A calcaneal tunnel for CFL reconstruction should be directed to the posterior inferior medial edge of the calcaneal tuberosity.
Aged
Aged, 80 and over
Anatomic Landmarks
Ankle Joint
/ surgery
Cadaver
Calcaneus
/ anatomy & histology
Female
Fibula
/ anatomy & histology
Humans
Joint Instability
/ surgery
Lateral Ligament, Ankle
/ surgery
Male
Sural Nerve
/ anatomy & histology
Tarsal Bones
/ anatomy & histology
Tendons
/ anatomy & histology
Bone tunnel
Calcaneofibular ligament
Hindfoot instability
Ligament reconstruction
Neurovascular bundle
Journal
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
ISSN: 1433-7347
Titre abrégé: Knee Surg Sports Traumatol Arthrosc
Pays: Germany
ID NLM: 9314730
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
24
02
2020
accepted:
26
06
2020
pubmed:
3
7
2020
medline:
14
5
2021
entrez:
3
7
2020
Statut:
ppublish
Résumé
Anatomical reconstruction of the calcaneofibular ligament (CFL) is a common technique to treat chronic lateral ankle instability. A bone tunnel is used to fix the graft in the calcaneus. The purpose of this study is to provide some recommendations about tunnel entrance and tunnel direction based on anatomical landmarks. The study consisted of two parts. The first part assessed the lateral tunnel entrance for location and safety. The second part addressed the tunnel direction and safety upon exiting the calcaneum on the medial side. In the first part, 29 specimens were used to locate the anatomical insertion of the CFL based on the intersection of two lines related to the fibular axis and specific landmarks on the lateral malleolus. In the second part, 22 specimens were dissected to determine the position of the neurovascular structures at risk during tunnel drilling. Therefore, a method based on four imaginary squares using external anatomical landmarks was developed. For the tunnel entrance on the lateral side, the mean distance to the centre of the CFL footprint was 2.8 ± 3.0 mm (0-10.4 mm). The mean distance between both observers was 4.2 ± 3.2 mm (0-10.3 mm). The mean distance to the sural nerve was 1.4 ± 2 mm (0-5.8 mm). The mean distance to the peroneal tendons was 7.3 ± 3.1 mm (1.2-12.4 mm). For the tunnel exit on the medial side, the two anterior squares always contained the neurovascular bundle. A safe zone without important neurovascular structures was found and corresponded to the two posterior squares. Lateral landmarks enabled to locate the CFL footprint. Precautions should be taken to protect the nearby sural nerve. A safe zone on the medial side could be determined to guide safe tunnel direction. A calcaneal tunnel should be directed to the posterior inferior medial edge of the calcaneal tuberosity.
Identifiants
pubmed: 32613335
doi: 10.1007/s00167-020-06134-x
pii: 10.1007/s00167-020-06134-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1325-1331Références
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