Ultrasound visibility of the sinus tarsi

NewsBot · Dec 16, 2014

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Sonographic visibility of the sinus tarsi with a 12 MHz transducer
Salvatore Massimo Stella, Barbara Ciampi, Eugenio Orsitto, Daniela Melchiorre, Piero Vincenzo Lippolis
Journal of Ultrasound; December 2014

Objectives
To assess the value of ultrasonography in studies of the ligaments within the sinus tarsi (ST) in healthy subjects.
Materials and methods
We examined 20 healthy volunteers using a 12-MHz transducer with THI and compound imaging. With the foot in inversion, the following structures were examined with coronal and transverse scans: (1) the root of the inferior extensor retinaculum (RIER); (2) the interosseous talocalcaneal ligament (ITCL); (3) the cervical ligament (CL); (4) the bifurcate ligament (BL); (5) the synovial recesses, which were examined for possible distention (distended synovial recesses, DSR). The sonographic features, orientation, and thickness of each ligament were assessed.
Results
The easiest structure to identify (visualized in 20/20 subjects) was the RIER, which formed a semiarch. The two deeper layers were hypoechoic, the superficial layer hyperechoic. The ITCL was situated posteriorly and deep with an oblique course. It appeared hypoechoic with a mean thickness of 4.06 mm ± 0.7. It was visualized in 18/20 (90 %) subjects. The CL (isoechoic/hyperechoic) was located more anteriorly at an intermediate depth. The orientation was almost vertical. It was visualized in 17/20 (85 %) subjects, with a mean thickness of 2.28 mm ± 0.34. The BL appeared hypoechoic. It was visualized in 19/20 (95 %) subjects with transverse (anterior end of the ST) and longitudinal scans. The calcaneonavicular and calcaneocuboid components displayed mean (SD) thicknesses of 2.09 mm ± 0.37 and 2.7 mm ± 0.32, respectively. The ITCL and RIER were visualized in the same scan as a semiarch. DSR was observed in 4/20 (20 %) subjects.
Conclusions
The present study shows that, in patients with suspected ST pathology, the anatomic structures that make up this recess can be adequately examined with ultrasonography performed with ordinary 12-MHz transducers.
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NewsBot · Mar 7, 2020

The intrinsic subtalar ligaments have a consistent presence, location and morphology
FrederickMichels et al
Foot and Ankle Surgery; 6 March 2020

Highlights
•This study clarifies some points of confusion in terminology and location of the intrinsic subtalar ligaments.
•The dimensions of the cervical ligament are very similar to the dimensions of the ATFL and CFL. This suggests an important function of the cervical ligament in the stability of the subtalar joint.
•The anterior capsular ligament is a small ligament with a consistent presence and location. The findings in this study are helpful to distinguish this ligament from the interosseous talocalcaneal ligament.
•The interosseous talocalcaneal ligament is a small ligament deeply located in the tarsal canal. Earlier studies mentioning the ITCL should be interpreted with caution, as they may have targeted the ACaL.
•The provided information about the locations of the different intrinsic subtalar ligaments and their footprints is useful to improve diagnostic tools and surgical techniques related tot subtalar instability.
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Background
Chronic subtalar instability is a disabling complication after acute ankle sprains. Currently, the literature describing the anatomy of the intrinsic subtalar ligaments is limited and equivocal which causes difficulties in diagnosis and treatment of subtalar instability. The purpose of this study is to assess the anatomical characteristics of the subtalar ligaments and to clarify some points of confusion.

Methods
In 16 cadaveric feet, the dimensions and locations of the subtalar ankle ligaments were assessed and measured. CT-scans before dissection and after indication of the footprints with radio-opaque paint allowed to generate 3D models and assess the footprint characteristics.

Results
The cervical ligament (CL) had similar dimensions as the lateral ligaments: anterior length 13.9 ± 1.5 mm, posterior length 18.5 ± 2.9 mm, talar width 13.6 ± 2.2 mm, calcaneal width 15.8 ± 3.7 mm. The anterior capsular ligament (ACaL) and interosseous talocalcaneal ligament (ITCL) were found to be smaller structures with consistent dimensions and locations.

Conclusion
This study identified consistent characteristics of the intrinsic subtalar ligaments and clarifies the local anatomical situation. The dimensions and footprints of the intrinsic ligaments of the subtalar joint suggest a more important role of the CL and ACaL in the stability of the subtalar joint. The results of this study are relevant to improve diagnostic tools and offer some guidelines when reconstructing the injured ligaments.
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NewsBot · Jun 28, 2020

The posterior talocalcaneal ligament: an MRI evaluation
Angelo Iovane, Antonio Palma, Giuseppe Messina, Francesco Cappello, Ewan Thomas & Roberto Fiore
Surgical and Radiologic Anatomy (2020)

Purpose
A wide inter-individual variability in terms of size, orientation and insertion is observed regarding ankle ligaments. The aim of this study is to identify and describe the anatomical features of the posterior talocalcaneal ligament (PTCL) observed through the use of magnetic resonance imaging (MRI) of the ankle.

Methods
The study was retrospectively carried out on 893 ankle MRI’s exams. The exams have all been performed using a 1.5-T (T) MRI. The same scanning protocols and scan planes were carried out in all the exams. The first evaluated parameter was the recognition of the PTCL. Subsequently, in all those cases where the ligament was present, its features such as insertion sites, length, and thickness were evaluated.

Results
The PTCL identification was possible in 77 exams (8.6% of the total number). Among these, we were able to identify some variants regarding insertion sites, length, and thickness. The PTCL could be further classified into four categories based on the most common characteristics observed.

Conclusions
Our study has identified different characteristics of the PTCL that allow us to further understand the characteristics of the ligament itself. In conclusion, the need for further studies focused on the biomechanical role of the PTCL in the ankle joint appears mandatory.
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