Bifurcate Ligament anatomy

NewsBot · Jan 17, 2019

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Anatomico-radiological Study of the Bifurcate Ligament of the Foot with Clinical Significance
Rene M. Kafka, Ian L. Aveytua, Paul J. Choi, Anthony C. DiLandro , R. Shane Tubbs, Marios Loukas, Douglas N. Mintz, Ritwik Baidya, Sushil Kumar, Santosh K. Sangari, Estomih P. Mtui, Anthony V. D'Antoni
Cureus 11(1): e3847: January 08, 2019

Introduction
Lateral ankle sprain caused by forcible plantar flexion and inversion of the foot commonly damages the anterior talofibular ligament and other ligaments. Unfortunately, involvement of the bifurcate ligament (BL) is often overlooked when assessing such injuries in clinical practice and identification of this ligament on magnetic resonance (MR) scans can be challenging. Anatomically, the BL is a Y-shaped structure with two bands: the calcaneonavicular ligament (CNL) and calcaneocuboid ligament (CCL). There are few anatomical studies on the morphometric characteristics of the BL and even fewer biomechanical studies. Therefore, the objective of this anatomico-radiological study was to investigate the morphology of the BL using a multifaceted approach, and classify the fiber characteristics of the CNL and CCL.

Materials and methods
We measured the length and the width of 53 embalmed cadaveric feet. Meticulous dissection of each foot was performed to expose the BL. Measurements of the length, width, thickness, and shape of the CNL and CCL were taken using a digital caliper. We also documented the fiber orientation of each ligament, and used a goniometer to measure the bifurcation angle between the CNL and CCL via two methods. Confirmatory histologic analysis of the ligaments was performed and digital radiographs of the ligaments with attached radiopaque monofilament were taken. We also included an MR scan of the BL. Using descriptive and inferential statistics, we documented any significant relationships between the variables.

Results
Mean (range) age at death of cadavers was 76 (42-94) years. The CNL was found in all the feet and the CCL was not present in 9.4% of the feet. Mean (standard deviation) length of the CNL and CCL was 22.7 (4.12) mm and 10.9 (2.53) mm, respectively. Mean (standard deviation) thickness of the CNL and CCL was 3.23 (1.56) mm and 1.48 (0.71) mm, respectively. Related to ligament morphology, the CNL was most frequently cord shaped (67.92%) and the CCL was most frequently flat shaped (83.33%). The mean bifurcation angle measured 32.75o and 29.31o in methods 1 and 2, respectively. The correlation between the two measured angles was very strong (p < 0.001).

Discussion
We found that 90.6% of feet had both the CNL and CCL, 9.4% had the CNL and no CCL, and none (0%) had the CCL and no CNL. These frequencies are similar to a recent Japanese study. Our sample of donors were American and predominantly white. Whether the difference in frequencies between the studies is related to ethnicity is unknown and requires future investigation. Interestingly, on average the CNLs were twice as long and twice as thick as the CCLs. The CCLs tended to be wider distally and tapered compared to the CNLs.

Conclusions
Our findings better classify the morphology and fiber orientation of the BL. Coupled with the radiographs and MR scan, our data may be of particular value to radiologists and surgeons. Our BL fiber orientation classification system and angle measurements can pave the way for future biomechanical studies to investigate any relationships between fiber type, angle, and strength of the constituent bands. More accurate descriptions of the BL should lead to improved diagnosis and treatment of ligamentous injuries of the foot.
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NewsBot · Jan 9, 2021

Morphological characteristics of the plantar calcaneocuboid ligaments
Mutsuaki Edama, Tomoya Takabayashi, Hirotake Yokota, Ryo Hrabayashi, Chie Sekine & Ikuo Kageyama
Journal of Foot and Ankle Research volume 14, Article number: 3 (2021)

Background
The aim of this study was to clarify the differences in morphological features between the long plantar ligament (LPL) and the short plantar ligament (SPL).

Methods
This investigation examined 50 legs from 25 Japanese cadavers. The LPL and SPL of each leg were classified into one of three types based on the shape and number of fiber bundles. Then, fiber bundle length, fiber bundle width, and fiber bundle thickness were measured.

Results
The LPL was rectangular in shape (Type I) in 12%, hourglass shape (Type II) in 62%, and triangular in shape (Type III) in 26%. The SPL was a single fiber bundle (Type I-a) in 26%, a surface fiber bundle and a deep fiber bundle (Type I-b) in 60%, and a surface fiber bundle (medial and lateral) and a deep fiber bundle (Type II) in 14%. Regarding the morphological characteristics, there were no significant differences among the types in the LPL, but there were differences between types and between surface and deep fiber bundles in the SPL.

Conclusions
For the LPL, the hourglass shape is the most common type. However, there appeared to be no functional difference due to the difference in the shape of the LPL, since there were no significant differences among the types in the LPL. For the SPL, there were types of single, double and triple fiber bundles; there may be functional differences based on the number of fiber bundles and between superficial and deep fibers.
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NewsBot · Jun 21, 2022

Anatomical and biomechanical evaluation of the lateral Calcaneo-Cuboid and Bifurcate Ligaments
Sebastian F.Baumbach et al
Foot and Ankle Surgery; 21 June 2022

Background
This study aims to analyze the ligaments of the dorso-lateral calcaneo-cuboid joint and to assess the biomechanical relevance of the bifurcate ligament.

Methods
16 specimens were analyzed for their ligamentous anatomy of the dorso-lateral calcaneo-cuboid joint and side-alternating assigned to two groups with varying ligamentous dissection order. The Chopart joint was stressed in plantar, medial, and lateral direction measuring the displacement by an 3D motion tracker for every dissection step.

Results
37.5% of specimens had all ligaments (lateral calcaneo-cuboid, dorsal calcaneo-cuboid, bifurcate calcaneo-cuboid, bifurcate calcaneo-navicular), 37.5% were lacking bifurcate´s calcaneo-cuboid-portion, and 25% presented without dorsal calcaneo-cuboid. Biomechanical testing revealed no significant displacement within the calcaneo-cuboid or talo-navicular joint for any stressed state except for axial compression with dissected dorsal talo-navicular joint capsule in Group 2.

Conclusion
Broad morphological variability and missing significant displacement regardless of its integrity, make the bifurcate ligament appear of limited biomechanical relevance.
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Craig Payne · Jun 21, 2022

oh, ok:
"make the bifurcate ligament appear of limited biomechanical relevance."

NewsBot · Jun 5, 2025

Anatomical study of the lateral plantar ligament of the population in the southwest of Shandong Province
Zhuan Gao et al
Surg Radiol Anat. 2025 Apr 30;47(1):133

Purpose: To clarify the anatomical characteristics of the lateral plantar ligament (LPL) of the transverse metatarsal arch (TMA) in the population of southwest Shandong Province, so as to complement the anatomical structures of the midfoot and Lisfranc joint complexes.

Methods: A total of 100 adult lower limbs were dissected and the types of LPL were divided according to their insertions, among them, 63 were (63%) and 37 were female (37%); 50 were on the left side (50%) and 50 were on the right side (50%). The fiber bundle length, origin width, insertion width, and thickness of the LPL were measured.

Results: (1) According to the insertions of the LPL, they were divided into: ① Type I, the LPL was inserted at the base of the second metatarsal (M2) in 47 cases; ② Type II, the LPL was inserted at the base of M2 and fused with tibialis posterior tendon (TPT) in 16 cases; ③ Type III, the LPL was absent in 16 cases; ④ Type IV, the LPL was inserted at TPT in 6 cases; ⑤ Type V, the LPL was inserted at the intermediate cuneiform (IC) in 1 case; ⑥ Type VI, bifid LPL with one bundle inserted at the base of M2, and the other bundle inserted at the medial cuneiform (MC) in 4 cases; ⑦ Type VII, two bundles of LPL inserted at the base of M2 in 8 cases; ⑧ Type VIII, the LPL consisted of 3 bundles; the distal, middle and proximal bundles was inserted at the base of M2, the TPT and the lateral side of navicular bone in 2 cases, respectively. (2) There was a statistical significance in the length of LPL between male (31.62 ± 3.83) mm and female (28.07 ± 3.46) mm (t=-3.050, P = 0.003). There was no statistical significance in the types of LPL between male and female (Z=-1.721, P > 0.05), and no statistical significance in the types between left and right sides (Z=-0.026, P > 0.05).

Conclusion: According to our research, LPL originates from M5 and is divided into 8 types according to its insertion location, of which insertion at the base of M2 is the most common. In addition, we found that LPL has fibrous fusion with the long plantar ligament and the TPT, which may be involved in maintaining arch stability. The classification of LPL in this study is a supplement to the anatomical structure of the middle foot and Lisfranc joint complex, providing a new direction for the diagnosis and treatment of middle foot and arch injury in the future.
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NewsBot · Jul 6, 2025

Anatomico-radiological Study of the Bifurcate Ligament of the Foot with Clinical Significance.
Kafka R M, Aveytua I L, Choi P J, et al.
Cureus 11(1): e3847. doi:10.7759/cureus.3847

Introduction
Lateral ankle sprain caused by forcible plantar flexion and inversion of the foot commonly damages the anterior talofibular ligament and other ligaments. Unfortunately, involvement of the bifurcate ligament (BL) is often overlooked when assessing such injuries in clinical practice and identification of this ligament on magnetic resonance (MR) scans can be challenging. Anatomically, the BL is a Y-shaped structure with two bands: the calcaneonavicular ligament (CNL) and calcaneocuboid ligament (CCL). There are few anatomical studies on the morphometric characteristics of the BL and even fewer biomechanical studies. Therefore, the objective of this anatomico-radiological study was to investigate the morphology of the BL using a multifaceted approach, and classify the fiber characteristics of the CNL and CCL.

Materials and methods
We measured the length and the width of 53 embalmed cadaveric feet. Meticulous dissection of each foot was performed to expose the BL. Measurements of the length, width, thickness, and shape of the CNL and CCL were taken using a digital caliper. We also documented the fiber orientation of each ligament, and used a goniometer to measure the bifurcation angle between the CNL and CCL via two methods. Confirmatory histologic analysis of the ligaments was performed and digital radiographs of the ligaments with attached radiopaque monofilament were taken. We also included an MR scan of the BL. Using descriptive and inferential statistics, we documented any significant relationships between the variables.

Results
Mean (range) age at death of cadavers was 76 (42-94) years. The CNL was found in all the feet and the CCL was not present in 9.4% of the feet. Mean (standard deviation) length of the CNL and CCL was 22.7 (4.12) mm and 10.9 (2.53) mm, respectively. Mean (standard deviation) thickness of the CNL and CCL was 3.23 (1.56) mm and 1.48 (0.71) mm, respectively. Related to ligament morphology, the CNL was most frequently cord shaped (67.92%) and the CCL was most frequently flat shaped (83.33%). The mean bifurcation angle measured 32.75o and 29.31o in methods 1 and 2, respectively. The correlation between the two measured angles was very strong (p < 0.001).

Discussion
We found that 90.6% of feet had both the CNL and CCL, 9.4% had the CNL and no CCL, and none (0%) had the CCL and no CNL. These frequencies are similar to a recent Japanese study. Our sample of donors were American and predominantly white. Whether the difference in frequencies between the studies is related to ethnicity is unknown and requires future investigation. Interestingly, on average the CNLs were twice as long and twice as thick as the CCLs. The CCLs tended to be wider distally and tapered compared to the CNLs.

Conclusions
Our findings better classify the morphology and fiber orientation of the BL. Coupled with the radiographs and MR scan, our data may be of particular value to radiologists and surgeons. Our BL fiber orientation classification system and angle measurements can pave the way for future biomechanical studies to investigate any relationships between fiber type, angle, and strength of the constituent bands. More accurate descriptions of the BL should lead to improved diagnosis and treatment of ligamentous injuries of the foot.
Click to expand...

NewsBot · Aug 3, 2025

The relation between the anterior talofibular ligament and the calcaneofibular ligament during range of motion of the ankle: A cadaveric study
Louis Brepoels et al
Foot (Edinb). 2025 Jul 30:64:102193.

The aim of the study is to analyze the relationship between the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) by measuring the angle between them in different ankle positions. Understanding these ligament dynamics can aid orthopedic and trauma surgeons in reconstructing the lateral ligament complex in cases of chronic ankle instability (CAI).

Methods: A cadaveric study was conducted using 22 embalmed human left ankles, with soft tissues removed except for the ligament structures. The angle between the ATFL and CFL was measured in five different ankle positions: neutral, dorsiflexion, plantar flexion, supination, and pronation. A goniometer was used for measurements, recorded twice by two independent surgical residents. Statistical analysis, including one-way repeated measures ANOVA, was performed to determine significant differences across positions.

Results: The mean angles measured in the five positions were 107.8° (neutral), 115.4° (dorsiflexion), 112.6° (plantar flexion), 107.9° (supination), and 114.8° (pronation). Although variations were observed, statistical analysis showed no significant differences in the angle across different positions.

Conclusion: This study provides insight into the anatomical relationship between the ATFL and CFL in various ankle positions. The relatively consistent angle suggests that the ligament orientation remains the same, which may have implications for reconstructive surgery and ankle stability assessment. Further research with a larger sample size is recommended to validate these findings and enhance surgical approaches for CAI treatment.
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NewsBot · Jun 8, 2026

An Anatomical Study on the Characteristics of the Shape of the Foot and Talofibular and Calcaneofibular Ligaments in Relation to the Different Number of Bundles of the Anterior Talofibular Ligament and its Relevance
Shinichi Tanaka et al
Kurume Med J. 2026 Jun 5.

This study aimed to investigate anatomical features by comparing and verifying the shape of the talus and calcaneofibular ligament (CFL) depending on the number of anterior talofibular ligament (ATFL) bundles. We also aimed to reveal the relationship between the ATFL and talofibular and CFL. We examined 118 feet from 59 cadaveric specimens and measured the ATFL and CFL, as well as the length, width and thickness of the talus and foot, by using digital calipers. We counted the number of ATFL bundles, calcaneofibular ligament, talus and foot. The ATFL was divided into two groups: one group with one bundle and one group with two bundles. We further examined the relationship between the shapes of the ATFL, CFL, talus and foot. The results were tested for differences in sex and showed that women had significantly wider (p<0.05) and longer (p<0.05) talus in the two-bundle group than in the one bundle group. The CFL was also significantly longer in the two-bundle group (p<0.05). A moderately significant correlation was found between the shapes of the ATFL and the talofibular and CFL. This study provided new anatomical findings that the ATFL attached to the high talus has two bundles. In addition, the ankle joint evaluation and rehabilitation was basic research that considered sex differences.
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NewsBot · Jul 9, 2026 at 1:21 AM

An Anatomical Study on the Characteristics of the Shape of the Foot and Talofibular and Calcaneofibular Ligaments in Relation to the Different Number of Bundles of the Anterior Talofibular Ligament and its Relevance
Shinichi Tanaka et al
Kurume Med J. 2026 Jul 1;72(1.2.3.4):59-70.

This study aimed to investigate anatomical features by comparing and verifying the shape of the talus and calcaneofibular ligament (CFL) depending on the number of anterior talofibular ligament (ATFL) bundles. We also aimed to reveal the relationship between the ATFL and talofibular and CFL. We examined 118 feet from 59 cadaveric specimens and measured the ATFL and CFL, as well as the length, width and thickness of the talus and foot, by using digital calipers. We counted the number of ATFL bundles, calcaneofibular ligament, talus and foot. The ATFL was divided into two groups: one group with one bundle and one group with two bundles. We further examined the relationship between the shapes of the ATFL, CFL, talus and foot. The results were tested for differences in sex and showed that women had significantly wider (p<0.05) and longer (p<0.05) talus in the two-bundle group than in the one bundle group. The CFL was also significantly longer in the two-bundle group (p<0.05). A moderately significant correlation was found between the shapes of the ATFL and the talofibular and CFL. This study provided new anatomical findings that the ATFL attached to the high talus has two bundles. In addition, the ankle joint evaluation and rehabilitation was basic research that considered sex differences.
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Bifurcate Ligament anatomy

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Classification of the interosseous tarsometatarsal ligaments of the foot

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Bifurcate Ligament anatomy

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Craig Payne Moderator

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NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Hydroxyapatite deposition disease (HADD) of the spring ligament

Unnecessary MRI in ankle ligament injuries?

The plantaris ligamentous tendon

Bunions and ligaments

Anatomy of the subtalar joint ligaments

Classification of the interosseous tarsometatarsal ligaments of the foot

Spring Ligament Failure as factor in Plantar Fasciitis

Share This Page

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