Effect of Bone Resection on Posterior Talofibular Ligament Integrity for Posterior Ankle Impingement Syndrome: A Cadaveric Study

Abstract

Purpose: The purpose of this study was to evaluate the attachment areas of the posterior talofibular ligament (PTFL) on the posterolateral tubercle of the talus and the remaining PTFL attachment areas after consequential bony excision.

Methods: Thirty fresh cadaveric ankles were dissected to study the proximal and distal attachment of the PTFL and separated the PTFL into anterior and posterior bundles. The description of the PTFL footprint and the anatomic landmarks from the surrounding structures were analyzed during consequential posterolateral bony excision.

Results: The average PTFL dimension was 26.11 mm (length), 7.65 mm (width), and 1.82 mm (thickness). The footprint area of the PTFL on the talar site consists of the posterior bundle (76.82%) and the anterior bundle (23.18%). If posterolateral tubercle excision was stayed up to a line of a bottom of the flexor hallucis longus (FHL) groove, at least 89% of the PTFL can be preserved.

Conclusion: The posterior bundle of the PTFL is the main bundle on the talar footprint area. To maintain the majority of the attachment of the PTFL, the resection of the posterolateral process could be performed to the bottom of the FHL tendon groove. If resection reaches to the posterior articular cartilage, less than 50% of the PTFL will be preserved. Understanding the footprint of the PTFL plays a key role in posterior ankle impingement surgery.

Clinical relevance: This study provides guidance for resection of the posterolateral tubercle of the talus and a portion of the PTFL attachment for posterior ankle impingement syndrome. Too much resection of the tubercle may cause instability symptoms.

Fig 1

The posterior ankle ligament.

Fig 2

Specific attachment areas of the posterior talofibular ligament (a) on the superior and (b) posterior views. The posterior bundle footprint is in green and yellow. The anterior bundle footprint is in red.

Fig 3

The 4 levels of the bony excision and the remaining area at the superior views of the posterior talus site; (a-d) defined as lines 1-4 of bony excision, respectively. The posterior bundle footprint is in green and yellow. The anterior bundle footprint is in red.

Fig 4

The 4 levels of the bony excision and the remaining area at the posterior views of the posterior talus site; (a-d) defined as lines 1-4 of bony excision, respectively. The posterior bundle footprint is in green and yellow. The anterior bundle footprint was in red.