Anatomical analysis of the lateral ligament complex in the neutral position and during plantar flexion

Abstract Aim The purpose of this study was to obtain anatomical information on the anterior talofibular ligament (ATFL), anterior tibiofibular ligament (ATiFL) and calcaneofibular ligament (CFL) in the neutral position and during plantar flexion. Methods Seventy specimens with whole ankle ligaments...

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Main Authors: Zhimin Chen, Han Yang, Xuequan Zhang, Minghao Su, Zeyu Li, Chang Liu, Zhaoming Xiao, Hiabin Liang, Guangwei Xu, Chujiang Xu, Jun Ouyang, Jingxing Dai
Format: Article
Language:English
Published: BMC 2025-05-01
Series:BMC Musculoskeletal Disorders
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Online Access:https://doi.org/10.1186/s12891-025-08699-5
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author Zhimin Chen
Han Yang
Xuequan Zhang
Minghao Su
Zeyu Li
Chang Liu
Zhaoming Xiao
Hiabin Liang
Guangwei Xu
Chujiang Xu
Jun Ouyang
Jingxing Dai
author_facet Zhimin Chen
Han Yang
Xuequan Zhang
Minghao Su
Zeyu Li
Chang Liu
Zhaoming Xiao
Hiabin Liang
Guangwei Xu
Chujiang Xu
Jun Ouyang
Jingxing Dai
author_sort Zhimin Chen
collection DOAJ
description Abstract Aim The purpose of this study was to obtain anatomical information on the anterior talofibular ligament (ATFL), anterior tibiofibular ligament (ATiFL) and calcaneofibular ligament (CFL) in the neutral position and during plantar flexion. Methods Seventy specimens with whole ankle ligaments were recorded for anatomy education. ATFLs with single, double, and triple bands corresponded to Types A, B, and C. In our study, different types of ATFLs with information on the length, width, ATFL/CFL angle, ATFL/ATiFL angle, and the distance of the fibular center of insertion (fCOI) of ATFL-CFL-ATiFL in the neutral position and 20° plantar flexion, was collected. Results In Type B, the length, width, and ATFL/ATiFL angle of the superior and inferior bands varied (length, P < 0.001; width, P < 0.001; ATFL/ATiFL angle, P < 0.001). Among the types, the total widths of Types A/B and A/C were significantly different (P < 0.01; P < 0.001). In terms of postural changes, significant differences in the ATFL/ATiFL angle were observed for Type A (P < 0.001), Type B (P < 0.001), and Type C (P < 0.01). Conclusions In conclusion, attention should be given to the ATFL widths of different ATFL types during surgical treatment because of the significant differences among the three ATFL types. The relative independence of ATiFL and the cooperative relationship between ATFL and CFL are instructive for different ATFL surgical procedures. The ATFL, CFL, and ATiFL data can be used for anatomical reconstruction and secondary proofreading for ATFL injury or chronic ankle instability.
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spelling doaj-art-3be7b257912d4ecd8e7738dee6dbc6f22025-08-20T02:15:16ZengBMCBMC Musculoskeletal Disorders1471-24742025-05-0126111110.1186/s12891-025-08699-5Anatomical analysis of the lateral ligament complex in the neutral position and during plantar flexionZhimin Chen0Han Yang1Xuequan Zhang2Minghao Su3Zeyu Li4Chang Liu5Zhaoming Xiao6Hiabin Liang7Guangwei Xu8Chujiang Xu9Jun Ouyang10Jingxing Dai11Department of Imaging Diagnostics, Nanfang Hospital, Southern Medical UniversityDepartment of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical UniversityHeyuan Hospital of TCMThe First Clinical Medicine College, Southern Medical UniversityGuangdong Provincial Key Laboratory of Digital Medicine and Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology (Southern Medical University) & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical UniversityGuangdong Provincial Key Laboratory of Digital Medicine and Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology (Southern Medical University) & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical UniversityGuangdong Provincial Key Laboratory of Digital Medicine and Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology (Southern Medical University) & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical UniversityGuangdong Provincial Key Laboratory of Digital Medicine and Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology (Southern Medical University) & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical UniversityGuangdong Provincial Key Laboratory of Digital Medicine and Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology (Southern Medical University) & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical UniversityDepartment of Orthopedics, TCM-Integrated Hospital, Southern Medical UniversityGuangdong Provincial Key Laboratory of Digital Medicine and Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology (Southern Medical University) & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical UniversityGuangdong Provincial Key Laboratory of Digital Medicine and Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology (Southern Medical University) & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical UniversityAbstract Aim The purpose of this study was to obtain anatomical information on the anterior talofibular ligament (ATFL), anterior tibiofibular ligament (ATiFL) and calcaneofibular ligament (CFL) in the neutral position and during plantar flexion. Methods Seventy specimens with whole ankle ligaments were recorded for anatomy education. ATFLs with single, double, and triple bands corresponded to Types A, B, and C. In our study, different types of ATFLs with information on the length, width, ATFL/CFL angle, ATFL/ATiFL angle, and the distance of the fibular center of insertion (fCOI) of ATFL-CFL-ATiFL in the neutral position and 20° plantar flexion, was collected. Results In Type B, the length, width, and ATFL/ATiFL angle of the superior and inferior bands varied (length, P < 0.001; width, P < 0.001; ATFL/ATiFL angle, P < 0.001). Among the types, the total widths of Types A/B and A/C were significantly different (P < 0.01; P < 0.001). In terms of postural changes, significant differences in the ATFL/ATiFL angle were observed for Type A (P < 0.001), Type B (P < 0.001), and Type C (P < 0.01). Conclusions In conclusion, attention should be given to the ATFL widths of different ATFL types during surgical treatment because of the significant differences among the three ATFL types. The relative independence of ATiFL and the cooperative relationship between ATFL and CFL are instructive for different ATFL surgical procedures. The ATFL, CFL, and ATiFL data can be used for anatomical reconstruction and secondary proofreading for ATFL injury or chronic ankle instability.https://doi.org/10.1186/s12891-025-08699-5Anterior talofibular ligament (ATFL)Ankle ligament repairAnatomyAnterior tibiofibular ligament (ATiFL)Calcaneofibular ligament (CFL)
spellingShingle Zhimin Chen
Han Yang
Xuequan Zhang
Minghao Su
Zeyu Li
Chang Liu
Zhaoming Xiao
Hiabin Liang
Guangwei Xu
Chujiang Xu
Jun Ouyang
Jingxing Dai
Anatomical analysis of the lateral ligament complex in the neutral position and during plantar flexion
BMC Musculoskeletal Disorders
Anterior talofibular ligament (ATFL)
Ankle ligament repair
Anatomy
Anterior tibiofibular ligament (ATiFL)
Calcaneofibular ligament (CFL)
title Anatomical analysis of the lateral ligament complex in the neutral position and during plantar flexion
title_full Anatomical analysis of the lateral ligament complex in the neutral position and during plantar flexion
title_fullStr Anatomical analysis of the lateral ligament complex in the neutral position and during plantar flexion
title_full_unstemmed Anatomical analysis of the lateral ligament complex in the neutral position and during plantar flexion
title_short Anatomical analysis of the lateral ligament complex in the neutral position and during plantar flexion
title_sort anatomical analysis of the lateral ligament complex in the neutral position and during plantar flexion
topic Anterior talofibular ligament (ATFL)
Ankle ligament repair
Anatomy
Anterior tibiofibular ligament (ATiFL)
Calcaneofibular ligament (CFL)
url https://doi.org/10.1186/s12891-025-08699-5
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