Cadaveric evaluation of distal fibular soft tissue anchor placement

The anterior talofibular ligament (ATFL) is the most injured component of the lateral ankle ligament complex. While most patients recover with conservative care, those with prolonged instability often require intervention. While many techniques have been described, direct repair of the ATFL is a widely utilized technique with intact native tissue, however in advanced disease the ligament is indirectly repaired using an anchor. Despite the frequent use of suture anchors, there remains a lack of consensus regarding the ideal placement, and potential iatrogenic injury within the distal fibula.

Determine the optimized placement of distal fibular soft tissue anchor in lateral ankle stabilization.

We conducted a cadaveric study using nineteen below-knee fresh-frozen lower extremities. Following careful anatomic dissection, 3.3 mm Medline DEXTACK^TM PUSH suture anchors were inserted into three defined zones along the distal fibula.

Following anchor placement, the fibula was hemisected to measure distances between the anchors and surrounding at-risk structures as well as anatomic relationship to ligamentous structures and lateral malleolus.

Statistically significant differences between zones were found in relation to the proximity of the anchors to the superficial peroneal nerve, lateral ankle gutter, AITFL, and ATFL origin (p < 0.05). No neurovascular injury was observed in any of the specimens. There were no cases of anchor violation of the posterior fibular cortex.

Zone-strategic placement may help minimize the risk of iatrogenic injury. Our findings reveal the need for meticulous surgical planning and consideration of appropriate anchor placement to optimize patient outcomes. Further clinical studies are recommended to confirm these results and guide future surgical practices.