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The calcaneofibular ligament has distinct anatomic morphological variants: an anatomical cadaveric study

Abstract

Purpose

The purpose of this study was to investigate if the calcaneofibular ligament (CFL) presents morphologic variants and measure the morphometrics of the ligament and its footprints

Methods

An anatomical study of 47 fresh-frozen below-the-knee ankle specimens was performed. Lateral ankle structures were dissected to expose the CFL. Overdissection was avoided to not modify the native morphology. The morphology (number and orientation of CFL bundles) and measurements of CFL insertions were recorded with ankle secured in neutral position.

Results

Four distinct morphological-oriented shapes of the CFL were observed. These included single bundle, Y-shape double bundle, V-shape double bundle, and associated with the lateral talocalcaneal ligament. The most frequent CFL morphology observed was the single bundle and the Y-shape double bundle, present in 21 (44.7%) and 13 (27.7%) ankles. The V-shape double bundle and the CFL double bundle associated with the lateral talocalcaneal ligaments were less common, appearing only in eight (17.0%) and five (10.6%) ankles. The CFL length was higher in single bundle and Y-shaped double bundle CFL variants, about 30 mm each. Footprint morphometrics were heterogenous amongst the different CFL variants.

Conclusion

The CFL presents four distinct morphological-oriented shapes. The double bundle, V-shaped and Y-shaped CFL variants are uncommon and poorly reported in the literature. Their relation to the lateral talocalcaneal ligament and the inferior fascicle of the anterior talofibular ligament requires further research. The CFL morphology provides detailed knowledge of CFL anatomy that can improve diagnostic procedures. Furthermore, this information can fine-tune graft selection and sizing and allow a more precise anatomic placement during surgical reconstruction.

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All the authors contributed substantially to conception and design, or acquisition of data, or analysis and interpretation of data; drafted the article or revised it critically for important intellectual content; provided the final approval of the version to be published; and agreed to act as guarantor of the work (ensuring that questions related to any part of the work are appropriately investigated and resolved).

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Correspondence to Bruno S. Pereira.

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Pereira, B.S., van Dijk, C.N., Andrade, R. et al. The calcaneofibular ligament has distinct anatomic morphological variants: an anatomical cadaveric study. Knee Surg Sports Traumatol Arthrosc 28, 40–47 (2020). https://doi.org/10.1007/s00167-019-05797-5

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  • DOI: https://doi.org/10.1007/s00167-019-05797-5

Keywords

  • Ankle ligaments
  • Anatomy
  • Ankle instability
  • Anatomic reconstruction
  • Calcaneofibular ligament