Connecting fibers between ATFL’s inferior fascicle and CFL transmit tension between both ligaments

Cordier, Guillaume; Nunes, Gustavo Araújo; Vega, Jordi; Roure, Francesc; Dalmau-Pastor, Miki

doi:10.1007/s00167-021-06496-w

Cited by 28 publications

(38 citation statements)

References 34 publications

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Section: Discussionmentioning

confidence: 99%

“…ATFL was known to have bers that merge with CFL extraarticularly [7,8,13,14,22,28], and various types of con uence in the super cial and deep layers had been reported [17]. The ber that connects the ATFL and CFL transmits the tension of both ligaments to each other [7]. Recently, the LFTCL complex was introduced and described as a complex structure in which the IB of ATFL and CFL merge extraarticularly.…”

Section: Discussionmentioning

confidence: 99%

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Difference in the fibular attachment structure between the superior and inferior fascicles of the anterior talofibular ligament using ultrasonography and histological examinations

et al. 2022

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The anterior talo bular ligament (ATFL) is divided into superior (SB) and inferior bands (IB). Although the differences in length and width are known, the structure of the bular attachment had not been elucidated. The present study aimed to clarify the differences in the bular attachment structure between ATFL's SB and IB using cross-sectional images along the ligament. MethodsAn anatomical study using 15 formalin-xed ankles was performed. The lateral ankle ligament complex was collected after a longitudinal image of SB/IB was visualized by ultrasonography. The specimens were decalci ed and sectioned longitudinally at the center of SB/IB using a microtome. Histological evaluation of the enthesis structure at the bular attachment of SB/IB was performed using hematoxylin-eosin and Masson's trichrome stains. ResultsA brillar pattern could not be observed in the longitudinal image at the IB level by ultrasonography. The lengths of ATFL's SB and IB were 20.6 ± 1.6 and 15.3 ± 1.3 mm, respectively, with thicknesses of 1.8 ± 0.4 and 1.0 ± 0.4 mm, respectively. The ATFL's IB was signi cantly shorter and thinner than the ATFL's SB. The bular attachment of ATFL's SB had distinct enthesis structure, whereas in the attachment structure of the ATFL's IB, there were several variations including a type with a narrower enthesis structure than the ATFL's SB and a type that merged with or wrapped around the calcaneo bular ligament. ConclusionThe bular attachment structure between ATFL's SB and IB differs. Our results could be useful information when performing ultrasonography and MRI diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Difference in the fibular attachment structure between the superior and inferior fascicles of the anterior talofibular ligament using ultrasonography and histological examinations

et al. 2022

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“…And also, in another study, Hattori S et al [15], found that the distances of the anchor and FOT was 6.0 ± 2.7 mm in open repair and 5.6 ± 3.3 mm in sonographically guided repair, it's very similar to our study, and indicating that the LPF was a very reliable landmarker for suture anchor implantation. Cordier G et al [31], carried out a cadaveric study and found out that the iATFL and CFL was connected by the arciform ber, the this ber was rm enough to transmit the tension between the iATFL and CFL. In fact, in our cadaveric study (not published), the iATFL, CFL and the arciform ber constructed a triangle complex, of which the apexs were located at the anterior border of bular between the bular tip and FOT, the TOT (Talar Obscure Tubercle) and the calcaneus insertion of CFL, so we could augment the iATFL and CFL by one single limb of the suture anchor under arthroscopy (supplementary 1).…”

Section: Discussionmentioning

confidence: 99%

The lowest point of fibula (LPF) could be used as a reliable bony landmark for arthroscopic anchor placement of lateral ankle ligaments ----compared with open Broström procedure

Xie

Chen

Fan

et al. 2022

Preprint

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Background Arthroscopic technique procedures was wide accepted for the treatment of chronic ankle instability (CAI). But little acknowledge was involved to the bony landmarks and anatomic features of different bundles of lateral ligaments under arthroscopic view. Methods Sixty patients with acute or chronic lateral ankle ligaments injury (LAI) were collected prospectively, and divided randomly into two groups. In arthroscopic group, the bone tunnels were made on the LPF arthroscopically. And in open group, the bone tunnels were made on the Fibular obscure tubercle (FOT) in open procedure. The inferior bundle of ATFL and Arcuate fibre was also identified reference to the LPF and labeled by a PDS II suture penetration. Following that, The distances of the bone tunnels to the different bony markers were measured and compare between two groups. The penetrating locations of PDS II on the inferior bundle of ATFL and Arcuate fibre were also confirmed intraoperatively. And the safe angle of anchor implantation on the axial view was measured on postoperative CT scan. Results The distances of bone tunnel to the fibular tip, the fibular insertion of anterior-inferior tibiofibular ligament (AITFL), and the FOT in arthroscopic and open locating groups were 4.9 ± 2.2 and 6.3 ± 2.2mm, 13.5 ± 2.7 and 12.4 ± 1.1mm, 5.8 ± 2.2 and 5.6 ± 1.0mm, respectively. The distances of bone tunnels to the FOT and fibular tip on 3d-CT view was 4.4 ± 1.5 and 4.6 ± 0.9 mm, 14.4 ± 3.2 and 13.2 ± 1.8 mm in arthroscopic and open group, and there were no significant differences between two groups. The safe angle of arthroscopic anchor placement on the axial plan was ranged from 24.9 ± 6.3o to 58.1 ± 8.0o. The PDS II sutures penetrating on the inferior bundles of ATFL and the arciform fibres were also comfirmed successfully by open visualizaion.The average distance of penetration point to the horizontal line cross the fibular tip was 2.3 ± 2.7 mm (ranged from − 3.1 to 6.0 mm), and to the vertical line cross the FOT was 2.7 ± 2.7 mm (ranged from − 2.5 to 7.5 mm). Conclusion Take the lowest point of fibula under arthroscopy (LPF) as a bony reference, we could identify the iATFL under arthroscopic visualization. By this way, we could place the suture anchors properly to the fibular footprint and suture the iATFL fibres successfully. Level of Evidence: IV, Prospective comparative investigation.

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“…In our study, patients with high activity with ATFL and CFL injuries showed higher HU values in the lateral region of the subtalar joint. The inferior fascicle of the ATFL has a fiber connected to the CFL, and these ligaments convey tension to each other and stabilize the subtalar joint as a complex [35]. By combining subtalar instability due to CFL deficiency and high activity, excessive stress to the lateral region of the subtalar joint may be provided.…”

Section: Discussionmentioning

confidence: 99%

High-stress distribution in the lateral region of the subtalar joint in the patient with chronic lateral ankle instability

Nakasa

Ikuta

Sumii

et al. 2021

Arch Orthop Trauma Surg

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Purpose Chronic lateral ankle instability (CLAI) is associated with osteoarthritis (OA). However, the characteristics of patients with CLAI who progress to OA are not clear. Measurement of Hounsfield Unit (HU) value on computed tomography (CT) is reported to be useful to evaluate the stress distribution. We aimed to evaluate the stress distribution in the ankle and subtalar joints and factors enhancing it in patients with CLAI. Materials and methods Thirty-three ankles with CLAI (CLAI group) and 26 ankles without CLAI (control group) were included. A mean age of CLAI was 35.2 years and control was 30.3 years. Color map was created in the ankle and subtalar joint according to the HU values using three-dimensional CT to identify the region with high HU values, and HU values in those regions were measured using two-dimensional CT and compared between control and CLAI groups. In CLAI group, the relationships between HU values and ankle activity score (AAS), OA, talar tilting angle (TTA), cartilage injury were assessed. ResultsThe HU values in the anteromedial region of the talus and lateral region in the subtalar joint were higher than those in the control. In CLAI, patients with an AAS of ≧ 6, over 10° of TTA, cartilage injury, and OA changes in the medial gutter had significantly higher HU values in the lateral region of the subtalar joint than those with an AAS of ≦5, less than 10° of TTA without cartilage injury and OA change. Conclusions CLAI patients, especially in the patients with high activity level, large TTA, cartilage injury, and OA changes at the medial gutter, have high HU values in the lateral region of the subtalar joint, which suggests that disruption of the subtalar compensation toward OA will occur. For these patients, instability should be completely eliminated to prevent ankle OA. Level of evidence Level III, comparative series.

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Connecting fibers between ATFL’s inferior fascicle and CFL transmit tension between both ligaments

Cited by 28 publications

References 34 publications

Difference in the fibular attachment structure between the superior and inferior fascicles of the anterior talofibular ligament using ultrasonography and histological examinations

Difference in the fibular attachment structure between the superior and inferior fascicles of the anterior talofibular ligament using ultrasonography and histological examinations

The lowest point of fibula (LPF) could be used as a reliable bony landmark for arthroscopic anchor placement of lateral ankle ligaments ----compared with open Broström procedure

High-stress distribution in the lateral region of the subtalar joint in the patient with chronic lateral ankle instability

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