Assessment of the feasibility of arthroscopic visualization of the lateral ligament of the ankle: a cadaveric study

An anatomical study was performed to assess the feasibility of arthroscopic visualization of the lateral ligaments of the ankle. The fibular, talar and calcanear insertions of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) were identified by standard arthroscopy portals. After dissection of the ATFL and CFL, bone tunnels were created at the estimated centres of their footprints. Dissection was then performed to identify the footprints and their position in relation to bony landmarks. The distance from the real centre of the footprint to the corresponding tunnel entrance was measured. Fourteen fresh frozen ankles were included. The ATFL and CFL were identified in all cases. The centre of the fibular ATFL footprint was found to be 16.1 +/- A 3.5 mm from the tip of the fibula, and the talar footprint was 18.4 +/- A 2.8 mm from the apex of the lateral talar process. The centre of the fibular CFL footprint was 4.2 +/- A 0.8 mm from the tip of the fibula, and the calcaneal footprint was 18.4 +/- A 2.5 mm from the fibular process of the calcaneum. The fibular tunnel was 2.9 +/- A 3 mm proximally from the centre of the ATFL fibular footprint, the talar tunnel was 4.4 +/- A 3.2 mm proximally from the centre of the talar footprint, and the calcaneal tunnel was 3.3 +/- A 2.8 mm too anterior from the CFL calcaneal footprint. No iatrogenic lesions were noted. Arthroscopic identification of the ATFL, CFL and their corresponding footprints can be considered safe and reliable. Tunnels entrances, in preparation for arthroscopic ligament reconstruction, are precisely positioned. Arthroscopic anatomical ligament reconstruction is a feasible option.