Lateral Ligaments Of The Ankle Research Articles

Investigation into the effect of deltoid ligament injury on rotational ankle instability using a three-dimensional ankle finite element model.

Injury to the lateral collateral ligament of the ankle may cause ankle instability and, when combined with deltoid ligament (DL) injury, may lead to a more complex situation known as rotational ankle instability (RAI). It is unclear how DL rupture interferes with the mechanical function of an ankle joint with RAI. To study the influence of DL injury on the biomechanical function of the ankle joint. A comprehensive finite element model of an ankle joint, incorporating detailed ligaments, was developed from MRI scans of an adult female. A range of ligament injury scenarios were simulated in the ankle joint model, which was then subjected to a static standing load of 300N and a 1.5Nm internal and external rotation torque. The analysis focused on comparing the distribution and peak values of von Mises stress in the articular cartilages of both the tibia and talus and measuring the talus rotation angle and contact area of the talocrural joint. The dimensions and location of insertion points of ligaments in the finite element ankle model were adopted from previous anatomical research and dissection studies. The anterior drawer distance in the finite element model was within 6.5% of the anatomical range, and the talus tilt angle was within 3% of anatomical results. During static standing, a combined rupture of the anterior talofibular ligament (ATFL) and anterior tibiotalar ligament (ATTL) generates new stress concentrations on the talus cartilage, which markedly increases the joint contact area and stress on the cartilage. During static standing with external rotation, the anterior talofibular ligament and anterior tibiotalar ligament ruptured the ankle's rotational angle by 21.8% compared to an intact joint. In contrast, static standing with internal rotation led to a similar increase in stress and a nearly 2.5 times increase in the talus rotational angle. Injury to the DL altered the stress distribution in the tibiotalar joint and increased the talus rotation angle when subjected to a rotational torque, which may increase the risk of RAI. When treating RAI, it is essential to address not only multi-band DL injuries but also single-band deep DL injuries, especially those affecting the ATTL.

Description of the lateral fibulotalocalcaneal ligament in fetal specimens and its potential clinical implications.

The increase in ankle sprains in children is a reflection of the greater inclusion of this population in sports. This places the calcaneofibular (CFL) and the anterior talofibular (ATFL) ligaments in focus for study. In adults, the presence of arcuate fibers extending between these two ligaments suggests the existence of a new anatomical and functional complex called the lateral fibulotalocalcaneal ligament of the ankle (LFTCL), which can be associated with the persistence of instability of the talocrural joint in ankle sprains. This study aimed to verify the presence of arciform fibers between the CFL and ATFL in human fetuses and to study the topography of the lateral ankle region. Forty matched fetal ankles aged between 28 and 38weeks, fixed in 4% formalin, were macroscopically, chemically and mesoscopically dissected and analyzed in stereoscope. The ATFL was characterized as a capsular ligament consisting of two fascicles (proximal and distal). The CFL was characterized as an extracapsular ligament. The LFTCL complex was verified in all specimens, characterized by the arcuate fibers between the ATFL and the CFL. Such results suggest that this functional unit is congenital and that it should be taken into consideration in the treatment of persistent ankle instabilities in the pediatric population.

FOOTPRINT ANALYSIS OF THE LATERAL LIGAMENTS OF THE ANKLE: A NEW APPROACH

AbstractThe lateral ligaments of the ankle composed of the anterior talofibular (ATFL), calcaneofibular (CFL) and posterior talofibular ligaments (PTFL), are amongst the most commonly injured ligaments of the human body. Although treatment methods have been explored exhaustively, healing outcomes remain poor with high rates of re-injury, chronic ankle instability and pain persisting. The introduction and application of tissue engineering methods may target poor healing outcomes and eliminate long-term complications, improving the overall quality of life of affected individuals. For any surgical procedure or tissue-engineered replacement to be successful, a comprehensive understanding of the complete anatomy of the native structure is essential. Knowledge of the dimensions of ligament footprints is vitally important for surgeons as it guides the placement of bone tunnels during repair. It is also imperative in tissue-engineered design as the creation of a successful replacement relies on a thorough understanding of the native anatomy and microanatomical structure. Several studies explore techniques to describe ligament footprints around the body, with limited studies describing in-depth footprint dimensions of the ATFL, CFL and PTFL. Techniques currently used to measure ligament footprints are complex and require resources which may not be readily available, therefore a new methodology may prove beneficial.ObjectivesThis study explores the application of a novel technique to assess the footprint of ankle ligaments through a straightforward inking method. This method aims to enhance surgical technique and contribute to the development of a tissue-engineered analogue based on real anatomical morphometric data.MethodsCadaveric dissection of the ATFL, CFL and PTFL was performed on 12 unpaired fresh frozen ankles adhering to regulations of the Human Tissue (Scotland) Act. The ankle complex with attaching ligaments was immersed in methylene blue. Dissection of the proximal and distal entheses of each ligament was carried out to reveal the unstained ligament footprint. Images of each ligament footprint were taken, and the area, length and width of each footprint were assessed digitally.ResultsThe collective area of the proximal entheses of the ATFL, CFL and PTFL measures 142.11 ± 12.41mm2. The mean areas of the superior (SB) and inferior band (IB) of the distal enthesis of the ATFL measured 41.72 ± 5.01mm2 and 26.66 ± 3.12mm2 respectively. The footprint of the distal enthesis of the CFL measured 146.07 ± 14.05mm2, while the footprint of the distal PTFL measured 126.26 ± 8.88mm2. The proximal footprint of the ATFL, CFL and PTFL measured 11.06 ± 0.69mm, 7.87 ± 0.43mm and 10.52 ± 0.63mm in length and 8.66 ± 0.50mm, 9.10 ± 0.92mm and 14.41 ± 1.30mm in width on average. The distal footprint of the ATFL (SB), ATFL (IB), CFL and PTFL measured 10.92 ± 0.81 mm, 8.46 ± 0.46mm, 13.98 ± 0.93mm and 11.25 ± 0.95mm in length and 7.76 ± 0.59mm, 7.51 ± 0.64mm, 18.98 ± 1.15mm and 24.80 ± 1.25mm in width on average.ConclusionsThis methodology provides an effective approach in the identification of the footprint of the lateral ligaments of the ankle to enhance surgical precision and accuracy in tissue-engineered design.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

The ATFL inferior fascicle, the CFL and the PTFL have a continuous footprint at the medial side of the fibula.

Knowledge of the complex anatomy of the lateral ankle ligaments is essential to understand its function, pathophysiology and treatment options. This study aimed to assess the lateral ligaments and their relationships through a 3D view achieved by digitally marking their footprints. Eleven fresh-frozen ankle specimens were dissected. The calcaneus, talus and fibula were separated, maintaining the lateral ligament footprints. Subsequently, each bone was assessed by a light scanner machine. Finally, all the scans were converted to 3D polygonal models. The footprint areas of the talus, calcaneus and fibula were selected, analysed and the surface area was quantified in cm2. After scanning the bones, the anterior talofibular ligament inferior fascicle (ATFLif), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL) footprints were continuous at the medial side of the fibula, corresponding to a continuous footprint with a mean area of 4.8 cm2 (± 0.7). The anterior talofibular ligament (ATFL) footprint on the talus consisted of 2 parts in 9 of the 11 feet, whilst there was a continuous insertion in the other 2 feet. The CFL insertion on the calcaneus was one single footprint in all cases. The tridimensional analysis of the lateral ligaments of the ankle demonstrates that the ATFLif, CFL and PTFL have a continuous footprint at the medial side of the fibula in all analysed specimens. These data can assist the surgeon in interpreting the ligament injuries, improving the imaging assessment and guiding the surgeon to repair and reconstruct the ligaments in an anatomical position.

The Outcome of Modified Mini-Open Brostrom Gould Ankle Surgery on Chronic Ankle Instability.

Introduction Modified Brostrom-Gould surgery (MBG) aims to repair the lateral ligaments of the ankle in patients with ligamentous laxity and chronic instability. Brostrom-Gould surgery-the Brostrom technique associated with Gould augmentation-is currently the gold standard surgical option for chronic ankle instability worldwide. Chronic lateral ankle instability caused by lateral ankle sprains is one of the most common sports-related injuries, and Brostrom-Gould surgery is commonly recommended as the operative treatment. While arthroscopic surgery is becoming the more heavily favored approach of choice, open Brostrom-Gould surgery is still pertinent for patients for whom arthroscopic repair is unsuitable. Aim This paper discusses a modified mini-open approach of the open Brostrom-Gould surgery with a smaller incision (1.5 cm) and aims to study the outcomes of this modified approach on patients' post-operative pain, stability, and functional outcome. Methods Forty-two patients were followed up for a mean of 2.6 years after undergoing modified mini-open Brostrom-Gould surgery. The Visual Analog Scale (VAS), the Foot and Ankle Outcome Score (FAOS), and Karlsson scores were used to monitor their post-operative recovery. The Wilcoxon signed-rank test and the SPSS Statistics (v.28.0.1) software were used for data management and analytics. Results The results showed a mean Karlsson score of 83.4, a mean FAOS score of 69.7, and a mean VAS score of 1.33. These results are comparable to studies conducted on conventional open Brostrom-Gould repair. Conclusion The modified mini-open Brostrom Gould provides a favorable functional outcome with a reduction in pain and suggests no decrease in efficacy with the modified approach. This is coupled with the added advantages of a smaller wound, better wound healing outcomes, and availability to patients not suited to arthroscopic repair.

Comparison arthroscopic reconstruction and percutaneous reconstruction of ankle lateral ligament for chronic ankle lateral instability: A protocol for a meta-analysis of comparative studies.

Ankle sprains occur very frequently in daily life, but people who do not pay attention to them and do not receive proper diagnosis and treatment are very prone to develop chronic ankle lateral instability (CALI) at a later stage. For CALI where conservative treatment has failed, reconstruction of the lateral collateral ligament of the ankle can achieve satisfactory results, but there are various and controversial ways of ligament reconstruction. While percutaneous reconstruction of ankle lateral ligament (PLCLR) needs to be performed repeatedly under fluoroscopy, total arthroscopic reconstruction of ankle lateral ligament (ALCLR) is increasingly recognized by experts and scholars for its minimally invasive and precise characteristics, and has achieved good clinical results. Therefore, it is imperative that a meta-analysis be performed to provide evidence as to whether there is a difference between ALCLR and PLCLR in the treatment of CALI. We will search articles in 7 electronic databases including Chinese National Knowledge Infrastructure, Wanfang Data, Chinese Scientific Journals Database, Chinese databases SinoMed, PubMed, Embase, and Cochrane Library databases. All the publications, with no time restrictions, will be searched without any restriction of language and status, the time from the establishment of the database to September 2022.We will apply the risk-of-bias tool of the Cochrane Collaboration for Randomized Controlled Trials to assess the methodological quality. Risk-of-Bias Assessment Tool for Non-randomized Studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software. This systematic review will evaluate the functional outcomes and radiographic results of ALCLR in the treatment of CALI. The conclusion of this study will provide evidence for judging whether ALCLR is superior to PLCLR for treatment of CALI. CRD42022362045.

Anatomical and biomechanical characteristics of fibularis longus tendon used for cruciate ligaments reconstruction

Abstract Introduction: Arthroscopic reconstruction of the cruciate ligament of the knee becomes routine with modern techniques and special instruments. However, the source of materials for this procedure has always been an eternal issue that affects the surgeons decision. The two peroneal tendons on the lateral side of the lower leg have the same function of plantar flexion and foot eversion. The fibularis longus tendon has been used for reconstruction such as the lateral collateral ligaments of the ankle or the Achilles tendon. Patients and methods: Descriptive cross-sectional study on twenty fresh cadavers were selected randomly for taking the fibularis longus tendon at the Department of Anatomy of the University of Medicine and Pharmacy, Ho Chi Minh City from January to July, 2022. Specimens with intact leg to lower knee segment were not crushed, well preserved and had never been used in previous studies. Results: Fibularis longus tendon length was 29,25 ± 2,1cm; the distances from fibularis longus tendon to deep fibular nerve and superficial fibular nerve was 71.1±8.63mm respectively, no split (longitudinal tear) was observed, the maximum tensile strength was 1170,4 ±203N, the maximum length of rupture 14,29 ± 3,88 mm. Conclusion: There was no split of fibularis longus tendon. Also no sign of impact on adjacent anatomy structures was found. The maximum tensile strength was equivalent to other grafts, such as the Hamstrings and patellar tendons. Its a potential source for arthroscopic reconstruction of the cruciate ligament Keywords: knee arthroplasty, fibularis longus tendon, grafts, Hamstrings tendon

Revision lateral ankle ligament reconstruction for patients with a failed modified Brostrom procedure

The Brostrom-Gould procedure has been considered as a gold standard operative technique for chronic lateral ankle instability. Despite the popularity and excellent outcomes of the modified Brostrom procedure, some patients still experience recurrence of ankle instability. Few studies reported outcomes of revision reconstruction for patients with a failed modified Brostrom procedure. This study aimed to evaluate the outcomes of a percutaneous anatomic revision lateral ankle ligament reconstruction for patients with a failed modified Brostrom procedure. From March 2017 to April 2020, 21 patients with persistent ankle instability after a modified Brostrom procedure underwent revision lateral ankle ligament reconstruction. The operation was performed through minimally invasive incisions. Functional assessment was performed using the Karlsson-Peterson ankle scoring system (KP) and the Visual Analogue Scale (VAS). The questionnaires of KP and VAS were completed before surgery and at the last follow-up. Patients' subjective satisfaction level was graded as excellent, good, fair, and poor. Preoperative and postoperative anterior talar displacement and varus talus tilt angle in stress radiographs were recorded. The average age at the revision surgery time was 39.6years. The mean follow-up was 39.2months. The VAS score improved from 4.1 ± 1.5 preoperatively to 1.3 ± 1.3 at the final follow-up (p < .05). The KP score improved from 59.0 ± 20.2 preoperatively to 88.2 ± 9.6 at the last follow-up (p < .05). The mean varus talar tilt angle was 14.1 ± 3.9mm preoperatively versus 4.9 ± 4.7mm at the final follow-up (p < .05). The mean anterior talar displacement was 12.8 ± 2.2mm versus 5.6 ± 3.7mm at the last follow-up (p < .05). The revision anatomic reconstruction of the lateral ligaments of the ankle is effective for patients with recurrent instability after a failed modified Broström procedure.

Anatomical Reconstruction of the Lateral Ligament of the Ankle (AntiRoLL) for Chronic Lateral Ankle Instability

Recently, anatomic reconstruction procedures for chronic lateral ankle instability (CLAI) using arthroscopic and percutaneous minimally invasive technique has been described with the goal of improving clinical outcomes of open non-MIS techniques. In this chapter we describe the history of reconstruction for CLAI and a new anatomical reconstruction of the lateral ankle ligament (AntiRoLL) MIS techniques.

Role of the Lateral Ankle Ligaments in the Vertical Stability of the Fibula

Category:Basic Sciences/Biologics; Ankle; TraumaIntroduction/Purpose:In unstable ankle fractures, syndesmosis and the deltoid ligament have been widely studied, and their importance in their pathophysiology and treatment is recognized. This is not the case of the ankle lateral ligaments, and in particular, their role in the vertical stability of the fibula is unknown. Given their anatomical position, they should avoid proximal translation of the distal fragment of the fibula fracture. Purpose: To quantify the superior translation of the fibula by applying a constant proximal traction force as the syndesmosis and lateral ankle ligaments are sectioned sequentially.Methods:Eleven human ankle cadaveric specimens were used (6 female, 5 male). Removal of the skin and muscles was performed down to the ankle level, preserving the interosseous membrane (IOM). A deep dissection was performed to identify the inferior tibiofibular ligaments and the lateral ligaments of the ankle. Each piece was mounted on a platform specially designed for this work (fig 1), fixing the foot with an axial load of 25 kg, and a proximal traction force of 50 N was applied to the fibula. The syndesmotic ligaments, IOM, anterior talofibular ligaments (ATFL), and calcaneofibular ligament (CFL) were sequentially sectioned. The proximal displacement of the fibula was measured after each sequential section. Normality analysis was performed with the Kolmogorov-Smirnov and Shapiro-Wilkins tests. Differences between groups were evaluated with the ANOVA test with Dunnett and Newman-Keuls post-test.Results:When applying 50 N of proximal traction, the proximal and vertical displacement of the fibula was as follows; no sectioning 1.96 +- 1.19 mm, syndesmosis/IOM sectioning 3.96 +- 1.33 mm, ATFL sectioning 5.9 +- 1.73 mm and 10.2 +- 2.76 mm after sectioning the CFL. Normal distribution was observed in all groups. All measurements had a statistically significant difference between each group (p <0.05).Conclusion:In this model, a complete syndesmosis/IOM lesion produces a mean fibular proximal displacement of 3.96 mm. By adding the ATFL and CFL complete injury, it reaches 10.2 mm. Clinical relevance: In an unstable ankle dislocation with a significant fibular proximal displacement, there is probably a severe compromise of the lateral ligament complex, which could have clinical relevance as it is part of the bone and ligamentary stability ring of the ankle. This is the first study that describes the role of the lateral ligament complex in fibular vertical stability.

Anterior Talofibular Ligament Augmentation With Internal Brace in the Office Setting

The anterior talofibular ligament (ATFL) is the most frequently injured lateral ligament of the ankle, and up to 20% of patients with ankle sprains may require surgical intervention to correct chronic lateral ankle instability. There has been increased interest in arthroscopic lateral ankle ligament repair techniques to minimize postoperative pain and expedite recovery. Additionally, the use of suture-tape augmentation may allow for improved recovery in those with ATFL reconstruction. The goal of this Technical Note is to describe the steps to performing in-office needle arthroscopy using suture tape as an internal brace for an ATFL deficient ankle. We also include an accompanying discussion on indications and opportunities afforded by an in-office procedure over the traditional operating room suite.

Intelligent localization and quantitative evaluation of anterior talofibular ligament injury using magnetic resonance imaging of ankle

BackgroundThere is a high incidence of injury to the lateral ligament of the ankle in daily living and sports activities. The anterior talofibular ligament (ATFL) is the most frequent types of ankle injuries. It is of great clinical significance to achieve intelligent localization and injury evaluation of ATFL due to its vulnerability.MethodsAccording to the specific characteristics of bones in different slices, the key slice was extracted by image segmentation and characteristic analysis. Then, the talus and fibula in the key slice were segmented by distance regularized level set evolution (DRLSE), and the curvature of their contour pixels was calculated to find useful feature points including the neck of talus, the inner edge of fibula, and the outer edge of fibula. ATFL area can be located using these feature points so as to quantify its first-order gray features and second-order texture features. Support vector machine (SVM) was performed for evaluation of ATFL injury.ResultsData were collected retrospectively from 158 patients who underwent MRI, and were divided into normal (68) and tear (90) group. The positioning accuracy and Dice coefficient were used to measure the performance of ATFL localization, and the mean values are 87.7% and 77.1%, respectively, which is helpful for the following feature extraction. SVM gave a good prediction ability with accuracy of 93.8%, sensitivity of 88.9%, specificity of 100%, precision of 100%, and F1 score of 94.2% in the test set.ConclusionExperimental results indicate that the proposed method is reliable in diagnosing ATFL injury. This study may provide a potentially viable method for aided clinical diagnoses of some ligament injury.

All-inside modified, lasso-loop, stitch arthroscopic ankle stabilization

PurposeTo introduce an all inside arthroscopic stabilization for the lateral instability of the ankle and clarify the effects on earlier return to activity and improvement of subjective clinical score (SAFE-Q). MethodsBetween April 2017 and April 2019, 75 ankles in 59 athletes underwent surgery to repair the lateral ligament of the ankle with all-inside arthroscopic repair using modified lasso-loop stitch technique; including 27 that underwent bilateral simultaneous surgery excluding simultaneous procedures for other pathologies. ResultsThe average time elapsed after surgery for walking, jogging, full athletic activities was 1.6±2.5, 16.9±3.7 and 42.4±19.3 days respectively. There was no statistically significant difference between the unilateral surgery and the bilateral simultaneous surgery groups. All subscales of the SAFE-Q before surgery and at 12 months after surgery were statistically significantly improved. ConclusionThe all-inside arthroscopic repair with modified lasso-loop stitch following an accelerated rehabilitation for lateral instability of the ankle in athletes provides an effective treatment to facilitate early return to athletic activities.

Hybrid Ankle Reconstruction of Lateral Ligaments

Open anatomic reconstruction of the lateral ligament (AntiRoLL) of the ankle with a gracilis Y graft and the inside-out technique are commonly used and have evolved to minimally invasive surgery, including arthroscopic AntiRoLL (A-AntiRoLL) and percutaneous AntiRoLL procedures. A-AntiRoLL allows assessment and treatment of intra-articular pathologies of the ankle concurrently with stabilization. However, the A-AntiRoLL technique is technically demanding, especially in the process of calcaneofibular ligament reconstruction under subtalar arthroscopy. In contrast, the percutaneous AntiRoLL procedure is a simple concept that does not require the skill of an experienced arthroscopist but requires an extra skin incision to assess and treat intra-articular pathologies of the ankle. This study describes the application of a minimally invasive anatomic reconstruction technique—hybrid AntiRoLL—for chronic instability of the ankle that does not require advanced arthroscopic technique to assess and treat intra-articular pathology simultaneously.

Arthroscopic Brostrom technique

Objective: To present the clinical and functional results of surgical treatment of patients with chronic instability of the ankle using the arthroscopic Brostrom technique. Methods: This is a case series of patients who underwent surgical treatment for chronic instability of the lateral ligament of the ankle using the arthroscopic Brostrom technique. Clinical assessments of ankle stability were performed preoperatively and at the last follow-up using the American Orthopedic Foot and Ankle Score (AOFAS), a visual analog scale (VAS) for pain, and the anterior drawer and talar inversion tilt tests. Surgical complications and patient satisfaction ratings were also analyzed. Results: A total of 16 patients were analyzed, with a mean follow-up of 14 months. There was a statistically significant (p&lt;0.001) improvement in mean AOFAS, which increased from 67.2 to 90.8 points and the mean VAS for pain score reduced from 6.5 to 1.5 points. All ankles were stable and had normal results for the anterior drawer test and the talar inversion tilt test. Three patients (19%) reported that resumption of sporting activities provoked subjective pain in the ankle, which improved progressively during follow-up. Two patients (12.5%) exhibited neurapraxia of the superficial peroneal nerve. A majority of the patients (81%) rated treatment as good or excellent. Conclusion: Treatment of chronic instability of the ankle ligament using the arthroscopic Brostrom technique restored ankle stability and achieved good clinical results. There was a high rate of early complications, but the majority were transitory and underwent complete remission during follow-up. Level of Evidence IV; Therapeutic Studies; Case Series.

Lateral Ligament Instability: Review of Pathology and Diagnosis.

Ankle sprains are a common injury that can lead to chronic lateral ankle instability resulting in pain, poor function, and decreased quality of life. The purpose of this review is to present information regarding injury mechanisms to the lateral ligaments of the ankle and the necessary steps to appropriately diagnose lateral ligament instability. The literature demonstrates that history and physical examination is often a reliable method for diagnosis of lateral ankle instability. In addition, imaging modalities are often used as adjuncts for diagnosis, especially when physical exam findings are equivocal. In summary, chronic lateral ligament instability of the ankle occurs secondary to failure of the lateral ligamentous complex. A focused physical examination to evaluate the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament is necessary for diagnosis. Imaging modalities including plain radiographs, stress radiographs, and MRI are helpful for definitive diagnosis and to rule out other pathology.

ANTERIOR TALOFIBULAR LIGAMENT (ATFL) RECONSRUCTION WITH MODIFIED BROSTROM-GOULD TECHNIQUE USING FIBER WIRE

Background: The incident of ankle sprain reported 1 of 10.000 case each day. The most incident was male about 22-24 year and sport active. We reported 2 cases (15 years old female and 21 years old male) both of them played routine basketball and futsal.Case: We reported 2 cases, male 21 years old and female 15 years old, both of them suffered from anterior talofibular ligament rupture, with AOFAS score fair (below 80 point) from the MRI there is rupture of ATFL.Discussion: The patient administered to the hospital after injury at sport. By physical examination (fair at AOFAS score) and radiological finding, they was decided underwent rupture anterior talofibular ligament and prepared for reconstruction with modified Brostrom-Gould technique using fiber wire. After + 3 month, the evaluation from physical diagnostic, radiology and we got an excellent AOFAS score, which means the 2 patient got really satisfaction and has no limitation at doing daily activities.Conclusion: ATFL is one of the lateral ligament of the ankle which protect the foot while moving at plantar flexion. Modified Brostrom-Gould technique using fiber wire gave good result for reconstruction ATFL rupture for these 2 patients.

The lateral ankle ligaments are interconnected: the medial connecting fibres between the anterior talofibular, calcaneofibular and posterior talofibular ligaments.

A deep knowledge of lateral ankle ligaments is necessary to understand its function, pathophysiology and treatment options. The ankle lateral collateral ligament is formed by the anterior talofibular ligament (ATFL), the calcaneofibular (CFL) and the posterior talofibular ligament (PTFL). Although previous studies have reported connections between these ligaments on its lateral side, no studies have specifically assessed connections on the medial side. The aim of this study was to assess the morphology and consistency of the medial connections between the components of the lateral collateral ligament complex of the ankle. Forty fresh-frozen ankle specimens were dissected to look for connections between the three lateral ankle ligaments. After visualization of the lateral ligaments was achieved, the fibula was amputated and ligament insertions were released at the talar and calcaneal insertion points. Observation of the connections and video analysis of the dynamic relationships of ligament connections were performed. Connections were found in all cases between the ATFL and PTFL, the ATFL and CFL, and the CFL and PTFL. Connections between ATFL and PTFL were not homogeneous. Although connections between the ATFLif and PTFL were noted in all cases (40), only 17 ankles (42.5%) had connections between the ATFLsf and PTFL. The amount of fibres of connection was also variable. Connections between the three components of the lateral collateral ligament of the ankle may be observed from the medial aspect of the ankle, and this may have important implications for arthroscopic lateral ligament repair.

Finite Element Analysis of the Expression of Plantar Pressure Distribution in the Injury of the Lateral Ligament of the Ankle

Finite Element Analysis of the Expression of Plantar Pressure Distribution in the Injury of the Lateral Ligament of the Ankle

Reliability of ultrasonography measurement of the anterior talofibular ligament (ATFL) length in healthy subjects (in vivo), based on examiner experience and patient positioning

BackgroundThe most common cause of ankle injury is the supination trauma, inflicting a partial or complete rupture of the anterior talofibular ligament (ATFL). Among conventional diagnostic tools and procedures of sports injuries, the method of stress-ultrasonography is reportedly a promising diagnostic tool for examining injuries of the lateral ligaments of the ankle. Preceding studies predominantly examined the comparability of stress-ultrasonography and other established diagnostic tools in terms of efficacy, viability and quality. The purpose of this study was to assess the reliability of stress-ultrasonography of the ATFL based on varying examiner experience and patient positioning.MethodSixteen healthy subjects were examined by four examiners with differing levels of skill and experience in ultrasonography, ranging from laymen to specialist. Measurements were recorded and interrater correlation coefficient (ICC) was applied in four positions, including a neutral position (A), medial rotation (B), plantar flexion (C) and inversion of the foot (D).ResultsThe length of the ATFL was 14.958 ± 2.145 mm in position A, 15.886 ± 1.994 mm in position B, 16.270 ± 1.858 mm in position C and 15.170 ± 1.781 mm in position D. The average length change was 0.928 ± 0.804 mm (6.656 ± 6.299%) in position B, 1.313 ± 1.266 mm (9.746 ± 9.484%) in position C and 0.213 ± 1.807 mm (2.604 ± 12.308%) in position D. The correlation of the combined results of all four investigators was 0.333 for position A, 0.386 for position B, 0.320 for position C and 0.517 for position D. The highest ICC (0.811) was recorded between the orthopedic specialist and the radiology specialist. The lowest ICC (0.299) was recorded between the laymen and the radiology specialist.ConclusionThe reliability of the ATFL examination seems to be exceedingly dependent on the examiner’s experience and skill in ultrasonographic (US) diagnostic. Moreover, the inversion positioning of the foot, described by the European Society of Musculoskeletal Radiology (ESSR) yielded the highest measurement reliability.