Purpose
To examine the anatomy of the lateral ankle after arthroscopic repair of the lateral
ligament complex (anterior talofibular ligament [ATFL] and calcaneofibular ligament
[CFL]) with regard to structures at risk.
Methods
Ten lower extremity cadaveric specimens were obtained and were screened for gross
anatomic defects and pre-existing ankle laxity. The ATFL and CFL were sectioned from
the fibula by an open technique. Standard anterolateral and anteromedial arthroscopy
portals were made. An additional portal was created 2 cm distal to the anterolateral
portal. The articular surface of the fibula was identified, and the ATFL and CFL were
freed from the superficial and deeper tissues. Suture anchors were placed in the fibula
at the ATFL and CFL origins and were used to repair the origin of the lateral collateral
structures. The distance from the suture knot to several local anatomic structures
was measured. Measurements were taken by 2 separate observers, and the results were
averaged.
Results
Several anatomic structures lie in close proximity to the ATFL and CFL sutures. The
ATFL sutures entrapped 9 of 55 structures, and no anatomic structures were inadvertently
entrapped by the CFL sutures. The proximity of the peroneus tertius and the extensor
tendons to the ATFL makes them at highest risk of entrapment, but the proximity of
the intermediate branch of the superficial peroneal nerve (when present) is a risk
with significant morbidity.
Conclusions
Our results indicate that the peroneus tertius and extensor tendons have the highest
risk for entrapment and show the smallest mean distances from the anchor knot to the
identified structure. Careful attention to these structures, as well as the superficial
peroneal nerve, is mandatory to prevent entrapment of tendons and nerves when one
is attempting arthroscopic lateral ankle ligament reconstruction.
Clinical Relevance
Defining the anatomic location and proximity of the intervening structures adjacent
to the lateral ligament complex of the ankle may help clarify the anatomic safe zone
through which arthroscopic repair of the lateral ligament complex can be safely performed.
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Article info
Publication history
Published online: April 15, 2013
Accepted:
February 12,
2013
Received:
May 16,
2012
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
