Anatomical review of the lateral collateral ligaments of the ankle: a cadaveric study

Abstract

Arrangements of the lateral collateral ligaments of the ankle are complex. Injuries to these ligaments can occur in the inverted planter flexed position of the ankle. Traditionally, the anterior talofibular ligament (ATFL) is the first ligament involved in such ankle injuries. We reviewed the anatomical arrangements of the lateral ankle. Twenty ankles from ten Caucasian cadavers were carefully dissected. Length and width of each ligament were measured in neutral, dorsiflexion and plantar flexion. The angle between the ATFL and other ligaments was also recorded. ATFL was present in 95% of ankles dissected. Five ankles showed two slip configuration of the ATFL. One ATFL was noted as being significantly thicker and another one was significantly narrow. Mean length of the ATFL in neutral was 15.5 mm (range 10-21 mm), which increased in plantar flexion to 18 mm (range 11-25 mm) and decreased slightly in dorsiflexion to 14.5 mm (range 10-19 mm). The calcaneofibular ligament was present in all dissections and had a mean measurement of 18.5 mm in neutral (range 14-23 mm) decreasing to 17 mm in planter flexion and 15.5 mm in dorsiflexion. Treating ligamentous ankle injuries can be very costly, thus creating a large economic burden to both patients and health institutions. Understanding the anatomical characteristics of the lateral collateral ligament complex of the ankle provides the basic foundation for understanding injuries and helps to clinically manage such injuries appropriately.

The anterior talofibular ligament: A detailed morphological study

“…Length decreased in dorsiflexion (18.81 mm) and eversion (18.25 mm) compared to neutral (20.17 mm) and increased in plantarflexion (21.06 mm) and inversion (20.26 mm). Raheem and O'Brien [22] reported similar changes in dorsiflexion (14.5 mm) and plantarflexion (18 mm) compared to neutral (15.5 mm). Nevertheless, both sets of results confirm that the ATFL is most taut in plantarflexion.…”

“…In the current study 22.9% of specimens had a single band, with two and three bands being observed in 56.3% and 20.8% of specimens respectively: this supports Milner and Soames [20] and Ugurlu et al [21], who both report the presence of one, two and three bands. Other authors [18,22,23] have reported one and two bands; however Sindel et al [25] found only two bands. Sarrafian (1993) [24] is of the opinion that the ATFL mainly consists of two bands, but it may occasionally have three.…”

“…Ligament width was not determined in different ankle joint positions, as Raheem and O'Brien [22] reported no change. Previous studies have reported ATFL width but did not specify where the measurement was taken.…”

“…Prior studies reported variation in the existence of one, two and three band forms of the ATFL [18][19][20][21][22][23][24]. ATFL originates from the anterior border of the fibular lateral malleolus [25].…”

“…The ATFL length was reported in previous literature is ranging between 13 mm and 40 mm [11,18,21,[27][28][29][30]. The width was reported in a number of studies which was reported to be ranging between 4 mm and 12.98 mm [18,21,22,28,30]. Dimmick et al [4] and Hua et al [10] used MRI to measure ATFL thickness which was reported to be 2.19 mm and 1.46 mm respectively.…”