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Dorsiflexion is more feasible than plantar flexion in ultrasound evaluation of the calcaneofibular ligament: a combination study of ultrasound and cadaver

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Ultrasound (US) is a valuable tool for the evaluation of chronic lateral instability of the ankle; however, the feasibility of US for calcaneofibular ligament (CFL) assessment remains unknown. This study aimed to depict and compare CFL on US in various ankle positions to determine the optimal method for evaluating CFL with US and to interpret US findings using cadaveric specimens.

Methods

The US study included 43 ankles of 25 healthy individuals. The CFL was scanned with US in 20° plantar flexion, neutral position, 20° dorsiflexion and maximum dorsiflexion. The distances between fibula and CFL were compared. The cadaveric study included macroscopic qualitative observation of the dynamic change of CFL in 7 ankles and quantitative observation of the directions of CFL and footprints in 17 ankles.

Results

In the US study, the mean distance (mm) between fibula and CFL was 7.3 ± 1.3 in 20° plantar flexion, 6.7 ± 1.6 in neutral position, 4.3 ± 2.5 in 20° dorsiflexion and 3.1 ± 2.1 in maximum dorsiflexion. The more dorsiflexed the ankle was, the shorter the distance between fibula and CFL was (Jonckheere’s trend test p < 0.001). In the cadaveric study, the CFL fibres were aligned parallel between the mid-substance and the fibular attachment in maximum dorsiflexion, whilst CFL was reflected and rotated in plantar flexion.

Conclusions

The whole length of the CFL, including its fibular attachment, is more likely to be visualized with US in dorsiflexion than in plantar flexion due to the direction of the CFL at the fibular attachment, which is parallel with the mid-substance in maximum dorsiflexion.

Level of evidence

IV.

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Acknowledgements

This study was partly supported by a grant from JA Kyosai Research Institute (Agricultural Cooperative Insurance Research Institute).

Funding

This study was partly supported by a grant from JA Kyosai Research Institute (Agricultural Cooperative Insurance Research Institute).

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Authors and Affiliations

  1. Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Soichi Hattori, Kentaro Amaha & Keiichi Akita

  2. Department of Sports Medicine, Kameda Medical Center, Kamogawa, Japan

    Soichi Hattori, Minoru Koyama & Hiroshi Ohuchi

  3. Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Akimoto Nimura & Masahiro Tsutsumi

Authors
  1. Soichi Hattori
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  2. Akimoto Nimura
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  3. Minoru Koyama
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  4. Masahiro Tsutsumi
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  5. Kentaro Amaha
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  6. Hiroshi Ohuchi
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  7. Keiichi Akita
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Correspondence to Akimoto Nimura.

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All authors declare that they have no conflict of interest.

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All procedures performed on human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Hattori, S., Nimura, A., Koyama, M. et al. Dorsiflexion is more feasible than plantar flexion in ultrasound evaluation of the calcaneofibular ligament: a combination study of ultrasound and cadaver. Knee Surg Sports Traumatol Arthrosc 28, 262–269 (2020). https://doi.org/10.1007/s00167-019-05630-z

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