Bony landmarks available for minimally invasive lateral ankle stabilization surgery

a cadaveric anatomical study

ESSKA-AFAS Ankle Instability Group

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose: The purpose of this study was to determine the clinical utility of three bony tubercles: fibular obscure tubercle, talar obscure tubercle and tuberculum ligamenti calcaneofibularis, to serve as anatomical landmarks for defining the precise location of the origins and insertions of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Methods: Twelve lower extremity cadaveric specimens were procured. The detectability of the tubercles was tested using palpation and fluoroscopy with subsequent confirmation after dissection. If the tubercles were present, then distances from the identified tubercles to the footprint centres and the intersection of the ATFL and CFL were measured to allow precise localization of the ATFL and CFL origin and intersection sites. Further, if the tubercles were not detectable, then an attempt to provide an alternative means of localizing ATFL and CFL origin and insertion sites was made by measuring distances between alternative landmarks and other important structures. All the measurements were performed by two researchers, and the results were averaged. Results: The fibular obscure tubercle existed and was detectable in all specimens. It was located 1.3 mm proximal to the articular tip of the fibula, 2.7 mm to the intersection of the ATFL and CFL, 3.7 mm distal to the ATFL and 4.9 mm proximal to the CFL origins. The talar obscure tubercle existed 58 % of specimens and was detectable in 57 %. The talar obscure tubercle was located 1.4 mm to the ATFL. The ATFL insertion point was located 60 % of the distance from the inferolateral corner to the anterolateral corner of the of talar body along the anterior border of the talar lateral articular facet. The tuberculum ligamenti calcaneofibularis existed in 33 % of specimens and was detectable in 8 %. The CFL inserted 17 mm on a perpendicular projected line distal from the subtalar joint. Conclusions: The fibular obscure tubercle was clinically relevant and reliable bony landmark of the ATFL and CFL origin location. However, the talar obscure tubercle was less reliable and the tuberculum ligamenti calcaneofibularis was rarely available and as such alternative landmarks for the ATFL and CFL insertion location should be utilized. The present study describes the utility of clinically relevant bony landmarks that may assist in identifying the origins and insertions of the ATFL and CFL to facilitate minimally invasive ankle stabilization surgery.

Original languageEnglish
Pages (from-to)1916-1924
Number of pages9
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Volume25
Issue number6
DOIs
Publication statusPublished - 2017 Jun 1

Fingerprint

Ankle Lateral Ligament
Ligaments
Ankle
Joints
Subtalar Joint
Fibula
Palpation
Fluoroscopy
Dissection
Lower Extremity
Research Personnel

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

@article{970e764fc2174bcc943204ebd6b58f6d,
title = "Bony landmarks available for minimally invasive lateral ankle stabilization surgery: a cadaveric anatomical study",
abstract = "Purpose: The purpose of this study was to determine the clinical utility of three bony tubercles: fibular obscure tubercle, talar obscure tubercle and tuberculum ligamenti calcaneofibularis, to serve as anatomical landmarks for defining the precise location of the origins and insertions of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Methods: Twelve lower extremity cadaveric specimens were procured. The detectability of the tubercles was tested using palpation and fluoroscopy with subsequent confirmation after dissection. If the tubercles were present, then distances from the identified tubercles to the footprint centres and the intersection of the ATFL and CFL were measured to allow precise localization of the ATFL and CFL origin and intersection sites. Further, if the tubercles were not detectable, then an attempt to provide an alternative means of localizing ATFL and CFL origin and insertion sites was made by measuring distances between alternative landmarks and other important structures. All the measurements were performed by two researchers, and the results were averaged. Results: The fibular obscure tubercle existed and was detectable in all specimens. It was located 1.3 mm proximal to the articular tip of the fibula, 2.7 mm to the intersection of the ATFL and CFL, 3.7 mm distal to the ATFL and 4.9 mm proximal to the CFL origins. The talar obscure tubercle existed 58 {\%} of specimens and was detectable in 57 {\%}. The talar obscure tubercle was located 1.4 mm to the ATFL. The ATFL insertion point was located 60 {\%} of the distance from the inferolateral corner to the anterolateral corner of the of talar body along the anterior border of the talar lateral articular facet. The tuberculum ligamenti calcaneofibularis existed in 33 {\%} of specimens and was detectable in 8 {\%}. The CFL inserted 17 mm on a perpendicular projected line distal from the subtalar joint. Conclusions: The fibular obscure tubercle was clinically relevant and reliable bony landmark of the ATFL and CFL origin location. However, the talar obscure tubercle was less reliable and the tuberculum ligamenti calcaneofibularis was rarely available and as such alternative landmarks for the ATFL and CFL insertion location should be utilized. The present study describes the utility of clinically relevant bony landmarks that may assist in identifying the origins and insertions of the ATFL and CFL to facilitate minimally invasive ankle stabilization surgery.",
author = "{ESSKA-AFAS Ankle Instability Group} and Kentaro Matsui and Oliva, {Xavier Martin} and Masato Takao and Pereira, {Bruno S.} and Gomes, {Tiago Mota} and Lozano, {Jan Martinez} and Jorge Batista and Thomas Bauer and James Calder and Choi, {Woo Jin} and Ali Ghorbani and Mark Glazebrook and St{\'e}phane Guillo and Kong, {Siu Wah} and Jon Karlsson and Lee, {Jin Woo} and jinwoo lee and Frederick Michels and Andy Molloy and Caio Nery and Satoru Ozeki and Christopher Pearce and Anthony Perera and H{\'e}lder Pereira and Bas Pijnenburg and Fernando Raduan and Stone, {James W.} and Masato Takao and Yves Tourn{\'e} and Mark Glazebrook",
year = "2017",
month = "6",
day = "1",
doi = "10.1007/s00167-016-4218-7",
language = "English",
volume = "25",
pages = "1916--1924",
journal = "Knee Surgery, Sports Traumatology, Arthroscopy",
issn = "0942-2056",
publisher = "Springer Verlag",
number = "6",

}

Bony landmarks available for minimally invasive lateral ankle stabilization surgery : a cadaveric anatomical study. / ESSKA-AFAS Ankle Instability Group.

In: Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 25, No. 6, 01.06.2017, p. 1916-1924.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Bony landmarks available for minimally invasive lateral ankle stabilization surgery

T2 - a cadaveric anatomical study

AU - ESSKA-AFAS Ankle Instability Group

AU - Matsui, Kentaro

AU - Oliva, Xavier Martin

AU - Takao, Masato

AU - Pereira, Bruno S.

AU - Gomes, Tiago Mota

AU - Lozano, Jan Martinez

AU - Batista, Jorge

AU - Bauer, Thomas

AU - Calder, James

AU - Choi, Woo Jin

AU - Ghorbani, Ali

AU - Glazebrook, Mark

AU - Guillo, Stéphane

AU - Kong, Siu Wah

AU - Karlsson, Jon

AU - Lee, Jin Woo

AU - lee, jinwoo

AU - Michels, Frederick

AU - Molloy, Andy

AU - Nery, Caio

AU - Ozeki, Satoru

AU - Pearce, Christopher

AU - Perera, Anthony

AU - Pereira, Hélder

AU - Pijnenburg, Bas

AU - Raduan, Fernando

AU - Stone, James W.

AU - Takao, Masato

AU - Tourné, Yves

AU - Glazebrook, Mark

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Purpose: The purpose of this study was to determine the clinical utility of three bony tubercles: fibular obscure tubercle, talar obscure tubercle and tuberculum ligamenti calcaneofibularis, to serve as anatomical landmarks for defining the precise location of the origins and insertions of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Methods: Twelve lower extremity cadaveric specimens were procured. The detectability of the tubercles was tested using palpation and fluoroscopy with subsequent confirmation after dissection. If the tubercles were present, then distances from the identified tubercles to the footprint centres and the intersection of the ATFL and CFL were measured to allow precise localization of the ATFL and CFL origin and intersection sites. Further, if the tubercles were not detectable, then an attempt to provide an alternative means of localizing ATFL and CFL origin and insertion sites was made by measuring distances between alternative landmarks and other important structures. All the measurements were performed by two researchers, and the results were averaged. Results: The fibular obscure tubercle existed and was detectable in all specimens. It was located 1.3 mm proximal to the articular tip of the fibula, 2.7 mm to the intersection of the ATFL and CFL, 3.7 mm distal to the ATFL and 4.9 mm proximal to the CFL origins. The talar obscure tubercle existed 58 % of specimens and was detectable in 57 %. The talar obscure tubercle was located 1.4 mm to the ATFL. The ATFL insertion point was located 60 % of the distance from the inferolateral corner to the anterolateral corner of the of talar body along the anterior border of the talar lateral articular facet. The tuberculum ligamenti calcaneofibularis existed in 33 % of specimens and was detectable in 8 %. The CFL inserted 17 mm on a perpendicular projected line distal from the subtalar joint. Conclusions: The fibular obscure tubercle was clinically relevant and reliable bony landmark of the ATFL and CFL origin location. However, the talar obscure tubercle was less reliable and the tuberculum ligamenti calcaneofibularis was rarely available and as such alternative landmarks for the ATFL and CFL insertion location should be utilized. The present study describes the utility of clinically relevant bony landmarks that may assist in identifying the origins and insertions of the ATFL and CFL to facilitate minimally invasive ankle stabilization surgery.

AB - Purpose: The purpose of this study was to determine the clinical utility of three bony tubercles: fibular obscure tubercle, talar obscure tubercle and tuberculum ligamenti calcaneofibularis, to serve as anatomical landmarks for defining the precise location of the origins and insertions of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Methods: Twelve lower extremity cadaveric specimens were procured. The detectability of the tubercles was tested using palpation and fluoroscopy with subsequent confirmation after dissection. If the tubercles were present, then distances from the identified tubercles to the footprint centres and the intersection of the ATFL and CFL were measured to allow precise localization of the ATFL and CFL origin and intersection sites. Further, if the tubercles were not detectable, then an attempt to provide an alternative means of localizing ATFL and CFL origin and insertion sites was made by measuring distances between alternative landmarks and other important structures. All the measurements were performed by two researchers, and the results were averaged. Results: The fibular obscure tubercle existed and was detectable in all specimens. It was located 1.3 mm proximal to the articular tip of the fibula, 2.7 mm to the intersection of the ATFL and CFL, 3.7 mm distal to the ATFL and 4.9 mm proximal to the CFL origins. The talar obscure tubercle existed 58 % of specimens and was detectable in 57 %. The talar obscure tubercle was located 1.4 mm to the ATFL. The ATFL insertion point was located 60 % of the distance from the inferolateral corner to the anterolateral corner of the of talar body along the anterior border of the talar lateral articular facet. The tuberculum ligamenti calcaneofibularis existed in 33 % of specimens and was detectable in 8 %. The CFL inserted 17 mm on a perpendicular projected line distal from the subtalar joint. Conclusions: The fibular obscure tubercle was clinically relevant and reliable bony landmark of the ATFL and CFL origin location. However, the talar obscure tubercle was less reliable and the tuberculum ligamenti calcaneofibularis was rarely available and as such alternative landmarks for the ATFL and CFL insertion location should be utilized. The present study describes the utility of clinically relevant bony landmarks that may assist in identifying the origins and insertions of the ATFL and CFL to facilitate minimally invasive ankle stabilization surgery.

UR - http://www.scopus.com/inward/record.url?scp=84976417871&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84976417871&partnerID=8YFLogxK

U2 - 10.1007/s00167-016-4218-7

DO - 10.1007/s00167-016-4218-7

M3 - Article

VL - 25

SP - 1916

EP - 1924

JO - Knee Surgery, Sports Traumatology, Arthroscopy

JF - Knee Surgery, Sports Traumatology, Arthroscopy

SN - 0942-2056

IS - 6

ER -