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The ATFL inferior fascicle, the CFL and the PTFL have a continuous footprint at the medial side of the fibula

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

Abstract

Purpose

Knowledge of the complex anatomy of the lateral ankle ligaments is essential to understand its function, pathophysiology and treatment options. This study aimed to assess the lateral ligaments and their relationships through a 3D view achieved by digitally marking their footprints.

Methods

Eleven fresh-frozen ankle specimens were dissected. The calcaneus, talus and fibula were separated, maintaining the lateral ligament footprints. Subsequently, each bone was assessed by a light scanner machine. Finally, all the scans were converted to 3D polygonal models. The footprint areas of the talus, calcaneus and fibula were selected, analysed and the surface area was quantified in cm2.

Results

After scanning the bones, the anterior talofibular ligament inferior fascicle (ATFLif), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL) footprints were continuous at the medial side of the fibula, corresponding to a continuous footprint with a mean area of 4.8 cm2 (± 0.7). The anterior talofibular ligament (ATFL) footprint on the talus consisted of 2 parts in 9 of the 11 feet, whilst there was a continuous insertion in the other 2 feet. The CFL insertion on the calcaneus was one single footprint in all cases.

Conclusion

The tridimensional analysis of the lateral ligaments of the ankle demonstrates that the ATFLif, CFL and PTFL have a continuous footprint at the medial side of the fibula in all analysed specimens. These data can assist the surgeon in interpreting the ligament injuries, improving the imaging assessment and guiding the surgeon to repair and reconstruct the ligaments in an anatomical position.

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Data availability

The datasets generated during the current study are available from the corresponding author on reasonable request.

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Funding

All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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Authors and Affiliations

  1. Foot and Ankle Unit, COTE Brasília Clinic, Conj. 16, SHIS QI 5 - Lago Sul, Brasília, Brasília, DF, 70390-150, Brazil

    Gustavo Araujo Nunes

  2. MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France

    Gustavo Araujo Nunes, Guillaume Cordier, Frederick Michels, Jordi Vega & Miki Dalmau-Pastor

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

    Gustavo Araujo Nunes, Jordi Vega & Miki Dalmau-Pastor

  4. Departament de Biologia Evolutiva, Facultat de Biologia, Ecologia i Ciències Ambientals, Universitat de Barcelona, Avd. Diagonal 643.08028, Barcelona, Spain

    Laura Monica Martinez

  5. Institut d’Arqueologia de la Universitat de Barcelona, Carrer de Montalegre, 8, 08001, Barcelona, Spain

    Laura Monica Martinez

  6. Sport Surgery-Foot and Ankle-Clinique du Sport, Bordeaux Merignac, Merignac, France

    Guillaume Cordier

  7. Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500, Kortrijk, Belgium

    Frederick Michels

  8. CiR Clinica de Podologia, Carrer d’Alacant, 30 08022, Barcelona, Spain

    Raquel Sanchez Moreno

Authors
  1. Gustavo Araujo Nunes
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  2. Laura Monica Martinez
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  3. Guillaume Cordier
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  4. Frederick Michels
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  5. Jordi Vega
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  6. Raquel Sanchez Moreno
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  7. Miki Dalmau-Pastor
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection and analysis were performed by: GAN, GC, RSM, FM, MD, JV and LMM. GAN wrote the first draft of the manuscript, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gustavo Araujo Nunes.

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Conflict of interest

The authors declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article. ICMJE forms for all authors are available online.

Ethical approval

The ethical committee of the University of Barcelona, with IRB number 00003099, approved this anatomical study.

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Nunes, G.A., Martinez, L.M., Cordier, G. et al. The ATFL inferior fascicle, the CFL and the PTFL have a continuous footprint at the medial side of the fibula. Knee Surg Sports Traumatol Arthrosc 31, 5207–5213 (2023). https://doi.org/10.1007/s00167-023-07556-z

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  • DOI: https://doi.org/10.1007/s00167-023-07556-z

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