The subchondral plate was thicker at the blouse than at the fibular end of the ligament (Fig. 1e,f), which was reflected in a significant difference between the average percentage of calcified tissue: marrow (CT: medulla) at both ends of the ligament (P < 0.05; Table 2 Interestingly, in bands where there was little difference between the percentage of medullary CT at the two theses at a depth of 2 mm below the tidal mark, there was a sharp decrease in bone density at the fibular end of the band, about 4 mm below the tidal mark (Fig. 1h). In addition, there was sometimes a difference in trabecular orientation at the stem and fibular insertions – the trabeculae at the fibular end were more clearly aligned along the longitudinal axis of the ligament (Fig. 1h). The morphometric results are summarized in Table 2. The approximate anatomy of ATFL is shown in Fig. 1(a). The stem and fibular end of the ligament are attached to the bone in addition to an articular surface.

The fibula thesis lies at an anterior point-above the end of the lateral malleolus, and the talar end of the ligament is attached to the anterior edge of the lateral articular surface of the talus. It thus easily engages at the entrance to the tarsal tunnel, so that the ligament “tightens” the talus and performs a distinct rotation around the anterolateral corner of its lateral articular surface. The regular alignment of the trabecula with the fibular thesis of some specimens suggests that charge transfer may be more directed than to the talar thesis. This may reflect the presence of a region of increased metachromasia or sesame fiber cartilage, in which the deep surface of the ligament presses against the talar articular cartilage. It is the proteoglycans in this region that should allow the band to resist intermittent compression during foot movements (Vogel et al., 1993; Benjamin and Ralphs, 1995, 1998; Benjamin et al., 1995; Vogel, 1995). The compressive force exerted by the talus on the ligament with a flexed and inverted plantar foot means that the load is dissipated from the talorthesis in a way that cannot occur with fibular insertion. This in turn could be responsible for the higher CFB:E ratio at the fibular end of the ligament – this increases the surface area at the ligament-bone junction, protects against shear (Schneider, 1956) and promotes the anchoring of the ligament to the bone (Milz et al. 2002). It should be noted that Gao and Messner (1996) proposed that the shape and interface length of the fibrocartilage-calcified bone junction in ligament insertions are determined by the tensile loads to which a ligament is subjected around puberty. Thus, the larger CFB:E ratio at the fibula thesis corresponds to our hypothesis that the tensile forces are higher here than at the stem end of the strip. Definitions of “anterior talofibular ligament (ATFL)”: Due to difficulties in obtaining fresh human material, routine histological observations were necessarily limited to tissues obtained from older dissecting cadavers.

This means that degenerative changes in ligaments and changes in bone mineral density are likely to occur more frequently than in younger people. However, it is reasonable to assume that similar soft tissue changes may also occur in connection with ligament damage in younger people. It is the changes in the bone that require careful interpretation. The absolute values reported for the CT:bone marrow ratio and subchondral plaque thickness are probably lower in the elderly, although our observations were limited to men where osteoporosis is less common. In the context of this study, however, comparative values at both ends of the range are more important. We suggest that the lower medullary CT ratio at the fibular fixation site and the thinner subchondral plaque both suggest that the bone here is weaker than at the talar thesis and that this is partly responsible for the greater incidence of avulsion fractures at the fibular end of the ligament. There is no reason to believe that the two ATFL entheses are affected differently by bone mineral loss and trabecular thinning that occurs with age. Abbreviations: CFB length – interface between calcified fibrocartilage and bone areas; SFBC:E ratio – length of BFC to enthesis; CT: medullary – percentage of calcified tissue: bone; E-SF – distance between the enthesis and the cartilage of the sesame fiber; L – left side; R – right side; UF – non-calcified fibrocartilage. Carcass 4 had a bony ossicle near the fibular end of the ligament and was the only case where the CFB:E ratio was lower at the fibular end than at the gown. Ankle sprains are common injuries – in the United Kingdom and the United States, respectively, approximately 5,000 and 27,000 new cases are reported daily (Brooks et al. 1981; Geppert, 1998).

Although they can occur in everyday life, they are particularly characteristic of sports such as basketball and football (Garrick, 1977). Most sprains affect the anterior talofibular ligament (ATFL), which is the weakest component of the lateral ligament complex of the ankle joint. When the foot is in an anatomical position, the ATFL is approximately horizontal, but when plantarbent, the ligament is almost parallel to the long axis of the leg. It is only in the latter position that the ligament is loaded and prone to injury, especially when the foot is inverted (Broström, 1964, 1966; Colville et al., 1990; Kannus and Renström, 1991; Marder, 1994). In one sample, there was a macroscopic bone ossicle near the fibular end of the ligament and an associated region of hypervascularity (Fig. 2f). On the lateral surface of the fibula there was a small space of appropriate size, and the space between the bone and the lateral surface of the fibula was filled with connective tissue. The ossicle had a distinctive articular fibrous cartilage on the side facing the malleolus (Fig. 2f,g). In the office, testing the ATFL tape is relatively easy, but you need to pay attention to the results. The two standard test modalities for desks are the front drawer test (ADT) and the dress inclination test (TTT). The anterior tensile test is performed by bending the ankle by 10 degrees, stabilizing the anterior distal tibia with one hand and using the other hand to fleece the posterior calcaneus (Fig.

4A). When the tibia is stabilized, we try to move the foot forward. Measurements of more than 3 mm in relation to the contralateral limb, with lateral vision, are considered pathological (Fig. 4C). The gown tilt test is performed when the patient is seated and the plantar ankle is bent by 10-20 degrees (Fig. 5).