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Connecting fibers between ATFL’s inferior fascicle and CFL transmit tension between both ligaments

  • ANKLE
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The lateral ligament complex of the ankle has been extensively studied. Recently an anatomical study described a connection between anterior talofibular ligament inferior fascicle (ATFLif) and calcaneofibular ligament (CFL). The applicability and the mechanical role of these connections have not yet been studied and need to be clarified. The purpose of this study is to evaluate the connection between ATFLif and CFL through a dynamic measurement analysis.

Methods

An anatomical study was performed in 13 fresh-frozen below-the-knee ankle specimens. Each specimen was dissected in a protocolized manner until the lateral ligaments were exposed. A complete injury to both ATFL’s fascicles was created in the proximal third of the ligament. A displacement transducer specifically design was inserted in the CFL and in the lateral part of the calcaneus to test its lengthening. A traction of 1 kg weight (9.8 N) was applied to ATFLif while the transducer measured the lengthening that this force created in the CFL.

Results

A total of 13 ankle specimens were carefully dissected. One specimen with signals of a prior traumatic injury of the ATFLif was excluded. A total of 12 specimens were included, 7 females and 5 males with an average age of 74 years (52–88 years). The right ankle was dissected in 6 specimens.

ATFL was identified as a two-fascicled ligament in all cases. The fibers connecting the ATFLif and CFL were observed in all specimens. The displacement transducer showed lengthening in the CFL in all measurements with a median of 0.59 mm (SD ± 0.34).

Conclusion

Connecting fibers between ATFLif and CFL are robust enough to transmit tension from one structure to the other. In the case of associated proximal lesions of the ATFLif and CFL, ligaments repair with a single suture may be considered. This can be applied in surgical procedures in patients with lateral ankle instability.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Chirurgie du Sport, Clinique du Sport Bordeaux-Mérignac, 2 rue Negrevergne, 33700, Mérignac, France

    Guillaume Cordier

  2. MIFAS By Grecmip (Minimally Invasive Foot and Ankle Society), Merignac, France

    Guillaume Cordier, Gustavo Araujo Nunes, Jordi Vega & Miki Dalmau-Pastor

  3. Hospital Santa Luzia Rede D’Or, Brasília, Distrito Federal, Brazil

    Gustavo Araujo Nunes

  4. Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, Human Anatomy Unit, University of Barcelona, Barcelona, Spain

    Gustavo Araujo Nunes, Jordi Vega & Miki Dalmau-Pastor

  5. Foot and Ankle Unit, iMove Tres Torres, Hospital Quirón Barcelona, Barcelona, Spain

    Jordi Vega

  6. Departament de Resistencia de Materials i Estructures a LʼEnginyeria, Escola Técnica Superior d’Enginyeria Industrial, Polytechnic University of Catalonia, Barcelona, Spain

    Francesc Roure

Authors
  1. Guillaume Cordier
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  2. Gustavo Araujo Nunes
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  3. Jordi Vega
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  4. Francesc Roure
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  5. Miki Dalmau-Pastor
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Correspondence to Guillaume Cordier.

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This study received Ethical approval by the ethical committee of the University of Barcelona with IRB number 00003099.

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Cordier, G., Nunes, G.A., Vega, J. et al. Connecting fibers between ATFL’s inferior fascicle and CFL transmit tension between both ligaments. Knee Surg Sports Traumatol Arthrosc 29, 2511–2516 (2021). https://doi.org/10.1007/s00167-021-06496-w

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