scholarly journals The Location of the Fibular Tunnel for Anatomically Accurate Reconstruction of the Lateral Ankle Ligament: A Cadaveric Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Jeong-Hyun Park ◽  
Hyung-Wook Kwon ◽  
Digud Kim ◽  
Kwang-Rak Park ◽  
Mijeong Lee ◽  
...  
Keyword(s):  
Double Bundle ◽  
Single Bundle ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Lateral Ankle ◽  
Bony Landmarks ◽  
Ankle Ligament ◽  
Significant Difference ◽  
Lateral Ankle Ligament ◽  
Accurate Reconstruction

We aimed to describe the location of fibular footprint of each anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), as well as their common origin in relation to bony landmarks of the fibula in order to determine the location of the fibular tunnel. In 105 ankle specimens, the center of the footprints of the ATFL and CFL (cATFL and cCFL, respectively) and the intersection point of their origin (intATFL-CFL) were investigated, and the distances from selected bony landmarks (the articular tip (AT) and the inferior tip (IT) of the fibula) were measured. Forty-two (40%) specimens had single-bundle ATFL, and 63 (60%) had double-bundle patterns. The distance between intATFL-CFL and IT was 12.0 ± 2.5   mm , and a significant difference was observed between the two groups ( p = 0.001 ). Moreover, the ratio of the intATFL-CFL location based on the anterior fibular border for all cadavers was 0.386. The present study suggests a reference ratio that can help surgeons locate the fibular tunnel for a more anatomically accurate reconstruction of the lateral ankle ligament. Also, it may be necessary to make a difference in the location of the fibular tunnel according to the number of ATFL bundles during surgery.

scholarly journals A Case Report of Tarsal Navicular Body Fracture with Lateral Ankle Ligament Complex Tear – a New Injury Combination

2021 ◽  
Vol 11 (8) ◽  
Author(s):  
Ankur Singh ◽  
Peter Gföller ◽  
Patryk Ulicki
Keyword(s):  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Mri Scan ◽  
Rare Injury ◽  
Lateral Ankle ◽  
Body Fracture ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
Tarsal Navicular Bone ◽  
Lateral Ankle Ligament Complex

Introduction: Fractures of tarsal navicular bone are a rare injury. A navicular fracture can occur either in isolation or associated with other bony or ligamentous injuries, depending on the severity and mechanism of trauma at the time of impact. We report a previously undescribed injury combination of navicular fracture with tear of the lateral ankle ligament complex. Case Report: An 18-year-old professional long jump athlete presented with a history of twisting injury immediately before taking off, while attempting a jump. A detailed clinical examination and radiological assessment with computed tomography (CT) and magnetic resonance imaging (MRI) scan were performed. She was diagnosed to have a navicular body fracture with complete rupture of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Acute fixation of navicular body fracture along with primary repair of ATFL and CFL was done. The final outcome of the patient was good with return to unrestricted physical activities after 4 months. Conclusion: A new injury combination of navicular fracture along with lateral ankle ligament complex tear is reported in a professional athlete. A high index of clinical suspicion and early detection using CT and MRI scan can identify this rare injury combination. Surgical treatment can result in favorable outcomes. Keywords: Tarsal navicular bone, fracture, anterior talofibular ligament, calcaneofibular ligament, computed tomography scan, magnetic resonance imaging scan.

scholarly journals Biomechanics of Ankle Ligament Reconstruction: A Cadaveric Study to Compare Stability of Reconstruction Techniques Using 1 or 2 Fibular Tunnels

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095928
Author(s):  
Martina Gautschi ◽  
Elias Bachmann ◽  
Camila Shirota ◽  
Tobias Götschi ◽  
Niklas Renner ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Ankle Instability ◽  
Intraoperative Complications ◽  
Lateral Ankle ◽  
Ankle Stability ◽  
Ankle Ligament ◽  
Significant Difference ◽  
Tunnel Technique ◽  
Lateral Ankle Ligament ◽  
Lateral Ankle Ligament Reconstruction

Background: Anatomic lateral ankle ligament reconstruction has been proposed for patients with chronic ankle instability. A reliable approach is a reconstruction technique using an allograft and 2 fibular tunnels. A recently introduced approach that entails 1–fibular tunnel reconstruction might reduce the risk of intraoperative complications and ultimately improve patient outcome. Hypothesis: We hypothesized that both reconstruction techniques show similar ankle stability (joint laxity and stiffness) and are similar to the intact joint condition. Study Design: Controlled laboratory study. Methods: A total of 10 Thiel-conserved cadaveric ankles were divided into 2 groups and tested in 3 stages—intact, transected, and reconstructed lateral ankle ligaments—using either the 1– or the 2–fibular tunnel technique. To quantify stability in each stage, anterior drawer and talar tilt tests were performed in 0°, 10°, and 20° of plantarflexion (anterior drawer test) or dorsiflexion (talar tilt test). Bone displacements were measured using motion capture, from which laxity and stiffness were calculated together with applied forces. Finally, reconstructed ligaments were tested to failure in neutral position with a maximal applicable torque in inversion. A mixed linear model was used to describe and compare the outcomes. Results: When ankle stability of intact and reconstructed ligaments was compared, no significant difference was found between reconstruction techniques for any flexion angle. Also, no significant difference was found when the maximal applicable torque of the 1-tunnel technique (9.1 ± 4.4 N·m) was compared with the 2-tunnel technique (8.9 ± 4.8 N·m). Conclusion: Lateral ankle ligament reconstruction with an allograft using 1 fibular tunnel demonstrated similar biomechanical stability to the 2-tunnel approach. Clinical Relevance: Demonstrating similar stability in a cadaveric study and given the potential to reduce intraoperative complications, the 1–fibular tunnel approach should be considered a viable option for the surgical therapy of chronic ankle instability. Clinical randomized prospective trials are needed to determine the clinical outcome of the 1-tunnel approach.

scholarly journals Immediate Unrestricted Weight Bearing with Simple Stirrup Brace Following Single Anchor Lateral Ankle Ligament Stabilization

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000 ◽  
Author(s):  
Christopher Diefenbach ◽  
Linda Dunaway ◽  
Larissa White ◽  
Gregory Lundeen
Keyword(s):  
Range Of Motion ◽  
Ligament Reconstruction ◽  
Weight Bearing ◽  
Lateral Ligament ◽  
Anterior Talofibular Ligament ◽  
Recurrent Instability ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament

Category: Ankle Introduction/Purpose: Anatomic lateral ankle ligament reconstruction has been shown to reliably restore the functional stability of the joint. Current orthopedic literature supports accelerated rehabilitation and protected weight bearing advancement as a safe and effective means to timely patient recovery. To our knowledge, there have not been clinical outcome reports of a protocol utilizing immediate unrestricted weight bearing in a stirrup brace following single anchor lateral ligament stabilization. The purpose of this study is to report on a series of patients treated with a more progressive protocol resulting in durable ankle stability and favorable clinical outcomes. Methods: A total of 28 patients with chronic lateral ankle ligament instability who failed conservative management underwent arthroscopy and modified Brostrom-Gould lateral ligament reconstruction between 2014 and 2015 were identified. The anterior talofibular and calcaneofibular ligaments were released from the fibula and advanced using one double-loaded metallic 3.5 mm suture anchor. Immediate unrestricted full weightbearing in a stirrup brace was allowed from the first postoperative day and accelerated physical therapy was initiated at 2 weeks postoperatively. Patients were assessed preoperatively, and at a minimum 1- year follow-up, using the AOFAS Hindfoot scale and VAS pain score. Additional postoperative outcome measures included the FAOS and a custom clinical questionnaire. Range of motion, ligamentous stability and single-blinded examination with Star Excursion Balance Test (SEBT) functional testing were performed postoperatively. Complication and recurrent instability rates were also recorded. Results: Twelve patients participated in the study (8F, 4 M). Mean age at final follow-up was 49 years (21-70). Average follow-up was 21 months (16 to 26). Average satisfaction score was 94%, and all patients reported they would have the procedure again. AOFAS Hindfoot score and VAS improved significantly from preoperative to postoperative, respectively (55.6 to 89.8, 5.4 to 1.6). Average postoperative FAOS score was 80.3 (51.8-100) . No measurable difference was observed on examination of range of motion, ligamentous stability, or SEBT testing in the anterior, posterolateral or posteromedial planes of the contralateral side, respectively (61.5 to 62.2 cm, 62.4 to 64.1 cm, 56.4 to 57.6 cm). No patients reported recurrent instability. Conclusion: This study demonstrates that anterior talofibular ligament and calcaneofibular ligament advancement utilizing a single 3.5 mm anchor construct followed by immediate unrestricted weight bearing is a safe and effective protocol for the treatment of chronic lateral ankle instability. Ligamentous stability was achieved and maintained in all patients across a wide variety of patient ages and desired activity levels. Patient satisfaction was excellent. This surgical technique and postoperative protocol may help reduce surgical time and implant cost, and may facilitate a more timely return to preinjury functional level.

A New Snowboard Injury Caused by “FLOW” Bindings

2014 ◽  
Vol 104 (3) ◽  
pp. 287-290
Author(s):  
Daniel Haverkamp ◽  
Daniel Hoornenborg ◽  
Mario Maas ◽  
Gino Kerkhoffs
Keyword(s):  
Surgical Repair ◽  
Anterior Talofibular Ligament ◽  
Syndesmotic Injury ◽  
Lateral Ankle ◽  
Ligament Rupture ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament

We present a case of a snowboard injury that caused a combination of a complete deltoid and anterior talofibular ligament rupture, without bony or syndesmotic injury. Initial surgical repair for both ligaments was performed. We describe the etiology of this injury to demonstrate the cause and existence of medial and lateral ankle ligament rupture without osseous and syndesmotic involvement and to create awareness of these types of injuries.

scholarly journals Evaluation of the Anterior Talofibular Ligament Using MRI after Arthroscopic Lateral Ankle Ligament Repair

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0044
Author(s):  
Ichiro Yoshimura ◽  
Kazuki Kanazawa ◽  
So Minokawa ◽  
Takuaki Yamamoto ◽  
Tomonobu Hagio
Keyword(s):  
Conservative Treatment ◽  
Clinical Outcomes ◽  
Signal Intensity ◽  
High Signal Intensity ◽  
High Signal ◽  
Anterior Talofibular Ligament ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament

Category: Ankle, Arthroscopy Introduction/Purpose: Ankle sprain commonly occurs in sports activities and most patients are successfully managed with conservative treatment. An incidence of 10–30% of patients will fail conservative treatment and result in chronic lateral ankle instability (CLAI) that may require surgical treatment. Recently, several systematic reviews reported that arthroscopic lateral ankle ligament repair for CLAI are provided good clinical results. However, the pathologic condition of the lateral ankle ligament after anatomical repair has not been clarified. Previous investigations have reported that ligament signal intensity using MRI has a strong negative linear relationship with material biomechanical strength properties. The purpose of this study was to report the clinical outcome and evaluation of the anterior talofibular ligament (ATFL) using MRI after arthroscopic lateral ankle ligament repair. Methods: We retrospectively reviewed 40 patients (40 ankles) who underwent arthroscopic lateral ankle ligament repair for CLAI. The average age at the time of surgery was 28 years (range 12–66 years). The average follow-up was 13 months (range 12– 18 months). Clinical outcomes were assessed preoperatively and 12 months postoperatively using Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale and Self-Administered Foot Evaluation Questionnaire (SAFE-Q). The ATFL was evaluated using 3.0-T MRI at the preoperatively, six months postoperatively and 12 months postoperatively. The ATFL characteristics classified into the following categories: nonvisualization of the ligament, discontinuity, a wavy or curved contour, or high signal intensity within the ligament. Results: The mean JSSF score increased from 72 preoperatively to 95 at 12 months postoperatively. The preoperative MRI findings of the ATFL were categorized as discontinuity (11 ankles), a wavy or curved contour (14 ankles), or high signal intensity within the ligament (22 ankles). The all ATFL findings at the six months postoperatively had straight band extending from the talus to the fibular malleolus, and nine of 40 ankles had high signal intensity within the ligament. The ATFL findings at the 12 months postoperatively revealed residual high signal intensity within the ligament in six of nine ankles. A comparison of the postoperative ATFL with high signal intensity and with low signal intensity group, there were no significant difference in postoperative clinical outcomes between the groups. Conclusion: This study demonstrated that arthroscopic lateral ankle ligament repair was an effective procedure for the treatment of CLAI and restored the condition of ATFL.

Morphology of Anterior Talofibular Ligament After Arthroscopic Lateral Ankle Ligament Repair

2020 ◽  
Vol 41 (8) ◽  
pp. 993-1001
Author(s):  
Tomonobu Hagio ◽  
Ichiro Yoshimura ◽  
Kazuki Kanazawa ◽  
So Minokawa ◽  
Takuaki Yamamoto
Keyword(s):  
Signal Intensity ◽  
Healing Process ◽  
Attachment Site ◽  
High Signal Intensity ◽  
High Signal ◽  
Anterior Talofibular Ligament ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament

Background: Arthroscopic lateral ankle ligament repair for chronic lateral ankle instability (CLAI) yields good clinical results. However, the healing process of the ligament after anatomical repair remains unclear. This study evaluated the functional and patient-based outcomes for CLAI patients who underwent arthroscopic lateral ankle ligament repair and the morphological condition of the repaired anterior talofibular ligament (ATFL). Methods: We retrospectively reviewed 47 patients (50 ankles) who underwent arthroscopic lateral ankle ligament repair for CLAI (mean follow-up, 14 months). The Japanese Society for Surgery of the Foot Ankle-Hindfoot (JSSF) scale score and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were assessed preoperatively and 12 months postoperatively. Magnetic resonance imaging (MRI) was performed preoperatively and at 6 and 12 months postoperatively to evaluate the ATFL. The functional and patient-based outcomes were compared between the group with repaired ATFLs and high signal intensity and the group with repaired ATFLs and low signal intensity. Results: The mean JSSF score improved significantly from 72.3 ± 11.6 preoperation to 95.3 ± 5.4 at 12 months postoperation. The MRI findings at 12 months postoperation showed that each repaired ATFL had a linear band structure from the talar to the fibular attachment site, and 41 of 50 ankles (82%) had low signal intensity of the ligament. On the SAFE-Q, the social functioning scores at 12 months postoperation were significantly higher in the low signal intensity group than in the high signal intensity group. Conclusion: Arthroscopic lateral ankle ligament repair for CLAI yielded good functional and patient-based outcomes and restored the morphological condition of the ATFL. Level of Evidence: Level III, retrospective comparative study.

Chronic Lateral Ankle Instability

Foot & Ankle ◽  
1991 ◽  
Vol 12 (3) ◽  
pp. 182-191 ◽  
Author(s):  
J. Wesley Peters ◽  
Saul G. Trevino ◽  
Per A. Renstrom
Keyword(s):  
Operative Treatment ◽  
Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Management Options ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Ankle Ligament ◽  
Lateral Ankle Instability ◽  
Anatomical Point ◽  
Lateral Ankle Ligament

Chronic lateral ankle instability may be present in as many as 10% to 30% of people suffering from acute lateral ankle ligament injuries. Ankle instability has been referred to as either functional instability or mechanical instability. Management options consist of either nonoperative or operative treatment, with the majority of the literature emphasizing operative management for chronic instability. Long-term studies assessing the different types of available operative repairs have now been published. This review article discusses chronic lateral ankle ligament instability from a functional, anatomical point of view. The indications for treatment, nonoperative and operative treatment, as well as the biomechanical information available regarding these methods of treatment are considered. The major emphasis of this review is discussion and analysis of the many different surgical treatment options. Following this review, we presently recommend anatomical repair to the bone of both the anterior talofibular ligament and the calcaneofibular ligament, together with imbrication of the ligaments. In patients with hypermobility, long-standing instability, or arthritis, reconstruction using the Chrisman-Snook technique is recommended.

scholarly journals The mechanical effect of the common fibers of the anterior talofibular and calcaneofibular ligaments

2021 ◽  
Vol 9 (2_suppl) ◽  
pp. 2325967121S0000
Author(s):  
Guillaume Cordier ◽  
Gustavo Araujo Nunes ◽  
Miki Dalmau-Pastor
Keyword(s):  
Fixed Point ◽  
Anatomical Study ◽  
Mechanical Effect ◽  
Lateral Ligament ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Distance Measurements ◽  
Measuring Device ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament

Objectives: The subject of the lateral ankle ligament complex is a familiar one. Common fibers between the inferior bundle of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) have been described. The purpose of this study is to investigate the possibility of transmitting a force to the CFL through the inf. ATFL. Methods: An anatomical study was carried out on 12 ankles. Each specimen was dissected according to a protocol to expose the lateral ligaments. A proximal section was made in the superior and inferior bands of the anterior talofibular ligament. A device capable of measuring shifting from one point in relation to another fixed point was used. The fixed point was implanted on the calcaneus and the other part of the sensor on the CFL. Traction of 1-kilogram was applied to the inferior band of the ATFL while the device measured the shifting of the CFL in millimeters. Two measurements were taken on each specimen by two observers. Sample data and distance measurements were recorded and analyzed. Results: It was possible to analyze 12 specimens. The specimens were from 7 women and 5 men and included 6 right and 6 left ankles. The anterior talofibular ligament was identified as a two-band ligament in all cases. One ankle had a lesion on the superior band of the ATFL. Common fibers that connect the inferior ATFL and the CFL were observed in all samples of this study. The measuring device showed shifting of the CFL in each case. The first series of measurements indicated average shifting of 0.74 mm (0.46; 1.35; +/- 0.34) and a median of 0.59 mm. The second series indicated a mean of 0.60 mm (0.23 - 1.13; +/- 0.32) and a median of 0.46 mm. Conclusion: There is an anatomical connection between the inferior ATFL and the CFL that is capable of transmitting a mechanical force to the CFL when the inferior ATFL is placed in traction. Improvement in the knowledge of the mechanical properties of the lateral ligament plane helps to clarify the possibilities for surgical repairs.

scholarly journals Relationship Between Peroneal Tendons and Anterior Talofibular Ligament

2021 ◽  
pp. 18
Author(s):  
Keyword(s):  
Double Bundle ◽  
Single Bundle ◽  
Anterior Talofibular Ligament ◽  
Lateral Ankle ◽  
Peroneal Tendons ◽  
Peroneus Longus ◽  
Three Bundles ◽  
Fresh Frozen ◽  
The Mean ◽  
Peroneus Brevis

Background: Anterior talofibular ligament (ATFL) injuries are the most common in ankle torsional injuries. ATFL and peroneal tendons are both important stabilizers of lateral ankle joint. We aimed to evaluate peroneal tendons and ATFL. Methods: Fifteen nonpaired leg of fresh frozen cadavers were assessed in this study. After harvesting, ATFL diameters were measured at three points by calipers, these are fibular side, intermediate side and talar side. The mean of these three measurements were assessed and tissue a 15 lb load was applied to the peroneal tendons for 10 minutes, and the transverse diameters were measured by folding the thickest part of the tendon in a double-strand. Results: 5 single bundle, 8 double-bundle and 2 three bundles of ATFL were obtained after dissection. . There was no correlation between ATFL diameter, peroneus longus, peroneus brevis and total tendon diameters of peroneus longus and peroneus brevis in women (p> 0.05). A strong correlation was found between ATFL diameter, peroneus longus (r: 0.95), peroneus brevis (r: 0.81) and total tendon diameters of peroneus longus and peroneus brevis (r: 0.92) in men. Conclusion: Relationship between the diameter of the ATFL and peroneal tendons diameters were evaluated and a correlation was observed in males, while no correlation was observed in females.

scholarly journals A New Landmark for Positioning the Anatomical Insertions of Lateral Ankle Ligaments under Arthroscopy: A Preliminary Study

2021 ◽  
Author(s):  
Yun-Feng Zhou ◽  
Bin Song ◽  
Zheng-Zheng Zhang ◽  
Da-Zheng Xu ◽  
Ruo-Qi Xie ◽  
...  
Keyword(s):  
Spatial Information ◽  
Average Distance ◽  
Intraclass Correlation ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Significant Difference ◽  
Preliminary Study ◽  
Lateral Ankle Ligaments

Abstract Background: Several landmarks are used to ascertain the insertions of lateral ankle ligaments, however, few could be discerned under arthroscopy. The objective of this study was to assess the feasibility and reliability of labeling the anterior process of fibular cartilage surface (FCAP) under arthroscopy, and to compare the distances from the new or conventional landmark to the ligament insertion.Methods: Twenty paired ankles from ten Chinese cadavers were included. A senior and a junior surgeon randomly performed the arthroscopic FCAP marking procedures for the paired ankles of a single cadaver using a Kirchner wire. The distance and direction from the anatomical FCAP' to the marked FCAP were recorded after open dissection. Reliability analysis were calculated using the intraclass correlation coefficient (ICC) and independent sample t test. Moreover, the distance from the upper landmarks (anterior fibular tubercle or FCAP) to the anterior talofibular ligament (ATFL) insertion center (distance “a” or “c”), and from the ATFL to calcaneofibular ligament (CFL) footprint center was measured at the anterolateral side (distance “b”) and lateral groove (distance “d”), respectively.Results: The FCAP was located 1.23±0.29 (range, 0.77–1.67) mm) and 1.52±0.41 (range, 0.92–2.03) mm from the anatomical FCAP' in the senior and junior surgeons’ operations, respectively, which showed no significant difference between the two groups (t=-1.773, P=0.093). And the calculated ICC was 0.767 (P=0.003). The average distance “a” was 19.03±1.47 (range, 16.29–21.3) mm, significantly longer than distance “c”, 15.98±0.97 (range, 14.48–18.02) mm (t=-7.72, P<0.001). However, the distance “b” (7.43±0.54 mm; range, 6.47–8.47) and distance “d” (7.78±0.67 mm; range, 6.42–9.03) showed no statistical difference (t=1.8, P=0.08).Conclusions: The FCAP may be a useful landmark that can be utilized to ascertain anatomical insertions of lateral ankle ligaments under arthroscopy. The measured distances from the landmark to the ligament footprint center could provide spatial information that assist in endoscopic anatomical repair or reconstruction.

Sign in / Sign up

Export Citation Format

Share Document