Topographical and morphological evaluation of the ligaments of the ankle joint: Anatomical reference for surgical reconstruction

Background Although several studies have described ankle ligaments, important gaps remain regarding combined quantitative and topographical analyses of both the medial and lateral ligament complexes in the same cohort. Furthermore, the surgical relevance of reproducible distances from palpable landmarks and the prevalence of anatomical variants has not been comprehensively reported. This study aimed to provide morphometric data and identify variations in the medial and lateral ankle ligaments.

Methods Ten ankle joints from five adult cadavers (three male, two female) were dissected. The anterior talofibular (ATFL), calcaneofibular (CFL), posterior talofibular (PTFL), tibionavicular (TNL), tibiocalcaneal (TCL), anterior tibiotalar (ATTL), and posterior tibiotalar (PTTL) ligaments were dissected and measured using digital vernier callipers. Topographical relationships and morphological features were documented. Comparisons between sides and sexes were performed.

Results Three morphological variants of the CFL and two of the ATFL were identified, while the PTFL, TCL, TNL, ATTL, and PTTL demonstrated consistent morphology. The mean ATFL length was 22.73 ± 2.01mm and the CFL 26.93 ± 3.86mm. No significant dimensional differences were found between right and left ankles or between sexes (P > 0.05). Distances from palpable landmarks to ligament attachment sites showed low variability (coefficient of variation <10%).

Conclusion This study provides reproducible morphometric and topographical data, as well as novel observations on morphological variations of the ATFL and CFL. These findings offer reliable anatomical reference points and contribute novel data that may refine pre-operative planning, graft positioning, and intra-operative localisation during ankle ligament reconstruction.