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Redefining anterior ankle arthroscopic anatomy: medial and lateral ankle collateral ligaments are visible through dorsiflexion and non-distraction anterior ankle arthroscopy

Knee Surgery, Sports Traumatology, Arthroscopy volume 28, pages 18–23 (2020)Cite this article

Abstract

Purpose

A thorough understanding of the arthroscopic anatomy is important to recognise pathological conditions. Although some ankle ligaments have been described as intra-articular structures, no studies have assessed the full visibility of these structures. The purpose of this study was to assess arthroscopic visibility of medial and lateral ankle collateral ligaments.

Methods

Arthroscopy was performed in 20 fresh frozen ankles. The arthroscope was introduced through the anteromedial portal and the anterior compartment was explored in ankle dorsiflexion without distraction. Intra-articular structures were tagged using a suture-passer introduced percutaneously and they were listed in a table according to the surgeon’s identification. After the arthroscopic procedure, the ankles were dissected to identify the suture-tagged structures.

Results

According to the suture-tagged structures, 100% correlation was found between arthroscopy and dissection. In the anterior compartment, the superior fascicle of the anterior talofibular ligament, the distal fascicle of the anterior tibiofibular ligament and the anterior tibiotalar ligament on the medial side were observed. The deep fascicle of the posterior tibiofibular ligament and the intermalleolar ligament were tagged at the posterior compartment.

Conclusion

Ankle dorsiflexion and non-distraction arthroscopic technique allows full visualisation of the medial and lateral ankle collateral ligaments: the superior fascicle of the anterior talofibular ligament, the distal fascicle of the anterior tibiofibular ligament and the anterior tibiotalar ligament. When using distraction, posterior structures as the deep fascicle of the posterior tibiofibular ligament and the intermalleolar ligament can be observed with anterior arthroscopy.

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Funding

No external funding was used for this study.

Author information

Affiliations

  1. Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain

    Miki Dalmau-Pastor, F. Malagelada & J. Vega

  2. GRECMIP-MIFAS (Groupe de Recherche et d’Étude en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), Merignac, France

    Miki Dalmau-Pastor & J. Vega

  3. Vilamèdic Medical Center, Santa Coloma de Gramanet, Barcelona, Spain

    Miki Dalmau-Pastor

  4. Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK

    F. Malagelada

  5. Department of Orthopedic Surgery, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Amsterdam, The Netherlands

    G. M. Kerkhoffs

  6. Academic Center for Evidence-based Sports medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands

    G. M. Kerkhoffs

  7. Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands

    G. M. Kerkhoffs

  8. Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden

    J. Karlsson

  9. Foot and Ankle Unit, Clinica Montallegro, Genoa, Italy

    M. Guelfi

  10. Human Anatomy and Embryology Unit, Department of Morphological Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain

    M. Guelfi

  11. Foot and Ankle Unit, iMove Tres Torres, Barcelona, Spain

    J. Vega

Authors
  1. Miki Dalmau-Pastor
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  2. F. Malagelada
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  3. G. M. Kerkhoffs
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  4. J. Karlsson
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  5. M. Guelfi
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  6. J. Vega
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Corresponding author

Correspondence to Miki Dalmau-Pastor.

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IRB approval was obtained at our institution with IRB number 00003099.

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Dalmau-Pastor, M., Malagelada, F., Kerkhoffs, G.M. et al. Redefining anterior ankle arthroscopic anatomy: medial and lateral ankle collateral ligaments are visible through dorsiflexion and non-distraction anterior ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc 28, 18–23 (2020). https://doi.org/10.1007/s00167-019-05603-2

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  • DOI: https://doi.org/10.1007/s00167-019-05603-2

Keywords

  • Arthroscopy
  • Anatomy
  • Ankle
  • Anterior talofibular ligament
  • Deltoid ligament
  • Intermalleolar ligament