The lateral fibulotalocalcaneal ligament complex: an ankle stabilizing isometric structure
- 11k Downloads
Ankle lateral collateral ligament complex has been the focus of multiple studies. However, there are no specific descriptions of how these ligaments are connected to each other as part of the same complex. The aim of this study was to describe in detail the components of the lateral collateral ligament complex—ATFL and CFL—and determine its anatomical relationships.
An anatomical study was performed in 32 fresh-frozen below-the-knee ankle specimens. A plane-per-plane anatomical dissection was performed. Overdissecting the area just distal to the inferior ATFL fascicle was avoided to not alter the original morphology of the ligaments and the connecting fibers between them. The characteristics of the ATFL and CFL, as well as any connecting fibers between them were recorded. Measures were obtained in plantar and dorsal flexion, and by two different observers.
The ATFL was observed as a two-fascicle ligament in all the specimens. The superior ATFL fascicle was observed intra-articular in the ankle, in contrast to the inferior fascicle. The mean distance measured between superior ATFL fascicle insertions increases in plantar flexion (median 19.2 mm in plantar flexion, and 12.6 mm in dorsal flexion, p < 0.001), while the same measures observed in the inferior ATFL fascicle does not vary (median 10.6 mm in plantar flexion, and 10.6 mm in dorsal flexion, n.s.). The inferior ATFL fascicle was observed with a common fibular origin with the CFL. The CFL distance between insertions does not vary with ankle movement (median 20.1 mm in plantar flexion, and 19.9 mm in dorsal flexion, n.s.). The inferior ATFL fascicle and the CFL were connected by arciform fibers, that were observed as an intrinsic reinforcement of the subtalar joint capsule.
The superior fascicle of the ATFL is a distinct anatomical structure, whereas the inferior ATFL fascicle and the CFL share some features being both isometric ligaments, having a common fibular insertion, and being connected by arciform fibers, and forming a functional and anatomical entity, that has been named the lateral fibulotalocalcaneal ligament (LFTCL) complex. The clinical relevance of this study is that the superior fascicle of the ATFL is anatomical and functionally a distinct structure from the inferior ATFL fascicle. The superior ATFL fascicle is an intra-articular ligament, that will most probably not be able to heal after a rupture, and a microinstability of the ankle is developed. However, when the LFTCL complex is injured, classical ankle instability resulted. In addition, because of the presence of LFTCL complex, excellent results are observed when an isolated repair of the ATFL is performed even when an injury of both the ATFL and CFL exists.
KeywordsAnkle ligaments Anatomy Ankle instability Microinstability Ankle lateral collateral ligament complex
No funding was received for this research project.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
Ethical approval was obtained with IRB number 00003099.
- 6.Edama M, Kageyama I, Kikumoto T, Nakamura M, Ito W, Nakamura E, Hirabayashi R, Takabayashi T, Inai T, Onishi H (2017) Morphological features of the anterior talofibular ligament by the number of fiber bundles. Ann Anat 28:69–74Google Scholar
- 10.Golanó P, Dalmau-Pastor M, Vega J, Batista JP (2014) The ankle in football, sports and traumatology: anatomy of the ankle. In: D’Hooghe PPRN, Kerkhoffs GMMJ. 1st edn. Springer, Paris, pp 1–24Google Scholar
- 21.Renstrom FH, Lynch SA (1999) Acute injuries of the ankle. Foot Ankle Clin 4:697–711Google Scholar
- 22.Sarrafian SK (1993) Anatomy of the foot and ankle, 2nd edn. JB Lippincott, Philadelphia, pp 159–217Google Scholar
- 25.Trouilloud P, Dia A, Grammont P, Gelle MC, Autissier JM (1988) Variations du ligament calcaneo-fibulaire. Aplications à la cinématique de la cheville (Variations in the calcaneofibular ligament. Applications to ankle kinetics). Bull Assoc Anat 72:31–35Google Scholar
- 28.Vega J, Rabat E (2013) Innovations in chronic ankle instability. Rev Cir Pie 27(2):71–79Google Scholar