Accuracy of radiographic techniques in detection of the calcaneofibular ligament calcaneal insertion for lateral ankle ligament complex surgery.
Ankle sprain
Calcaneofibular ligament
Chronic ankle instability
Lateral ankle ligament complex
Lateral ankle ligament reconstruction
Minimally invasive ankle surgery
Journal
Surgical and radiologic anatomy : SRA
ISSN: 1279-8517
Titre abrégé: Surg Radiol Anat
Pays: Germany
ID NLM: 8608029
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
received:
08
02
2023
accepted:
03
05
2023
medline:
5
7
2023
pubmed:
18
5
2023
entrez:
17
5
2023
Statut:
ppublish
Résumé
Grade III ankle sprains that fail conservative treatment can require surgical management. Anatomic procedures have been shown to properly restore joint mechanics, and precise localization of insertion sites of the lateral ankle complex ligaments can be determined through radiographic techniques. Ideally, radiographic techniques that are easily reproducible intraoperatively will lead to a consistently well-placed CFL reconstruction in lateral ankle ligament surgery. To determine the most accurate method to locate the calcaneofibular ligament (CFL) insertion radiographically. MRIs of 25 ankles were utilized to identify the "true" insertion of the CFL. Distances between the true insertion and three bony landmarks were measured. Three proposed methods (Best, Lopes, and Taser) for determining the CFL insertion were applied to lateral ankle radiographs. X and Y coordinate distances were measured from the insertion found on each proposed method to the three bony landmarks: the most superior point of the postero-superior surface of the calcaneus, the posterior most aspect of the sinus tarsi, and the distal tip of the fibula. X and Y distances were compared to the true insertion found on MRI. All measurements were made using a picture archiving and communication system. The average, standard deviation, minimum, and maximum were obtained. Statistical analysis was performed using repeated measures ANOVA, and a post hoc analysis was performed with the Bonferroni test. The Best and Taser techniques were found to be closest to the true CFL insertion when combining X and Y distances. For distance in the X direction, there was no significant difference between techniques (P = 0.264). For distance in the Y direction, there was a significant difference between techniques (P = 0.015). For distance in the combined XY direction, there was a significant difference between techniques (P = 0.001). The CFL insertion as determined by the Best method was significantly closer to the true insertion compared to the Lopes method in the Y (P = 0.042) and XY (P = 0.004) directions. The CFL insertion as determined by the Taser method was significantly closer to the true insertion compared to the Lopes method in the XY direction (P = 0.017). There was no significant difference between the Best and Taser methods. If the Best and Taser techniques can be readily used in the operating room, they would likely prove the most reliable for finding the true CFL insertion.
Sections du résumé
BACKGROUND
BACKGROUND
Grade III ankle sprains that fail conservative treatment can require surgical management. Anatomic procedures have been shown to properly restore joint mechanics, and precise localization of insertion sites of the lateral ankle complex ligaments can be determined through radiographic techniques. Ideally, radiographic techniques that are easily reproducible intraoperatively will lead to a consistently well-placed CFL reconstruction in lateral ankle ligament surgery.
PURPOSE
OBJECTIVE
To determine the most accurate method to locate the calcaneofibular ligament (CFL) insertion radiographically.
METHODS
METHODS
MRIs of 25 ankles were utilized to identify the "true" insertion of the CFL. Distances between the true insertion and three bony landmarks were measured. Three proposed methods (Best, Lopes, and Taser) for determining the CFL insertion were applied to lateral ankle radiographs. X and Y coordinate distances were measured from the insertion found on each proposed method to the three bony landmarks: the most superior point of the postero-superior surface of the calcaneus, the posterior most aspect of the sinus tarsi, and the distal tip of the fibula. X and Y distances were compared to the true insertion found on MRI. All measurements were made using a picture archiving and communication system. The average, standard deviation, minimum, and maximum were obtained. Statistical analysis was performed using repeated measures ANOVA, and a post hoc analysis was performed with the Bonferroni test.
RESULTS
RESULTS
The Best and Taser techniques were found to be closest to the true CFL insertion when combining X and Y distances. For distance in the X direction, there was no significant difference between techniques (P = 0.264). For distance in the Y direction, there was a significant difference between techniques (P = 0.015). For distance in the combined XY direction, there was a significant difference between techniques (P = 0.001). The CFL insertion as determined by the Best method was significantly closer to the true insertion compared to the Lopes method in the Y (P = 0.042) and XY (P = 0.004) directions. The CFL insertion as determined by the Taser method was significantly closer to the true insertion compared to the Lopes method in the XY direction (P = 0.017). There was no significant difference between the Best and Taser methods.
CONCLUSION
CONCLUSIONS
If the Best and Taser techniques can be readily used in the operating room, they would likely prove the most reliable for finding the true CFL insertion.
Identifiants
pubmed: 37198438
doi: 10.1007/s00276-023-03162-3
pii: 10.1007/s00276-023-03162-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
917-922Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.
Références
Best R, Mauch F, Fischer KM, Rueth J, Brueggemann GP (2015) Radiographic monitoring of the distal insertion of the calcaneofibular ligament in anatomical reconstructions of ankle instabilities: a preliminary cadaveric study. Foot Ankle Surg 21(4):245–249. https://doi.org/10.1016/j.fas.2015.01.006
doi: 10.1016/j.fas.2015.01.006
pubmed: 26564725
Buzzi R, Todescan G, Brenner E, Segoni F, Inderster A, Aglietti P (1993) Reconstruction of the lateral ligaments of the ankle: an anatomic study with evaluation of isometry. J Sports Traumatol Relat Res 15:55–74
Clanton TO, Campbell KJ, Wilson KJ et al (2014) Qualitative and quantitative anatomic investigation of the lateral ankle ligaments for surgical reconstruction procedures. J Bone Joint Surg Am 96(12):e98. https://doi.org/10.2106/JBJS.M.00798
doi: 10.2106/JBJS.M.00798
pubmed: 24951749
Ferran NA, Oliva F, Maffulli N (2009) Ankle instability. Sports Med Arthrosc Rev 17(2):139–145. https://doi.org/10.1097/JSA.0b013e3181a3d790
doi: 10.1097/JSA.0b013e3181a3d790
pubmed: 19440141
Fong DT, Hong Y, Chan LK, Yung PS, Chan KM (2007) A systematic review on ankle injury and ankle sprain in sports. Sports Med 37(1):73–94. https://doi.org/10.2165/00007256200737010-00006
doi: 10.2165/00007256200737010-00006
pubmed: 17190537
Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC (1998) Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int 19(10):653–660. https://doi.org/10.1177/107110079801901002
doi: 10.1177/107110079801901002
pubmed: 9801078
Kaplan LD, Jost PW, Honkamp N, Norwig J, West R, Bradley JP (2011) Incidence and variance of foot and ankle injuries in elite college football players. Am J Orthop (Belle Mead NJ) 40(1):40–44
pubmed: 21720586
Kelikian A, Sarrafian S (2011) Sarrafian’s anatomy of the foot and ankle: descriptive, topographic, functional. Lippincott, Williams & Wilkins, Wolters Kluwer, Philadelphia, pp 40–119
Krähenbühl N, Weinberg MW, Davidson NP, Mills MK, Hintermann B, Saltzman CL, Barg A (2018) Currently used imaging options cannot accurately predict subtalar joint instability. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-5232-8
doi: 10.1007/s00167-018-5232-8
pubmed: 30367197
Laidlaw PP (1904) The varieties of the Os Calcis. J Anat Physiol 38(Pt 2):133–143
pubmed: 17232593
pmcid: 1287374
Lalevée M, Anderson DD, Wilken JM (2023) Current challenges in chronic ankle instability: review and perspective. Foot Ankle Clin 28(1):129–143. https://doi.org/10.1016/j.fcl.2022.11.003
doi: 10.1016/j.fcl.2022.11.003
pubmed: 36822682
Lin CI, Houtenbos S, Lu YH, Mayer F, Wippert PM (2021) The epidemiology of chronic ankle instability with perceived ankle instability—a systematic review. J Foot Ankle Res 14(1):41. https://doi.org/10.1186/s13047-021-00480-w
doi: 10.1186/s13047-021-00480-w
pubmed: 34049565
pmcid: 8161930
Lopes R, Noailles T, Brulefert K, Geffroy L, Decante C (2018) Anatomic validation of the lateral malleolus as a cutaneous marker for the distal insertion of the calcaneofibular ligament. Knee Surg Sports Traumatol Arthrosc 26(3):869–874. https://doi.org/10.1007/s00167-016-4250-7
doi: 10.1007/s00167-016-4250-7
pubmed: 27497693
Matsui K, Oliva XM, Takao M et al (2017) Bony landmarks available for minimally invasive lateral ankle stabilization surgery: a cadaveric anatomical study. Knee Surg Sports Traumatol Arthrosc 25(6):1916–1924. https://doi.org/10.1007/s00167-016-4218-7
doi: 10.1007/s00167-016-4218-7
pubmed: 27351549
Matsui K, Burgesson B, Takao M et al (2016) Minimally invasive surgical treatment for chronic ankle instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 24(4):1040–1048. https://doi.org/10.1007/s00167-016-4041-1
doi: 10.1007/s00167-016-4041-1
pubmed: 26869032
McKay GD, Goldie PA, Payne WR, Oakes BW (2001) Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med 35(2):103–108. https://doi.org/10.1136/bjsm.35.2.103
doi: 10.1136/bjsm.35.2.103
pubmed: 11273971
pmcid: 1724316
Michels F, Matricali G, Wastyn H, Vereecke E, Stockmans F (2021) A calcaneal tunnel for CFL reconstruction should be directed to the posterior inferior medial edge of the calcaneal tuberosity. Knee Surg Sports Traumatol Arthrosc 29(4):1325–1331. https://doi.org/10.1007/s00167-020-06134-x
doi: 10.1007/s00167-020-06134-x
pubmed: 32613335
Michels F, Matricali G, Guillo S et al (2020) An oblique fibular tunnel is recommended when reconstructing the ATFL and CFL. Knee Surg Sports Traumatol Arthrosc 28:124–131. https://doi.org/10.1007/s00167-019-05583-3
doi: 10.1007/s00167-019-05583-3
pubmed: 31240379
Michels F, Clockaerts S, Van Der Bauwhede J, Stockmans F, Matricali G (2019) Does subtalar instability really exist? A systematic review. Foot Ankle Surg. https://doi.org/10.1016/j.fas.2019.02.001
doi: 10.1016/j.fas.2019.02.001
pubmed: 30827926
Michels F, Pereira H, Calder J et al (2018) Searching for consensus in the approach to patients with chronic lateral ankle instability: ask the expert. Knee Surg Sports Traumatol Arthrosc 26(7):2095–2102. https://doi.org/10.1007/s00167-017-4556-0
doi: 10.1007/s00167-017-4556-0
pubmed: 28439639
Nery C, Raduan F, Del Buono A, Asaumi ID, Cohen M, Maffulli N (2011) Arthroscopic-assisted Broström-Gould for chronic ankle instability: a long-term follow-up. Am J Sports Med 39(11):2381–2388. https://doi.org/10.1177/0363546511416069
doi: 10.1177/0363546511416069
pubmed: 21803979
Noailles T, Lopes R, Padiolleau G, Gouin F, Brilhault J (2018) Non-anatomical or direct anatomical repair of chronic lateral instability of the ankle: a systematic review of the literature after at least 10 years of follow-up. Foot Ankle Surg 24(2):80–85. https://doi.org/10.1016/j.fas.2016.10.005
doi: 10.1016/j.fas.2016.10.005
pubmed: 29409255
Sankey RA, Brooks JH, Kemp SP, Haddad FS (2008) The epidemiology of ankle injuries in professional rugby union players. Am J Sports Med 36(12):2415–2424. https://doi.org/10.1177/0363546508322889
doi: 10.1177/0363546508322889
pubmed: 18779364
Song Y, Li H, Sun C et al (2019) Clinical guidelines for the surgical management of chronic lateral ankle instability: a consensus reached by systematic review of the available data. Orthop J Sports Med 7(9):2325967119873852. https://doi.org/10.1177/2325967119873852
doi: 10.1177/2325967119873852
pubmed: 31579683
pmcid: 6757505
Struijs P, Kerkhoffs G (2002) Ankle sprain. Clin Evid 2002(8):1050–1059
Taser F, Shafiq Q, Ebraheim NA (2006) Anatomy of lateral ankle ligaments and their relationship to bony landmarks. Surg Radiol Anat 28(4):391–397. https://doi.org/10.1007/s00276-006-0112-1
doi: 10.1007/s00276-006-0112-1
pubmed: 16642279
van den Bekerom MP, Kerkhoffs GM, McCollum GA, Calder JD, van Dijk CN (2013) Management of acute lateral ankle ligament injury in the athlete. Knee Surg Sports Traumatol Arthrosc 21(6):1390–1395. https://doi.org/10.1007/s00167-012-2252-7
doi: 10.1007/s00167-012-2252-7
pubmed: 23108678