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Bony landmarks available for minimally invasive lateral ankle stabilization surgery: a cadaveric anatomical study

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

Abstract

Purpose

The purpose of this study was to determine the clinical utility of three bony tubercles: fibular obscure tubercle, talar obscure tubercle and tuberculum ligamenti calcaneofibularis, to serve as anatomical landmarks for defining the precise location of the origins and insertions of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL).

Methods

Twelve lower extremity cadaveric specimens were procured. The detectability of the tubercles was tested using palpation and fluoroscopy with subsequent confirmation after dissection. If the tubercles were present, then distances from the identified tubercles to the footprint centres and the intersection of the ATFL and CFL were measured to allow precise localization of the ATFL and CFL origin and intersection sites. Further, if the tubercles were not detectable, then an attempt to provide an alternative means of localizing ATFL and CFL origin and insertion sites was made by measuring distances between alternative landmarks and other important structures. All the measurements were performed by two researchers, and the results were averaged.

Results

The fibular obscure tubercle existed and was detectable in all specimens. It was located 1.3 mm proximal to the articular tip of the fibula, 2.7 mm to the intersection of the ATFL and CFL, 3.7 mm distal to the ATFL and 4.9 mm proximal to the CFL origins. The talar obscure tubercle existed 58 % of specimens and was detectable in 57 %. The talar obscure tubercle was located 1.4 mm to the ATFL. The ATFL insertion point was located 60 % of the distance from the inferolateral corner to the anterolateral corner of the of talar body along the anterior border of the talar lateral articular facet. The tuberculum ligamenti calcaneofibularis existed in 33 % of specimens and was detectable in 8 %. The CFL inserted 17 mm on a perpendicular projected line distal from the subtalar joint.

Conclusions

The fibular obscure tubercle was clinically relevant and reliable bony landmark of the ATFL and CFL origin location. However, the talar obscure tubercle was less reliable and the tuberculum ligamenti calcaneofibularis was rarely available and as such alternative landmarks for the ATFL and CFL insertion location should be utilized. The present study describes the utility of clinically relevant bony landmarks that may assist in identifying the origins and insertions of the ATFL and CFL to facilitate minimally invasive ankle stabilization surgery.

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Abbreviations

FOT:

Fibular obscure tubercle

TOT:

Talar obscure tubercle

TLC:

Tuberculum ligamenti calcaneofibularis

ATFL:

Anterior talofibular ligament

CFL:

Calcaneofibular ligament

CAI:

Chronic ankle instability

MIS:

Minimally invasive ankle stabilization surgery

AL:

Anterolateral

IL:

Inferolateral

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Acknowledgments

We thank Prof. Mariano Monzo and his Surgical Skills Lab at University of Barcelona for support in this study.

European Society of Sports Traumatolgy, Knee surgery and Arthroscopy Ankle and Foot Associates Ankle Instability Group

Jorge Batista, Thomas Bauer, James Calder, Woo Jin Choi, Ali Ghorbani, Mark Glazebrook, Stéphane Guillo, Siu Wah Kong, Jon Karlsson, Jin Woo Lee, Peter G. Mangone, Frederick Michels, Andy Molloy, Caio Nery, Satoru Ozeki, Christopher Pearce, Anthony Perera, Hélder Pereira, Bas Pijnenburg, Fernando Raduan, James W. Stone, Masato Takao, Yves Tourné.

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Authors and Affiliations

  1. Queen Elizabeth II Health Sciences Center Halifax Infirmary (Suite 4867), Dalhousie University, 1796 Summer Street, Halifax, NS, B3H3A7, Canada

    Kentaro Matsui & Mark Glazebrook

  2. Department of Orthopaedic Surgery, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan

    Kentaro Matsui

  3. Department of Human Anatomy, Dissection Room, Faculty of Medicine, University of Barcelona, Calle Casanova, 143, 08038, Barcelona, Spain

    Xavier Martin Oliva

  4. Foot and Ankle Surgery, Remei Hospital, Barcelona, Spain

    Xavier Martin Oliva

  5. Department of Orthopaedic Surgery, Teikyo Institute of Sports Science and Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan

    Masato Takao

  6. Department of Sport and Medical Science, Teikyo Institute of Sports Science and Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan

    Masato Takao

  7. Orthopedic Surgery Department, Hospital de Braga, Sete Fontes – São Victor, 4710-243, Braga, Portugal

    Bruno S. Pereira

  8. University of Barcelona, Calle Casanova, 143, 08038, Barcelona, Spain

    Tiago Mota Gomes & Jan Martinez Lozano

Authors
  1. Kentaro Matsui
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  2. Xavier Martin Oliva
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  3. Masato Takao
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  4. Bruno S. Pereira
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  7. Mark Glazebrook
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Consortia

ESSKA AFAS Ankle Instability Group

  • Jorge Batista
  • , Thomas Bauer
  • , James Calder
  • , Woo Jin Choi
  • , Ali Ghorbani
  • , Mark Glazebrook
  • , Stéphane Guillo
  • , Siu Wah Kong
  • , Jon Karlsson
  • , Jin Woo Lee
  • , Peter G. Mangone
  • , Frederick Michels
  • , Andy Molloy
  • , Caio Nery
  • , Satoru Ozeki
  • , Christopher Pearce
  • , Anthony Perera
  • , Hélder Pereira
  • , Bas Pijnenburg
  • , Fernando Raduan
  • , James W. Stone
  • , Masato Takao
  •  & Yves Tourné

Corresponding author

Correspondence to Kentaro Matsui.

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Matsui, K., Oliva, X.M., Takao, M. et al. Bony landmarks available for minimally invasive lateral ankle stabilization surgery: a cadaveric anatomical study. Knee Surg Sports Traumatol Arthrosc 25, 1916–1924 (2017). https://doi.org/10.1007/s00167-016-4218-7

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  • DOI: https://doi.org/10.1007/s00167-016-4218-7

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