The anterior inferior tibiofibular ligament and talar impingement: a cadaveric study.

Impingement by the distal fascicle of the anterior inferior tibiofibular ligament (AITFL) is a relatively new entity among the known causes of anterolateral impingement syndromes of the ankle. This study investigated the anatomy of the anterior inferior tibiofibular ligament and its possible role in talar impingement in 47 ankles of 27 cadavers. The length, width, insertion point to the fibula and the interactions with talus were noted, as was the relationship of the fascicle and talus during different ankle movements before and after incision of the lateral ligaments. A distal fascicle of the AITFL was found in 39 of the 47 ankles (83%) and appeared as a single-complete ligament in the remaining 8 ankles (17%). The fascicle averaged 16.1+/-2.94 mm in length (range 10-21) and 4.2+/-1.00 mm in width (range, 3-7). The insertion point of the fascicle on the fibula averaged 10.3+/-2.27 mm (5-13) distal to the joint level. Contact between the ligament and the lateral dome of the talus was observed in 42 specimens (89.3%). Bending of the fascicle was observed in 8 of these 42 ankles with forced dorsiflexion. These 8 specimens were significantly wider and longer than the specimens without bending of the fascicle. Incision of the anterior talofibular ligament led to bending in dorsiflexion in additional 11 ankles. The total 19 fascicles with bending after incision of the anterior talofibular ligament were significantly longer and inserted more distally than the remaining 20 fascisles without bending. Manual traction simulating distraction during arthroscopic procedures relieved the contact. These findings show that the presence of the distal fascicle of the AITFL and its contact with the talus is a normal finding. However, it may become pathological due to anatomical variations and/or instability of the ankle resulting from torn lateral ligaments. When observed during an ankle arthroscopy, the surgeon should look for the criteria described in the present study to decide whether it is pathological and needs to be resected.

[Comparison of four evaluation systems used for ankle injuries]. / Ayak bilegi hastaliklarinda dört farkli degerlendirme yönteminin karsilastirilmasi.

OBJECTIVES: Unlike the knee and shoulder, no widely accepted scoring system exists for the ankle joint. The aim of this study was to compare the results of diverse scoring systems used in ankle injuries. METHODS: We compared the results of four evaluation systems used for the ankle including those proposed by (i) Meislin et al. (ME), (ii) Martin et al. (MA), (iii) Kaikkonen and Kannus (KK) and (iv) a modified Bray's system (B). With the use of these evaluation systems we assessed the results of (i) 21 patients who underwent arthroscopic treatment for anterolateral impingement of the ankle, (ii) 17 patients who underwent surgical treatment for bimalleolar ankle fractures, and (iii) 22 patients receiving conservative treatment for grade 2-3 lateral ankle sprains. Statistical analyses were made using the chi-square test. RESULTS: The four scoring systems yielded similar results ranging from 23% to 33% in three groups, whereas conflicting results were obtained in the remaining cases (67% to 77%). The scores indicating poor outcomes were the highest with the ME and MA systems which included more subjective criteria. Similarly, the number of excellent results were significantly lower in these two systems than those of B and KK (p<0.001). CONCLUSION: Due to the high incidence of conflicting results between the scoring systems used, any particular patient may be rated as fair with one system and excellent with another. A standard ankle scoring system requires the inclusion of objective, subjective, and functional criteria, with each patient being evaluated according to individual activity levels as well.