Department of Orthopaedic Surgery, Washington University in Saint Louis/Barnes-Jewish Hospital, St Louis, Missouri, USA.
Am J Sports Med. 2019 Jan;47(1):138-143. doi: 10.1177/0363546518808060. Epub 2018 Nov 19.
Ankle sprains are the most common musculoskeletal injury in the United States. Chronic lateral ankle instability can ultimately require operative intervention to decrease pain and restore stability to the ankle joint. There are no anatomic studies investigating the vascular supply to the lateral ankle ligamentous complex.
To define the vascular anatomy of the lateral ligament complex of the ankle.
Descriptive laboratory study.
Thirty pairs of cadaveric specimens (60 total legs) were amputated below the knee. India ink, followed by Ward blue latex, was injected into the peroneal, anterior tibial, and posterior tibial arteries to identify the vascular supply of the lateral ligaments of the ankle. Chemical debridement was performed with 8.0% sodium hypochlorite to remove the soft tissues, leaving casts of the vascular anatomy intact. The vascular supply to the lateral ligament complex was then evaluated and recorded.
The vascular supply to the lateral ankle ligaments was characterized in 56 specimens: 52 (92.9%) had arterial supply with an origin from the perforating anterior branch of the peroneal artery; 51 (91.1%), from the posterior branch of the peroneal artery; 29 (51.8%), from the lateral tarsal branch of the dorsalis pedis; and 12 (21.4%), from the posterior tibial artery. The anterior branch of the peroneal artery was the dominant vascular supply in 39 specimens (69.6%).
There are 4 separate sources of extraosseous blood supply to the lateral ligaments of the ankle. In all specimens, the anterior talofibular ligament was supplied by the anterior branch of the peroneal artery and/or the lateral tarsal artery of the dorsalis pedis, while the posterior talofibular ligament was supplied by the posterior branch of the peroneal artery and/or the posterior tibial artery. The calcaneofibular ligament received variable contributions from the anterior and posterior branches of the peroneal artery, with few specimens receiving a contribution from the lateral tarsal or posterior tibial arteries.
Understanding the vascular anatomy of the lateral ligament complex is beneficial when considering surgical management and may provide insight into factors that lead to chronic instability.
踝关节扭伤是美国最常见的肌肉骨骼损伤。慢性外侧踝关节不稳定最终可能需要手术干预来减轻疼痛并恢复踝关节的稳定性。目前还没有研究外侧踝关节韧带复合体的解剖血管供应的解剖学研究。
定义踝关节外侧韧带复合体的血管解剖结构。
描述性实验室研究。
从膝关节以下截肢了 30 对尸体标本（共 60 条腿）。将印度墨水和 Ward 蓝乳胶注入腓骨前动脉、胫骨前动脉和胫骨后动脉，以确定踝关节外侧韧带的血管供应。用 8.0%次氯酸钠进行化学清创，以去除软组织，使血管解剖结构的铸型保持完整。然后评估和记录外侧韧带复合体的血管供应。
在 56 个标本中，对外侧踝关节韧带的血管供应进行了特征描述：52 个（92.9%）具有来自腓骨前穿支的动脉供应；51 个（91.1%）来自腓骨后支；29 个（51.8%）来自足背外侧分支；12 个（21.4%）来自胫骨后动脉。在 39 个标本中（69.6%），腓骨前支是主要的血管供应源。
有 4 个单独的骨外血供源供应踝关节外侧韧带。在所有标本中，距腓前韧带由腓骨前支和/或足背外侧动脉供应，而距腓后韧带由腓骨后支和/或胫骨后动脉供应。跟腓韧带接受来自腓骨前支和后支的不同程度的贡献，少数标本接受来自足背外侧或胫骨后动脉的贡献。
了解外侧韧带复合体的血管解剖结构有利于考虑手术治疗，并可能深入了解导致慢性不稳定的因素。
