Complejo ligamentoso lateral de la articulación talocrural (tobillo): biometría y patrones de división / Lateral ankle ligamentous complex: biometrics and division patterns

El complejo ligamentoso lateral de la articulación talocrural o «tobillo» (CLT) contempla básicamente tres estructuras denominadas como ligamento talofibular anterior (LTFA), ligamento calcaneofibular (LCF) y ligamento talofibular posterior (LTFP). En los últimos artículos publicados en relación con la morfología del CLT, se clasifica al LTFA en tres tipos, basada en el número de bandas o fascículos. Esta variabilidad morfológica plantea nuevos desafíos de estudios anatómicos en la biomecánica y estabilidad de la región talocrural. El objetivo de este estudio fue profundizar la anatomía de este complejo, en base a disecciones por capa que nos permitan visualizar las relaciones existentes entre estos ligamentos y estructuras aledañas. Se utilizaron 10 piezas congeladas pertenecientes al Departamento de Anatomía y Medicina Legal de la Facultad de Medicina de la Universidad de Chile, cuyos ligamentos fueron localizados y medidos en ancho y longitud. Para el LTFA se observó un patrón único en 5 muestras, bifurcado en 4, mientras que en un caso se visualizó un patrón trifurcado. El conocimiento del complejo ligamentoso lateral de tobillo, así como de su dirección, biometría y bandas o fascículos son un importante aporte para la imagenología, rehabilitación, clínica y cirugías que aborden esta región.

SUMMARY: The lateral ankle complex (LAC) basically includes three structures called anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL). In recent works published in relation to the morphology of LAC, ATFL is classified into three types, based on the number of bands or fascicles. This morphological modification poses new challenges for anatomical studies in biomechanics and ankle stability. The objective of this is to deepen in greater detail the anatomy of this complex, based on dissections by layer that allow us to study the existing relationships between these ligaments and surrounding structures. 10 frozen pieces belonging to the Department of Anatomy and Legal Medicine of the Faculty of Medicine of the University of Chile were used; whose ligaments were located and measured in width and length. For ATFL, a single pattern was found in 5 samples, bifurcated in 4, while a trifurcated pattern was seen in one case. Knowledge of the lateral ligamentous complex of the ankle, as well as its direction, biometry and bands or fascicles, are an important contribution to imaging, rehabilitation, clinics and surgeries that address this region.

Fracturas del maleolo posterior del tobillo, clasificación y visión de tratamiento / Fractures of the Ankle Posterior Malleolus, Classification and Treatment Vision

Introducción: Las fracturas del maleolo posterior son comunes y son resultado de lesiones por rotación del tobillo que se ignoran debido a la reducción espontánea de estos fragmentos después de la reducción abierta del maléolo lateral. La tendencia actual es realizar la corrección anatómica de la articulación y evitar un escalón intraarticular. Objetivo: Revisar el estado actual de los conocimientos y clasificación de las fracturas del maleolo tibial posterior y las tendencias de su tratamiento. Métodos: Se realiza una revisión de la literatura en PubMed de los trabajos publicados en inglés entre los años 2011-2021, con los siguientes términos de búsqueda: fracturas del maleolo tibial posterior, clasificación de las fracturas del maléolo tibial posterior", tratamiento de las fracturas del maleolo tibial posterior". También se revisaron artículos accesibles de forma libre, o a través del servicio ClinicalKey e Hinari. Conclusiones: La reposición anatómica del maleolo tibial posterior en fracturas de tobillo permite alcanzar mejores resultados. Las clasificaciones y el abordaje posterolateral contribuyen a lograrlo(AU)

Introduction: Fractures of the posterior malleolus are common and resulting from rotational injuries of the ankle, which are ignored due to the spontaneous reduction of these fragments after open reduction of the lateral malleolus. The current trend is to perform the anatomical correction of the joint and to avoid an intra-articular step. Objective: To review the current state of knowledge and classification of posterior tibial malleolus fractures and treatment trends. Methods: A review was carried out of the PubMed literature of papers published in English in the period 2011-2021; the search terms adopted were posterior tibial malleolus fractures, posterior tibial malleolus fracture classification, reatment of fractures of the posterior tibial malleolus. Articles freely accessible or through Clinical Key and Hinari service were also reviewed. Conclusions: The anatomical repositioning of the posterior tibial malleolus in ankle fractures allows to achieve better results. The classifications and the posterolateral approach help to achieve this(AU)

The attachment sites and attachment areas of deltoid ligament related to clinical implications: a cadaveric study / Los sitios y las áreas de inserción del ligamento deltoideo relacionadas con las implicaciones clínicas: un estudio cadavérico

Currently, the treatment for patients with deltoid ligament injuries who require surgical treatment are anatomical repair and reconstruction. The clinicians should understand the exact knowledge of attachment areas of individual bands of deltoid ligament for a successful treatment. We studied 46 ankles of fresh frozen cadavers. The individual bands of deltoid ligament were divided to small fibers. Afterwards, each small fiber of each band was cut and marked with acrylic color on the origin and insertion followed by photo taking. Lastly, the photos of individual origin and insertion were used to calculate the attachment areas. We found six bands of deltoid ligament in all ankles except tibionavicular ligament. Moreover, we discovered deep to tibiocalcaneal and posterior to sustentaculum tali ligaments in 3 cases. Regarding the attachment area, the deep posterior tibiotalar ligament had the largest proximal and distal attachment areas which were 87.36±23.15 mm2 and 88.88±24.24 mm2, respectively. The anterior tibiotalar ligament had the least proximal and distal attachment areas which were 23.12±8.25 mm2 and 33.16±14.63 mm2, respectively. Hence, the accuracy and exact areas of attachment of deltoid ligament are important as it can help clinicians to select the suitable treatments including injury prevention.

Actualmente, el tratamiento para pacientes con lesiones del ligamento colateral medial de la articulación talocrural (ligamento deltoideo), que requieren tratamiento quirúrgico es la reparación y reconstrucción anatómica. Los médicos, para un tratamiento exitoso, deben conocer exactactamente las áreas de inserción de las partes de ligamento deltoideo. Estudiamos 46 tobillos de cadáveres congelados frescos. Las bandas individuales del ligamento deltoideo se dividieron en fibras pequeñas. Posteriormente, cada pequeña fibra de cada banda se cortó y marcó con color acrílico en el origen y la inserción, seguido de la toma de fotografías. Por último, las fotos de origen e inserción individuales se utilizaron para calcular las áreas. Encontramos seis bandas de ligamento deltoides en todos los tobillos, excepto el ligamento tibionavicular. Además, descubrimos en profundidad hasta los ligamentos tibiocalcaneaos y posteriores al sustentaculum tali en 3 casos. Con respecto al área de inserciónn, la parte tibiotalar posterior profundamente tenía las áreas de inserción proximal y distal más largas, que eran 87.36 ± 23.15 mm2 y 88.88 ± 24.24 mm2, respectivamente. La parte tibiotalar anterior del ligamento deltoideo tpresentaba áreas de unión menos proximales y distales 23.12 ± 8.25 mm2 y 33.16 ± 14.63 mm2, respectivamente. Por lo tanto, la precisión y las áreas exactas de inserción del ligamento deltoideo de la articulación talocrural son importantes, ya que pueden ayudar a los médicos a seleccionar los tratamientos adecuados, incluida la prevención de lesiones.

Cirugía artroscópica de la cámara anterior de tobillo / Arthroscopic surgery of the ankle

La cirugía artroscópica del tobillo es un procedimiento relativamente nuevo y forma parte del arsenal terapéutico actual del cirujano ortopedista. Se considera un procedimiento demandante desde el punto de vista técnico y requiere de gran pericia para trabajar en un espacio reducido. Sin embargo, con el perfeccionamiento de la técnica se ha convertido en el gold standard para el tratamiento de ciertas patologías como el síndrome de fricción anterior y las lesiones osteocondrales. Consideramos de mucha importancia, el conocimiento de la anatomía para evitar lesiones de elementos vasculares en la realización de los portales y el conocimiento de los sectores pasibles de exploración en cada una de las puertas de entrada, como así también las distintas técnicas que permiten una visualización más extensa de la articulación. En esta nota técnica describiremos los puntos más sobresalientes en cuanto a la topografía periarticular y la técnica per se para la correcta realización de este procedimiento y para evitar, en la medida de lo posible, potenciales complicaciones.

Arthroscopic surgery of the ankle is a relatively new procedure and is part of the current orthopedic surgeon arsenal. It is considered technically demanding and requires a skilled surgeon in order to be able to work in a restricted space. However, with the improvement of the technique, it has become the gold standard for the treatment of certain pathologies such as anterior impingiment syndrome and osteochondral lesions . To avoid injury, portal placement must be based on a thorough understanding of the ankle and foot extra-articular anatomy. The risk of injury to neurovascular structures is the greatest concern, as well as the different techniques that allow a wider visualization of the articular surface. This technical note will describe the most important points regarding the periarticular topography and the technique itself for the successful completion of this procedure and to avoid potential complications as far as possible.

Efeitos da bandagem elástica adesiva no equilíbrio postural de indivíduos sedentários / Effects of the elastic adhesive tape on postural balance of sedentary individuals

Diversos recursos podem ser utilizados para produzir efeitosbenéficos sobre o Equilíbrio Postural (EP), dentre eles supõe-seo método da bandagem elástica adesiva (BEA). O objetivo destapesquisa foi analisar os efeitos da BEA no EP de indivíduos sedentários.O estudo realizado foi série de casos com uma amostra de16 indivíduos de ambos os sexos, com média de idade de 23,0 ±2,7 anos e de Índice de Massa Corporal (IMC) de 21,9 ± 2,2 kg/m². Foi utilizado para obtenção dos dados o sistema F-Scan comum sensor F-Mat modelo 3100 (Tekscan, Inc., South Boston, MA)e software versão 4.21, por meio do qual foram obtidos os parâmetros:comprimento total da trajetória, amplitude dos deslocamentosnos sentidos ântero-posterior e médio-lateral e velocidade máximaatingida pelo centro de pressão. Não foram encontradas diferençasestatisticamente significativas em nenhuma das comparações entreos parâmetros avaliados, concluindo que o uso da BEA não produziuefeitos sobre o EP dos indivíduos estudados.

Several features can be used to produce beneficial effects onthe Postural Balance (PB), among them the elastic adhesive tape(EAT). The objective of this research was to analyze the effects ofthe EAT on PB of sedentary individuals. The study was a serie ofcases with a sample of 16 individuals of both sexes 23.0 ± 2.7 yearsold and Body Mass Index (BMI) of 21.9 ± 2.2 kg/m². Was usedfor data collection the F-Scan system with a F-Mat sensor model3100 (Tekscan Inc., South Boston, MA) and software version 4.21,through which were obtained the parameters: total length of thetrajectory, amplitude of displacements in the anterior-posterior andmedial-lateral and maximum speed reached by the center of pressure.It was found no statistically significant differences in any ofthe comparisons between the parameters evaluated, concluding thatthe EAT had not produced effects on PB of the studied individuals.

Qualitative and Quantitative Assessment of Isotropic Ankle Magnetic Resonance Imaging: Three-Dimensional Isotropic Intermediate-Weighted Turbo Spin Echo versus Three-Dimensional Isotropic Fast Field Echo Sequences

OBJECTIVE: To compare the image quality of volume isotropic turbo spin echo acquisition (VISTA) imaging method with that of the three-dimensional (3D) isotropic fast field echo (FFE) imaging method applied for ankle joint imaging. MATERIALS AND METHODS: MR imaging of the ankles of 10 healthy volunteers was performed with VISTA and 3D FFE sequences by using a 3.0 T machine. Two radiologists retrospectively assessed the tissue contrast between fluid and cartilage (F-C), and fluid and the Achilles tendon (F-T) with use of a 4-point scale. For a quantitative analysis, signal-to-noise ratio (SNR) was obtained by imaging phantom, and the contrast ratios (CRs) were calculated between F-T and F-C. Statistical analyses for differences in grades of tissue contrast and CRs were performed. RESULTS: VISTA had significantly superior grades in tissue contrast of F-T (p = 0.001). Results of 3D FFE had superior grades in tissue contrast of F-C, but these result were not statistically significant (p = 0.157). VISTA had significantly superior CRs in F-T (p = 0.002), and 3D FFE had superior CRs in F-C (p = 0.003). The SNR of VISTA was higher than that of 3D FFE (49.24 vs. 15.94). CONCLUSION: VISTA demonstrates superior tissue contrast between fluid and the Achiles tendon in terms of quantitative and qualitative analysis, while 3D FFE shows superior tissue contrast between fluid and cartilage in terms of quantitative analysis.

Age determination in girls of Jodhpur Region by epiphyseal union of bones at ankle joint.

There is no statistical data to establish variation in epiphyseal fusion in Western Rajasthan populations. This significant oversight can lead to exclusion of persons of interest in a forensic investigation. Epiphyseal fusion of the distal tibia and fibula in sixty females was analyzed on radiological basis to assess the range of variation of epiphyseal fusion at each age. In the study the X ray films of the subjects were divided into three groups on the basis of degree of fusion. Firstly, those which were showing No Epiphyseal Fusion (N), secondly those showing Partial Union (P), and thirdly those showing Complete Fusion (C). Observations made were compared with the previous studies. Results indicate that complete fusion in females occurs as early as 14 years in the distal tibia and fibula. All females demonstrated complete fusion by 19 years with no significant differences between ancestral groups.

Study of calcaneal articular facets in human tali.

AIM: Aim of the present study is to know the presence and their percentages of incidences of various patterns of calcaneal articular facets in human tali. PLACE OF STUDY: Department of Anatomy of Sree Dev Raj Urs Medical College, Tamaka, Kolar, Karnataka, India. PERIOD OF STUDY: It is a study of two years of 1996-97 and 1997-98 batches of students. METHODS AND MATERIALS: Two hundred and forty unknown, dry human tali possessed from the bone sets of students of above batches constituted the materials for the study during the above period. They were carefully examined for articular facets and classified into five groups. Observations: The present study on human tali revealed five types articular facets .They are Type-1 were observed in 10% (in 24 tali), similarly Type-2 in 50% (120 tali), Type-3 in 16.66% (40 tali), Type-4 in 5.00% (12 tali), Type-5 in 18.41% (44 tali). Later they were well compared and correlated with available literatures. CONCLUSION: This study on human tali has revealed the type of gait, and walking habits and weight bearing bone that has given rise to various articular facets. Hence it has been studied and reported.

Anatomical study of the anterior talo-fibular ligament of human ankle joint

Twenty formalin preserved lower limbs were used in this study. Fifteen limbs [13 males and 2 females] were dissected to explore the lateral collateral ligament and 5 limbs were sectioned transversely at the level of lateral malleolus. MRI studies were done on five volunteers [three males and two females] while each subject was in supine position and the foot in the neutral position. The anterior talofibular ligament was a thickening of the capsule of ankle joint. It was a broadband attached from the anterior margin of the fibula to the lateral aspect of the neck of talus. It assumed two forms, either single band or two bands fused together with a separation line. The presence of more than one band had a great importance during the surgical repair of severed talofibular ligament, not to repair only one band and miss the other. All ligaments of the fibula were attached to its anterior border or anterior surface only for the tip of lateral malleolus to be free from ligamentous insertion, which is necessary for screw-like movement of fibula on its long axis. Although the anterior talofibular ligament is a major component of the lateral collateral ligament and plays an important role in stabilizing the ankle joint, yet it is the weakest one and the first to be injured in cases of sprain of ankle joint. Different ligaments attached to the lateral malleolus were found to be very close together in order to reinforce this weak anterior talofibular ligament. The inferior extensor retinaculum was attached to the lateral malleolus very close to the anterior talofibular ligament, so this retinaculum can be used during the repair of the ligament to reinforce it

Resonancia magnética del tobillo: podemos identificar al ligamento colateral externo y aseverar la existencia de lesiones? / MR imaging of the ankle: can we identify the lateral ligament and assess its injuries?

La RM es un método de comprobada utilidad para el estudio de las patologías osteoarticulares. Dado que siempre considerado un método "limitado" en el diagnóstico de las patologías ligamentarias, nuestro objetivo fue demostrar sus posibilidades en la observación de la anatomía normal del ligamento colateral externo (el más frecuentemente dañado en los eventos traumáticos) y su capacidad para evidenciar lesiones ligamentarias agudas y crónicas. Se estudiaron 6 tobillos de voluntarios normales sin antecedentes patológicos y un segundo grupo de 40 tobillos evaluados estudiados entre julio de 1995 y agosto de 1997. La visualización del ligamento colateral externo en los sujetos normales se logró en todos los casos y el fascículo de más difícil visualización fue el peroneocalcáneo por su trayecto oblicuo. En los pacientes con antecedentes traumáticos el ligamento más lesionado fue el peróneoastragalino anterior. Concluimos que el uso de esta modalidad diagnóstica en el tobillo provee al médico tratante de un panorama claro de la patología ligamentaria y de las lesiones asociadas en el tobillo, lo cual le permite planear medidas terapéuticas acordes al cuadro clínico del paciente

Ecografía músculotendinosa del retropié: patología traumática / Ultrasonography of ankle

La ecografía nos brinda una ayuda importante en el diagnóstico de la patología inflamatoria-traumática de los tendones del retropié, en especial Aquiles y tibial posterior. Es nuestro objetivo en este trabajo hacer una demostración correlativa de la clínica y la imagen, en las enfermedades que afectan a estos tendones, proponiendo una clasificación que sea útil para la terapéutica de esta afecciones

Resonancia magnética de tobillo / Magnetic resonance imaging of the ankle

La articulación del tobillo debido a la frecuencia con que sufren traumatismos nos obliga a conocer profundamente su anatomía y patología, sobre todo con Resonancia Magnética, la cual nos permite visualizar y evaluar cada una de sus estructuras. En este artículo, tratamos en forma suscinta la anatomía y patología de ligamentos y tendones de esta articulación