High-Resolution Ultrasound of Multibanded Anterior Talofibular Ligament: Anatomical Correlation on Cadavers and Sonographic Pathologic Findings in Sprained Ankles

Purpose: The purpose of this study is to evaluate the frequency and ultrasound (US) characteristics of multibanded anterior talofibular ligaments (ATFLs) in normal ankles and to characterize the tear types of ATFLs in sprained ankles, using a high-frequency US probe.

Methods and Materials: In the first session, 10 unembalmed cadaveric ankle-foot specimens were evaluated by placing 0.2 to 0.3 mL diluted colored latex (green, red, and blue) adjacent and into in the presumed fascicles of ATFLs using direct 15-7 MHz US visualization. At a minimum of 24 hours postinjection, specimens were dissected to identify the fascicles of the ligament and determine whether the sonographically guided latex injection had accurately localized all the components. In the second phase, US of 20 ankles was obtained from 10 asymptomatic volunteers. The number of bands in the ATFLs and the locations of the ATFLs were evaluated by two readers. In the third session, US of 20 sprained ankles was evaluated by two readers for determining the number of bands in the ATFLs and the presence of tears in each band.

Results: In the first session, the colored latex was placed correctly in all the specimens; one ATFL was single banded, eight were double banded, and one was triple banded. In double-banded ATFLs, the superior band was about two times wider and thicker than the inferior band. On healthy volunteers, distribution of single-, double-, and triple-banded ATFLs confirmed data found on cadavers. The depth, width, and location of single-banded ATFLs and the superior band of double-banded ATFLs were not statistically significantly different. In the third session, the most common type of injury in double-banded ATFLs was a two-band tear.

Conclusion: High-resolution US is able to accurately depict the multi-banded anatomical configuration of ATFLs, providing detailed information about alteration in morphology of each component of ligament. Most ATFL ligaments consisted of two bands, and tears in both bands were the most common type of injury in double-banded ATFLs.

Publication History

Article published online:
17 December 2020