Morphology of the Ankle Collateral Ligaments
: Functional and Clinical Considerations

  • Bader Khawaji

Student thesis: Doctoral ThesisDoctor of Philosophy


The current study aimed to investigate the anatomy and function of the ankle collateral ligaments, in order to provide a good knowledge base that could be used in clinical and biomechanical applications. Sixty eight cadaveric feet were dissected (age range: 62 – 98 years) and the morphology and ligament behaviour investigated. Data collected included the number of bands of each ligament, its dimensions, the exact proximal and distal attachment sites, the bony attachment lengths and changes in ligament length in different joint positions. The anterior talofibular ligament (ATFL) was found to have either one, two or three bands and originated 11 mm anterosuperior to the lateral malleolar tip and inserted 4.46 mm anteromedial to the anterolateral malleolar line of the talus. The ATFL limits plantarflexion, inversion and talar adduction, and internal rotation. The calcaneofibular ligament (CFL) originated 7.63 mm from the lateral malleolar tip and passed to the calcaneal lateral surface to insert 17.7 mm commonly posterosuperior to the fibular tubercle. The CFL resists dorsiflexion, eversion and fibular abduction, and external rotation. The posterior talofibular ligament (PTFL) was attached proximally to the malleolar fossa of the lateral malleolus 9.75 mm from the tip and inserted all the way into the posterolateral surface of the talus ending either lateral or lateral and posterior to the posterolateral tubercle. The PTFL restricts dorsiflexion, fibular abduction and external rotation, and talar abduction and posterior displacement.

The superficial layer of the deltoid ligament consisted of four bands which all originated from the medial malleolus: these were the tibionavicular (TNL), tibiospring (TSL), tibiocalcaneal (TCL), and superficial tibiotalar (STTL) ligaments. The TNL widely inserted into the navicular and talus and may blend with the spring ligament; the TSL commonly attached to the spring ligament and sustentaculum tali; the TCL inserted distally into the sustentaculum tali and talar posteromedial tubercle; the STTL, which was absent in 7.8% of specimens, had a common distal attachment to the talar medial surface and talar posteromedial tubercle. The TNL limits plantarflexion, inversion and talar adduction and internal rotation; the TSL supports the head of the talus and may have isometric characteristics; the TCL and STTL restrict dorsiflexion, eversion, talar abduction and external rotation, and tibial internal rotation.

The deep component of the deltoid ligament consisted of the constant posterior tibiotalar ligament (one to four bands) (PTTL) and the anterior tibiotalar ligament (one or two bands) (ATTL), which was absent in 3.3% of specimens. The PTTL originated between the anterior and posterior colliculi filling the intercollicular groove of the medial malleolus, while the ATTL originated from the medial malleolus commonly from the tip, the anterior and medial surfaces of the anterior colliculus. Both deep layer components inserted distally into the talar medial surface commonly anterosuperior to the talar posteromedial tubercle. The PTTL limits dorsiflexion, eversion, talar abduction and external rotation, and tibial internal rotation, while the ATTL may restrict plantarflexion, inversion, talar internal rotation and adduction, and tibial external rotation. The findings of the present study may aid in the diagnosis and surgical treatment of ankle collateral ligaments injuries. Furthermore, they may help in understanding of the mechanism of injury and provide a good knowledge base for the development of appropriate injury prevention methodology or devices.
Date of Award2016
Original languageEnglish
SupervisorRoger Soames (Supervisor) & Clare Lamb (Supervisor)

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