The posterior fibulotalocalcaneal ligament complex: a forgotten ligament

Peter A J De Leeuw,Miki Dalmau-Pastor,Jon Karlsson,Jordi Vega

doi:10.1007/s00167-020-06431-5

Abstract

PurposeThe purpose of the present anatomical study was to define the exact morphology of the posterior fibulotalocalcaneal ligament complex (PFTCLC), both for a better orientation and understanding of the anatomy, especially during hindfoot endoscopy.MethodsTwenty-three fresh frozen specimens were dissected in order to clarify the morphology of the PFTCLC.ResultsIn all specimens, the ligament originated from the posteromedial border of the lateral malleolus between the posterior tibiofibular ligament (superior border) and the calcaneofibular ligament (CFL), (inferior border). This origin functions as the floor for the peroneal tendon sheath. The origin of the PFTCLC can be subdivided into two parts, a superior and inferior part. The superior part forms an aponeurosis with the superior peroneal retinaculum and the lateral septum of the Achilles tendon. From this structure, two independent laminae can be identified. The inferior part of the origin has no role in the aponeurosis and ligamentous fibres run obliquely to insert in the lateral surface of the calcaneus, in the same orientation as the CFL, but slightly more posterior, which was a consistent finding in all examined specimens. The PFTCLC is maximally tensed with ankle dorsiflexion and is located within the fascia of the deep posterior compartment of the leg.ConclusionsThe PFTCLC is part of the normal anatomy of the hindfoot and therefore should be routinely recognized and partly released to achieve access to the posterior ankle anatomical pathology, relevant for hindfoot endoscopy. The origin of the ligament complex forms the floor for the peroneal tendon sheath. The superior part of the origin plays a role in the formation of an aponeurosis with the superior peroneal retinaculum and the lateral septum of the Achilles tendon.

Highlights

Defining and understanding human anatomy is important for adequate, safe and reproducible surgery without iatrogenic damage to our patients [4, 6, 7]
The inferior border of the posterior fibulotalocalcaneal ligament complex (PFTCLC) origin was clearly separated from the origin of the calcaneofibular ligament (CFL)
This ligament is a specialized part of the fascia of the deep posterior compartment, which is a constant finding in all examined specimens

Summary

Introduction

Defining and understanding human anatomy is important for adequate, safe and reproducible surgery without iatrogenic damage to our patients [4, 6, 7]. It was a continuous finding that a strong and broad fascial like structure had to be penetrated in order to be able to reach the level of the posterolateral subtalar joint to subsequently identify the flexor hallucis longus (FHL) and the ankle joint [18]. In 1932, Rouvière and Canela Lazaro described the posterior fibulotalocalcaneal ligament (PFTCL), being a specialized part of the fascia of the deep posterior compartment of the leg [12]. They described this structure as an extrinsic ligament that occupies the posterior and posterolateral corner of the ankle joint [12] (Fig. 1). Sarrafian described some anatomical aspects of this ligament, resembling the work by Rouvière and Canela Lazaro [13]

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Conclusion