Anatomical analysis of the lateral ligament complex in the neutral position and during plantar flexion

The purpose of this study was to obtain anatomical information on the anterior talofibular ligament (ATFL), anterior tibiofibular ligament (ATiFL) and calcaneofibular ligament (CFL) in the neutral position and during plantar flexion.

Seventy specimens with whole ankle ligaments were recorded for anatomy education. ATFLs with single, double, and triple bands corresponded to Types A, B, and C. In our study, different types of ATFLs with information on the length, width, ATFL/CFL angle, ATFL/ATiFL angle, and the distance of the fibular center of insertion (fCOI) of ATFL-CFL-ATiFL in the neutral position and 20° plantar flexion, was collected.

In Type B, the length, width, and ATFL/ATiFL angle of the superior and inferior bands varied (length, P < 0.001; width, P < 0.001; ATFL/ATiFL angle, P < 0.001). Among the types, the total widths of Types A/B and A/C were significantly different (P < 0.01; P < 0.001). In terms of postural changes, significant differences in the ATFL/ATiFL angle were observed for Type A (P < 0.001), Type B (P < 0.001), and Type C (P < 0.01).

In conclusion, attention should be given to the ATFL widths of different ATFL types during surgical treatment because of the significant differences among the three ATFL types. The relative independence of ATiFL and the cooperative relationship between ATFL and CFL are instructive for different ATFL surgical procedures. The ATFL, CFL, and ATiFL data can be used for anatomical reconstruction and secondary proofreading for ATFL injury or chronic ankle instability.