Surgical and Radiologic Anatomy

, Volume 28, Issue 4, pp 391–397 | Cite as

Anatomy of lateral ankle ligaments and their relationship to bony landmarks

Original Article


This study was designed to determine and describe precise anatomy of the lateral ankle ligaments and their relationship to adjacent osseous structures. This study was performed on 42 legs of 22 adult human embalmed cadavers. The lateral ankle ligaments were carefully dissected using a 2.5× surgical loupe. Mean values for the length, width and angle of the individual lateral ankle ligaments were measured. The precise location of insertion points and course of each ligament was observed and noted with ankle placed in neutral position. The anterior talofibular and calcaneofibular ligaments were coated with radio-opaque material. Radiographs were then taken in the anteroposterior, mortise and lateral projections. The anterior talofibular ligament (ATFL) was a flat, quadrilateral ligament and it made mean angle of 25° (range 5°–45°) with horizontal plane, and a mean angle of 47° (range 45°–56°) with sagittal plane. The posterior talofibular ligament was oriented in a nearly horizontal plane. Calcaneofibular ligament (CFL) was a flat oval ligament. It made a mean angle of 40° (range 30°–58°) with horizontal plane, and mean angle of 51° (range 32°–60°) with sagittal plane. The angle between CFL and ATFL was approximately 132° (range 118°–145°). These data provides important information for diagnosing injury and reconstructing lateral ankle ligaments.


Anterior talofibular ligament Posterior talofibular ligament Calcaneofibular ligament Lateral ankle ligaments Ankle sprints Quantitative radiography 


  1. 1.
    Anderson ME (1985) Reconstruction of the lateral ligaments of the ankle using the plantaris tendon. J Bone Joint Surg Am 67(6):930–934PubMedGoogle Scholar
  2. 2.
    Brostrom L (1965) Sprained ankles. 3. Clinical observations in recent ligament ruptures. Acta Chir Scand 130(6):560–569PubMedGoogle Scholar
  3. 3.
    Burks RT, Morgan J (1994) Anatomy of the lateral ankle ligaments. Am J Sports Med 22(1):72–77PubMedCrossRefGoogle Scholar
  4. 4.
    Clanton TO (1989) Instability of the subtalar joint. Orthop Clin North Am 20(4):583–592PubMedGoogle Scholar
  5. 5.
    Cox JS (1985) Surgical and nonsurgical treatment of acute ankle sprains. Clin Orthop Relat Res 198:118–126PubMedGoogle Scholar
  6. 6.
    Dunlop MG, Beattie TF, White GK et al (1986) Guidelines for selective radiological assessment of inversion ankle injuries. Br Med J (Clin Res Ed):293(6547):603–605CrossRefGoogle Scholar
  7. 7.
    Garrick JG (1977) The frequency of injury, mechanism of injury, and epidemiology of ankle sprains. Am J Sports Med 5(6):241–242PubMedCrossRefGoogle Scholar
  8. 8.
    Gerber JP, Williams GN, Scoville CR et al (1998) Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int 19(10):653–660PubMedGoogle Scholar
  9. 9.
    Kaye JJ, Bohne WHO (1977) A radiographic study of the ligamentous anatomy of the ankle. Radiology 125:659–667PubMedGoogle Scholar
  10. 10.
    Kjaersgaard-Andersen P, Wethelund JO, Nielsen S (1987) Lateral talocalcaneal instability following section of the calcaneofibular ligament: a kinesiologic study. Foot Ankle 7(6):355–361PubMedGoogle Scholar
  11. 11.
    Kumai T, Takamura Y, Rufai A et al (2002) The functional anatomy of the human anterior talofibular ligament in relation to ankle sprains. J Anat 200:457–465PubMedCrossRefGoogle Scholar
  12. 12.
    Laidlaw PL (1904) The varieties of the os calcis. J Anat Physiol 38:138Google Scholar
  13. 13.
    Lassiter TE Jr, Malone TR, Garrett WE Jr (1989) Injury to the lateral ligaments of the ankle. Orthop Clin North Am 20(4):629–640PubMedGoogle Scholar
  14. 14.
    McDermott JE, Scranton PE Jr, Rogers JV (2004) Variations in fibular position, talar length, and anterior talofibular ligament length. Foot Ankle Int 25(9):625–629PubMedGoogle Scholar
  15. 15.
    Milner CE, Soames RW (1997) Anatomical variations of the anterior talofibular ligament of the ankle joint. J Anat 191:457–458PubMedCrossRefGoogle Scholar
  16. 16.
    Milner CE, Soames RW (1998) Anatomy of the collateral ligaments of the human ankle joint. Foot Ankle Int 19(11):757–760PubMedGoogle Scholar
  17. 17.
    Muhle C, Frank LR, Rand T et al (1999) Collateral ligaments of the ankle: high-resolution MR imaging with a local gradient coil and anatomic correlation in cadavers. Radiographics 19(3):673–683PubMedGoogle Scholar
  18. 18.
    Ruth CJ (1961) The surgical treatment of injuries of the fibular collateral ligaments of the ankle. J Bone Joint Surg Am 43-A(2):229–239Google Scholar
  19. 19.
    Sarrafian SK (1983) Syndesmology. In: anatomy of the foot and ankle. Lippincott, Philadelphia, pp 148–157Google Scholar
  20. 20.
    Schneck CD, Mesgarzadeh M, Bonakdarpour A et al (1992) MR imaging of the most commonly injured ankle ligaments. Part I. Normal anatomy. Radiology 184(2):499–506PubMedGoogle Scholar
  21. 21.
    Siegler S, Block J, Schneck CD (1988) The mechanical characteristics of the collateral ligaments of the human ankle joint. Foot Ankle 8(5):234–242PubMedGoogle Scholar
  22. 22.
    Testut L, Latarjet A (1918) Traite d’Anatomie Humaine, 9th edn. Doin & Cie, Patis, pp 711–715Google Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Figen Taser
    • 1
  • Qaiser Shafiq
    • 1
  • Nabil A. Ebraheim
    • 1
  1. 1.Department of Orthopaedic SurgeryMedical University of OhioToledoUSA

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