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

Jeong-Hyun Park,Mijeong Lee,Digud Kim,Kwang-Rak Park,Yu-Jin Choi,Jaeho Cho,Hyung-Wook Kwon,Ying-Qi Zhang

doi:10.1155/2021/5575524

Jeong-Hyun Park, Mijeong Lee + Show 6 more

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https://doi.org/10.1155/2021/5575524

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Abstract

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.

Highlights

Ankle sprain is the most common sports-related injury that usually involves the lateral ligament complex (LLC) of the ankle [1, 2]
The distance between the articular tip (AT) and inferior tip (IT) and the distance between cATFL and IT were significantly greater in males than in females (Table 2)
The first contribution of the present study is to propose that surgeons can use a reference ratio to locate the fibular tunnel for anatomic reconstruction of the lateral

Summary

Introduction

Ankle sprain is the most common sports-related injury that usually involves the lateral ligament complex (LLC) of the ankle [1, 2]. Among the three ligaments of the LLC, anterior talofibular ligament (ATFL) rupture occurs in 80% of patients, the rest showing rupture of the calcaneofibular ligament (CFL) combined with ATFL. The latter condition causes instability of the ankle or subtalar joint, the posterior talofibular ligament (PTFL) is rarely involved [3,4,5,6]. The minimally invasive surgical (MIS) technique recently emerged and reduces the incidence of postoperative complications These procedures using percutaneous or arthroscopic techniques are focused on the anatomic repair or reconstruction of the ATFL and/or CFL [17]

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