Background

To optimize the biomechanical outcomes in lateral ankle ligament reconstruction, avoid stiffness or residual laxity, aiming for an isometric reconstruction of the anterior lateral talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) is mandatory. However, the localization of the optimal ligament insertion remains challenging to assess intraoperatively.

Method

Three-dimensional (3D) surface models from 10 healthy ankles were generated. 30 insertion points of the CFL were defined on the lateral side of the calcaneus each 10% of its total length in the dorsal-to-ventral and proximal-to-distal plane. 6 insertion points were defined at the ventral ridge of fibula from the malleolar tip and 5 insertions were defined along the lateral talar process. The ligament length variation of ATFL and CFL was assessed after a simulation of the flexion/extension around a simulated tibiotalar axis and inversion/eversion around a simulated subtalar axis in 36 different positions.

Results

The isometric point of CFL on the calcaneus is located at about 60% along the dorsal-to-ventral and between 60% and 70% along the proximal-to-distal plane. From maximal extension to flexion, these points present respectively a length variation of − 0.8 to − 1.1 mm (p = 0.46) and − 1.1 to − 0.8 mm (p = 0.56). A fibular insertion at 5 mm proximal to the malleolar tip present a length variation ranging from − 0.1–1 mm (p < 0.001) for ATFL and from − 0.7–0.5 mm (p < 0.001) for CFL. A talar insertion point of the ATFL located 5 mm proximal to the subtalar joint present the lowest variation, ranging from − 1.1–0.7 mm (p < 0.001), however an insertion at 20- or 25-mm present isometry (+0.1 to +0.9 mm p = 0.1, and +0.4 to +0.4 mm p = 1 respectively) if the fibular insertion is located at 5 mm proximal to the malleolar tip.

Conclusion

This study provides anatomical references which are reproducible in daily practice. These insertion points allow to achieve a stable reconstruction while maintaining a tension-free mobilization of the ankle.

中文翻译：

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外踝韧带重建中的等距点：三维运动学研究

背景

为了优化踝关节外侧韧带重建的生物力学结果，避免僵硬或残余松弛，必须对前外侧距腓韧带 (ATFL) 和跟腓韧带 (CFL) 进行等距重建。然而，最佳韧带插入的定位在术中评估仍然具有挑战性。

方法

生成了来自 10 个健康脚踝的三维 (3D) 表面模型。CFL 的 30 个插入点被定义在跟骨的外侧，每个插入点在背侧到腹侧和近端到远端平面中的总长度的 10%。从踝尖开始在腓骨腹侧脊定义了 6 个插入点，沿着外侧距骨过程定义了 5 个插入点。在模拟 36 个不同位置的模拟胫骨轴周围的屈曲/伸展和围绕模拟距下轴的内翻/外翻后，评估了 ATFL 和 CFL 的韧带长度变化。

结果

CFL 在跟骨上的等距点位于沿背侧至腹侧的约 60% 处以及沿近端至远端平面的 60% 至 70% 之间。从最大伸展到屈曲，这些点分别呈现 − 0.8 至 − 1.1 mm (p = 0.46) 和 − 1.1 至 − 0.8 mm (p = 0.56) 的长度变化。距踝尖近端 5 mm 处的腓骨止点对于 ATFL 的长度变化范围为 − 0.1–1 mm (p < 0.001)，对于 CFL 的长度变化范围为 − 0.7–0.5 mm (p < 0.001)。位于距下关节近端 5 mm 处的 ATFL 距骨插入点呈现最小变化，范围为 − 1.1–0.7 mm (p < 0.001)，但是 20- 或 25-mm 处的插入呈现等距（+0.1 至 + 0.9 毫米 p = 0.1 和 +0.4 至 +0.4 毫米 p = 1）如果腓骨插入位于踝尖近端 5 毫米处。

结论

这项研究提供了在日常实践中可重现的解剖学参考。这些插入点可以实现稳定的重建，同时保持脚踝的无张力活动。