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. 2024 Nov;144(11):5021-5030.
doi: 10.1007/s00402-024-05598-7. Epub 2024 Sep 30.

Clinical significance of posterior talofibular ligament injury in chronic lateral ankle instability

Tomoyuki Nakasa  1 , Yasunari Ikuta  2 , Shingo Kawabata  2 , Satoru Sakurai  2 , Dan Moriwaki  2 , Saori Ishibashi  2 , Asyumaredha Asril Silan  2   3 , Nobuo Adachi  2
Affiliations

Clinical significance of posterior talofibular ligament injury in chronic lateral ankle instability

Tomoyuki Nakasa et al. Arch Orthop Trauma Surg. 2024 Nov.

Abstract

Purpose: Although arthroscopic repair of the anterior talofibular ligament (ATFL) is widely performed, the effect of posterior talofibular ligament (PTFL) injury on clinical outcomes remains unclear. This study aimed to evaluate the magnetic resonance imaging (MRI) findings of the PTFL in chronic lateral ankle instability (CLAI) and determine whether the presence or absence of PTFL injury affected the postoperative outcomes of arthroscopic ATFL repair.

Materials and methods: Forty ankles of 35 patients who underwent arthroscopic repair for CLAI were included in this study as the experimental group, together with 25 ankles of 24 patients without CLAI as the control group. The PTFL thickness (PTFLT) and PTFL cross-sectional area (PTFLCSA) were measured using MRI and compared between the control and CLAI groups. The clinical outcomes of arthroscopic repair were compared between ankles with and without PTFL injuries.

Results: The mean PTFLT and PTFLCSA values were significantly higher in the CLAI group than in the control group. The PTFLT and PTFLCSA in the PTFL injury group were significantly larger than those in the non-injury group in the CLAI group. Postoperatively, there were no significant differences in clinical scores and talar tilt angles on stress radiographs between ankles with and without PTFL injury; however, instability recurrence was frequently observed in ankles with PTFL injury (32.1%) compared to the ankles without PTFL injury (16.7%). Poor-quality ATFL remnant, ATFL inferior fascicle, and calcaneofibular ligament injuries were frequently observed in ankles with PTFL injuries.

Conclusions: Our findings indicate that PTFL injury is highly associated with CLAI but it does not affect postoperative clinical scores. However, postoperative instability recurrence was more often observed in ankles with PTFL injuries, given that they frequently have poor-quality ATFL remnants and CFL injuries.

Evidence level: Level III.

Keywords: Anterior talofibular ligament; Calcaneofibular ligament; Chronic lateral ankle instability; Magnetic resonance imaging; Posterior talofibular ligament.

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Conflict of interest statement

Declarations. Conflict of interest: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethical approval: We obtained institutional review board approval for this study. Ethical approval for this study was obtained from the ethics committee of Hiroshima University (Approval number: E-14). Informed consent: Informed consent was obtained from all individual participants.

Figures

Fig. 1
Fig. 1
Evaluation of posterior talofibular ligament (PTFL) injury on magnetic resonance imaging (MRI). A Measurement of PTFL thickness (PTFLT) B. Measurement of the PTFL cross-sectional area (PTFLCSA)
Fig. 2
Fig. 2
Comparison of the PTFL in the ankle with or without the chronic lateral ankle instability (CLAI). A Control group. B CLAI group. Arrows: PTFL, Arrowhead: Anterior talofibular ligament (ATFL)
Fig. 3
Fig. 3
Representative images of the CLAI with ATFL superior and inferior fascicles, CFL, and PTFL
See this image and copyright information in PMC

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