Anatomical Characteristics of the Calcaneofibular Ligament of Ankle Joint in Korean Population

Category: Ankle Introduction/Purpose: Acute inversion ankle sprains are among the most common musculoskeletal injuries. Higher grade sprains, which include anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) injury, can be particularly problematic and often require surgical repair. The implications of CFL injury on ankle instability are unclear. We aim to evaluate the impact of CFL injury on ankle stability and subtalar joint biomechanics. We hypothesized that CFL injury will result in decreased stiffness and torque, and alteration of ankle contact mechanics compared to the uninjured ankle in a cadaveric model. Methods: Twenty matched cadaveric ankles dissected of skin and subcutaneous tissue were mounted to an Instron with 20° of ankle plantar flexion and 15° of internal rotation. Intact specimens were axially loaded to body weight, then underwent inversion stress along the anatomic axis of the ankle from 0 to 20° (simulating inversion injury) for three cycles. ATFL and CFL were sequentially sectioned, and inversion testing repeated for each condition. Stiffness and change in torque were recorded using an Instron, and pressure and contact area were recorded using a calibrated Tekscan sensor system. Inversion angle of the talus and calcaneus relative to the ankle mortise were recorded using a three-dimensional motion capture system. Paired t tests were performed for inter and intra-group comparisons. Results: Stiffness and torque did not significantly decrease after sectioning of the ATFL, but did decreased significantly after sectioning of CFL. Peak pressures in the tibiotalar joint decreased significantly following CFL release compared to both the uninjured ankle and ATFL-only release. Mean contact area significantly increased following CFL release compared to both the uninjured ankle and ATFL release. There was a concentration of force in the anteromedial ankle joint during weight-bearing inversion. However, the center-of-force shifts 1.22 mm posteromedial after CFL release relative to an intact ankle. Motion capture showed a significant and sequential increase in inversion angle of both the calcaneus and talus, after release of each ligament. There was significantly more inversion in the subtalar joint than the tibiotalar joint with weight-bearing inversion. Conclusion: There is significantly lower stiffness and torque with weight-bearing inversion of the ankle joint complex following injury to both ATFL and CFL, and sequentially greater inversion of the talus and calcaneus with progressive ligament injury. This corresponds to a significant shift in the center of force in the tibiotalar joint. CFL contributes considerably to lateral ankle stability, and sprains that include CFL injury result in substantial alteration of contact mechanics at the ankle and subtalar joints. Repair of CFL may be beneficial during lateral ligament reconstruction, potentially mitigating long-term consequences (e.g., articular damage) of a loose or incompetent CFL.

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Deep-Learning-Based MRI Images for Analysis of Sport-Induced Ankle Joint Injury

Scientific Programming ◽

10.1155/2021/5544160 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Wenbo Zhang

Keyword(s):

Neural Network ◽

Ankle Joint ◽

Good Prognosis ◽

Anterior Talofibular Ligament ◽

Calcaneofibular Ligament ◽

Joint Injury ◽

The Neural Network ◽

Number Of Patients ◽

Magnetic Resonance Imaging Mri ◽

Grade Iii

This study was to analyze the sport-induced ankle joint injury (AJI) images based on the neural network algorithms using the magnetic resonance imaging (MRI). 20 patients and 20 volunteers were included in the experimental and control groups, respectively. The hybrid diffusion equation (HDE) neural network (HDENN) algorithm was compared with the fully convolutional neural network (FCNN) and the FCNN preprocessing, and the HDE was applied to the MRI analysis of sport-induced AJI. The results showed that the total score of MRI image for the conventional position of the anterior talofibular ligament (ATFL) and posterior talofibular ligament (PTFL) was concentrated in 4 (55%) and 5 (65%), respectively. The number of patients with good prognosis with grade II injury (11 cases) was much higher than that of grade III injury (2 cases), and the number of patients with poor prognosis (4 cases) was lower than that of grade III injury (6 cases) ( P < 0.05 ). Conventional MRI was recommended to observe the ATFL and PTFL, and the valgus position MRI was recommended for the calcaneofibular ligament (CFL); conservative treatment was recommended for patients with grades I and II AJI, but surgical treatment was recommended for patients with grade III AJI.

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The Role of Calcaneofibular Ligament Injury in Ankle Instability: Implications for Surgical Management

The American Journal of Sports Medicine ◽

10.1177/0363546518815160 ◽

2018 ◽

Vol 47 (2) ◽

pp. 431-437 ◽

Cited By ~ 10

Author(s):

Kenneth J. Hunt ◽

Helder Pereira ◽

Judas Kelley ◽

Nicholas Anderson ◽

Richard Fuld ◽

...

Keyword(s):

Contact Mechanics ◽

Ankle Joint ◽

Contact Area ◽

Ankle Instability ◽

Peak Torque ◽

Ligament Injury ◽

Lateral Ligament ◽

Anterior Talofibular Ligament ◽

Ankle Sprains ◽

Calcaneofibular Ligament

Background: Acute inversion ankle sprains are among the most common musculoskeletal injuries. Higher grade sprains, including anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) injury, can be particularly challenging. The precise effect of CFL injury on ankle instability is unclear. Hypothesis: CFL injury will result in decreased stiffness, decreased peak torque, and increased talar and calcaneal motion and will alter ankle contact mechanics when compared with the uninjured ankle and the ATFL-only injured ankle in a cadaveric model. Study Design: Descriptive laboratory study. Methods: Ten matched pairs of cadaver specimens with a pressure sensor in the ankle joint and motion trackers on the fibula, talus, and calcaneus were mounted on a material testing system with 20° of ankle plantarflexion and 15° of internal rotation. Intact specimens were axially loaded to body weight and then underwent inversion along the anatomic axis of the ankle from 0° to 20°. The ATFL and CFL were sequentially sectioned and underwent inversion testing for each condition. Linear mixed models were used to determine significance for stiffness, peak torque, peak pressure, contact area, and inversion angles of the talus and calcaneus relative to the fibula across the 3 conditions. Results: Stiffness and peak torque did not significantly decrease after sectioning of the ATFL but decreased significantly after sectioning of the CFL. Peak pressures in the tibiotalar joint decreased and mean contact area increased significantly after CFL release. Significantly more inversion of the talus and calcaneus as well as calcaneal medial displacement was seen with weightbearing inversion after sectioning of the CFL. Conclusion: The CFL contributes considerably to lateral ankle instability. Higher grade sprains that include CFL injury result in significant decreases in rotation stiffness and peak torque, substantial alteration of contact mechanics at the ankle joint, increased inversion of the talus and calcaneus, and increased medial displacement of the calcaneus. Clinical Relevance: Repair of an injured CFL should be considered during lateral ligament reconstruction, and there may be a role for early repair in high-grade injuries to avoid intermediate and long-term consequences of a loose or incompetent CFL.

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The Use of a 6-DOF Robotic System for the Functional Analysis of Ankle Joint Ligaments

Volume 1B: Extremity; Fluid Mechanics; Gait; Growth, Remodeling, and Repair; Heart Valves; Injury Biomechanics; Mechanotransduction and Sub-Cellular Biophysics; MultiScale Biotransport; Muscle, Tendon and Ligament; Musculoskeletal Devices; Multiscale Mechanics; Thermal Medicine; Ocular Biomechanics; Pediatric Hemodynamics; Pericellular Phenomena; Tissue Mechanics; Biotransport Design and Devices; Spine; Stent Device Hemodynamics; Vascular Solid Mechanics; Student Paper and Design Competitions ◽

10.1115/sbc2013-14460 ◽

2013 ◽

Author(s):

Satoshi Yamakawa ◽

Takuma Kobayashi ◽

Kei Kimura ◽

Daisuke Suzuki ◽

Kota Watanabe ◽

...

Keyword(s):

Ankle Joint ◽

Joint Instability ◽

Experimental Methodology ◽

Reconstruction Technique ◽

Ankle Sprains ◽

Joint Stability ◽

Calcaneofibular Ligament ◽

Ankle Ligaments ◽

Specific Loading ◽

Tensile Forces

Ankle sprains are common injuries in daily and athletic activities. An epidemiological report indicated that the incidence rate of ankle sprains treated in emergency departments in the USA is more than 2 per 1000 persons a year, and the rate is estimated to be more than double as for ankle sprains in athletic activity [1]. Better understanding of ankle biomechanics is, therefore, important for the improvement of clinical outcome. Many investigators have performed in vitro and in vivo experiments to determine the mechanical roles of ankle structures such as range of motion, contribution of ankle ligaments to joint stability, joint instability due to ligament transection, and so on. In spite of these efforts, tensile forces in ankle ligaments in response to specific loading conditions still remains unclear because of a lack of experimental methodology. Meanwhile, the use of robotic technology for knee joint biomechanics study has been established by Fujie et al [2]. Using the technique, tensile forces in knee cruciate ligaments have been determined by Woo et al [3], Li et al [4], Fujie et al [5], and other groups, while ligament reconstruction technique has been evaluated by many investigators [for example 6–8]. Therefore, the objectives of the present study were to determine the ankle joint instability due to ligament transection and to determine the tensile forces in the anterior tarofibular ligament (ATFL) and calcaneofibular ligament (CFL) in response to anterior-posterior (AP) drawer force to the human cadaveric ankle joints.

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Operative Technique for Lateral Collateral Ligament Ankle Joint Injuries. Treatment for the Calcaneofibular Ligament.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.41.657 ◽

1992 ◽

Vol 41 (2) ◽

pp. 657-660

Author(s):

Takehiko Morikawa ◽

Toru Nishiyama

Keyword(s):

Ankle Joint ◽

Operative Technique ◽

Lateral Collateral Ligament ◽

Collateral Ligament ◽

Calcaneofibular Ligament ◽

Joint Injuries

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The in situ force in the calcaneofibular ligament and the contribution of this ligament to ankle joint stability

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2016.10.009 ◽

2016 ◽

Vol 40 ◽

pp. 8-13 ◽

Cited By ~ 9

Author(s):

Takuma Kobayashi ◽

Satoshi Yamakawa ◽

Kota Watanabe ◽

Kei Kimura ◽

Daisuke Suzuki ◽

...

Keyword(s):

Ankle Joint ◽

Joint Stability ◽

Calcaneofibular Ligament ◽

In Situ Force

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Anatomic Measurement and Variability Analysis of the Anterior Talofibular Ligament and Calcaneofibular Ligament of the Ankle

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211047269 ◽

2021 ◽

Vol 9 (11) ◽

pp. 232596712110472

Author(s):

Han Yang ◽

Minghao Su ◽

Zhimin Chen ◽

Rongmei Qu ◽

Zhirong Yuan ◽

...

Keyword(s):

Ankle Joint ◽

Coefficient Of Variation ◽

Articular Surface ◽

Lateral Collateral Ligament ◽

Anatomic Reconstruction ◽

Anterior Talofibular Ligament ◽

Calcaneofibular Ligament ◽

Tissue Quality ◽

Length Width ◽

Lateral Ankle Ligaments

Background: The anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) contribute greatly to the overall stability of the ankle joint; however, ATFL and combined ATFL-CFL sprains are common. Anatomic reconstruction of the lateral collateral ligament with grafts has been proposed for patients with poor tissue quality or inadequate local tissue. Anatomic reconstruction of the lateral ankle ligaments requires a good understanding of their anatomic location. Purpose: To describe the anatomy of the ATFL and CFL ligaments quantitatively and qualitatively and explore the relationship of some morphological parameters. Study Design: Descriptive laboratory study. Methods: A total of 66 adult ankle specimens were analyzed for ATFL band type, origin, length, width, thickness, and angle between the ATFL and CFL, and 73 adult ankle specimens were used for measuring the origin of the CFL. The coefficient of variation was used to describe and compare the respective variability of angle, length, width, and thickness. The origin of the ATFL was labeled as point A, and the leading edge of the CFL intersection with the articular surface of the calcaneus was considered point B. Results: The ATFL had a variable number of bands. A high degree of variability (coefficient of variation >0.2) was seen for most morphological measurements of the ATFL. In addition, the length of distance AB also varied. The CFL originated at the tip of the fibula in only 9% of specimens. It was found more commonly at the anterior border of the lateral malleolus (4.94 ± 1.70 mm from the tip). The angle between the ATFL and CFL was consistent at 100° to 105º. Conclusion: A fair amount of variability of ATFL length, width, and thickness were found in our study, with less variability in the ATFL-CFL angle. Most CFLs attached anterior to the tip of the fibula. Clinical Relevance: Providing relevant anatomic data of ATFL and CFL is important in ensuring proper surgical treatment of ankle joint injuries.

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The Effect of Damage to the Lateral Collateral Ligaments on the Mechanical Characteristics of the Ankle Joint—An In-Vitro Study

Journal of Biomechanical Engineering ◽

10.1115/1.2891163 ◽

1990 ◽

Vol 112 (2) ◽

pp. 129-137 ◽

Cited By ~ 22

Author(s):

S. Siegler ◽

Jie Chen ◽

C. D. Schneck

Keyword(s):

Ankle Joint ◽

Diagnostic Procedure ◽

Mechanical Characteristics ◽

Three Dimensional ◽

Lower Limbs ◽

Anterior Talofibular Ligament ◽

Collateral Ligaments ◽

Ligament Injuries ◽

Calcaneofibular Ligament ◽

Lateral Collateral Ligaments

Injuries to the lateral collateral ligaments of the ankle joint are among the most frequently occurring injuries at the lower limb. The present study was conducted for the purpose of establishing the basis for the development of a quantitative diagnostic procedure for such injuries. To achieve this goal, the effect of four types of ligament injuries on the three-dimensional mechanical characteristics of the ankle were investigated. These types of injuries consisted of: 1) isolated tear of the anterior talofibular ligament; 2) isolated tear of the calcaneofibular ligament; 3) isolated tear of the posterior talofibular ligament; and 4) combined tear of both the anterior talofibular ligament and the calcaneofibular ligament. The experiments were conducted on 31 amputated lower limbs and consisted of comparing the three-dimensional load-displacement and flexibility characteristics of the ankle joint prior to and following sectioning of selected ligaments. The experimental and analytical procedures used to derive these characteristics was developed previously by the authors [3, 24]. From the results of this study it was concluded that the three-dimensional flexibility characteristics of the ankle joint are strongly influenced by damage to the lateral collateral ligaments. Furthermore, it was found that each type of ligament injury produced unique and identifiably changes in the flexibility characteristics of the ankle. These unique changes, which are described in detail in this paper, can be used to discriminate between the different types of ligament injuries. Consequently, it was concluded that it is feasible to develop a quantitative diagnostic procedure for ankle ligament injuries based on the effect of the injury on the flexibility characteristics of the ankle.

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The Benefits of the Plastination Techniques for the Anatomo Clinical Studies of Ankle Joint Ligaments Injuries

Materiale Plastice ◽

10.37358/mp.17.3.4877 ◽

2017 ◽

Vol 54 (3) ◽

pp. 487-490

Author(s):

Alina Maria Sisu ◽

Gheorghe Noditi ◽

Dan Grigorescu ◽

Sorin Floresc ◽

Jenel Marian Patrascu ◽

...

Keyword(s):

Ankle Joint ◽

Deltoid Ligament ◽

Anterior Talofibular Ligament ◽

Ligament Injuries ◽

Calcaneofibular Ligament ◽

Conventional Mri ◽

Ankle Ligament ◽

Ct And Mri ◽

Second Degree

The present research was made by following three directions: dissection and plastination, clinical ankle joint ligament injuries and MRI and CT examination of the cases.191 cases of ankle joint ligament injuries have been studied during two years. They were examined clinically and radiologically, using CT and MRI testing. The classification of ankle sprain was based on the number of injured ligaments. Out of the 191 cases diagnosed with ligament injuries, 92 involved the anterior talofibular ligament, 54 in the calcaneofibular ligament, 40 involved the posterior talofibular ligament and 5 involved the deltoid ligament. First degree sprain involves the injury of the anterior talofibular ligament, the second degree sprain involves the injury of the anterior talofibular ligament and of the calcaneofibular ligament, and the third degree sprain involves the damaging of anterior and posterior talofibular ligaments, as well as the calcaneofibular ligament. In this paper we have diagnosed a number of 39 first degree springs, 12 of second degree springs and 41 of third degree springs. The standard X- ray examinations have a low diagnostic rate of the ankle ligament injuries. Conventional MRI has a higher accuracy in diagnosing ankle joint collateral ligaments lesions.

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