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Individual fascicles of the ankle lateral ligaments and the lateral fibulotalocalcaneal ligament complex can be identified on 3D volumetric MRI

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

Abstract

Purpose

Lateral ligament ankle sprains are common and the anatomy on imaging studies is vital for accurate diagnosis. The lateral fibulotalocalcaneal ligament (LFTCL) complex consists of the inferior fascicle of the anterior talofibular ligament (ATFL) which is connected by arciform fibres with the calcaneofibular ligament (CFL). The superior fascicle of ATFL is an independent structure that should be assessed individually. MRI evaluation of these distinct fascicles and the arciform fibres has not been described. The aim of this study is to identify the anatomical relationship of these components of the LFTCL complex in healthy individuals on MRI.

Methods

Thirty ankles from healthy volunteers were imaged using 3D volumetric MRI. The ATFL fascicles and size were evaluated. Presence of arciform fibres connecting the inferior ATFL fascicle and CFL to form the LFTCL complex and anatomical relationship around the lateral ligament complex were assessed.

Results

Both the superior and inferior ATFL fascicles were observed in 26 (86.7%) ankles. The superior ATFL fascicle was significantly larger in all specimens (39% longer and 80.7% wider). For the specimens with a single fascicle, this was similar in size to the superior fascicle observed in the other 26 specimens. These measurements were not affected by age or gender. Arciform fibres of the LFTCL complex were identified in 22 (84.6%) specimens with two ATFL fascicles and three (75%) ankles with a single ATFL fascicle. Connecting fibres from the ATFL to PTFL were observed in 19 (63.3%) ankles while connections between the CFL and PTFL were identified in 21 (70%) ankles. Five ankles had a perforating artery visualized in the intervening space between the superior and inferior ATFL fascicles (a branch of the lateral tarsal artery of the dorsalis pedis artery).

Conclusion

Two distinct ATFL fascicles may be identified in the majority of ankles on MRI. Isolated injury to the superior fascicle identified on MRI may be useful when diagnosing patients presenting with symptoms of subtle instability without overt ankle laxity on clinical examination. The current study is the first to identify the arciform fibres of the LFTCL complex supporting isolated ATFL repair in the presence of intact LFTCL complex.

Level of evidence

Level III.

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Data availability statement

Authors can confirm that all relevant data are included in the article and/or its supplementary information files.

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Funding

There is no funding for this study.

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Authors and Affiliations

  1. Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK

    Choon Chiet Hong, Justin C. Lee, Anika Tsuchida, Mai Katakura, Mary Jones, Adam W. Mitchell & James Calder

  2. Department of Orthopaedic Surgery, National University Hospital, 1E, Kent Ridge Road, Singapore, 119228, Singapore

    Choon Chiet Hong

  3. Department of Orthopaedic Surgery, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands

    Anika Tsuchida

  4. Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Mai Katakura

  5. Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain

    Miki Dalmau-Pastor

  6. MIFAS By GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France

    Miki Dalmau-Pastor

  7. Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK

    James Calder

Authors
  1. Choon Chiet Hong
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  2. Justin C. Lee
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  4. Mai Katakura
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  6. Adam W. Mitchell
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  7. Miki Dalmau-Pastor
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  8. James Calder
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Contributions

All authors contributed to the study conception and design. AT, MK and MJ: prepared the study protocol and performed the ethical review process. Material preparation, data collection and analysis were performed by CCH, JCL, AWM, MD-P and JC. The first draft of the manuscript was written by CCH and all authors commented on previous versions of the manuscript. JC: supervised and reviewed the final manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Choon Chiet Hong.

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Conflict of interest

All authors do not have any conflict of interest except for James Calder who received remuneration for speaking in educational programme by Arthrex unrelated to this study.

Ethical approval

Institutional approval to undertake this study was provided by the West Midlands—Coventry & Warwickshire Research Ethics Committee (Reference: 19/WM/0383).

Informed consent

Informed consent was obtained for all volunteers prior to the scan.

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Hong, C.C., Lee, J.C., Tsuchida, A. et al. Individual fascicles of the ankle lateral ligaments and the lateral fibulotalocalcaneal ligament complex can be identified on 3D volumetric MRI. Knee Surg Sports Traumatol Arthrosc 31, 2192–2198 (2023). https://doi.org/10.1007/s00167-022-07275-x

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  • DOI: https://doi.org/10.1007/s00167-022-07275-x

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