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Kono K, Yamaguchi S, Kimura S, Mikami Y, Kitsukawa K, Matsumoto K, Edama M, Shiko Y, Horii M, Sasho T, Ohtori S. Anterior talofibular ligament footprint dimension measured using three-dimensional magnetic resonance imaging. Skeletal Radiol 2025; 54:937-945. [PMID: 39243297 DOI: 10.1007/s00256-024-04778-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 08/01/2024] [Accepted: 08/20/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE Knowledge of footprint anatomy is essential for ankle anterior talofibular ligament repair and reconstruction. We aimed to determine the intra- and inter-rater measurement reliability of the anterior talofibular ligament footprint dimension using three-dimensional MRI. METHODS MRI images of 20 ankles with intact ligaments, including 11 with a single bundle and nine with double-bundle ligaments, were analyzed. Imaging was performed using a 3.0-Tesla MRI. Isotropic three-dimensional proton density-weighted images with a voxel size of 0.6 mm were obtained. The fibular and talar footprints were manually segmented using image processing software to create three-dimensional ligament footprints. The lengths, widths, and areas of each sample were measured. A certified orthopedic surgeon and a senior orthopedic fellow performed the measurements twice at 6-week intervals. The intra- and inter-rater differences in the measurements were calculated. RESULTS The length, width, and area of the single-bundle fibular footprint were 8.7 mm, 5.4 mm, and 37.4 mm2, respectively. Those of the talar footprint were 8.4 mm, 4.3 mm, and 30.1 mm2, respectively. The inferior bundle of the double-bundle ligament was significantly smaller than the single and superior bundles (p < 0.001). No differences were observed between intra-rater measurements by either rater, with maximum differences of 0.7 mm, 0.5, and 1.7 mm2, in length, width, and area, respectively. The maximum inter-rater measurement differences were 1.9 mm, 0.5, and 2.4 mm2, respectively. CONCLUSION Measurements of the anterior talofibular ligament dimensions using three-dimensional MRI were sufficiently reliable. This measurement method provides in vivo quantitative data on ligament footprint anatomy.
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Affiliation(s)
- Kenta Kono
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan
| | - Satoshi Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan.
- Graduate School of Global and Transdisciplinary Studies, Chiba University, Chiba, Japan.
| | - Seiji Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan
| | - Yukio Mikami
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan
| | - Kaoru Kitsukawa
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Koji Matsumoto
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Yuki Shiko
- Biostatistics Section, Chiba University Hospital Clinical Research Center, Chiba, Japan
| | - Manato Horii
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan
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Ruzik K, Gonera B, Borowski A, Karauda P, Aragonés P, Olewnik Ł. Anatomic Variations of the Calcaneofibular Ligament. Foot Ankle Int 2024; 45:784-795. [PMID: 38590202 DOI: 10.1177/10711007241241073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND The lateral ankle joint comprises the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL). The purpose of this study was to propose a classification of CFL morphology. METHODS The material comprised 120 paired lower limbs from human cadavers (30 male, 30 female), mean age 62.3 years. The morphology was carefully assessed, and morphometric measurements were performed. RESULTS A 4-part method for anatomic classification can be suggested based on our study. Type 1 (48.3%), the most common type, was characterized by a bandlike morphology. Type 2 (9.2%) was characterized by a Y-shaped band, and type 3 (21.7%) by a V-shaped band. Type 4 (20.8%) was characterized by the presence of 2 or 3 bands. Type 2 and 4 were divided into further subtypes based on origin footprint. CONCLUSION The aim of our study was to describe variations of calcaneofibular ligament. Our proposed 4-part classification may be of value in clinical practice in future recognition of CFL injuries and in its repair or reconstruction. CLINICAL RELEVANCE The anatomy of the CFL plays an important role in stability of the ankle. Greater recognition of anatomical variation may help improve reconstructive options for patients with chronic lateral ankle instability.
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Affiliation(s)
- Kacper Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Bartosz Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Andrzej Borowski
- Clinic of Orthopaedic and Paediatric Orthopaedics, Medical University of Lodz, Lodz, Poland
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Paloma Aragonés
- Department of Orthopedics Surgery, Hospital Santa Cristina, Madrid, Spain
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
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Kim JH, Jin ZW, Hayashi S, Murakami G, Rodríguez-Vázquez JF, Abe H. Major change in morphology of the talofibular ligaments during fetal development and growth. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1121-1129. [PMID: 35857084 DOI: 10.1007/s00276-022-02987-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/08/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND PURPOSE Ankle sprain is often attributed to damage of the anterior and posterior talofibular ligaments (ATFL, PTFL). We compared the morphology of these ligaments in fetuses of different gestational ages (GAs) with the horizontal configuration in adults. MATERIALS AND METHODS Histological sections of unilateral ankles were examined in 22 fetuses, 10 at GA of 9-12 weeks and 12 at GA of 26-39 weeks. RESULTS At a GA of 9 to 10 weeks, the ATFL and PTFL consisted of horizontally running straight fibers. The initial ATFL appeared as a thickening of the capsule of the talocrural joint, although the initial PTFL was distant from this joint. Until a GA of 12 weeks, the talus and fibula were separated by an expanding joint cavity. Thus, the initial horizontal ligaments were "pulled" in a distal direction. The distal parts of the ligaments consisted of thin collagenous fibers that had an irregular array, whereas the short proximal parts had thick fibers and a horizontal array. In near-term fetuses, the ligaments contained no horizontal fibers. The ATFL had a wavy course around the thick synovial fold, and was exposed to the joint cavity along the entire course; the distal part was thinner than the proximal part. The PTFL was bulky and consisted of fibers with an irregular array. Therefore, the morphology in a near-term fetus was quite different from that in adults. CONCLUSION The horizontal and straight composite ankle fibers in adults apparently result from postnatal reconstruction, depending on mechanical demand.
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Affiliation(s)
- Ji Hyun Kim
- Department of Anatomy, Jeonbuk National University Medical School, Geunji-ro 20, Deukjin-gu, Jeonju, 54907, Korea.
| | - Zhe-Wu Jin
- Department of Anatomy, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Shogo Hayashi
- Department of Anatomy, Division of Basic Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Gen Murakami
- Division of Internal Medicine, Cupid Clinic, Iwamizawa, Japan
| | | | - Hiroshi Abe
- Emeritus Professor of Akita University School of Medicine, Akita, Japan
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