Anatomy and Cell Biology

Korean Association of Anatomists (대한해부학회)
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Anatomical study of the bone morphology of the anterior talofibular ligament attachment

  • Hitomi Fujishiro (Department of Anatomy and Physiological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University) ;
  • Akimoto Nimura (Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University) ;
  • Mizuki Azumaya (Department of Anatomy and Physiological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University) ;
  • Soichi Hattori (Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University) ;
  • Osamu Hoshi (Department of Anatomy and Physiological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University) ;
  • Keiichi Akita (Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University)
  • Received : 2023.01.05
  • Accepted : 2023.05.19
  • Published : 2023.09.30
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Abstract

Anterior talofibular ligament (ATFL) injuries are the most common cause of ankle sprains. To ensure anatomically accurate surgery and ultrasound imaging of the ATFL, anatomical knowledge of the bony landmarks around the ATFL attachment to the distal fibula is required. The purpose of the present study was to anatomically investigate the ATFL attachment to the fibula with respect to bone morphology and attachment structures. First, we analyzed 36 feet using micro-computed tomography. After excluding 9 feet for deformities, the remaining 27 feet were used for chemically debrided bone analysis and macroscopic and histological observations. Ten feet of living specimens were observed using ultrasonography. We found that a bony ridge was present at the boundary between the attachments of the ATFL and calcaneofibular ligament (CFL) to the fibula. These two attachments could be distinguished based on a difference in fiber orientation. Histologically, the ATFL was attached to the anterodistal part of the fibula via fibrocartilage anterior to the bony ridge indicating the border with the CFL attachment. Using ultrasonography in living specimens, the bony ridge and hyperechoic fibrillar pattern of the ATFL could be visualized. We established that the bony ridge corresponded to the posterior margin of the ATFL attachment itself. The ridge was obvious, and the superior fibers of the ATFL have directly attached anteriorly to it. This bony ridge could become a valuable and easy-to-use landmark for ultrasound imaging of the ATFL attachment if combined with the identification of the fibrillar pattern of the ATFL.

Keywords

Acknowledgement

We acknowledge and thank the anonymous individuals who generously donated their bodies for this study.

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