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The lateral ankle ligaments are interconnected: the medial connecting fibres between the anterior talofibular, calcaneofibular and posterior talofibular ligaments

Knee Surgery, Sports Traumatology, Arthroscopy volume 28, pages 34–39 (2020)Cite this article

Abstract

Purpose

A deep knowledge of lateral ankle ligaments is necessary to understand its function, pathophysiology and treatment options. The ankle lateral collateral ligament is formed by the anterior talofibular ligament (ATFL), the calcaneofibular (CFL) and the posterior talofibular ligament (PTFL). Although previous studies have reported connections between these ligaments on its lateral side, no studies have specifically assessed connections on the medial side. The aim of this study was to assess the morphology and consistency of the medial connections between the components of the lateral collateral ligament complex of the ankle.

Methods

Forty fresh-frozen ankle specimens were dissected to look for connections between the three lateral ankle ligaments. After visualization of the lateral ligaments was achieved, the fibula was amputated and ligament insertions were released at the talar and calcaneal insertion points. Observation of the connections and video analysis of the dynamic relationships of ligament connections were performed.

Results

Connections were found in all cases between the ATFL and PTFL, the ATFL and CFL, and the CFL and PTFL. Connections between ATFL and PTFL were not homogeneous. Although connections between the ATFLif and PTFL were noted in all cases (40), only 17 ankles (42.5%) had connections between the ATFLsf and PTFL. The amount of fibres of connection was also variable.

Conclusion

Connections between the three components of the lateral collateral ligament of the ankle may be observed from the medial aspect of the ankle, and this may have important implications for arthroscopic lateral ligament repair.

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References

  1. Acevedo JI, Mangone PG (2011) Arthroscopic lateral ankle ligament reconstruction. Tech Foot Ankle Surg 10:111–116

    Article  Google Scholar 

  2. Burks RT, Morgan J (1994) Anatomy of the lateral ankle ligaments. Am J Sports Med 22(1):72–77

    CAS  Article  Google Scholar 

  3. Clanton TO, Campbell KJ, Wilson KJ, Michalski MP, Goldsmith MT, Wijdicks CA, LaPrade RF (2014) Qualitative and quantitative anatomic investigation of the lateral ankle ligaments for surgical reconstruction procedures. J Bone Jt Surg Am 96(12):e98

    Article  Google Scholar 

  4. Dalmau-Pastor M, Malagelada F, Kerkhoffs GM, Karlsson J, Guelfi M, Vega J (2019) 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. https://doi.org/10.1007/s00167-019-05603-2

    Article  PubMed  Google Scholar 

  5. Dalmau-Pastor M, Vega J (2017) Letter regarding. Foot Ankle Int 38(3):343–345

    Article  Google Scholar 

  6. Edama M, Kageyama I, Kikumoto T, Nakamura M, Ito W, Nakamura E, Hirabayashi R, Takabayashi T, Inai T, Onishi H (2018) Morphological features of the anterior talofibular ligament by the number of fiber bundles. Ann Anat 216:69–74. https://doi.org/10.1016/j.aanat.2017.11.001

    Article  PubMed  Google Scholar 

  7. Guillo S, Archbold P, Perera A, Bauer T, Sonnery-Cottet B (2014) Arthroscopic anatomic reconstruction of the lateral ligaments of the ankle with gracilis autograft. Arthrosc Tech 3(5):e593–598

    Article  Google Scholar 

  8. Hintermann B, Golano P (2014) The anatomy and function of the deltoid ligament. Tech Foot Ankle Surg 13(2):67–72

    Article  Google Scholar 

  9. Kakegawa A, Mori Y, Tsuchiya A, Sumitomo N, Fukushima N, Moriizumi T (2019) Independent attachment of lateral ankle ligaments: anterior talofibular and calcaneofibular ligaments—a cadaveric study. J Foot Ankle Surg 58(4):717–722

    Article  Google Scholar 

  10. Khawaji B, Soames R (2015) The anterior talofibular ligament: a detailed morphological study. Foot (Edinb) 25(3):141–147

    Article  Google Scholar 

  11. Kim ES, Lee KT, Park JS, Lee YK (2011) Arthroscopic anterior talofibular ligament repair for chronic ankle instability with a suture anchor technique. Orthopedics 34(4):1–5

    Google Scholar 

  12. Kumai T, Takakura Y, Rufai A, Milz S, Benjamin M (2002) The functional anatomy of the human anterior talofibular ligament in relation to ankle sprains. J Anat 200(5):457–465

    CAS  Article  Google Scholar 

  13. Markatos K, Kaseta MK, Lallos SN, Korres DS, Efstathopoulos N (2013) The anatomy of the ACL and its importance in ACL reconstruction. Eur J Orthop Surg Traumatol 23(7):747–752

    CAS  Article  Google Scholar 

  14. Milner CE, Soames RW (1998) The medial collateral ligaments of the human ankle joint: anatomical variations. Foot Ankle Int 19(5):289–292

    CAS  Article  Google Scholar 

  15. Milner CE, Soames RW (1997) Anatomical variations of the anterior talofibular ligament of the human ankle joint. J Anat 191(Pt 3):457–458

    Article  Google Scholar 

  16. Milner CE, Soames RW (1998) Anatomy of the collateral ligaments of the human ankle joint. Foot Ankle Int 19(11):757–760

    CAS  Article  Google Scholar 

  17. Nery C, Raduan F, Del Buono A, Asaumi ID, Cohen M, Maffulli N (2011) Arthroscopic-assisted Broström–Gould for chronic ankle instability: a long-term follow-up. Am J Sports Med 39(11):2381–2388

    Article  Google Scholar 

  18. Raheem OA, O’Brien M (2011) Anatomical review of the lateral collateral ligaments of the ankle: a cadaveric study. Anat Sci Int 86(4):189–193

    Article  Google Scholar 

  19. Takao M, Glazebrook M, Stone J, Guillo S (2015) Ankle arthroscopic reconstruction of lateral ligaments (ankle anti-ROLL). Arthrosc Tech 4(5):e595–e600

    Article  Google Scholar 

  20. Takao M, Matsui K, Stone J, Glazebrook M, Kennedy JG, Guillo S, Calder JD, Karlsson J, Ankle Instability Group (2016) Arthroscopic anterior talofibular ligament repair for lateral instability of the ankle. Knee Surg Sports Traumatol Arthrosc 24(4):1003–1006

    Article  Google Scholar 

  21. Vega J, Golanó P, Pellegrino A, Rabat E, Peña F (2013) All-inside arthroscopic lateral collateral ligament repair for ankle instability with a knotless suture anchor technique. Foot Ankle Int 34(12):1701–1709

    Article  Google Scholar 

  22. Vega J, Allmendinger J, Malagelada F, Guelfi M, Dalmau-Pastor M (2017) Combined arthroscopic all-inside repair of lateral and medial ankle ligaments is an effective treatment for rotational ankle instability. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-017-4736-y

    Article  PubMed  Google Scholar 

  23. Vega J, Montesinos E, Malagelada F, Baduell A, Guelfi M, Dalmau-Pastor M (2018) Arthroscopic all-inside anterior talo-fibular ligament repair with suture augmentation gives excellent results in case of poor ligament tissue remnant quality. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-5117-x

    Article  PubMed  Google Scholar 

  24. Vega J, Guelfi M, Malagelada F, Peña F, Dalmau-Pastor M (2018) Arthroscopic all-inside anterior talofibular ligament repair through a three-portal and no-ankle-distraction technique. JBJS Essent Surg Tech 8(3):e25

    Article  Google Scholar 

  25. Vega J, Malagelada F, Manzanares Céspedes MC, Dalmau-Pastor M (2018) The lateral fibulotalocalcaneal ligament complex: an ankle stabilizing isometric structure. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-5188-8

    Article  PubMed  Google Scholar 

  26. Vega J, Poggio D, Heyrani N, Malagelada F, Guelfi M, Sarcon A, Dalmau-Pastor M (2019) Arthroscopic all-inside ATiFL's distal fascicle transfer for ATFL's superior fascicle reconstruction or biological augmentation of lateral ligament repair. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05460-z

    Article  PubMed  Google Scholar 

  27. Vega J, Malagelada F, Karlsson J, Kerkhoffs GM, Guelfi M, Dalmau-Pastor M (2019) A step-by-step arthroscopic examination of the anterior ankle compartment. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05756-0

    Article  PubMed  Google Scholar 

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Affiliations

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

    M. Dalmau-Pastor, F. Malagelada, M. C. Manzanares & J. Vega

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

    M. Dalmau-Pastor & J. Vega

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

    M. Dalmau-Pastor

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

    F. Malagelada

  5. Trauma and Orthopaedics, Chelsea and Westminster Hospital, London, UK

    J. Calder

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

    J. Vega

Authors
  1. M. Dalmau-Pastor
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  2. F. Malagelada
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  3. J. Calder
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  4. M. C. Manzanares
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  5. J. Vega
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Corresponding author

Correspondence to M. Dalmau-Pastor.

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Ethical approval was obtained with IRB number IRB00003099.

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Dalmau-Pastor, M., Malagelada, F., Calder, J. et al. The lateral ankle ligaments are interconnected: the medial connecting fibres between the anterior talofibular, calcaneofibular and posterior talofibular ligaments. Knee Surg Sports Traumatol Arthrosc 28, 34–39 (2020). https://doi.org/10.1007/s00167-019-05794-8

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  • DOI: https://doi.org/10.1007/s00167-019-05794-8

Keywords

  • Anatomy
  • Ankle
  • Anterior talofibular ligament
  • Calcaneofibular ligament
  • Posterior talofibular ligament
  • Ankle lateral ligaments