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X-shaped inferior extensor retinaculum and its doubtful use in the Bröstrom–Gould procedure

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

Abstract

Purpose

The inferior extensor retinaculum (IER) is an aponeurotic structure located in the anterior aspect of the ankle. According to the literature, it can be used to reinforce a repair of the anterior talofibular ligament in ankle instability. Despite its usual description as an Y-shaped structure, it is still unclear which part of the retinaculum is used for this purpose, or if it is instead the crural fascia that is being used. The purpose of this study is to define the anatomical characteristics of the IER to better understand its role in the Broström–Gould procedure.

Methods

Twenty-one ankles were dissected. The morphology of the IER and its relationship with neighbouring structures were recorded.

Results

Seventeen (81%) of the IER in this study had an X-shaped morphology, with the presence of an additional oblique superolateral band. This band, by far the thinnest of the retinaculum, is supposed to be used to reinforce the repair of the anterior talofibular ligament. The intermediate dorsal cutaneous nerve (lateral branch of the superficial peroneal nerve) was found to cross the retinaculum in all cases.

Conclusions

The IER is most commonly seen as an X-shaped structure, but the fact that the oblique superolateral band is a thin band of tissue probably indicates that it may not add significant strength to ankle stability. Furthermore, the close relationship of the retinaculum with the superficial peroneal nerve is another factor to consider before deciding to perform a Broström–Gould procedure. These anatomical findings advise against the use of the Gould augmentation.

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Authors and Affiliations

  1. Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, C/FeixaLlarga, s/n, 09806, Hospitalet de Llobregat, Barcelona, Spain

    M. Dalmau-Pastor, F. Malagelada, M. C. Manzanares & J. Vega

  2. Faculty of Health Sciences at Manresa, University of Vic-Central University of Catalonia, Manresa, Barcelona, Spain

    M. Dalmau-Pastor

  3. Foot and Ankle Unit, Hospital Quirón Barcelona, Barcelona, Spain

    J. Vega

  4. Foot and Ankle Unit, Orthopaedic and Trauma Surgery, Heatherwood and Wexham Park Hospitals, Frimley Health NHS Trust, Ascot, Berkshire, UK

    F. Malagelada

  5. Chair Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    G. M. M. J. Kerkhoffs

  6. Chair Academic Center for Evidence Based Sports Medicine (ACES), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    G. M. M. J. Kerkhoffs

  7. Co-Chair Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands

    G. M. M. J. Kerkhoffs

Authors
  1. M. Dalmau-Pastor
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  2. F. Malagelada
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  3. G. M. M. J. Kerkhoffs
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  4. M. C. Manzanares
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  5. J. Vega
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Corresponding author

Correspondence to M. Dalmau-Pastor.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

No external source of funding was used.

Ethical approval

This study has been performed with human specimens donated to the Anatomy Unit of the University of Barcelona. Ethical aproval was granted.

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Dalmau-Pastor, M., Malagelada, F., Kerkhoffs, G.M.M.J. et al. X-shaped inferior extensor retinaculum and its doubtful use in the Bröstrom–Gould procedure. Knee Surg Sports Traumatol Arthrosc 26, 2171–2176 (2018). https://doi.org/10.1007/s00167-017-4647-y

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  • DOI: https://doi.org/10.1007/s00167-017-4647-y

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