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How to drill the talar tunnel in ATFL reconstruction?

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Reconstruction of the anterior talofibular ligament may be indicated in cases of residual instability after conservative treatment. Often, a bone tunnel is used for fixation in the talar bone. The purpose of this study is to evaluate possible routes for drilling the talar tunnel.

Methods

Virtual tunnels were generated in a 3D bone model, oriented towards the following external landmarks: the talar neck, the most anterior point of the medial malleolus (MM), the most distal point of the MM, the most medial point of the MM, and the most posterior point of the MM. The parameters analysed for tunnels with lengths of 20, 25, and 30 mm were the maximum distance inside the bone and the distance from the tunnel to the bone surface. A minimal safe distance (MSD) was calculated for a tunnel with a diameter of 5 mm.

Results

The shortest measured distance before arriving outside the talar bone was 16.7 mm. The longest distances were obtained in the tunnels oriented towards the talar neck (mean value of 36.6, SD 2.8) and towards the most posterior point of the MM (mean value of 35.8, SD 0.3). Only one tunnel, measuring 20 mm in depth and oriented towards the most posterior point of the MM, revealed no individual values below the MSD.

Conclusion

External landmarks are useful for drilling a talar tunnel during reconstruction of the anterior talofibular ligament. Only one tunnel, oriented towards the most posterior point of the MM, measuring 5 mm in diameter and with a maximum depth of 20 mm, was safe in all individuals. Surgeons should be aware of these limits when treating patients with ankle instability.

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Acknowledgments

This research was supported by the Materialise Chair Handsurgery Kortrijk.

Author information

Authors and Affiliations

  1. Orthopaedic Department, AZ Groeninge Kortrijk, Burg Vercruysselaan 5, 8500, Kortrijk, Belgium

    Frederick Michels

  2. Orthopaedic Department, Mérignac Sport Clinic, 2, Rue Georges Negrevergne, 33700, Mérignac, France

    Stéphane Guillo

  3. Radiology Department, AZ Groeninge Kortrijk, Burg Vercruysselaan 5, 8500, Kortrijk, Belgium

    Frederik Vanrietvelde

  4. Radiology Department, AZ Groeninge Kortrijk, President Kennedylaan 4, 8500, Kortrijk, Belgium

    Eddy Brugman

  5. Orthopaedic Department, AZ Groeninge Kortrijk, Loofstraat 43, 8500, Kortrijk, Belgium

    Filip Stockmans

  6. Department of Development and Regeneration, Faculty of Medicine, University of Leuven Campus Kortrijk, Etienne Sabbelaan 53, 8500, Kortrijk, Belgium

    Filip Stockmans

Authors
  1. Frederick Michels
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  2. Stéphane Guillo
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  3. Frederik Vanrietvelde
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  4. Eddy Brugman
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  5. Filip Stockmans
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Ankle Instability Group

Corresponding author

Correspondence to Frederick Michels.

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No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Additional information

Ankle Instability Group, members are as follows: J. Batista, T. Bauer, J. Calder, W. J. Choi, A. Ghorbani, M. Glazebrook, S. Guillo, J. Karlsson, S. W. Kong, J. W. Lee, P. G. Mangone, F. Michels, A. Molloy, C. Nery, S. Ozeki, C. Pearce, A. Perera, H. Pereira, B. Pijnenburg, F. Raduan, J. W. Stone, M. Takao, Y. Tourné.

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Michels, F., Guillo, S., Vanrietvelde, F. et al. How to drill the talar tunnel in ATFL reconstruction?. Knee Surg Sports Traumatol Arthrosc 24, 991–997 (2016). https://doi.org/10.1007/s00167-016-4018-0

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  • DOI: https://doi.org/10.1007/s00167-016-4018-0

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