[Morphology and clinical aspect of the lateral ligaments of the ankle joint (author's transl)]

Abstract

The direction of movement and the range of movement of a joint are determined by the lengths of the ligaments and the positions of their origins and insertions. It follows that any operation which alters the length of a ligament or moves one of its points of attachment is unphysiological. Reconstruction should be carried out with due regard to the normal anatomy. In the ankle joint, for example, the tip of the lateral malleolus should be left free of ligamentary insertions. Until now, anatomical illustrations have shown the lateral ligaments of the ankle joint to be attached to the anterior border of the fibula and to its anterior and lateral surface. All the older illustrations emphasize a band of fibers which passes directly from the neck of the talus to the calcaeus. This band varies in thickness and always forms the base of the triangle formed by the anterior talofibular ligament and the calcaneofibular ligament. Examination of surgical specimens and amputated ankle joints shows that the lateral tip of the fibula is free of ligamentary insertions. The lateral fibular ligaments are attached to the distal end of the fibula around the border of the cartilaginous foint surface. The only fibers which are derived from the lateral surface are those from the periosteum. This fact is of considerable importance in reconstructive surgery of the ankle joint, since strong ligamentary insertions which surround the lateral surface of the fibula necessarily oppose rotation or screw-like movement of the fibula about its longitudinal axis.