PDF(Pubmed)
Abstract：
When lateral ankle sprains progress into chronic lateral ankle instability (CLAI), restoring precise anatomic relationships of the lateral ankle ligament complex (LALC) surgically is complex. This study quantifies the radiographic relationships between the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and prominent osseous landmarks visible under fluoroscopy to assist in perioperative practices for minimally invasive surgery for CLAI.
Ten fresh frozen ankle specimens were dissected to expose the LALC and prepared by threading a radiopaque filament through the ligamentous footprints of the ATFL and CFL. Fluoroscopic images were digitally analyzed to define dimensional characteristics of the ATFL and CFL. Directional measurements of the ligamentous footprints relative to the lateral process of the talus and the apex of the posterior facet of the calcaneus were calculated.
Dimensional measurements of the ATFL were a mean length of 9.3 mm, fibular footprint of 9.4 mm, and talar footprint of 9.1 mm. Dimensional measurements of the CFL were a mean length of 19.4 mm, fibular footprint of 8.2 mm, and calcaneal footprint of 7.3 mm. From the radiographic apparent tip of the lateral process of the talus, the fibular attachment of the ATFL was found 13.3 mm superior and 4.4 mm posterior, whereas the talar attachment was found 11.5 mm superior and 4.8 mm anterior. From the radiographic apparent posterior apex of the posterior facet of the calcaneus, the fibular attachment of the CFL was found 0.2 mm inferior and 6.8 mm anterior, whereas the calcaneal attachment was found 14.3 mm inferior and 5.9 mm posterior.
The ATFL and CFL were radiographically analyzed using radiopaque filaments to outline the ligamentous footprints in their native locations. These ligaments were also localized with reference to 2 prominent osseous landmarks. These findings may assist in perioperative practices for keyhole incision placement and arthroscopic guidance. Perfect lateral ankle joint imaging with talar domes superimposed is required to be able to do this.
Radiographic evaluation of the ATFL and CFL with reference to prominent osseous landmarks identified under fluoroscopy may assist in perioperative practices for minimally invasive surgery to address CLAI for keyhole incision placement and arthroscopic guidance.
Ten fresh frozen ankle specimens were dissected to expose the LALC and prepared by threading a radiopaque filament through the ligamentous footprints of the ATFL and CFL. Fluoroscopic images were digitally analyzed to define dimensional characteristics of the ATFL and CFL. Directional measurements of the ligamentous footprints relative to the lateral process of the talus and the apex of the posterior facet of the calcaneus were calculated.
Dimensional measurements of the ATFL were a mean length of 9.3 mm, fibular footprint of 9.4 mm, and talar footprint of 9.1 mm. Dimensional measurements of the CFL were a mean length of 19.4 mm, fibular footprint of 8.2 mm, and calcaneal footprint of 7.3 mm. From the radiographic apparent tip of the lateral process of the talus, the fibular attachment of the ATFL was found 13.3 mm superior and 4.4 mm posterior, whereas the talar attachment was found 11.5 mm superior and 4.8 mm anterior. From the radiographic apparent posterior apex of the posterior facet of the calcaneus, the fibular attachment of the CFL was found 0.2 mm inferior and 6.8 mm anterior, whereas the calcaneal attachment was found 14.3 mm inferior and 5.9 mm posterior.
The ATFL and CFL were radiographically analyzed using radiopaque filaments to outline the ligamentous footprints in their native locations. These ligaments were also localized with reference to 2 prominent osseous landmarks. These findings may assist in perioperative practices for keyhole incision placement and arthroscopic guidance. Perfect lateral ankle joint imaging with talar domes superimposed is required to be able to do this.
Radiographic evaluation of the ATFL and CFL with reference to prominent osseous landmarks identified under fluoroscopy may assist in perioperative practices for minimally invasive surgery to address CLAI for keyhole incision placement and arthroscopic guidance.
摘要：
■当外侧踝关节扭伤发展为慢性外侧踝关节不稳（CLAI）时，通过手术恢复踝关节外侧韧带复合体（LALC）的精确解剖关系是复杂的。这项研究量化了距腓前韧带（ATFL）之间的影像学关系，跟胫韧带(CFL),透视下可见突出的骨标志，以协助CLAI微创手术的围手术期实践。
■解剖十个新鲜的冷冻脚踝样本以暴露LALC，并通过将不透射线的细丝穿过ATFL和CFL的韧带足迹来制备。对荧光图像进行数字分析以定义ATFL和CFL的尺寸特征。计算了韧带足迹相对于距骨外侧突和跟骨后小平面顶点的定向测量值。
■ATFL的尺寸测量值平均长度为9.3mm，腓骨足印9.4毫米，和9.1毫米的距骨足迹。CFL的尺寸测量值平均长度为19.4mm，腓骨足印8.2毫米，和7.3毫米的跟骨足迹。从距骨侧突的放射学表观尖端，发现ATFL的腓骨附着在上13.3毫米和后4.4毫米，而距骨附着被发现是11.5毫米上和4.8毫米前。从射线照相的跟骨后小平面的明显后尖，CFL的腓骨附着在下0.2毫米和前6.8毫米，而跟骨附着在下方14.3毫米和后方5.9毫米处。
■使用不透射线的细丝对ATFL和CFL进行射线照相分析，以勾勒出其天然位置的韧带足迹。这些韧带也参照2个突出的骨标志进行了定位。这些发现可能有助于锁孔切口放置和关节镜指导的围手术期实践。要做到这一点，需要完美的外侧踝关节成像与距骨圆顶叠加。
■ATFL和CFL的影像学评估参考透视下确定的突出骨标志，可能有助于微创手术的围手术期实践，以解决锁孔切口放置和关节镜指导的CLAI。
■解剖十个新鲜的冷冻脚踝样本以暴露LALC，并通过将不透射线的细丝穿过ATFL和CFL的韧带足迹来制备。对荧光图像进行数字分析以定义ATFL和CFL的尺寸特征。计算了韧带足迹相对于距骨外侧突和跟骨后小平面顶点的定向测量值。
■ATFL的尺寸测量值平均长度为9.3mm，腓骨足印9.4毫米，和9.1毫米的距骨足迹。CFL的尺寸测量值平均长度为19.4mm，腓骨足印8.2毫米，和7.3毫米的跟骨足迹。从距骨侧突的放射学表观尖端，发现ATFL的腓骨附着在上13.3毫米和后4.4毫米，而距骨附着被发现是11.5毫米上和4.8毫米前。从射线照相的跟骨后小平面的明显后尖，CFL的腓骨附着在下0.2毫米和前6.8毫米，而跟骨附着在下方14.3毫米和后方5.9毫米处。
■使用不透射线的细丝对ATFL和CFL进行射线照相分析，以勾勒出其天然位置的韧带足迹。这些韧带也参照2个突出的骨标志进行了定位。这些发现可能有助于锁孔切口放置和关节镜指导的围手术期实践。要做到这一点，需要完美的外侧踝关节成像与距骨圆顶叠加。
■ATFL和CFL的影像学评估参考透视下确定的突出骨标志，可能有助于微创手术的围手术期实践，以解决锁孔切口放置和关节镜指导的CLAI。
