Per James Linklater:If doing an arthroscopic repair, the technique differs between superior fascicle torn only vs sup and Inf
No diff if open repair for most surgeons
Roar’s post reminded me of this case I posted in Jan 2023….there are many more OCADers since then, and this is an interesting topic, so here it is:
I wonder if anyone is reporting, or trying to make sense of differential injury to the superior and inferior fascicles of the ATFL.
Case in point:
This is actually the opposite of what I think I generally see.
The superior fascicle (white arrow) is intact.
The red arrow points to the inferior fascicle….with all that periligamentous edema that you can trace continuously to the CFL) between the peroneals and calcaneus…..because, according to this article, they are connected by arciform fibers (fancy word!) forming an LFTCL complex….so they are injured in concert with one another.
I don’t know if that means that we see CFL injury in association with all/most inferior fascicle injury—-but we certainly see Isolated superior fascicle tear sparing the CFL frequently.
Here the arrow points to the contiguously injured CFL
Superior fascicle is minding its own business.
All that edema inferiorly along the course of the inferior fascicle and CFL.
I do not know how the surgical repair may have been altered by this deeper understanding of the anatomy.
I mostly just see Brostrom / Modified Brostrom repair and they tend to do well.
Hilary
Dear friends!
I would like to thank all of you dear colleagues for good advice, cool cases and also for sharing insights in diagnostic dilemmas during 2023.
I would also like to extend a thank you – I am sure on behalf of all of you – to Hilary Umans, for the dedication and perseverance in the OCAD group and community. It is much appreciated!
I have a question related to MSK as well – probably relevant as a lot of us are entering a very slippery part of the year:
Does anyone have a good article recommendation for me regarding the significance of identifying the different parts of the anterior talofibular ligament, the relevance for management of these injuries and possible instability.
Or an explanation that is easy to understand – this topic is still a bit unclear for me. It will be appreciated!
