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Isometric points in lateral ankle ligament reconstruction: A three-dimensional kinematic study
Sylvano Mania1, Christoph Zindel1, Stephan Wirth1
1Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, CH-8008, Zürich, Switzerland.
Summary
This study identifies optimal insertion points for ankle ligament reconstruction, improving biomechanical outcomes and reducing stiffness. Precise anatomical references aid surgeons in achieving stable, tension-free reconstructions for better patient mobility.
Area of Science:
- Orthopedic Surgery
- Biomechanics
- Anatomy
Background:
- Ankle ligament reconstruction aims to optimize biomechanical outcomes, avoiding stiffness and laxity.
- Isometric reconstruction of the anterior lateral talofibular ligament (ATFL) and calcaneofibular ligament (CFL) is crucial.
- Accurate intraoperative localization of optimal ligament insertion points remains a challenge.
Purpose of the Study:
- To determine precise anatomical insertion points for the ATFL and CFL to achieve isometric reconstruction.
- To provide reproducible references for optimizing lateral ankle ligament reconstruction.
Main Methods:
- Generated 3D surface models of 10 healthy ankles.
- Defined multiple potential insertion points for CFL on the calcaneus and fibula, and for ATFL on the fibula and talus.
- Simulated ankle joint movements (flexion/extension, inversion/eversion) to assess ligament length variations at different insertion points.
Main Results:
- The isometric point for CFL on the calcaneus is approximately 60% dorsally and 60-70% proximally.
- Fibular insertion at 5mm proximal to the malleolar tip showed minimal length variation for both ATFL and CFL.
- Talar insertion of ATFL at 5mm proximal to the subtalar joint had the lowest variation, while insertions at 20-25mm approached isometry with specific fibular placements.
Conclusions:
- Identified reproducible anatomical references for ATFL and CFL insertion points.
- These points facilitate stable ankle reconstructions.
- Achieved reconstructions maintain tension-free mobilization of the ankle.
