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Difference in the fibular attachment structure between the superior and inferior fascicles of the anterior talofibular ligament using ultrasonography and histological examinations

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Abstract

Purpose

The anterior talofibular ligament (ATFL) is divided into superior (SB) and inferior bands (IB). Although the differences in length and width are known, the structure of the fibular attachment had not been elucidated. The present study aimed to clarify the differences in the fibular attachment structure between ATFL’s SB and IB using cross-sectional images along the ligament.

Methods

An anatomical study using 15 formalin-fixed ankles was performed. The lateral ankle ligament complex was collected after a longitudinal image of SB/IB was visualized by ultrasonography. The specimens were decalcified and sectioned longitudinally at the center of SB/IB using a microtome. Histological evaluation of the enthesis structure at the fibular attachment of SB/IB was performed using hematoxylin–eosin and Masson’s trichrome stains.

Results

A fibrillar pattern could not be observed in the longitudinal image at the IB level by ultrasonography. The lengths of ATFL’s SB and IB were 20.6 ± 1.6 and 15.3 ± 1.3 mm, respectively, with thicknesses of 1.8 ± 0.4 and 1.0 ± 0.4 mm, respectively. The ATFL’s IB was significantly shorter and thinner than the ATFL’s SB. The fibular attachment of ATFL’s SB had distinct enthesis structure, whereas in the attachment structure of the ATFL’s IB, there were several variations including a type with a narrower enthesis structure than the ATFL’s SB and a type that merged with or wrapped around the calcaneofibular ligament.

Conclusion

The fibular attachment structure between ATFL’s SB and IB differs. Our results could be useful information when performing ultrasonography and MRI diagnosis.

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Acknowledgements

The authors sincerely thank those who donated their bodies to medical science so that anatomical research could be performed.

Funding

This study was partly supported by a research grant from Teikyo Heisei University (Grant number: 21THU007).

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Authors and Affiliations

  1. Faculty of Human Care, Teikyo Heisei University, 2-51-4 Higashi-Ikebukuro, Toshimaku, Tokyo, Japan

    Akira Kakegawa

  2. Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan

    Akira Kakegawa, Nanae Fukushima, Norimi Sumitomo, Ayata Nagira & Yuko Ichinose

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  1. Akira Kakegawa
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  2. Nanae Fukushima
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Contributions

AK: study design, data collection, data analysis, manuscript writing. NF: histological experiment, data analysis, manuscript writing. NS, AN and YI: histological experiment, critical revisions to the manuscript. All authors read and approved the final manuscript prior to submission.

Corresponding author

Correspondence to Akira Kakegawa.

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Conflict of interest

All authors declare that have no conflict of interest regarding this study.

Ethical approval

This study protocol was approved by the Institutional Review Board of Shinshu University, Matsumoto, Nagano Prefecture, Japan (Approval No.4340) and Teikyo Hisei University, Toshima-ku, Tokyo, Japan (Approval No. R01-022).

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Informed consent of this anatomical study was obtained from the families of the donated cadavers.

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Kakegawa, A., Fukushima, N., Sumitomo, N. et al. Difference in the fibular attachment structure between the superior and inferior fascicles of the anterior talofibular ligament using ultrasonography and histological examinations. Surg Radiol Anat 44, 1513–1520 (2022). https://doi.org/10.1007/s00276-022-03049-9

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