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Assessment of the feasibility of arthroscopic visualization of the lateral ligament of the ankle: a cadaveric study

  • Ankle
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

An anatomical study was performed to assess the feasibility of arthroscopic visualization of the lateral ligaments of the ankle.

Methods

The fibular, talar and calcanear insertions of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) were identified by standard arthroscopy portals. After dissection of the ATFL and CFL, bone tunnels were created at the estimated centres of their footprints. Dissection was then performed to identify the footprints and their position in relation to bony landmarks. The distance from the real centre of the footprint to the corresponding tunnel entrance was measured.

Results

Fourteen fresh frozen ankles were included. The ATFL and CFL were identified in all cases. The centre of the fibular ATFL footprint was found to be 16.1 ± 3.5 mm from the tip of the fibula, and the talar footprint was 18.4 ± 2.8 mm from the apex of the lateral talar process. The centre of the fibular CFL footprint was 4.2 ± 0.8 mm from the tip of the fibula, and the calcaneal footprint was 18.4 ± 2.5 mm from the fibular process of the calcaneum. The fibular tunnel was 2.9 ± 3 mm proximally from the centre of the ATFL fibular footprint, the talar tunnel was 4.4 ± 3.2 mm proximally from the centre of the talar footprint, and the calcaneal tunnel was 3.3 ± 2.8 mm too anterior from the CFL calcaneal footprint. No iatrogenic lesions were noted.

Conclusion

Arthroscopic identification of the ATFL, CFL and their corresponding footprints can be considered safe and reliable. Tunnels entrances, in preparation for arthroscopic ligament reconstruction, are precisely positioned. Arthroscopic anatomical ligament reconstruction is a feasible option.

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References

  1. Burks RT, Morgan J (1994) Anatomy of the lateral ankle ligaments. Am J Sports Med 22:72–77

    Article  CAS  PubMed  Google Scholar 

  2. Clanton TO, Campbell KJ, Wilson KJ, Michalski MP, Goldsmith MT, Wijdicks CA, LaPrade RF (2014) Qualitative and quantitative anatomic investigation of the lateral ankle ligaments for surgical reconstruction procedures. J Bone Joint Surg Am 96:e98

    Article  PubMed  Google Scholar 

  3. Cottom JM, Rigby RB (2013) The “All Inside” arthroscopic Broström procedure: a prospective study of 40 consecutive patients. J Foot Ankle Surg 52:568–574

    Article  PubMed  Google Scholar 

  4. Freeman MAR (1965) Treatment of ruptures of the lateral ligament of the ankle. J Bone Joint Surg Br 47:661–668

    CAS  PubMed  Google Scholar 

  5. Golanó P, Vega J, de Leeuw PAJ, Malagelada F, Manzanares MC, Götzens V, van Dijk CN (2010) Anatomy of the ankle ligaments: a pictorial essay. Knee Surg Sports Traumatol Arthrosc 18:557–569

    Article  PubMed  PubMed Central  Google Scholar 

  6. Guillo S, Bauer T, Lee JW, Takao M, Kong SW, Stone JW, Mangone PG, Molloy A, Perera A, Pearce CJ, Michels F, Tourné Y, Ghorbani A, Calder J (2013) Consensus in chronic ankle instability: aetiology, assessment, surgical indications and place for arthroscopy. Orthop Traumatol Surg Res 99:S411–S419

    Article  CAS  PubMed  Google Scholar 

  7. Hertel J (2002) Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train 37:364–375

    PubMed  PubMed Central  Google Scholar 

  8. Hiller CE, Kilbreath SL, Refshauge KM (2011) Chronic ankle instability: evolution of the model. J Athl Train 46:133–141

    Article  PubMed  PubMed Central  Google Scholar 

  9. Khawaji B, Soames R (2015) The anterior talofibular ligament: a detailed morphological study. Foot (Edinb) 25:141–147

    Article  Google Scholar 

  10. Krips R, van Dijk CN, Lehtonen H, Halasi T, Moyen B, Karlsson J (2002) Sports activity level after surgical treatment for chronic anterolateral ankle instability. A multicenter study. Am J Sports Med 30:13–19

    PubMed  Google Scholar 

  11. Nery C, Raduan F, Del Buono A, Asaumi ID, Cohen M, Maffulli N (2011) Arthroscopic-assisted Brostrom-Gould for chronic ankle instability: a long-term follow-up. Am J Sports Med 39:2381–2388

    Article  PubMed  Google Scholar 

  12. Neuschwander TB, Indresano AA, Hughes TH, Smith BW (2013) Footprint of the lateral ligament complex of the ankle. Foot Ankle Int 34:582–586

    Article  PubMed  Google Scholar 

  13. Takao M, Innami K, Matsushita T, Uchio Y, Ochi M (2008) Arthroscopic and magnetic resonance image appearance and reconstruction of the anterior talofibular ligament in cases of apparent functional ankle instability. Am J Sports Med 36:1542–1547

    Article  PubMed  Google Scholar 

  14. Tropp H, Odenrick P, Gillquist J (1985) Stabilometry recordings in functional and mechanical instability of the ankle joint. Int J Sports Med 6:180–182

    Article  CAS  PubMed  Google Scholar 

  15. Wenny R, Duscher D, Meytap E, Weninger P, Hirtler L (2015) Dimensions and attachments of the ankle ligaments: evaluation for ligament reconstruction. Anat Sci Int 90:161–171

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank sincerely Mr. Jean Thès for his drawings.

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Authors and Affiliations

  1. Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, 9 Avenue du Général de Gaulle, 92100, Boulogne-Billancourt, France

    André Thès, Shahnaz Klouche, Mathieu Ferrand, Philippe Hardy & Thomas Bauer

  2. UFR des Sciences de la Santé, Université de Versailles Saint-Quentin-en-Yvelines, 78035, Versailles, France

    Philippe Hardy

Authors
  1. André Thès
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  2. Shahnaz Klouche
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  3. Mathieu Ferrand
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  4. Philippe Hardy
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  5. Thomas Bauer
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Corresponding author

Correspondence to Thomas Bauer.

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Thès, A., Klouche, S., Ferrand, M. et al. Assessment of the feasibility of arthroscopic visualization of the lateral ligament of the ankle: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 24, 985–990 (2016). https://doi.org/10.1007/s00167-015-3804-4

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  • DOI: https://doi.org/10.1007/s00167-015-3804-4

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