Dimensions and attachments of the ankle ligaments: evaluation for ligament reconstruction

Abstract

For operative reconstruction, precise anatomic information on the dimensions of the ankle ligaments is important and can help to optimize these procedures. The purpose of this study was to investigate the length and width dimensions of the ankle ligaments and to contrast the results with the published literature. Seventeen non-paired adult, formalin-fixed ankle specimen were dissected to expose the capsuloligamentous structures. The following ligaments were investigated: tibiofibular syndesmosis (anterior and posterior tibiofibular ligament/ATiFL and PTiFL), lateral ankle ligaments (anterior and posterior talofibular ligament, calcaneofibular ligament/ATFL, PTFL and CFL), medial ankle ligaments (deltoid ligament, anterior and posterior tibiotalar ligament/ATTL and PTTL). After identification of the ligaments, the dimensions were measured with a ruler and a sliding caliper. Additionally, the attachment area and the center of insertion (COI) were evaluated. The dimensions of the ligaments were recorded. Measurements were calculated and discussed according to the existing literature. The tibial COI of the ATiFL was situated 8.35 ± 2.05 mm from the inferior articular surface of the tibia and 5.04 ± 1.32 mm from the fibular notch. Its fibular COI was situated 25.45 ± 5.84 mm from the tip of the lateral malleolus and 3.12 ± 1.01 mm from the malleolar articular surface. The calcaneal COI of the CFL was situated 20.63 ± 3.56 mm anterior and 5.73 ± 1.89 mm plantar to the superior edge of the calcaneal. Its fibular attachment of the CFL was directly at the tip of the lateral malleolus, dorsal to the fibular attachment of the ATFL. Studies of the therapeutic options in severe ankle ligament injuries have shown better results in anatomical reconstructions compared to other operative treatments. To optimize these procedures, exact anatomical information on the dimensions of the ankle ligaments should be beneficial.

Anatomical Footprint of the Tibialis Anterior Tendon: Surgical Implications for Foot and Ankle Reconstructions

“…All photos were digitally measured by use of Image J (http://rsb.info.nih.gov/ij/) software [18]. Different types of TAT footprints were distinguished according to the shape and area of the tendon attachment.…”

Anatomy of anterior talofibular ligament and calcaneofibular ligament for minimally invasive surgery: a systematic review

“…The ATFL was identified as an intra-capsular structure in their all cases [38]. The bundle pattern of the ATFL was studied in 11 of 14 studies [4,6,19,22,23,26,28,31,33,34,[38][39][40].…”

Morphological variations of the deltoid ligament of the medial ankle

“…Conservative therapy is indicated in most patients with acute deltoid ligament injury, but surgical treatment is recommended if conservative therapy is ineffective or patients report chronic instability of the medial ankle. Since the concept of surgical treatment has recently changed to anatomical reconstruction or repair in the fields of orthopedic surgery and sports medicine, the footprint and morphology of the individual bands of the deltoid ligament need to be understood if procedures are to succeed (Campbell et al, ; Wenny et al, ).…”