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Relationship between inferior fascicle of anterior talofibular ligament and articular capsule in lateral ankle ligament complex

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Abstract

Purpose

The lateral ankle ligament complex (LALC) is composed of anterior talofibular (ATFL), calcaneofibular (CFL), and posterior talofibular (PTFL) ligaments, all of which have a connection/continuous fiber. However, the structural link between the LALC and the articular capsule remains unknown. The goal of our study was to determine the connection between ATFL’s inferior fascicle and the articular capsule.

Methods

In this study, we utilized 84 formalin-fixed ankles to elucidate the structure of LALC. Between ATFL and CFL, the bundle number of ATFL and arciform fiber was investigated. The specimens were decalcified and sectioned coronally using a freezing microtome, in the case of double bundles of ATFL, to study the connection between the inferior fascicle of ATFL and the articular capsule.

Results

ATFL had a single (25%), double (74%), and triple (1%) bundle number, respectively. The arciform fiber connecting the ATFL and the CFL was found in the superficial layer of all ankles (100%). There were two types of relationships between the inferior fascicle of ATFL and the articular capsule: 36 ankles (58%) were extracapsular, and 26 of 62 ankles (42%) were integrated with the inferior-lateral articular capsule. There are two kinds of relationships between the inferior fascicle of the ATFL and the articular capsule: extracapsular and integrated-capsular.

Conclusions

The inferior fascicle of ATFL has a variant and integrated-capsular type is reinforced inferior-lateral articular capsule and enters the joint to form continuous fibers with PTFL, making LALC. These anatomical findings are helpful in ultrasonography diagnosis and arthroscopic ankle surgery.

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Acknowledgements

The authors sincerely thank those who donated their bodies to science, so that anatomical research could be performed.

Funding

This study was partly supported by a research grant from Teikyo Heisei University (Grant Number: 20THU005).

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Authors and Affiliations

  1. Faculty of Health Care, Teikyo Heisei University, 2-51-4 Higashi-ikebukuro, Toshimaku, Tokyo, 170-8445, Japan

    Akira Kakegawa

  2. Department of Anatomy, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan

    Akira Kakegawa, Nanae Fukushima, Norimi Sumitomo, Ayata Nagira, Yuko Ichinose & Tetsuji Moriizumi

Authors
  1. Akira Kakegawa
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  2. Nanae Fukushima
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  3. Norimi Sumitomo
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  4. Ayata Nagira
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  5. Yuko Ichinose
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  6. Tetsuji Moriizumi
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Contributions

AK: study design, data collection, data analysis, and manuscript writing. NF: data collection, data analysis, and manuscript writing. NS, AN, YI, and TM: data collection and critical revisions to the manuscript. All authors read and approved the final manuscript prior to submission.

Corresponding author

Correspondence to Akira Kakegawa.

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Conflict of interest

All authors declare that have no conflict of interest regarding this study.

Ethical approval

This study protocol was approved by the Institutional Review Board of Shinshu University, Matsumoto, Nagano Prefecture, Japan (Approval No. 4340) and Teikyo Hisei University, Toshima-ku, Tokyo, Japan (Approval No. R01-022).

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Informed consent of anatomical study was obtained from the families of the donated cadavers.

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Kakegawa, A., Fukushima, N., Sumitomo, N. et al. Relationship between inferior fascicle of anterior talofibular ligament and articular capsule in lateral ankle ligament complex. Surg Radiol Anat 44, 253–259 (2022). https://doi.org/10.1007/s00276-021-02851-1

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  • DOI: https://doi.org/10.1007/s00276-021-02851-1

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