Abstract：
BACKGROUND: In lateral ankle instability, anatomical ligament reconstructions are generally performed using arthroscopy. The ligament graft is passed through the talar, fibular and calcaneal tunnels, reconstructing the anterior talofibular and calcaneofibular (CFL) bundles. However, the calcaneal insertion of the CFL needs to be performed in an extra-articular fashion, and cannot be carried out under arthroscopy, thus requiring specific anatomical landmarks. For obtaining these landmarks, methods based on radiography or surface anatomy have already been described but can only offer an approximate identification of the actual CFL anatomical insertion point. In contrast, an ultrasound technique allows direct visualization of the insertion point and of the sural nerve that may be injured during surgery. Our study aimed to assess the reliability and accuracy of ultrasound visualization when performing calcaneal insertion of the CFL with specific monitoring of the sural nerve.
METHODS: Our anatomical study was carried out on 15 ankles available from a body donation program. Ultrasound identification of the sural nerve was obtained first with injection of dye. A needle was positioned at the level of the calcaneal insertion of the CFL. After dissection, in all the ankles, the dye was in contact with the sural nerve and the needle was located in the calcaneal insertion area of the CFL. The mean distance between the sural nerve and the needle was 4.8 mm (range 3-7 mm).
CONCLUSIONS: A pre- or intra-operative ultrasound technique is a simple and reliable means for obtaining anatomical landmarks when drilling the calcaneal tunnel for ligament reconstruction of the lateral plane of the ankle. This tunnel should preferably be drilled obliquely from the heel towards the subtalar joint (1 h-3 h direction on an ultrasound cross section), which preserves a maximum distance from the sural nerve for safety purposes, while allowing an accurate anatomical positioning of the osseous tunnel.
METHODS: Our anatomical study was carried out on 15 ankles available from a body donation program. Ultrasound identification of the sural nerve was obtained first with injection of dye. A needle was positioned at the level of the calcaneal insertion of the CFL. After dissection, in all the ankles, the dye was in contact with the sural nerve and the needle was located in the calcaneal insertion area of the CFL. The mean distance between the sural nerve and the needle was 4.8 mm (range 3-7 mm).
CONCLUSIONS: A pre- or intra-operative ultrasound technique is a simple and reliable means for obtaining anatomical landmarks when drilling the calcaneal tunnel for ligament reconstruction of the lateral plane of the ankle. This tunnel should preferably be drilled obliquely from the heel towards the subtalar joint (1 h-3 h direction on an ultrasound cross section), which preserves a maximum distance from the sural nerve for safety purposes, while allowing an accurate anatomical positioning of the osseous tunnel.
摘要：
背景：在外侧踝关节不稳中，解剖韧带重建通常使用关节镜进行。韧带移植物穿过距骨,腓骨和跟骨隧道,重建前距腓骨和跟腓骨（CFL）束。然而,CFL的跟骨插入需要以关节外的方式进行，并且不能在关节镜下进行，因此需要特定的解剖标志。为了获得这些地标，已经描述了基于射线照相术或表面解剖的方法,但只能提供实际CFL解剖插入点的近似识别。相比之下,超声技术可以直接观察插入点和手术中可能受伤的腓肠神经。我们的研究旨在评估在执行跟骨插入CFL并对腓肠神经进行特定监测时超声可视化的可靠性和准确性。
方法：我们的解剖学研究是在15个脚踝上进行的，这些脚踝是通过一项身体捐献计划获得的。首先通过注射染料获得腓肠神经的超声鉴定。将针定位在CFL的跟骨插入的水平处。解剖后,在所有的脚踝，染料与腓肠神经接触,针头位于CFL的跟骨插入区.腓肠神经和针头之间的平均距离为4.8mm（范围3-7mm）。
结论：术前或术中超声技术是一种简单可靠的方法，用于在跟骨隧道钻孔以重建踝关节侧平面的韧带时获得解剖标志。该隧道最好从脚跟向距骨下关节倾斜钻孔(超声横截面上的1h-3h方向)。为了安全起见，它保留了与腓肠神经的最大距离，同时允许骨隧道的准确解剖定位。
方法：我们的解剖学研究是在15个脚踝上进行的，这些脚踝是通过一项身体捐献计划获得的。首先通过注射染料获得腓肠神经的超声鉴定。将针定位在CFL的跟骨插入的水平处。解剖后,在所有的脚踝，染料与腓肠神经接触,针头位于CFL的跟骨插入区.腓肠神经和针头之间的平均距离为4.8mm（范围3-7mm）。
结论：术前或术中超声技术是一种简单可靠的方法，用于在跟骨隧道钻孔以重建踝关节侧平面的韧带时获得解剖标志。该隧道最好从脚跟向距骨下关节倾斜钻孔(超声横截面上的1h-3h方向)。为了安全起见，它保留了与腓肠神经的最大距离，同时允许骨隧道的准确解剖定位。
