ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2020
An oblique fibular tunnel is recommended when reconstructing the ATFL and CFL.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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12 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.
- All-inside arthroscopic procedures for chronic lateral ankle instability: evidence-based clinical practice guidelines.British medical bulletin · 2025Guideline
- Fibula single-tunnel versus fibula double-tunnel for both anterior talofibular ligament and calcaneofibular ligament reconstruction: a biomechanical comparison.BMC musculoskeletal disorders · 2025Article
- Arthroscopic Anatomic Lateral Ankle Reconstruction Using Allograft: A Simplified Approach.Arthroscopy techniques · 2024Article
- Optimal fibular tunnel direction for anterior talofibular ligament reconstruction: 45 degrees outperforms 30 and 60 degrees.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Accuracy of radiographic techniques in detection of the calcaneofibular ligament calcaneal insertion for lateral ankle ligament complex surgery.Surgical and radiologic anatomy : SRA · 2023Article
- Role of the intrinsic subtalar ligaments in subtalar instability and consequences for clinical practice.Frontiers in bioengineering and biotechnology · 2023Review
- Anatomic reconstruction using the autologous gracilis tendon achieved less sprain recurrence than the Broström-Gould procedure but delayed recovery in chronic lateral ankle instability.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2022Article
- The L-shaped tunnel technique showed favourable outcomes similar to those of the Y-graft technique in anatomic lateral ankle ligament reconstruction.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2022Article
- A calcaneal tunnel for CFL reconstruction should be directed to the posterior inferior medial edge of the calcaneal tuberosity.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2021Article
- Arthroscopic Anatomical Repair of Anterior Talofibular Ligament for Chronic Lateral Instability of the Ankle: Medium- and Long-Term Functional Follow-Up.Orthopaedic surgery · 2020Article
- Endoscopic anatomic ligament reconstruction is a reliable option to treat chronic lateral ankle instability.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2020Article
- Ankle arthroscopy: the wave that's coming.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2020Article
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Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeA bone tunnel is often used during the reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). The purpose of this study is to compare proposed directions for drilling this fibular tunnel and to assess potential tunnel length, using a 5-mm-diameter tunnel and surrounding bone.
methodsAnonymous DICOM data from spiral CT-scan images of the ankle were obtained from 12 Caucasian patients: 6 females and 6 males. Virtual tunnels were generated in a 3D bone model with angles of 30°, 45°, 60° and 90° in relation to the fibular long axis. Several measurements were performed: distance from entrance to perforation of opposing cortex, shortening of the tunnel, distance from tunnel centre to bone surface.
resultsA tunnel in a perpendicular direction resulted in an average possible tunnel length of 16.8 (± 2.7) mm in the female group and 20.3 (± 3.4) mm in the male group. A tunnel directed at 30° offered the longest length: 30.9 (± 2.5) mm in the female group and 34.4 (± 2.9) mm in the male group. The use of a 5-mm-diameter tunnel in a perpendicular direction caused important shortening of the tunnel at the entrance in some cases. The perpendicular tunnel was very near to the digital fossa while the most obliquely directed tunnels avoided this region.
conclusionAn oblique tunnel allows for a longer tunnel and avoids the region of the digital fossa, thereby retaining more surrounding bone. In addition, absolute values of tunnel length are given, which can be useful when considering the use of certain implants. We recommend drilling an oblique fibular tunnel when reconstructing the ATFL and CFL.
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