Optimal fibular tunnel direction for anterior talofibular ligament reconstruction: 45 degrees outperforms 30 and 60 degrees
Purpose There is currently no consensus on the optimal drilling direction of the fibular bone tunnel for anterior talofibular ligament (ATFL) reconstruction, and few studies have investigated the potential injury to the peroneus longus and brevis tendons and the possibility of fibular fractures duri...
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| Published in | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 31; no. 10; pp. 4546 - 4550 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Berlin/Heidelberg
Springer Berlin Heidelberg
01.10.2023
John Wiley & Sons, Inc |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Purpose
There is currently no consensus on the optimal drilling direction of the fibular bone tunnel for anterior talofibular ligament (ATFL) reconstruction, and few studies have investigated the potential injury to the peroneus longus and brevis tendons and the possibility of fibular fractures during the drilling process. The aim of this study was to assess the potential risk of drilling the tunnel from different directions and determine the most appropriate tunnel direction. The hypothesis was that drilling the tunnel in the 45-degree direction would be the safest and most suitable for the fibular tunnel.
Methods
Forty-eight fibular tunnels were drilled on fresh ankle specimens using a K-wire guide and a 5.0 mm hollow drill. Three tunnel orientations were created, parallel to the sagittal plane of the long axis of the fibula and angled 30°, 45°, and 60° to the coronal plane. The length of the fibular tunnel and the distances from the outlet of the K-wire to the peroneus longus and brevis tendons were measured. The occurrence of a fibula fracture was also observed.
Results
The lengths of the bone tunnels in the three groups were 32.9 ± 6.1 mm (30°), 27.2 ± 4.4 mm (45°) and 23.6 ± 4.0 mm (60°). The length of the tunnel drilled at 30° was the longest when compared with that of the tunnels drilled at 45° and 60° (all
p
values < 0.05). The distances from the outlet of the K-wire to the peroneus longus tendon were 3.0 ± 3.8 mm (30°), 3.8 ± 3.2 mm (45°) and 5.3 ± 1.8 mm (60°), and the distances to the peroneus brevis tendon were 4.2 ± 4.0 mm (30°), 6.1 ± 3.8 mm (45°), 7.9 ± 3.5 mm (60°). In terms of protecting the peroneus longus and brevis tendons, drilling in the 60° direction was better than drilling in the 30° and 45° directions (all
p
values < 0.05). The risk of injury to the peroneal longus and brevis tendons was 62.5% (30°), 31.3% (45°), and 0% (60°). Although no fibular fractures were observed in any of the three directions, drilling the bone tunnel in the 60° direction disrupted the lateral cortex of the fibula.
Conclusion
This study shows that drilling the tunnel in the 45° direction is less likely to cause injury to the peroneus longus and brevis tendons, while ensuring that the tunnel has a sufficient length and avoiding fracturing the distal fibula. Drilling a fibular bone tunnel in a 45° direction is safer and recommended for ATFL reconstruction. |
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| AbstractList | There is currently no consensus on the optimal drilling direction of the fibular bone tunnel for anterior talofibular ligament (ATFL) reconstruction, and few studies have investigated the potential injury to the peroneus longus and brevis tendons and the possibility of fibular fractures during the drilling process. The aim of this study was to assess the potential risk of drilling the tunnel from different directions and determine the most appropriate tunnel direction. The hypothesis was that drilling the tunnel in the 45-degree direction would be the safest and most suitable for the fibular tunnel.
Forty-eight fibular tunnels were drilled on fresh ankle specimens using a K-wire guide and a 5.0 mm hollow drill. Three tunnel orientations were created, parallel to the sagittal plane of the long axis of the fibula and angled 30°, 45°, and 60° to the coronal plane. The length of the fibular tunnel and the distances from the outlet of the K-wire to the peroneus longus and brevis tendons were measured. The occurrence of a fibula fracture was also observed.
The lengths of the bone tunnels in the three groups were 32.9 ± 6.1 mm (30°), 27.2 ± 4.4 mm (45°) and 23.6 ± 4.0 mm (60°). The length of the tunnel drilled at 30° was the longest when compared with that of the tunnels drilled at 45° and 60° (all p values < 0.05). The distances from the outlet of the K-wire to the peroneus longus tendon were 3.0 ± 3.8 mm (30°), 3.8 ± 3.2 mm (45°) and 5.3 ± 1.8 mm (60°), and the distances to the peroneus brevis tendon were 4.2 ± 4.0 mm (30°), 6.1 ± 3.8 mm (45°), 7.9 ± 3.5 mm (60°). In terms of protecting the peroneus longus and brevis tendons, drilling in the 60° direction was better than drilling in the 30° and 45° directions (all p values < 0.05). The risk of injury to the peroneal longus and brevis tendons was 62.5% (30°), 31.3% (45°), and 0% (60°). Although no fibular fractures were observed in any of the three directions, drilling the bone tunnel in the 60° direction disrupted the lateral cortex of the fibula.
This study shows that drilling the tunnel in the 45° direction is less likely to cause injury to the peroneus longus and brevis tendons, while ensuring that the tunnel has a sufficient length and avoiding fracturing the distal fibula. Drilling a fibular bone tunnel in a 45° direction is safer and recommended for ATFL reconstruction. PurposeThere is currently no consensus on the optimal drilling direction of the fibular bone tunnel for anterior talofibular ligament (ATFL) reconstruction, and few studies have investigated the potential injury to the peroneus longus and brevis tendons and the possibility of fibular fractures during the drilling process. The aim of this study was to assess the potential risk of drilling the tunnel from different directions and determine the most appropriate tunnel direction. The hypothesis was that drilling the tunnel in the 45-degree direction would be the safest and most suitable for the fibular tunnel. MethodsForty-eight fibular tunnels were drilled on fresh ankle specimens using a K-wire guide and a 5.0 mm hollow drill. Three tunnel orientations were created, parallel to the sagittal plane of the long axis of the fibula and angled 30°, 45°, and 60° to the coronal plane. The length of the fibular tunnel and the distances from the outlet of the K-wire to the peroneus longus and brevis tendons were measured. The occurrence of a fibula fracture was also observed.ResultsThe lengths of the bone tunnels in the three groups were 32.9 ± 6.1 mm (30°), 27.2 ± 4.4 mm (45°) and 23.6 ± 4.0 mm (60°). The length of the tunnel drilled at 30° was the longest when compared with that of the tunnels drilled at 45° and 60° (all p values < 0.05). The distances from the outlet of the K-wire to the peroneus longus tendon were 3.0 ± 3.8 mm (30°), 3.8 ± 3.2 mm (45°) and 5.3 ± 1.8 mm (60°), and the distances to the peroneus brevis tendon were 4.2 ± 4.0 mm (30°), 6.1 ± 3.8 mm (45°), 7.9 ± 3.5 mm (60°). In terms of protecting the peroneus longus and brevis tendons, drilling in the 60° direction was better than drilling in the 30° and 45° directions (all p values < 0.05). The risk of injury to the peroneal longus and brevis tendons was 62.5% (30°), 31.3% (45°), and 0% (60°). Although no fibular fractures were observed in any of the three directions, drilling the bone tunnel in the 60° direction disrupted the lateral cortex of the fibula.ConclusionThis study shows that drilling the tunnel in the 45° direction is less likely to cause injury to the peroneus longus and brevis tendons, while ensuring that the tunnel has a sufficient length and avoiding fracturing the distal fibula. Drilling a fibular bone tunnel in a 45° direction is safer and recommended for ATFL reconstruction. There is currently no consensus on the optimal drilling direction of the fibular bone tunnel for anterior talofibular ligament (ATFL) reconstruction, and few studies have investigated the potential injury to the peroneus longus and brevis tendons and the possibility of fibular fractures during the drilling process. The aim of this study was to assess the potential risk of drilling the tunnel from different directions and determine the most appropriate tunnel direction. The hypothesis was that drilling the tunnel in the 45-degree direction would be the safest and most suitable for the fibular tunnel.PURPOSEThere is currently no consensus on the optimal drilling direction of the fibular bone tunnel for anterior talofibular ligament (ATFL) reconstruction, and few studies have investigated the potential injury to the peroneus longus and brevis tendons and the possibility of fibular fractures during the drilling process. The aim of this study was to assess the potential risk of drilling the tunnel from different directions and determine the most appropriate tunnel direction. The hypothesis was that drilling the tunnel in the 45-degree direction would be the safest and most suitable for the fibular tunnel.Forty-eight fibular tunnels were drilled on fresh ankle specimens using a K-wire guide and a 5.0 mm hollow drill. Three tunnel orientations were created, parallel to the sagittal plane of the long axis of the fibula and angled 30°, 45°, and 60° to the coronal plane. The length of the fibular tunnel and the distances from the outlet of the K-wire to the peroneus longus and brevis tendons were measured. The occurrence of a fibula fracture was also observed.METHODSForty-eight fibular tunnels were drilled on fresh ankle specimens using a K-wire guide and a 5.0 mm hollow drill. Three tunnel orientations were created, parallel to the sagittal plane of the long axis of the fibula and angled 30°, 45°, and 60° to the coronal plane. The length of the fibular tunnel and the distances from the outlet of the K-wire to the peroneus longus and brevis tendons were measured. The occurrence of a fibula fracture was also observed.The lengths of the bone tunnels in the three groups were 32.9 ± 6.1 mm (30°), 27.2 ± 4.4 mm (45°) and 23.6 ± 4.0 mm (60°). The length of the tunnel drilled at 30° was the longest when compared with that of the tunnels drilled at 45° and 60° (all p values < 0.05). The distances from the outlet of the K-wire to the peroneus longus tendon were 3.0 ± 3.8 mm (30°), 3.8 ± 3.2 mm (45°) and 5.3 ± 1.8 mm (60°), and the distances to the peroneus brevis tendon were 4.2 ± 4.0 mm (30°), 6.1 ± 3.8 mm (45°), 7.9 ± 3.5 mm (60°). In terms of protecting the peroneus longus and brevis tendons, drilling in the 60° direction was better than drilling in the 30° and 45° directions (all p values < 0.05). The risk of injury to the peroneal longus and brevis tendons was 62.5% (30°), 31.3% (45°), and 0% (60°). Although no fibular fractures were observed in any of the three directions, drilling the bone tunnel in the 60° direction disrupted the lateral cortex of the fibula.RESULTSThe lengths of the bone tunnels in the three groups were 32.9 ± 6.1 mm (30°), 27.2 ± 4.4 mm (45°) and 23.6 ± 4.0 mm (60°). The length of the tunnel drilled at 30° was the longest when compared with that of the tunnels drilled at 45° and 60° (all p values < 0.05). The distances from the outlet of the K-wire to the peroneus longus tendon were 3.0 ± 3.8 mm (30°), 3.8 ± 3.2 mm (45°) and 5.3 ± 1.8 mm (60°), and the distances to the peroneus brevis tendon were 4.2 ± 4.0 mm (30°), 6.1 ± 3.8 mm (45°), 7.9 ± 3.5 mm (60°). In terms of protecting the peroneus longus and brevis tendons, drilling in the 60° direction was better than drilling in the 30° and 45° directions (all p values < 0.05). The risk of injury to the peroneal longus and brevis tendons was 62.5% (30°), 31.3% (45°), and 0% (60°). Although no fibular fractures were observed in any of the three directions, drilling the bone tunnel in the 60° direction disrupted the lateral cortex of the fibula.This study shows that drilling the tunnel in the 45° direction is less likely to cause injury to the peroneus longus and brevis tendons, while ensuring that the tunnel has a sufficient length and avoiding fracturing the distal fibula. Drilling a fibular bone tunnel in a 45° direction is safer and recommended for ATFL reconstruction.CONCLUSIONThis study shows that drilling the tunnel in the 45° direction is less likely to cause injury to the peroneus longus and brevis tendons, while ensuring that the tunnel has a sufficient length and avoiding fracturing the distal fibula. Drilling a fibular bone tunnel in a 45° direction is safer and recommended for ATFL reconstruction. Purpose There is currently no consensus on the optimal drilling direction of the fibular bone tunnel for anterior talofibular ligament (ATFL) reconstruction, and few studies have investigated the potential injury to the peroneus longus and brevis tendons and the possibility of fibular fractures during the drilling process. The aim of this study was to assess the potential risk of drilling the tunnel from different directions and determine the most appropriate tunnel direction. The hypothesis was that drilling the tunnel in the 45‐degree direction would be the safest and most suitable for the fibular tunnel. Methods Forty‐eight fibular tunnels were drilled on fresh ankle specimens using a K‐wire guide and a 5.0 mm hollow drill. Three tunnel orientations were created, parallel to the sagittal plane of the long axis of the fibula and angled 30°, 45°, and 60° to the coronal plane. The length of the fibular tunnel and the distances from the outlet of the K‐wire to the peroneus longus and brevis tendons were measured. The occurrence of a fibula fracture was also observed. Results The lengths of the bone tunnels in the three groups were 32.9 ± 6.1 mm (30°), 27.2 ± 4.4 mm (45°) and 23.6 ± 4.0 mm (60°). The length of the tunnel drilled at 30° was the longest when compared with that of the tunnels drilled at 45° and 60° (all p values < 0.05). The distances from the outlet of the K‐wire to the peroneus longus tendon were 3.0 ± 3.8 mm (30°), 3.8 ± 3.2 mm (45°) and 5.3 ± 1.8 mm (60°), and the distances to the peroneus brevis tendon were 4.2 ± 4.0 mm (30°), 6.1 ± 3.8 mm (45°), 7.9 ± 3.5 mm (60°). In terms of protecting the peroneus longus and brevis tendons, drilling in the 60° direction was better than drilling in the 30° and 45° directions (all p values < 0.05). The risk of injury to the peroneal longus and brevis tendons was 62.5% (30°), 31.3% (45°), and 0% (60°). Although no fibular fractures were observed in any of the three directions, drilling the bone tunnel in the 60° direction disrupted the lateral cortex of the fibula. Conclusion This study shows that drilling the tunnel in the 45° direction is less likely to cause injury to the peroneus longus and brevis tendons, while ensuring that the tunnel has a sufficient length and avoiding fracturing the distal fibula. Drilling a fibular bone tunnel in a 45° direction is safer and recommended for ATFL reconstruction. Purpose There is currently no consensus on the optimal drilling direction of the fibular bone tunnel for anterior talofibular ligament (ATFL) reconstruction, and few studies have investigated the potential injury to the peroneus longus and brevis tendons and the possibility of fibular fractures during the drilling process. The aim of this study was to assess the potential risk of drilling the tunnel from different directions and determine the most appropriate tunnel direction. The hypothesis was that drilling the tunnel in the 45-degree direction would be the safest and most suitable for the fibular tunnel. Methods Forty-eight fibular tunnels were drilled on fresh ankle specimens using a K-wire guide and a 5.0 mm hollow drill. Three tunnel orientations were created, parallel to the sagittal plane of the long axis of the fibula and angled 30°, 45°, and 60° to the coronal plane. The length of the fibular tunnel and the distances from the outlet of the K-wire to the peroneus longus and brevis tendons were measured. The occurrence of a fibula fracture was also observed. Results The lengths of the bone tunnels in the three groups were 32.9 ± 6.1 mm (30°), 27.2 ± 4.4 mm (45°) and 23.6 ± 4.0 mm (60°). The length of the tunnel drilled at 30° was the longest when compared with that of the tunnels drilled at 45° and 60° (all p values < 0.05). The distances from the outlet of the K-wire to the peroneus longus tendon were 3.0 ± 3.8 mm (30°), 3.8 ± 3.2 mm (45°) and 5.3 ± 1.8 mm (60°), and the distances to the peroneus brevis tendon were 4.2 ± 4.0 mm (30°), 6.1 ± 3.8 mm (45°), 7.9 ± 3.5 mm (60°). In terms of protecting the peroneus longus and brevis tendons, drilling in the 60° direction was better than drilling in the 30° and 45° directions (all p values < 0.05). The risk of injury to the peroneal longus and brevis tendons was 62.5% (30°), 31.3% (45°), and 0% (60°). Although no fibular fractures were observed in any of the three directions, drilling the bone tunnel in the 60° direction disrupted the lateral cortex of the fibula. Conclusion This study shows that drilling the tunnel in the 45° direction is less likely to cause injury to the peroneus longus and brevis tendons, while ensuring that the tunnel has a sufficient length and avoiding fracturing the distal fibula. Drilling a fibular bone tunnel in a 45° direction is safer and recommended for ATFL reconstruction. |
| Author | Wang, Jing-Song Song, Bin Wang, Peng Luo, Xi-Yuan Liu, Cheng-Xiao Zhou, Yun-Feng Li, Wei-Ping Deng, Xing-Hao Zhang, Zheng-Zheng Liu, Tian-Yu Xu, Da-Zheng Ma, Yu-Fan |
| Author_xml | – sequence: 1 givenname: Cheng-Xiao surname: Liu fullname: Liu, Cheng-Xiao organization: Department of Orthopedics, Sun Yat-Sen Memorial Hospital – sequence: 2 givenname: Zheng-Zheng surname: Zhang fullname: Zhang, Zheng-Zheng organization: Department of Orthopedics, Sun Yat-Sen Memorial Hospital – sequence: 3 givenname: Jing-Song surname: Wang fullname: Wang, Jing-Song organization: Department of Orthopedics, Sun Yat-Sen Memorial Hospital – sequence: 4 givenname: Xi-Yuan surname: Luo fullname: Luo, Xi-Yuan organization: Sun Yat-Sen University – sequence: 5 givenname: Tian-Yu surname: Liu fullname: Liu, Tian-Yu organization: Sun Yat-Sen University – sequence: 6 givenname: Yu-Fan surname: Ma fullname: Ma, Yu-Fan organization: Sun Yat-Sen University – sequence: 7 givenname: Xing-Hao surname: Deng fullname: Deng, Xing-Hao organization: Department of Orthopedics, Sun Yat-Sen Memorial Hospital – sequence: 8 givenname: Yun-Feng surname: Zhou fullname: Zhou, Yun-Feng organization: Department of Orthopedics, Sun Yat-Sen Memorial Hospital – sequence: 9 givenname: Da-Zheng surname: Xu fullname: Xu, Da-Zheng organization: Sun Yat-Sen University – sequence: 10 givenname: Wei-Ping surname: Li fullname: Li, Wei-Ping organization: Department of Orthopedics, Sun Yat-Sen Memorial Hospital – sequence: 11 givenname: Peng surname: Wang fullname: Wang, Peng email: wangp57@mail.sysu.edu.cn organization: Department of Orthopedics, Eighth Affiliated Hospital of Sun Yat-Sen University – sequence: 12 givenname: Bin surname: Song fullname: Song, Bin email: songbin9806@163.com organization: Department of Orthopedics, Sun Yat-Sen Memorial Hospital |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37308663$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. 2023 European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA). |
| Copyright_xml | – notice: The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. – notice: 2023 European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) – notice: 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA). |
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| DOI | 10.1007/s00167-023-07452-6 |
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| Issue | 10 |
| Keywords | Ankle instability Ligament reconstruction Anterior talofibular ligament |
| Language | English |
| License | http://onlinelibrary.wiley.com/termsAndConditions#vor 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA). |
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| PublicationTitle | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
| PublicationTitleAbbrev | Knee Surg Sports Traumatol Arthrosc |
| PublicationTitleAlternate | Knee Surg Sports Traumatol Arthrosc |
| PublicationYear | 2023 |
| Publisher | Springer Berlin Heidelberg John Wiley & Sons, Inc |
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| References | Davda, Malhotra, O’Donnell, Singh, Cullen (CR2) 2017; 2 Vilá-Rico, Cabestany-Castellà, Cabestany-Perich, Núñez-Samper, Ojeda-Thies (CR18) 2019; 25 Mercer, Azam, Davalos, Kaplan, Colasanti, Chen, Kanakamedala, Dankert, Stone, Kennedy (CR9) 2022; 11 Michels, Cordier, Burssens, Vereecke, Guillo (CR10) 2016; 24 DiGiovanni, Fraga, Cohen, Shereff (CR5) 2000; 21 CR19 Dias, Lewis, Alkhalfan, Ahluwalia, Ray (CR4) 2022; 33 Guillo, Bauer, Lee, Takao, Kong, Stone, Mangone, Molloy, Perera, Pearce, Michels, Tourné, Ghorbani, Calder (CR7) 2013; 99 Takao, Oae, Uchio, Ochi, Yamamoto (CR15) 2005; 33 Michels, Matricali, Guillo, Vanrietvelde, Pottel, Stockmans (CR13) 2020; 28 CR14 de Vries, Krips, Sierevelt, Blankevoort, van Dijk (CR3) 2011 Corte-Real, Caetano (CR1) 2021; 6 Youn, Kim, Lee, Choi, Lee (CR22) 2012; 33 Usuelli, Indino, Di Silvestri, Manzi, Maffulli (CR16) 2021 Vega, Malagelada, Manzanares Céspedes, Dalmau-Pastor (CR17) 2020; 28 Yokoe, Tajima, Yamaguchi, Nagasawa, Ota, Morita, Chosa (CR21) 2021; 11 Kawaguchi, Taketomi, Mizutani, Inui, Yamagami, Kono, Kage, Takei, Fujiwara, Ogata, Tanaka (CR8) 2022; 10 Drakos, Hansen, Kukadia (CR6) 2022; 27 Michels, Pereira, Calder, Matricali, Glazebrook, Guillo, Karlsson, Acevedo, Batista, Bauer, Calder, Carreira, Choi, Corte-real, Glazebrook, Ghorbani, Giza, Guillo, Hunt, Karlsson, Kong, Lee, Michels, Molloy, Mangone, Matsui, Nery, Ozeki, Pearce, Pereira, Perera, Pijnenburg, Raduan, Stone, Takao, Tourné, Vega (CR12) 2018; 26 Michels, Cordier, Guillo, Stockmans (CR11) 2016; 21 Yang, Chen, Loh, Tzeng, Chang, Wang (CR20) 2022; 10 2021; 6 2017; 2 2021; 11 2013; 99 2011 2021 2000; 21 2019; 25 2016; 21 2020; 28 2022; 10 2022; 33 2022; 11 2012; 33 2022; 27 2005; 33 2016; 24 2018; 26 e_1_2_12_3_2 e_1_2_12_2_2 e_1_2_12_5_2 e_1_2_12_4_2 e_1_2_12_19_2 e_1_2_12_18_2 e_1_2_12_17_2 e_1_2_12_16_2 e_1_2_12_15_2 e_1_2_12_20_2 e_1_2_12_21_2 e_1_2_12_22_2 e_1_2_12_23_2 e_1_2_12_14_2 e_1_2_12_13_2 e_1_2_12_12_2 e_1_2_12_11_2 e_1_2_12_7_2 e_1_2_12_10_2 e_1_2_12_6_2 e_1_2_12_9_2 e_1_2_12_8_2 |
| References_xml | – ident: CR19 – volume: 11 issue: 1 year: 2021 ident: CR21 article-title: Orthopaedic medical examination for young amateur athletes: a repeated cross-sectional study from 2014 to 2018 publication-title: BMJ Open doi: 10.1136/bmjopen-2020-042188 – volume: 28 start-page: 124 issue: 1 year: 2020 end-page: 131 ident: CR13 article-title: An oblique fibular tunnel is recommended when reconstructing the ATFL and CFL publication-title: Knee Surg Sports Traumatol Arthrosc doi: 10.1007/s00167-019-05583-3 – volume: 99 start-page: S411 issue: 8S year: 2013 end-page: S419 ident: CR7 article-title: Consensus in chronic ankle instability: aetiology, assessment, surgical indications and place for arthroscopy publication-title: Orthop Traumatol Surg Res doi: 10.1016/j.otsr.2013.10.009 – volume: 21 start-page: 665 issue: 3 year: 2016 end-page: 680 ident: CR11 article-title: Endoscopic ankle lateral ligament graft anatomic reconstruction publication-title: Foot Ankle Clin doi: 10.1016/j.fcl.2016.04.010 – ident: CR14 – volume: 33 start-page: 87 year: 2022 end-page: 94 ident: CR4 article-title: Current concepts in the surgical management of chronic ankle lateral ligament instability publication-title: J Orthop doi: 10.1016/j.jor.2022.07.006 – volume: 6 start-page: 420 issue: 6 year: 2021 end-page: 431 ident: CR1 article-title: Ankle and syndesmosis instability: consensus and controversies publication-title: EFORT Open Rev doi: 10.1302/2058-5241.6.210017 – volume: 28 start-page: 8 issue: 1 year: 2020 end-page: 17 ident: CR17 article-title: The lateral fibulotalocalcaneal ligament complex: an ankle stabilizing isometric structure publication-title: Knee Surg Sports Traumatol Arthrosc doi: 10.1007/s00167-018-5188-8 – volume: 25 start-page: 24 issue: 1 year: 2019 end-page: 30 ident: CR18 article-title: All-inside arthroscopic allograft reconstruction of the anterior talo-fibular ligament using an accesory transfibular portal publication-title: Foot Ankle Surg doi: 10.1016/j.fas.2017.12.008 – volume: 33 start-page: 99 issue: 2 year: 2012 end-page: 104 ident: CR22 article-title: Percutaneous lateral ligament reconstruction with allograft for chronic lateral ankle instability publication-title: Foot Ankle Int doi: 10.3113/FAI.2012.0099 – volume: 27 start-page: 371 issue: 2 year: 2022 end-page: 384 ident: CR6 article-title: Ankle instability publication-title: Foot Ankle Clin doi: 10.1016/j.fcl.2021.11.025 – volume: 21 start-page: 809 issue: 10 year: 2000 end-page: 815 ident: CR5 article-title: Associated injuries found in chronic lateral ankle instability publication-title: Foot Ankle Int doi: 10.1177/107110070002101003 – volume: 24 start-page: 1007 issue: 4 year: 2016 end-page: 1014 ident: CR10 article-title: Endoscopic reconstruction of CFL and the ATFL with a gracilis graft: a cadaveric study publication-title: Knee Surg Sports Traumatol Arthrosc doi: 10.1007/s00167-015-3779-1 – volume: 33 start-page: 814 issue: 6 year: 2005 end-page: 823 ident: CR15 article-title: Anatomical reconstruction of the lateral ligaments of the ankle with a gracilis autograft: a new technique using an interference fit anchoring system publication-title: Am J Sports Med doi: 10.1177/0363546504272688 – volume: 26 start-page: 2095 issue: 7 year: 2018 end-page: 2102 ident: CR12 article-title: Searching for consensus in the approach to patients with chronic lateral ankle instability: ask the expert publication-title: Knee Surg Sports Traumatol Arthrosc doi: 10.1007/s00167-017-4556-0 – volume: 10 start-page: 23259671221107344 issue: 7 year: 2022 ident: CR8 article-title: Dynamic postural stability is decreased during the single-leg drop landing task in male collegiate soccer players with chronic ankle instability publication-title: Orthop J Sport Med doi: 10.1177/23259671221107343 – volume: 2 start-page: 281 issue: 6 year: 2017 end-page: 292 ident: CR2 article-title: Peroneal tendon disorders publication-title: EFORT Open Rev doi: 10.1302/2058-5241.2.160047 – year: 2011 ident: CR3 article-title: Interventions for treating chronic ankle instability publication-title: Cochrane Database Syst Rev doi: 10.1002/14651858.CD004124.pub3 – volume: 11 start-page: e545 issue: 4 year: 2022 end-page: e550 ident: CR9 article-title: Anterior talofibular ligament augmentation with internal brace in the office setting publication-title: Arthrosc Tech doi: 10.1016/j.eats.2021.12.005 – year: 2021 ident: CR16 article-title: Clinical outcomes and return to sport after minimally invasive reconstruction of the lateral ligament complex with semitendinosus tendon autograft in chronic lateral ankle instability publication-title: J Am Podiatr Med Assoc doi: 10.7547/19-012 – volume: 10 start-page: 23259671221126692 issue: 10 year: 2022 ident: CR20 article-title: Chronic lateral ankle instability treated with tendon allografting: a preliminary comparison of arthroscopic and open anatomic ligament reconstruction publication-title: Orthop J Sport Med doi: 10.1177/23259671221126693 – volume: 28 start-page: 8 issue: 1 year: 2020 end-page: 17 article-title: The lateral fibulotalocalcaneal ligament complex: an ankle stabilizing isometric structure publication-title: Knee Surg Sports Traumatol Arthrosc – volume: 99 start-page: S411 issue: 8S year: 2013 end-page: S419 article-title: Consensus in chronic ankle instability: aetiology, assessment, surgical indications and place for arthroscopy publication-title: Orthop Traumatol Surg Res – volume: 21 start-page: 809 issue: 10 year: 2000 end-page: 815 article-title: Associated injuries found in chronic lateral ankle instability publication-title: Foot Ankle Int – year: 2011 article-title: Interventions for treating chronic ankle instability publication-title: Cochrane Database Syst Rev – volume: 33 start-page: 99 issue: 2 year: 2012 end-page: 104 article-title: Percutaneous lateral ligament reconstruction with allograft for chronic lateral ankle instability publication-title: Foot Ankle Int – volume: 2 start-page: 281 issue: 6 year: 2017 end-page: 292 article-title: Peroneal tendon disorders publication-title: EFORT Open Rev – volume: 28 start-page: 124 issue: 1 year: 2020 end-page: 131 article-title: An oblique fibular tunnel is recommended when reconstructing the ATFL and CFL publication-title: Knee Surg Sports Traumatol Arthrosc – volume: 25 start-page: 24 issue: 1 year: 2019 end-page: 30 article-title: All‐inside arthroscopic allograft reconstruction of the anterior talo‐fibular ligament using an accesory transfibular portal publication-title: Foot Ankle Surg – year: 2021 article-title: Clinical outcomes and return to sport after minimally invasive reconstruction of the lateral ligament complex with semitendinosus tendon autograft in chronic lateral ankle instability publication-title: J Am Podiatr Med Assoc – volume: 26 start-page: 2095 issue: 7 year: 2018 end-page: 2102 article-title: Searching for consensus in the approach to patients with chronic lateral ankle instability: ask the expert publication-title: Knee Surg Sports Traumatol Arthrosc – volume: 6 start-page: 420 issue: 6 year: 2021 end-page: 431 article-title: Ankle and syndesmosis instability: consensus and controversies publication-title: EFORT Open Rev – volume: 21 start-page: 665 issue: 3 year: 2016 end-page: 680 article-title: Endoscopic ankle lateral ligament graft anatomic reconstruction publication-title: Foot Ankle Clin – volume: 11 start-page: e545 issue: 4 year: 2022 end-page: e550 article-title: Anterior talofibular ligament augmentation with internal brace in the office setting publication-title: Arthrosc Tech – volume: 27 start-page: 371 issue: 2 year: 2022 end-page: 384 article-title: Ankle instability publication-title: Foot Ankle Clin – volume: 24 start-page: 1007 issue: 4 year: 2016 end-page: 1014 article-title: Endoscopic reconstruction of CFL and the ATFL with a gracilis graft: a cadaveric study publication-title: Knee Surg Sports Traumatol Arthrosc – volume: 10 issue: 7 year: 2022 article-title: Dynamic postural stability is decreased during the single‐leg drop landing task in male collegiate soccer players with chronic ankle instability publication-title: Orthop J Sport Med – volume: 33 start-page: 814 issue: 6 year: 2005 end-page: 823 article-title: Anatomical reconstruction of the lateral ligaments of the ankle with a gracilis autograft: a new technique using an interference fit anchoring system publication-title: Am J Sports Med – volume: 33 start-page: 87 year: 2022 end-page: 94 article-title: Current concepts in the surgical management of chronic ankle lateral ligament instability publication-title: J Orthop – volume: 10 issue: 10 year: 2022 article-title: Chronic lateral ankle instability treated with tendon allografting: a preliminary comparison of arthroscopic and open anatomic ligament reconstruction publication-title: Orthop J Sport Med – volume: 11 issue: 1 year: 2021 article-title: Orthopaedic medical examination for young amateur athletes: a repeated cross‐sectional study from 2014 to 2018 publication-title: BMJ Open – ident: e_1_2_12_21_2 doi: 10.1177/23259671221126693 – ident: e_1_2_12_2_2 doi: 10.1302/2058‐5241.6.210017 – ident: e_1_2_12_10_2 doi: 10.1016/j.eats.2021.12.005 – ident: e_1_2_12_17_2 doi: 10.7547/19‐012 – ident: e_1_2_12_5_2 doi: 10.1016/j.jor.2022.07.006 – ident: e_1_2_12_12_2 doi: 10.1016/j.fcl.2016.04.010 – ident: e_1_2_12_3_2 doi: 10.1302/2058‐5241.2.160047 – ident: e_1_2_12_13_2 doi: 10.1007/s00167‐017‐4556‐0 – ident: e_1_2_12_14_2 doi: 10.1007/s00167‐019‐05583‐3 – ident: e_1_2_12_4_2 doi: 10.1002/14651858.CD004124.pub3 – ident: e_1_2_12_22_2 doi: 10.1136/bmjopen‐2020‐042188 – ident: e_1_2_12_7_2 doi: 10.1016/j.fcl.2021.11.025 – ident: e_1_2_12_8_2 doi: 10.1016/j.otsr.2013.10.009 – ident: e_1_2_12_16_2 doi: 10.1177/0363546504272688 – ident: e_1_2_12_23_2 doi: 10.3113/FAI.2012.0099 – ident: e_1_2_12_11_2 doi: 10.1007/s00167‐015‐3779‐1 – ident: e_1_2_12_15_2 doi: 10.3390/ijerph19095291 – ident: e_1_2_12_6_2 doi: 10.1177/107110070002101003 – ident: e_1_2_12_19_2 doi: 10.1016/j.fas.2017.12.008 – ident: e_1_2_12_18_2 doi: 10.1007/s00167‐018‐5188‐8 – ident: e_1_2_12_20_2 – ident: e_1_2_12_9_2 doi: 10.1177/23259671221107343 |
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There is currently no consensus on the optimal drilling direction of the fibular bone tunnel for anterior talofibular ligament (ATFL) reconstruction,... There is currently no consensus on the optimal drilling direction of the fibular bone tunnel for anterior talofibular ligament (ATFL) reconstruction, and few... PurposeThere is currently no consensus on the optimal drilling direction of the fibular bone tunnel for anterior talofibular ligament (ATFL) reconstruction,... |
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| SubjectTerms | Ankle Ankle instability Anterior talofibular ligament Drilling Fibula Fractures Health risks Injuries Ligament reconstruction Ligaments Medicine Medicine & Public Health Orthopedics Sports Medicine Tendons Tunnels Wire |
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| Title | Optimal fibular tunnel direction for anterior talofibular ligament reconstruction: 45 degrees outperforms 30 and 60 degrees |
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