Francisco Guerra-Pinto1, Alirio Fabian2, Tiago Mota3, Tania Díaz4, Mariano Monzo5, Xavier Martin Oliva6. 1. Department of Orthopedic Surgery, Hospital Ortopédico de Sant'Ana, Hospital da Cruz Vermelha Portuguesa, Portugal; Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain. Electronic address: fguerrapinto@gmail.com. 2. Orthopedic Surgeon, Department of Orthopedics, Hospital de San Juan de Dios, Guatemala City, Guatemala. Electronic address: aliriofabian@gmail.com. 3. Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain. Electronic address: Tmotagom7@alumnes.ub.edu. 4. Molecular Oncology and Embryology Laboratory, Human Anatomy Unit, School of Medicine, University of Barcelona, 08036 Barcelona, Spain. 5. Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain. 6. Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Orthopedic Surgeon, Department of Orthopedics, Clinica Del Remei, Barcelona, Spain. Electronic address: xmoliva@inbox.com.
Abstract
INTRODUCTION: A precise understanding of the anatomy of the multiple bundles of the deltoid ankle ligament might have clinical impact. The most relevant deltoid anatomical series report a variable frequency of the tibiocalcaneal ligament, possibly the most important bundle to be reconstructed in medial ankle insufficiency. Our purpose was to access the deltoid's tibiocalcaneal ligament morphology in a large anatomical study as well as to perform a historical literature review on the reasons for its variable prevalence. MATERIALS AND METHODS: Forty-three ankle specimen were dissected to describe the prevalence of superficial and deep deltoid bundles, with special attention to the tibiocalcaneal ligament and its variants. RESULTS: All ankles had distinct deep and superficial bundles. In all 43 ankles the tibionavicular and tibiospring ligaments were clearly identified. The superficial posterior tibiotalar ligament was identified in 38 ankles (88%). The deep anterior tibiotalar bundle was identified in 35 ankles (81%). The deep posterior tibiotalar bundle was identified in all ankles. The tibiocalcaneal ligament was identified in 33 ankles (77%). In ten ankles there wasn't a direct bundle between the tibia and the sustentaculum tali. In all of these, however, we found some fibers spanning the gap between the tibiospring ligament and the sustentaculum tali. CONCLUSION: The tibiocalcaneal ligament is present in most specimens. In those in which we could not identify a direct bundle between the tibia and the calcareous we found a variant of the tibiospring ligament that connects to the sustentaculum tali.
INTRODUCTION: A precise understanding of the anatomy of the multiple bundles of the deltoid ankle ligament might have clinical impact. The most relevant deltoid anatomical series report a variable frequency of the tibiocalcaneal ligament, possibly the most important bundle to be reconstructed in medial ankle insufficiency. Our purpose was to access the deltoid's tibiocalcaneal ligament morphology in a large anatomical study as well as to perform a historical literature review on the reasons for its variable prevalence. MATERIALS AND METHODS: Forty-three ankle specimen were dissected to describe the prevalence of superficial and deep deltoid bundles, with special attention to the tibiocalcaneal ligament and its variants. RESULTS: All ankles had distinct deep and superficial bundles. In all 43 ankles the tibionavicular and tibiospring ligaments were clearly identified. The superficial posterior tibiotalar ligament was identified in 38 ankles (88%). The deep anterior tibiotalar bundle was identified in 35 ankles (81%). The deep posterior tibiotalar bundle was identified in all ankles. The tibiocalcaneal ligament was identified in 33 ankles (77%). In ten ankles there wasn't a direct bundle between the tibia and the sustentaculum tali. In all of these, however, we found some fibers spanning the gap between the tibiospring ligament and the sustentaculum tali. CONCLUSION: The tibiocalcaneal ligament is present in most specimens. In those in which we could not identify a direct bundle between the tibia and the calcareous we found a variant of the tibiospring ligament that connects to the sustentaculum tali.