Researchers at the UB describe a new anatomical structure in the ankle

Researchers at the UB describe a new anatomical structure in the ankle https://i2.wp.com/www.eresviral.com/wp-content/uploads/2018/11/Investigadores-de-la-UB-describen-una-nueva-estructura-anatómica-en-el-tobillo.jpg?fit=219%2C146&ssl=1

Researchers at the UB describe a new anatomical structure in the ankle







According to the manuals of human anatomy, the ligaments of the ankle joint are structures that are grouped by two large ligament complexes: the lateral collateral ligament - located on the lateral part of the joint and formed by three ligaments that are independent of each other - and the medial collateral ligament or deltoid ligament. In a scientific study published now, a research team from the UB (Catalunya, Spain) has defined a new anatomical structure in the ankle: the lateral fibulotalocalcaneal ligamentous complex (LFTCL, in English). The description of this anatomical structure has been possible thanks to the examination of fibers that connect two of the components of the lateral collateral ligament. In addition, for the first time one of the parts of this new structure is described as intra-articular. These results, published in the scientific journal Knee Surgery, Sports Traumatology, Arthroscopy, change the understanding of this articulation and could explain why many ankle sprains continue to produce pain even months or years after the initial injury.



The team responsible for the discovery is specialized in the anatomy of the musculoskeletal system, and Jordi Vega, Francesc Malagelada, M.ª Cristina Manzanares and Miquel Dalmau Pastor, from the Faculty of Medicine and Health Sciences of the UB are part of it.



The lateral ligaments of the ankle are those that are injured more often in the human body, especially because of ankle sprains. In addition, many people who suffer from this injury have ankle discomfort that lengthen in time, and a tendency to suffer a new sprain that medicine has not been able to explain until now. "This lack of explanation was the key to changing the way to approach the dissection of the ligaments, and then we realized that some fibers of connection between ligaments were removed as usual because they were not thought to be part of the ligament," he explains. Miquel Dalmau Pastor, researcher of the Human Anatomy and Embryology Unit and the Department of Pathology and Experimental Therapeutics of the UB.







The researchers of the UB, Cristina Manzanares and Miquel Dalmau. (Photo: U. Barcelona)



According to the new work, these fibers connect the fascicle (bundle of ligamentous fibers) inferior of the anterior talofibular ligament and the calcaneofibular ligament, two of the three components of the lateral collateral ligament. "This connection has never been described, and contrary to what was thought until now, suggests that the two ligaments that connect are a functional unit. That is, we could consider these two ligaments connected as a unique anatomical structure, which we have called the lateral fibulotalocalcaneal ligamentous complex, "explains Dalmau Pastor.



This description also fits with some clinical publications that showed the good results of the isolated repair of the anterior talofibular ligament in cases of complete injury of the anterior talofibular ligaments and calcaneofibular ligament. "These publications made us think that if repairing only the anterior talofibular ligament, the calcaneofibular ligament was repaired, that could only happen if there was any connection between the ligaments," recalls Jordi Vega.



Careful dissection of the joint capsule of the ankle has also made it possible to identify for the first time the intraarticular component of the anterior talofibular ligament. According to the study, this ligament would be formed by two fascicles, one upper and one lower, that are respectively inside and outside the joint. The inferior fascicle, together with the calcaneofibular ligament and the arcuate fibers that join them, would form the lateral fibulothalcalcaneal complex, which would therefore be an extra-articular structure.



The fact that part of the anterior talofibular ligament was an intra-articular structure could have implications for the evolution and treatment of ankle injuries. "This finding makes us think that the behavior after an injury will be similar to that of other intra-articular ligaments, such as the anterior cruciate ligament of the knee, which are not able to heal on their own when they are broken, which causes the joint to remain unstable and requires surgery in many cases, "explains Dalmau Pastor.



Likewise, these results could explain why many sprains continue to produce pain even if the person follows the treatment recommended by their doctor or physiotherapist. "Being intraarticular, the ligament does not heal and the instability of the joint continues to produce pain and makes these patients have many chances of suffering more sprains and develop other injuries in the ankle," says Francesc Malagelada.



In addition to the anatomical observation in the dissections made at the University of Barcelona, ​​researchers have studied how ligaments behave dynamically. "The superior fascicle of the anterior talofibular ligament, in addition to being intra-articular, is not an isometric structure, that is, it relaxes when the foot is in dorsiflexion, and tenses when it is in plantar flexion. On the other hand, the inferior fasciculus, the arcuate fibers and the calcaneofibular ligament, that is to say, the ligamentous complex described, are extra-articular structures and yes they are isometric, so they are always in tension in any position of the foot », concludes M.ª Cristina Manzanares



Due to the great novelty that this structure represents, several research projects have been initiated on its biomechanics, histology and clinic, coordinated by this UB team and in collaboration with Roure, of the Polytechnic University of Catalonia; James Calder, of the Imperial College of London, and Gino Kerkhoffs, of the University of Amsterdam. This is a project funded by the Research and Study Group in Mini-invasive Foot Surgery (GRECMIP). (Source: U. Barcelona)



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