The lateral fibulotalocalcaneal ligament complex: an ankle stabilizing isometric structure

Introduction of the paper

One of the most common injuries related to foot biomechanics is a lateral ankle sprain, where the anterior talofibular ligament (ATFL) is injured in isolation in 80% of cases, which can be combined with a calcaneofibular ligament (CFL) injury in the remaining 20%. This ligament injury can cause instability in the ankle.

In contrast to chronic ankle instability, microinstability is an emerging concept in the ankle joint, and the pathological mechanism that could explain the consequences of a partial rupture of ATFL’s superior fascicle. The findings of this anatomical study is that, although ATFL is known to consist of two fascicles, there are no specific descriptions of how these ligaments are related or connected to each other as part of the same complex. ATFL’s superior fascicle has shown to be an intraarticular structure and therefore a different anatomical structure than ATFL’s inferior fascicle. On the other hand, ATFL’s inferior fascicle and CFL share some features:

– are both isometric

– they are extraarticular ligaments,

– have a common fibular insertion

– are connected by arc-shaped fibers.

The anatomical description of this ligament complex that is made for the first time in this study has been called the lateral fibulotalocalcaneal ligament complex of the ankle.

The clinical implications this description has could explain the high index of chronic pain after an ankle sprain, reported in 30 and 40% of patients that suffered an inversion ankle sprain.

Intra-articular ligaments have an impaired ability to heal after injury (as happens with the anterior cruciate ligament in the knee), and therefore ATFL’s superior fascicle being an intra-articular structure could explain why patients have chronic pain after an ankle sprain (ATFL’s superior fascicle is not healing properly) but they do not obtain a clear diagnosis from their physicians (most clinical and imaging tests will struggle diagnosing an isolated ATFL’s superior fascicle injury-they are sensitive enough only to diagnose a complete ATFL’s superior and inferior fascicle rupture). Thus, proper diagnosis of ATFL’s superior fascicle injuries represents the future of ankle pathology.

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