The lateral fibulotalocalcaneal ligament complex of the ankle. The anatomical connection between the inferior fascicle of the anterior talofibular ligament and the calcaneofibular ligament.
ESSKA Academy. Dalmau-Pastor M. May 11, 2018; 218058; FP32-934
Miki Dalmau-Pastor
Miki Dalmau-Pastor
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Objectives: The objectives of the study were: to clarify the anatomic relation (if any) between the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL); to provide anatomical support to the stablished fact that a repair of the ATFL also increases tension on CFL; to clarify the anatomy of ATFL (1, 2, or 3 fascicles); to verify the intra-articular or extra-articular location of the ligaments.

Methods: 30 fresh-frozen ankle specimens were dissected. Careful dissection of the lateral ankle ligaments was performed. Methodology when making a classic ankle ligaments dissection consists in resecting any fibers that are not ligament consistent. In this case and in order to assess if there are any anatomical relation between the ATFL and CFL, any fibers found plantar to the ATFL were preserved for further analysis. Measures of the ligaments from insertion-to-insertion in maximum plantarflexion and dorsiflexion were performed in order to assess the function of each ligament structure.

Results: The ATFL is a 2 fascicles ligament: the superior fascicle is intra-articular and it is relaxed in dorsiflexion and tenses in plantarflexion; the inferior fascicle is extra-articular and it is an isometric structure. Arciform fibers connecting the inferior fascicle of ATFL and CFL were found in every case, forming an anatomical unit that was named by the authors as the lateral fibulotalocalcaneal ligament complex of the ankle. The ligament complex includes the following structures: inferior fascicle of ATFL, arciform fibers and CFL: these three structures were extra-articular and were isometric structures.

Conclusions: The findings of this anatomical study will change forever the understanding of ankle ligaments. The fact that the ATFL has two fascicles with very different characteristics probably means that the two fascicles should indeed be considered two different ligaments. On the other hand, the fact that the inferior fascicle of ATFL, the arciform fibers and the CFL form an isometric complex highlight the importance that the lateral fibulotalocalcaneal ligament complex will have in ankle instability diagnosis and treatment.

ankle anatomy; ankle ligaments; ankle instability;
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