The Location of the Fibular Tunnel for Anatomically Accurate Reconstruction of the Lateral Ankle Ligament: A Cadaveric Study

Park, Jeong-Hyun; Kwon, Hyung-Wook; Kim, Digud; Park, Kwang-Rak; Lee, Mijeong; Choi, Yujin; Cho, Jaeho

doi:10.1155/2021/5575524

Cited by 8 publications

(10 citation statements)

References 35 publications

(56 reference statements)

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“…A cadaveric study confirmed the reliability of the lateral malleolus as a skin marker for the distal insertion of the central beam [21]. The precision of the fibular insertions of the anterior talofibular ligaments (ATFL) and calcaneofibularis (CFL), as well as their common origin with respect to the bony landmarks of the fibula, are necessary to determine the location of the fibular tunnel in reconstructive surgery [22]. The results obtained in the current study are relatively close and, on average, are 6.2 ± 0.9mm.…”

Section: Discussionmentioning

confidence: 86%

Anatomical dissection of the calcaneofibular ligament of the ankle – a macroscopic and morphometric study

Yabka

Hamzaoui²

2021

J Pre Clin Clin Res.

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Introduction and objective. Common to the talocrural and subtalar joints, the calcaneofibular ligament forms with the anterior bundle a mechanical coupling factor for ankle stabilization. Adhering to the deep surface of the fibular sheath, doubled in depth by the lateral talocalcaneal ligament, it is solicited in isolated varus and its lesion is involved in subtalar instability. The therapeutic strategy for chronic ankle instability is currently based on the anatomical reconstruction of the ligaments, particularly by arthroscopy, hence the objective of this study, which aims to highlight the great variability of the calcaneofibular ligament. Materials and method. Our work is based on the dissection of 24 ankles. The number of beams, the dimensions at the neutral point and after power-up, the relationships with the surrounding anatomical structures as well as the points of insertion of the CFL are studied. Results. The calcaneofibular ligament was monofascicular in 91.6% of cases and bifascicular in 8.4%. Its average length in a neutral position was 26.85 ± 3.46 mm, and its width was 5.33 ± 1.45 mm. In dorsiflexion, the length was 27.10 ± 0.05 mm, and in forced inversion, it was 26.98 ± 0.07 mm. The distance between its fibular insertion and the apex of the lateral malleolus was 6.2 ± 0.9 mm. Conclusions. Injuries of the calcaneofibular ligament are common in lateral ankle sprains, which can often get complicated by chronic instability. The macroscopic and morphometric knowledge of this ligament can allow a more accurate anatomical reconstruction and a more accurate choice of graft.

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Section: Discussionmentioning

confidence: 86%

Anatomical dissection of the calcaneofibular ligament of the ankle – a macroscopic and morphometric study

Yabka

Hamzaoui²

2021

J Pre Clin Clin Res.

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“…The precise origin and insertion areas of the ligaments may help the surgeon to locate the bony tunnel. Thus, it is important to know the origin and insertion point for correct anatomic reconstruction 17 . Several studies focused on the attachment areas of each lateral ankle ligament in various aspects not only for providing the basic anatomical knowledge but also in terms of clinical application.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the minimal invasive surgical procedure was used to treat the CLAI providing the good view to define the ligaments 7,8 . In both percutaneous and arthroscopic surgical approaches for treating the CLAI, a single fibular tunnel with a shared origin site for the ATFL and CFL is required 17 . However, understanding how ligaments are attached helps with more precise positioning of the tunnel for repair or reconstructions.…”

Section: Introductionmentioning

confidence: 99%

The Specific Anatomical Morphology of Lateral Ankle Ligament: Qualitative and Quantitative Cadaveric based Study

Inchai,

Vaseenon,

Tanaka

et al. 2023

Orthopaedic Surgery

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ObjectiveThe accurate understanding in morphological features of the lateral ankle ligaments is necessary for the diagnosis and management of ankle instability and other ankle problems. The purpose of this study was to evaluate the anatomical morphology and the attachment areas of lateral ligament complex of ankle joint based on the cadaveric study.MethodsFifty‐four fresh frozen cadaveric ankles were dissected to evaluate the lateral ankle ligaments. Each ligament was separated into two or three small bundles. In the investigated footprint areas, acrylic colors were used as a marker point to locate specific areas of ligament bundle attached to the bone. The Image J software was used to measure and analyze the sizes of the specific footprint areas to achieve descriptive statistical analysis.ResultsThe double bands of anterior talofibular ligament (ATFL) were found as a major type in the present study with 57.41% (31 of 54 ankles) while the single band of ATFL was observed in 42.59% (23 of 54 ankles). The attachment sizes of the ATFL, posterior talofibular ligament (PTFL) and calcaneofibular ligament (CFL) were evaluated into two areas; proximal and distal attachments. The average of proximal or fibular part of ATFL, PTFL and CFL were 85.06, 134.27, 93.91 mm2 respectively. The average of distal part of ATFL, PTFL and CFL were 100.07, 277.61, 249.39 mm2 respectively.ConclusionConsidering the lateral ankle ligament repaired or reconstruction especially using arthroscopy, the precise understanding in specific detail of the lateral ankle ligament may help both diagnose and select the appropriate treatment for solving the ankle problems. These observations may help the surgeon to perform the surgical procedure for determining the appropriate techniques and avoid complication to patients.

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“…The anatomic measurements in this study indicated that the tunnel locations might be slightly lower than which described by Lan et al Bony landmarks, such as the inferior tip of the fibula and fibular obscure tubercle, have been widely used in anatomical studies to assess the fibular insertions of the ATFL and CFL. The distance from ligamentous attachments to the inferior tip of the fibula varied in the literature, 2,4,17,24,25,27,34 whereas the fibular obscure tubercle was available and reliable for identifying the attachments of the ATFL and CFL. 23 Using the distal fascicle of the AITFL, the locations of the ATFL and CFL corresponded with the fibular obscure tubercle.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the intersection point of the ATFL and CFL (intATFL-CFL) in the fibula was identified by minimal dissection of the most inferior and posterior fibers of the ATFL and the most anterior fiber of the CFL (Figure 2). 24 Two observers performed all measurements to calculate the intraclass correlation coefficients (ICCs). Each observer measured the distances using a caliper 3 times to calculate the mean values.…”

Section: Methodsmentioning

confidence: 99%

The Distal Fascicle of the Anterior Inferior Tibiofibular Ligament: A Potential Landmark for Lateral Ankle Ligament Reconstruction

Wang,

Zhao,

Shi

et al. 2023

Foot Ankle Int.

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Background: A reliable landmark and precise distances from the ligament attachments are needed for lateral ankle stabilization surgery. The distal fascicle of the anterior inferior tibiofibular ligament (AITFL) has been used to locate the anterior talofibular ligament (ATFL) or calcaneofibular ligament (CFL) centers on the fibula. However, there is no anatomic study to validate the distal fascicle of the AITFL as a landmark of lateral ankle ligament stabilization, and more importantly, the exact distances from the ATFL or CFL attachments to the distal fascicle of the AITFL are unknown. Methods: Sixteen frozen cadaveric specimens (8 paired specimens) with no previous history of ankle injury were used in this study. Whether the distal fascicle of AITFL was present in each specimen was confirmed. Then, the distances from the most distal insertion of the AITFL’s distal fascicle to the footprint centers of the ATFL and CFL on the fibula were measured. All measurements were performed by 2 observers, and the intraobserver and interobserver reliabilities were analyzed by intraclass correlation coefficients (ICCs). Results: The distal fascicle of the AITFL was found in all specimens (100%). The mean distance from the most distal insertion of the AITFL’s distal fascicle to the footprint centers of the ATFL, CFL, and the intersection center of the 2 ligaments on the fibula was 6.0 to 7.1 mm, 11.5 to 13.2 mm, and 9.0 to 10.0 mm, respectively. Excellent interobserver and intraobserver agreement (all ICCs > 0.9, P < .01) was shown in the anatomic measurements of these distances. Conclusion: In this cadaveric study, we found that the distal fascicle was a constant structure of the AITFL in the lateral ankle. The distances from the most distal insertion of the AITFL’s distal fascicle to the ligamentous footprint centers were reliable and may be used to identify the origins of the ATFL and CFL for lateral ankle ligament reconstruction. Clinical Relevance: This anatomic study validates the AITFL’s distal fascicle as a potential landmark and, more importantly, determines the range of distances from AITFL’s distal fascicle to the attachment centers of lateral ankle ligaments by anatomic measurements. The data may be used to identify the ATFL and CFL for lateral ankle stabilization surgery and become particularly valuable for endoscopic or arthroscopic techniques.

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The Location of the Fibular Tunnel for Anatomically Accurate Reconstruction of the Lateral Ankle Ligament: A Cadaveric Study

Cited by 8 publications

References 35 publications

Anatomical dissection of the calcaneofibular ligament of the ankle – a macroscopic and morphometric study

Anatomical dissection of the calcaneofibular ligament of the ankle – a macroscopic and morphometric study

The Specific Anatomical Morphology of Lateral Ankle Ligament: Qualitative and Quantitative Cadaveric based Study

The Distal Fascicle of the Anterior Inferior Tibiofibular Ligament: A Potential Landmark for Lateral Ankle Ligament Reconstruction

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