No Difference between Percutaneous and Arthroscopic Techniques in Identifying the Calcaneal Insertion during Ankle Lateral Ligament Reconstruction: A Cadaveric Study

Liu, Hongyun; Li, Shengkun; Zhou, Ru; Chen, Shiyi; Hua, Yinghui

doi:10.1155/2019/2128960

Cited by 4 publications

(5 citation statements)

References 30 publications

(45 reference statements)

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“…The reliability of this method was not assessed. Lopes et al used the tip of the lateral malleolus as a landmark and related the CFL footprint to a point 1 cm distal and posterior to the tip of the lateral malleolus [14, 15]. The accuracy of this method was similar to the findings in our study.…”

Section: Discussionsupporting

confidence: 87%

A calcaneal tunnel for CFL reconstruction should be directed to the posterior inferior medial edge of the calcaneal tuberosity

Michels

Matricali

Wastyn

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose Anatomical reconstruction of the calcaneoibular ligament (CFL) is a common technique to treat chronic lateral ankle instability. A bone tunnel is used to ix the graft in the calcaneus. The purpose of this study is to provide some recommendations about tunnel entrance and tunnel direction based on anatomical landmarks. Methods The study consisted of two parts. The irst part assessed the lateral tunnel entrance for location and safety. The second part addressed the tunnel direction and safety upon exiting the calcaneum on the medial side. In the irst part, 29 specimens were used to locate the anatomical insertion of the CFL based on the intersection of two lines related to the ibular axis and speciic landmarks on the lateral malleolus. In the second part, 22 specimens were dissected to determine the position of the neurovascular structures at risk during tunnel drilling. Therefore, a method based on four imaginary squares using external anatomical landmarks was developed. Results For the tunnel entrance on the lateral side, the mean distance to the centre of the CFL footprint was 2.8 ± 3.0 mm (0-10.4 mm). The mean distance between both observers was 4.2 ± 3.2 mm (0-10.3 mm). The mean distance to the sural nerve was 1.4 ± 2 mm (0-5.8 mm). The mean distance to the peroneal tendons was 7.3 ± 3.1 mm (1.2-12.4 mm). For the tunnel exit on the medial side, the two anterior squares always contained the neurovascular bundle. A safe zone without important neurovascular structures was found and corresponded to the two posterior squares. Conclusion Lateral landmarks enabled to locate the CFL footprint. Precautions should be taken to protect the nearby sural nerve. A safe zone on the medial side could be determined to guide safe tunnel direction. A calcaneal tunnel should be directed to the posterior inferior medial edge of the calcaneal tuberosity.

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Section: Discussionsupporting

confidence: 87%

A calcaneal tunnel for CFL reconstruction should be directed to the posterior inferior medial edge of the calcaneal tuberosity

Michels

Matricali

Wastyn

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“…Li et al [15] compared the two positioning techniques (arthroscopic and percutaneous) mentioned above and found no difference in their respective outcomes, while pointing out that arthroscopic positioning resulted in anterior and inferior positioning in the center of the CFL, and that percutaneous positioning resulted in a posterior and inferior position.…”

Section: Discussionmentioning

confidence: 99%

“…Best et al [2] used radiographic identi cation on a sample of 10 ankles. Lopes et al [17] used a sample of 30 ankles, while Li et al [15] used 15 ankles.…”

Section: Discussionmentioning

confidence: 99%

“…However, the calcanean insertion of the CFL can only be performed in an extra-articular fashion [8]: as arthroscopy is not available in this case, accurate anatomical landmarks are needed for successful insertion. Signi cant variations are observed on how to position the calcaneal tunnel among the many surgical reconstruction techniques described in the literature [17,9,15]. During this lateral ligament repair, the sural nerve is at risk of injury, due to its course close to the calcaneal area of the CFL reinsertion.…”

Section: Introductionmentioning

confidence: 99%

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Advantages of ultrasound identification of the distal insertion of the calcaneofibular ligament during ligament reconstructions

Beldame¹,

Charpail

Sacco

et al. 2023

Surg Radiol Anat

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Introduction: In lateral ankle instability, anatomical ligament reconstructions are generally performed using arthroscopy. The ligament graft is passed through the talar, bular and calcaneal tunnels, reconstructing the anterior talo bular and calcaneo bular (CFL) bundles. However, the calcaneal insertion of the CFL needs to be performed in an extra-articular fashion, and cannot be carried out under arthroscopy, thus requiring speci c anatomical landmarks. For obtaining these landmarks, methods based on radiography or surface anatomy have already been described but can only offer an approximate identi cation of the actual CFL anatomical insertion point. In contrast, an ultrasound technique allows direct visualization of the insertion point and of the sural nerve that may be injured during surgery. Our study aimed to assess the reliability and accuracy of ultrasound visualization when performing calcaneal insertion of the CFL with speci c monitoring of the sural nerve.Material and methods: Our anatomical study was carried out on 15 ankles available from a body donation program. Ultrasound identi cation of the sural nerve was obtained rst with injection of dye. A needle was positioned at the level of the calcaneal insertion of the CFL.After dissection, in all the ankles, the dye was in contact with the sural nerve and the needle was located in the calcaneal insertion area of the CFL. The mean distance between the sural nerve and the needle was 4.8mm (range 3-7 mm).Discussion-Conclusion: A pre-or intra-operative ultrasound technique is a simple and reliable means for obtaining anatomical landmarks when drilling the calcaneal tunnel for ligament reconstruction of the lateral plane of the ankle. This tunnel should preferably be drilled obliquely from the heel towards the subtalar joint (1h-3h direction on an ultrasound cross-section), which preserves a maximum distance from the sural nerve for safety purposes, while allowing an accurate anatomical positioning of the osseous tunnel.

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“… 119 As there is no difference in identifying the CFL insertion at the calcaneus between the percutaneous and the arthroscopic techniques, both techniques are suitable as reconstruction procedures. 106 So et al 164 proposed a standardized method for tunnel placement to reconstruct the ITCL via a suture-button fixation device ( Figure 9 ) using a fluoroscopically guided percutaneous technique. Excessive initial graft tension of the CFL should be avoided, as it can overconstrain the graft and lead to abnormal subtalar kinematics.…”

Section: Treatmentmentioning

confidence: 99%

Current Concepts on Subtalar Instability

Pereira

Andrade

Espregueira-Mendes

et al. 2021

Orthopaedic Journal of Sports Medicine

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Subtalar instability remains a topic of debate, and its precise cause is still unknown. The mechanism of injury and clinical symptoms of ankle and subtalar instabilities largely overlap, resulting in many cases of isolated or combined subtalar instability that are often misdiagnosed. Neglecting the subtalar instability may lead to failure of conservative or surgical treatment and result in chronic ankle instability. Understanding the accurate anatomy and biomechanics of the subtalar joint, their interplay, and the contributions of the different subtalar soft tissue structures is fundamental to correctly diagnose and manage subtalar instability. An accurate diagnosis is crucial to correctly identify those patients with instability who may require conservative or surgical treatment. Many different nonsurgical and surgical approaches have been proposed to manage combined or isolated subtalar instability, and the clinician should be aware of available treatment options to make an informed decision. In this current concepts narrative review, we provide a comprehensive overview of the current knowledge on the anatomy, biomechanics, clinical and imaging diagnosis, nonsurgical and surgical treatment options, and outcomes after subtalar instability treatment.

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No Difference between Percutaneous and Arthroscopic Techniques in Identifying the Calcaneal Insertion during Ankle Lateral Ligament Reconstruction: A Cadaveric Study

Cited by 4 publications

References 30 publications

A calcaneal tunnel for CFL reconstruction should be directed to the posterior inferior medial edge of the calcaneal tuberosity

A calcaneal tunnel for CFL reconstruction should be directed to the posterior inferior medial edge of the calcaneal tuberosity

Advantages of ultrasound identification of the distal insertion of the calcaneofibular ligament during ligament reconstructions

Current Concepts on Subtalar Instability

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