Anatomical variation in the form of inter- and intra-individual laterality of the calcaneofibular ligament

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.

Calcaneofibular ligament may act as a tensioner of peroneal tendons as revealed by a contactless three-dimensional scan system on cadavers

“…The length was defined as the distance between the fibular origin and most proximal insertion on the calcaneus (Fig. 3 c) 4 , 13 , whereas the portion that intersected with the PLT and PBT was defined as the width (Fig. 3 d).…”

“…However, a precise understanding of the ligament has not been fully achieved. Several cadaveric studies have revealed structural variations in the CFL regarding length, width, running angle, or size of the attachment area 3 , 4 . Among the parameters, the running angle of the CFL ranges from 0° to 90°, as reported by Ruth 5 , and the angle shows a difference in tensing behavior, as noted in a simulation study by Edama et al 6 .…”

“…Regardless of the morphological variety, the CFL always closely crosses under the deep side of the peroneus longus tendon (PLT) and peroneus brevis tendon (PBT) (Fig. 1 ) 4 . An interesting finding is that histological examinations reveal fibrocartilaginous changes on the contact surface of the CFL with the peroneal tendons 9 .…”

Ultrasound shear wave elastography of the anterior talofibular and calcaneofibular ligaments in healthy subjects

“…The CFL stabilizes the subtalar joint, extending from the lateral malleolar tip to the trochlear eminence of the calcaneus, crossing deep to the peroneal tendons and sheaths ( 3 ) . The proximal attachment of the CFL is found just below the ATFL, with interconnecting fibers between these ligaments frequently observed ( 2 ) .…”

Prediction of suspicious ankle instability using the calcaneofibular ligament cross-sectional area

“…In the neutral state, the CFL's responsibility is resistance to inversion during dorsiflexion. The CFL stabilizes the subtalar joint and resists inversion alongside the ATFL during plantarflexion (10,11). Ankle magnetic resonance imaging (A-MRI) is beneficial for analyzing the pathologic abnormalities of the CFL and other related pathologic conditions in the ankle anatomy (12).…”