Morphometric Study of Anterior Talofibular Ligament of Ankle

Abstract

Ankle joint (talocrural) is a hinge joint. The ligaments of this joint are medial and lateral collateral ligaments. Medial deltoid ligament has superficial and deep components. Lateral collateral ligament has Anterior Talofibular (ATFL), Calcaneofibular (CFL) and Posterior Talofibular ligaments (PTFL) as three discrete parts. These two major ligamentous complexes are the main stabilizers of ankle joint which are appreciated both in MRI and cadaveric dissections. Ankle sprains are most common in athletes and in other sports like basketball, soccer, football and volleyball. Lateral ankle sprains account for about 85% of all ankle sprains; with anterior talofibular ligament being the most frequently injured. Morphometry and variations of ligaments of ankle has not been well documented in literature. Hence this study was taken up. Study was done by dissection on 60 cadaveric lower limbs, irrespective of sex from the Department of Anatomy, Kempegowda Institute of Medical Sciences, Bangalore. By dissection, both single (18%) as well as double banded (82%) ATFL were found. The average length and width of ATFL irrespective of side was noted. There was no statistical significance in the values between the right and the left ankles. The data represented in this study may be important when considering surgical repair or reconstruction of traumatized or attenuated collateral ligaments.

Anatomical dissection of the calcaneofibular ligament of the ankle – a macroscopic and morphometric study

“…For the latter author [17], who worked on 44 ankles, the variation of the final insertion led to a modification of the angle of the CFL with the sagittal plane; his knowledge is interesting in the radiological diagnosis of ligamentous damage. According to the same authors, the orientation of the ligament also changes depending on the position of the talus, in varus or valgus, which could be a factor of instability and predispose to ankle sprains [7][8][9][10][11][12][13][14][15][16][17]. In the current study, a common insertion with the distal bundle of the ATFL was found in 4% of the cases.…”

“…The CFL shares some features with the distal bundle of the ATFL: 2 isometric ligaments with a common fibular insertion, connected by arciform fibres, and forming a functional and anatomical entity which has been named the lateral fibulotalocalcaneal ligament complex (LFTCL), the lesion of which can cause classical instability [4][5][6][7][8][9][10][11][12][13][14][15][16].…”

“…Kitsoulis, in his work on the morphology of the calcaneofibular ligament, reports a common insertion of the fibular with the anterior talofibular ligament in 33% of cases, whereas Taser cited an anterior calcaneal termination in front of the fibular tubercle in 24 (54%) of cases [7][8][9][10][11][12][13][14][15][16][17]. For the latter author [17], who worked on 44 ankles, the variation of the final insertion led to a modification of the angle of the CFL with the sagittal plane; his knowledge is interesting in the radiological diagnosis of ligamentous damage.…”

“…Its morphometric aspects have been reported in various cadaveric studies, its dimensions, on average, are 31 ± 6 mm in length, and 4.4 ± 3.1 mm in width, its angle with the sagittal plane -51.11°. Its maximum elongation in extreme inversion and in dorsiflexion is 2.88% of its initial length [9][10]. The fibular insertion centre is 4.2 ± 1.8 mm from the apex of the lateral malleolus, and the calcaneal insertion centre is 18.4 ± 2.5 mm from the apex of the fibular process of the calcaneus (radiological interest) [11].…”