Michels Frederick, Matricali Giovanni, Vereecke Evie, Dewilde Miloud, Vanrietvelde Frederik, Stockmans Filip
Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium; GRECMIP - MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied - Minimally Invasive Foot and Ankle Society), Merignac, France.
Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium; Institute of Orthopaedic Research and Training, KU Leuven, Leuven, Belgium.
Foot Ankle Surg. 2021 Jan;27(1):101-109. doi: 10.1016/j.fas.2020.03.002. Epub 2020 Mar 6.
Chronic subtalar instability is a disabling complication after acute ankle sprains. Currently, the literature describing the anatomy of the intrinsic subtalar ligaments is limited and equivocal which causes difficulties in diagnosis and treatment of subtalar instability. The purpose of this study is to assess the anatomical characteristics of the subtalar ligaments and to clarify some points of confusion.
In 16 cadaveric feet, the dimensions and locations of the subtalar ankle ligaments were assessed and measured. CT-scans before dissection and after indication of the footprints with radio-opaque paint allowed to generate 3D models and assess the footprint characteristics.
The cervical ligament (CL) had similar dimensions as the lateral ligaments: anterior length 13.9 ± 1.5 mm, posterior length 18.5 ± 2.9 mm, talar width 13.6 ± 2.2 mm, calcaneal width 15.8 ± 3.7 mm. The anterior capsular ligament (ACaL) and interosseous talocalcaneal ligament (ITCL) were found to be smaller structures with consistent dimensions and locations.
This study identified consistent characteristics of the intrinsic subtalar ligaments and clarifies the local anatomical situation. The dimensions and footprints of the intrinsic ligaments of the subtalar joint suggest a more important role of the CL and ACaL in the stability of the subtalar joint. The results of this study are relevant to improve diagnostic tools and offer some guidelines when reconstructing the injured ligaments.
距下关节慢性不稳定是急性踝关节扭伤后一种致残性并发症。目前,关于距下关节固有韧带解剖结构的文献有限且存在争议,这给距下关节不稳定的诊断和治疗带来了困难。本研究的目的是评估距下关节韧带的解剖特征,并澄清一些混淆点。
对16具尸体足进行研究,评估并测量距下关节韧带的尺寸和位置。在解剖前以及用不透射线的颜料标记出韧带附着点后进行CT扫描,以生成三维模型并评估附着点特征。
颈韧带(CL)的尺寸与外侧韧带相似:前长13.9±1.5毫米,后长18.5±2.9毫米,距骨宽度13.6±2.2毫米,跟骨宽度15.8±3.7毫米。发现前关节囊韧带(ACaL)和距跟骨间韧带(ITCL)结构较小,尺寸和位置较为一致。
本研究确定了距下关节固有韧带的一致特征,并阐明了局部解剖情况。距下关节固有韧带的尺寸和附着点表明CL和ACaL在距下关节稳定性中发挥着更重要的作用。本研究结果有助于改进诊断工具,并为重建受损韧带提供一些指导原则。