Bruno S Pereira1,2,3,4, C Niek van Dijk5,6,7, Renato Andrade5,8,9, Ricardo P Casaroli-Marano10, João Espregueira-Mendes5,8,11,12, Xavier Martin Oliva10,13. 1. Hospital Privado de Braga, Lugar da Igreja Nogueira, Braga, Portugal. pereira.bac@gmail.com. 2. Clínica Do Dragão, Espregueira-Mendes Sports Center, FIFA Medical Centre of Excellence, Porto, Portugal. pereira.bac@gmail.com. 3. Facultad de Medicina, University of Barcelona, Casanova, 143, 08036, Barcelona, Spain. pereira.bac@gmail.com. 4. Dom Henrique Research Centre, Porto, Portugal. pereira.bac@gmail.com. 5. Clínica Do Dragão, Espregueira-Mendes Sports Center, FIFA Medical Centre of Excellence, Porto, Portugal. 6. Department Orthopedic Surgery, Academic Medical Center (AMC), Amsterdam, The Netherlands. 7. FIFA Medical Centre of Excellence Ripoll De Prado and Van Dijk Sport Clinic, Madrid, Spain. 8. Dom Henrique Research Centre, Porto, Portugal. 9. Faculty of Sports, University of Porto, Porto, Portugal. 10. Facultad de Medicina, University of Barcelona, Casanova, 143, 08036, Barcelona, Spain. 11. ICVS/3Bs, PT Government Associate Laboratory, Braga/Guimarães, Portugal. 12. School of Medicine, Minho University, Braga, Portugal. 13. Orthopedic Surgery Department, Clínica Ntra. Sra. Del Remei, Carrer de l'Escorial, 148, 08024, Barcelona, Spain.
Abstract
PURPOSE: The purpose of this study was to investigate if the calcaneofibular ligament (CFL) presents morphologic variants and measure the morphometrics of the ligament and its footprints METHODS: An anatomical study of 47 fresh-frozen below-the-knee ankle specimens was performed. Lateral ankle structures were dissected to expose the CFL. Overdissection was avoided to not modify the native morphology. The morphology (number and orientation of CFL bundles) and measurements of CFL insertions were recorded with ankle secured in neutral position. RESULTS: Four distinct morphological-oriented shapes of the CFL were observed. These included single bundle, Y-shape double bundle, V-shape double bundle, and associated with the lateral talocalcaneal ligament. The most frequent CFL morphology observed was the single bundle and the Y-shape double bundle, present in 21 (44.7%) and 13 (27.7%) ankles. The V-shape double bundle and the CFL double bundle associated with the lateral talocalcaneal ligaments were less common, appearing only in eight (17.0%) and five (10.6%) ankles. The CFL length was higher in single bundle and Y-shaped double bundle CFL variants, about 30 mm each. Footprint morphometrics were heterogenous amongst the different CFL variants. CONCLUSION: The CFL presents four distinct morphological-oriented shapes. The double bundle, V-shaped and Y-shaped CFL variants are uncommon and poorly reported in the literature. Their relation to the lateral talocalcaneal ligament and the inferior fascicle of the anterior talofibular ligament requires further research. The CFL morphology provides detailed knowledge of CFL anatomy that can improve diagnostic procedures. Furthermore, this information can fine-tune graft selection and sizing and allow a more precise anatomic placement during surgical reconstruction.
PURPOSE: The purpose of this study was to investigate if the calcaneofibular ligament (CFL) presents morphologic variants and measure the morphometrics of the ligament and its footprints METHODS: An anatomical study of 47 fresh-frozen below-the-knee ankle specimens was performed. Lateral ankle structures were dissected to expose the CFL. Overdissection was avoided to not modify the native morphology. The morphology (number and orientation of CFL bundles) and measurements of CFL insertions were recorded with ankle secured in neutral position. RESULTS: Four distinct morphological-oriented shapes of the CFL were observed. These included single bundle, Y-shape double bundle, V-shape double bundle, and associated with the lateral talocalcaneal ligament. The most frequent CFL morphology observed was the single bundle and the Y-shape double bundle, present in 21 (44.7%) and 13 (27.7%) ankles. The V-shape double bundle and the CFL double bundle associated with the lateral talocalcaneal ligaments were less common, appearing only in eight (17.0%) and five (10.6%) ankles. The CFL length was higher in single bundle and Y-shaped double bundle CFL variants, about 30 mm each. Footprint morphometrics were heterogenous amongst the different CFL variants. CONCLUSION: The CFL presents four distinct morphological-oriented shapes. The double bundle, V-shaped and Y-shaped CFL variants are uncommon and poorly reported in the literature. Their relation to the lateral talocalcaneal ligament and the inferior fascicle of the anterior talofibular ligament requires further research. The CFL morphology provides detailed knowledge of CFL anatomy that can improve diagnostic procedures. Furthermore, this information can fine-tune graft selection and sizing and allow a more precise anatomic placement during surgical reconstruction.
Authors: Jeffrey D Simpson; Ethan M Stewart; Anastasia M Mosby; David M Macias; Harish Chander; Adam C Knight Journal: J Sport Rehabil Date: 2019-08-01 Impact factor: 1.931