167-016-4194-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/31/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE To gain a better understanding of the precise anatomy of the lateral ligaments of the ankle through a systematic review of published cadaveric studies in order to improve anatomical minimally invasive surgery (MIS) for treatment of chronic ankle instability (CAI). METHODS A systematic review of the literature was performed using the PubMed, EMBASE, Cochrane databases and Web of Science on June 2015 with the two search concepts: "lateral ligament of the ankle" and "anatomy". Anatomical studies that reported gross anatomy of the anterior talar fibular ligament (ATFL) and calcaneal fibular ligament (CFL) in English were included to assess the morphology and origins and insertions of the ligaments. All records found in the literature search were screened by title and abstract. Potentially relevant articles were selected for full-text review. Each of the identified articles was reviewed and included in qualitative synthesis. The following data were abstracted from the included articles: authors, date of publication, sample size, mean age, the length and the width of the each ligament, number of bundle of the ATFL and the location and the footprint of the origins and insertions for the ATFL and CFL. RESULTS Sixteen studies were identified indicating the length of the ATFL and CFL was 12-24.8 and 18.5-35.8 mm, respectively, while the width was 5-11.1 and 4.6-7.6 mm, respectively. Fibular origins of the ATFL and CFL were located on the anterior border of distal fibula at a distance of 10-13.8 and 5.3-8.5 mm proximal to the tip of the fibula, respectively. The talar insertion of the ATFL was located 14.2-18.1 mm to the subtalar joint or 11.3-14.8 mm to the anterolateral corner of the talar body. The calcaneal insertion of the CFL was located 12.1-13 mm to the subtalar joint or 13.2-27.1 mm to the peroneal tubercle on the lateral wall of calcaneus. CONCLUSION Systematic review of the literature of the research for the ATFL and CFL has identified the morphology of the ligaments and their location of origins and insertions. This is the best available data about the ATFL and CFL which will facilitate more precise anatomical MIS for treatment of CAI. LEVEL OF EVIDENCE Systematic review, Level IV.
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Affiliation(s)
- Kentaro Matsui
- Queen Elizabeth II Health Sciences Center Halifax Infirmary, Dalhousie University, 1796 Summer Street, Halifax, NS, B3H3A7, Canada.
- Department of Orthopaedic Surgery, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan.
| | - Masato Takao
- Department of Orthopaedic Surgery, Department of Sport and Medical Science, Teikyo Institute of Sports Science and Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Yuki Tochigi
- Department of Orthopaedic Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minai-Koshigaya, Koshigaya, 343-8555, Japan
| | - Satoru Ozeki
- Department of Orthopaedic Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minai-Koshigaya, Koshigaya, 343-8555, Japan
| | - Mark Glazebrook
- Queen Elizabeth II Health Sciences Center Halifax Infirmary (Suite 4867), Dalhousie University, 1796 Summer Street, Halifax, NS, B3H3A7, Canada
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22
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Iwata Y. Novel stress radiography technique for avulsion fracture of the lateral malleolus in children: a report of three cases. J Orthop Surg (Hong Kong) 2016; 24:113-5. [PMID: 27122525 DOI: 10.1177/230949901602400125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study reports a novel stress radiography technique to evaluate an avulsion fracture at the lateral malleolus in children. Radiographs in the stress anteroposterior view or the Haraguchi calcaneofibular ligament or anterior tarofibular ligament (ATFL) projection could not detect any fracture; only manual inversion stress radiography in the Haraguchi ATFL projection could identify the avulsion fracture.
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Affiliation(s)
- Y Iwata
- Iwata Orthopedics and Rheumatology Clinic, Japan
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23
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Abstract
The anterior talofibular ligament (ATFL) is commonly injured and may result in ankle instability. Good results from ATFL reconstruction have been reported; however complications and movement restrictions have also been observed. ATFL differences have been reported; however details of its precise bony attachment are lacking. This study provides a detailed morphology of the ATFL with respect to surgical and clinical applications. ATFL morphology, number of bands and the exact insertion points were studied in 50 formaldehyde embalmed feet. ATFL length was measured in different joint positions to assess its functional role: ATFL length varied from 18.81 mm in dorsiflexion to 21.06 mm in plantarflexion: mid-length width and thickness were 4.97 mm and 1.01 mm respectively. The bony attachment lengths were also measured: mean proximal and distal bony attachment lengths were 4.68 mm and 3.1mm respectively, while 13.04 mm had no bony attachment. One (22.9%), two (56.3%) and three (20.8%) band morphologies were observed originating 10.37 mm anterosuperior to the lateral malleolar tip and inserting 3.92 mm anterior to the anterior lateral malleolar line (ALML). Detailed morphology of the ATFL may help in restoring injured ATFL function by appropriate ligament reconstruction, as well as aid the understanding of the mechanism of ligament injury.
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Affiliation(s)
- Bader Khawaji
- Centre for Anatomy and Human Identification, College of Art, Science and Engineering, University of Dundee, Dundee DD1 5EH, UK; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Roger Soames
- Centre for Anatomy and Human Identification, College of Art, Science and Engineering, University of Dundee, Dundee DD1 5EH, UK
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24
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Haytmanek CT, Williams BT, James EW, Campbell KJ, Wijdicks CA, LaPrade RF, Clanton TO. Radiographic identification of the primary lateral ankle structures. Am J Sports Med 2015; 43:79-87. [PMID: 25325559 DOI: 10.1177/0363546514553778] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lateral ankle ligament injuries rank among the most frequently observed athletic injuries, requiring repair or reconstruction when indicated. However, there is a lack of quantitative data detailing the ligament attachment sites on standard radiographic views. PURPOSE To quantitatively describe the anatomic attachment sites of the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL) on standard radiographic views with respect to reproducible osseous landmarks to assist with intraoperative and postoperative assessment of lateral ankle ligament repairs and reconstructions. STUDY DESIGN Descriptive laboratory study. METHODS Twelve nonpaired, fresh-frozen cadaveric foot and ankle specimens were dissected to identify the origins and insertions of the 3 primary lateral ankle ligaments. Ligament footprint centers were marked with 2-mm stainless steel spheres shallowly embedded at the level of the cortical bone prior to obtaining standard lateral and mortise radiographs. Measurements were performed twice by 2 blinded raters independently to calculate mean distances and assess reliability via intraclass correlation coefficients (ICCs). RESULTS Radiographic measurements demonstrated excellent reproducibility between raters (all interobserver ICCs>0.97) and across trials (all intraobserver ICCs>0.99). On the lateral view, the ATFL fibular attachment (mean±SD) was 8.4±1.8 mm proximal and anterior to the inferior tip of the lateral malleolus and attached on the talus 13.8±2.0 mm proximal and anterior to the apex of the lateral talar process. The CFL originated 5.0±1.4 mm superior and anterior to the inferior tip of the lateral malleolus and inserted on the calcaneus 18.5±4.6 mm posterior and superior to the posterior point of the peroneal tubercle. On the mortise view, the ATFL origin was 4.9±1.4 mm proximal to the inferior tip of the lateral malleolus and inserted on the talus 9.0±2.1 mm medial and superior of the apex of the lateral talar process and 18.9±3.1 mm inferior and slightly lateral to the superior lateral corner of the talar dome. The fibular CFL origin was 2.9±1.6 mm proximal and slightly medial to the inferior tip of the lateral malleolus and inserted on the calcaneus 18.0±5.1 mm distal to the apex of the lateral talar process. CONCLUSION Radiographic parameters quantitatively describing the anatomic origins and insertions of the lateral ankle ligaments were defined with excellent reproducibility and agreement between reviewers. CLINICAL RELEVANCE Quantitative radiographic anatomy data will assist in preoperative planning, improve intraoperative localization, and provide objective measures for postoperative assessment of anatomic repairs and reconstructions.
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Affiliation(s)
- C Thomas Haytmanek
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
| | | | - Evan W James
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
| | - Thomas O Clanton
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
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25
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Kwon DR, Park GY. Differences in lateral ankle ligaments between affected and unaffected legs in children with spastic hemiplegic cerebral palsy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:313-317. [PMID: 23341388 DOI: 10.7863/jum.2013.32.2.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To investigate the architectural alterations of the lateral ankle ligaments in spastic hemiplegic cerebral palsy. METHODS Eight children (5 male and 3 female; mean age ± SD, 5.2 ± 2.7 years) with spastic hemiplegic cerebral palsy were recruited. A modified Ashworth scale and passive ankle dorsiflexion angle were evaluated. Sonograms of the anterior talofibular ligament and calcaneofibular ligament were obtained to measure ligament thickness, and the anterior talofibular/calcaneofibular ligament thickness ratio was calculated. Two sonographic measurements were taken to check for intra-rater reliability. RESULTS The interclass correlation coefficients of the repeated anterior talofibular ligament and calcaneofibular ligament thickness measurements in the unaffected/affected legs were 0.960/0.945 and 0.922/0.933, respectively. The anterior talofibular ligament thickness in the affected legs was significantly greater than that in the unaffected legs (2.50 ± 0.35 versus 1.40 ± 0.28 mm; P = .011), but the calcaneofibular ligament thickness in the affected legs was significantly less than that in the unaffected legs (0.80 ± 0.18 versus 1.28 ± 0.31 mm; P = .021). The anterior talofibular/calcaneofibular ligament thickness ratio in the affected legs was significantly greater than that in unaffected legs (2.10 ± 0.81 versus 1.03 ± 0.13; P = .012). The ratio was positively correlated with the modified Ashworth scale and age but negatively correlated with the passive ankle dorsiflexion angle in the affected legs. CONCLUSIONS This study revealed an increased anterior talofibular ligament thickness and a decreased calcaneofibular ligament thickness in the affected legs compared with the unaffected legs. These architectural features of the lateral ankle ligaments may contribute to the equinovarus deformity of the ankle together with spastic leg muscles in children with spastic hemiplegic cerebral palsy.
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Affiliation(s)
- Dong Rak Kwon
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
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26
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Yıldız S, Yalcın B. The anterior talofibular and calcaneofibular ligaments: an anatomic study. Surg Radiol Anat 2013; 35:511-6. [PMID: 23292089 DOI: 10.1007/s00276-012-1071-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 12/27/2012] [Indexed: 11/25/2022]
Abstract
Inversion injuries of the ankle are the most common sport injuries. Extreme inversion of the ankle affects frequently lateral ankle ligaments, especially the anterior talofibular and calcaneofibular ligaments. The aim of this study is to investigate the ligaments in detail to contribute to accurate evaluation of radiological investigations and more precise surgical interventions by clarifying the anatomic structure of the ligaments by considering their functional importance. In the study, length between the attachment points and width at the midpoint of the anterior talofibular and calcaneofibular ligaments, length and width of the bands of anterior talofibular ligament, and connecting ligaments extending from the talus to calcaneus exchanging from the both ligaments were measured on the 46 ankles. In addition, angles between these ligaments and between longitudinal axis of the fibula and both ligaments were measured. Relationship between determined variables on the right and left sides was statistically analyzed. In diagnosis and treatment methods, the clinical importance of the anatomy of the lateral collateral ligaments of the ankle, especially the anterior talofibular and calcaneofibular ligaments, was frequently reported in the literature. Angular measurements benefit in determination of the ligament injury. Therefore, knowledge about normal anatomic angles between each other and angles between longitudinal axis of the fibula and both ligaments was certainly important for the correct diagnosis. Nowadays, surgical reconstructions of the ligaments are frequently used. During the surgical invention, length and width of the ligaments are necessary to determine quantity of ligament loss. Nonetheless, knowledge of ligament attachments contributes to more accurate reconstructions.
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Affiliation(s)
- Selda Yıldız
- Department of Anatomy, Faculty of Medicine, Gulhane Military Medical Academy, Etlik, 06018 Ankara, Turkey.
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