ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2021
A calcaneal tunnel for CFL reconstruction should be directed to the posterior inferior medial edge of the calcaneal tuberosity.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 13 citations in OpenAlex.
- Functional Anatomy and Clinical Significance of the Lateral Ankle Ligaments: A Cadaveric Study.Cureus · 2026Article
- Arthroscopic Anatomic Lateral Ankle Reconstruction Using Allograft: A Simplified Approach.Arthroscopy techniques · 2024Article
- Arthroscopic Modified Broström Repair with Suture-Tape Augmentation of the Calcaneofibular Ligament for Lateral Ankle Instability.Arthroscopy techniques · 2024Article
- Lateral Ankle Ligaments: An Insight Into Their Functional Anatomy, Variations, and Surgical Importance.Cureus · 2024Article
- Advantages of ultrasound identification of the distal insertion of the calcaneofibular ligament during ligament reconstructions.Surgical and radiologic anatomy : SRA · 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
- Arthroscopic and Open Procedures Result in Similar Calcaneal Tunnels for Anatomical Reconstruction of Lateral Ankle Ligaments.Arthroscopy, sports medicine, and rehabilitation · 2023Article
- Role of the intrinsic subtalar ligaments in subtalar instability and consequences for clinical practice.Frontiers in bioengineering and biotechnology · 2023Review
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Authors and funding
5 authors at 3 institutions in 4 countries.
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No grant is acknowledged in the PubMed record.
Abstract
purposeAnatomical reconstruction of the calcaneofibular ligament (CFL) is a common technique to treat chronic lateral ankle instability. A bone tunnel is used to fix the graft in the calcaneus. The purpose of this study is to provide some recommendations about tunnel entrance and tunnel direction based on anatomical landmarks.
methodsThe study consisted of two parts. The first part assessed the lateral tunnel entrance for location and safety. The second part addressed the tunnel direction and safety upon exiting the calcaneum on the medial side. In the first part, 29 specimens were used to locate the anatomical insertion of the CFL based on the intersection of two lines related to the fibular axis and specific landmarks on the lateral malleolus. In the second part, 22 specimens were dissected to determine the position of the neurovascular structures at risk during tunnel drilling. Therefore, a method based on four imaginary squares using external anatomical landmarks was developed.
resultsFor the tunnel entrance on the lateral side, the mean distance to the centre of the CFL footprint was 2.8 ± 3.0 mm (0-10.4 mm). The mean distance between both observers was 4.2 ± 3.2 mm (0-10.3 mm). The mean distance to the sural nerve was 1.4 ± 2 mm (0-5.8 mm). The mean distance to the peroneal tendons was 7.3 ± 3.1 mm (1.2-12.4 mm). For the tunnel exit on the medial side, the two anterior squares always contained the neurovascular bundle. A safe zone without important neurovascular structures was found and corresponded to the two posterior squares.
conclusionLateral landmarks enabled to locate the CFL footprint. Precautions should be taken to protect the nearby sural nerve. A safe zone on the medial side could be determined to guide safe tunnel direction. A calcaneal tunnel should be directed to the posterior inferior medial edge of the calcaneal tuberosity.
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