Functional Anatomy and Clinical Significance of the Lateral Ankle Ligaments: A Cadaveric Study

Tears in the lateral ankle ligaments are among the most common injuries in both athletes and the general population. The ligaments involved in the lateral ankle complex include the anterior tibiofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior tibiofibular ligament (PTFL). Information on the anatomy and variation of these structures is currently limited. This study aims to provide detailed documentation of the anatomy and morphometry of the lateral ankle ligament complex (LALC).

This study involved 22 cadaveric ankles. Ankles with pre- or post-mortem injuries or prior surgical interventions were excluded. The ligaments were exposed following detailed dissection of the anterior and lateral aspects of the ankle, according to Cunningham's dissection manual. Measurements of length and width were taken using a digital vernier caliper, and morphological characteristics, including shape and orientation, were recorded.

The ATFL was noted to have four different shape morphologies, including single-banded (14/22 = 64%), double-banded (4/22 = 18%), V-shaped (3/22 = 14%), and Y-shaped (1/22 = 4.5%). The ATFL had an average length of 23.8 mm and an average width of 11.4 mm. The CFL had no variation in shape and was only seen in single-banded formation; it had an average length of 22.9 mm and an average width of 7.8 mm. The PTFL had no variation in shape and was only seen in single-banded formation; it had an average length of 18.1 mm and an average width of 7.8 mm.

Our investigation highlights the variability of the LALC in both size and shape. Understanding the anatomical characterization of these ligaments is crucial for orthopedic surgeons when planning repair or reconstruction.