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Anatomic study of the medial side of the ankle base on the joint capsule: an alternative description of the deltoid and spring ligament.
J Exp Orthop. 2019 Jan 28; 6(1):2.JE

Abstract

BACKGROUND

Adult acquired flatfoot deformity (AAFD) is caused by impaired medial ligamentous structures and posterior tibialis tendon dysfunction (PTTD). Although degeneration and trauma could separately cause AAFD, how these factors interact in the pathomechanism of AAFD is unclear. The joint capsule in the medial ankle is considered an important structure, providing passive stability by limiting joint movement. Previous reports on the joint capsule suggest its involvement in pathological changes of the ankle, but because of the high priority placed on the ligaments, few reports address the ankle joint from the joint capsule standpoint. The current study aimed to anatomically examine the medial ankle joint, focusing on the deltoid and spring ligaments in perspective of the joint capsule.

METHODS

We conducted a descriptive anatomical study of 19 embalmed cadavers (mean 82.7 years, range 58 to 99). We included 22 embalmed cadaveric ankles. We detached the joint capsule in 16 ankles from the anterior to posteromedial joint, analyzed the capsular attachments of the ankle and adjacent joints, and measured the widths of the bony attachments. We histologically analyzed the joint capsule using Masson's trichrome staining in 6 ankles.

RESULTS

The capsule could be separated as a continuous sheet, including 3 different tissues. The anterior capsule was composed of fatty tissue. Between the medial malleolus and talus, the capsule was strongly connected and was composed of fibrous tissue, normally referred to as the deep deltoid ligament. The tibial attachment formed a steric groove, and the talar side of the attachment formed an elliptical depressed area. On the medial part of the subtalar and talonavicular joints, the capsule covered the joints as cartilaginous tissue, normally referred to as the superomedial ligament of the spring ligament. The outer side of the cartilaginous and fibrous tissue formed the sheath floor of the posterior tibialis tendon. Histological analysis revealed three different tissue types.

CONCLUSIONS

The capsules of the ankle, subtalar, and talonavicular joints could be detached as a continuous sheet. The deltoid and the superomedial ligament of the spring ligaments could be interpreted as a part of the continuous capsule, which had different histological features.

LEVEL OF EVIDENCE

Descriptive Laboratory Study.

Authors+Show Affiliations

Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan. Department of Orthopaedic Surgery, St. Luke's International Medical center, Tokyo, Japan.Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. nimura.orj@tmd.ac.jp.Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan. Department of Orthopaedic Surgery, St. Luke's International Medical center, Tokyo, Japan.Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. JA Kyosai Research Institute, Tokyo, Japan.Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30689117

Citation

Amaha, Kentaro, et al. "Anatomic Study of the Medial Side of the Ankle Base On the Joint Capsule: an Alternative Description of the Deltoid and Spring Ligament." Journal of Experimental Orthopaedics, vol. 6, no. 1, 2019, p. 2.
Amaha K, Nimura A, Yamaguchi R, et al. Anatomic study of the medial side of the ankle base on the joint capsule: an alternative description of the deltoid and spring ligament. J Exp Orthop. 2019;6(1):2.
Amaha, K., Nimura, A., Yamaguchi, R., Kampan, N., Tasaki, A., Yamaguchi, K., Kato, R., & Akita, K. (2019). Anatomic study of the medial side of the ankle base on the joint capsule: an alternative description of the deltoid and spring ligament. Journal of Experimental Orthopaedics, 6(1), 2. https://doi.org/10.1186/s40634-019-0171-y
Amaha K, et al. Anatomic Study of the Medial Side of the Ankle Base On the Joint Capsule: an Alternative Description of the Deltoid and Spring Ligament. J Exp Orthop. 2019 Jan 28;6(1):2. PubMed PMID: 30689117.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anatomic study of the medial side of the ankle base on the joint capsule: an alternative description of the deltoid and spring ligament. AU - Amaha,Kentaro, AU - Nimura,Akimoto, AU - Yamaguchi,Reiko, AU - Kampan,Natnicha, AU - Tasaki,Atsushi, AU - Yamaguchi,Kumiko, AU - Kato,Ryuichi, AU - Akita,Keiichi, Y1 - 2019/01/28/ PY - 2018/07/06/received PY - 2019/01/17/accepted PY - 2019/1/29/entrez PY - 2019/1/29/pubmed PY - 2019/1/29/medline KW - Anatomy KW - Capsule KW - Deltoid ligament KW - Medial ankle KW - Spring ligament SP - 2 EP - 2 JF - Journal of experimental orthopaedics JO - J Exp Orthop VL - 6 IS - 1 N2 - BACKGROUND: Adult acquired flatfoot deformity (AAFD) is caused by impaired medial ligamentous structures and posterior tibialis tendon dysfunction (PTTD). Although degeneration and trauma could separately cause AAFD, how these factors interact in the pathomechanism of AAFD is unclear. The joint capsule in the medial ankle is considered an important structure, providing passive stability by limiting joint movement. Previous reports on the joint capsule suggest its involvement in pathological changes of the ankle, but because of the high priority placed on the ligaments, few reports address the ankle joint from the joint capsule standpoint. The current study aimed to anatomically examine the medial ankle joint, focusing on the deltoid and spring ligaments in perspective of the joint capsule. METHODS: We conducted a descriptive anatomical study of 19 embalmed cadavers (mean 82.7 years, range 58 to 99). We included 22 embalmed cadaveric ankles. We detached the joint capsule in 16 ankles from the anterior to posteromedial joint, analyzed the capsular attachments of the ankle and adjacent joints, and measured the widths of the bony attachments. We histologically analyzed the joint capsule using Masson's trichrome staining in 6 ankles. RESULTS: The capsule could be separated as a continuous sheet, including 3 different tissues. The anterior capsule was composed of fatty tissue. Between the medial malleolus and talus, the capsule was strongly connected and was composed of fibrous tissue, normally referred to as the deep deltoid ligament. The tibial attachment formed a steric groove, and the talar side of the attachment formed an elliptical depressed area. On the medial part of the subtalar and talonavicular joints, the capsule covered the joints as cartilaginous tissue, normally referred to as the superomedial ligament of the spring ligament. The outer side of the cartilaginous and fibrous tissue formed the sheath floor of the posterior tibialis tendon. Histological analysis revealed three different tissue types. CONCLUSIONS: The capsules of the ankle, subtalar, and talonavicular joints could be detached as a continuous sheet. The deltoid and the superomedial ligament of the spring ligaments could be interpreted as a part of the continuous capsule, which had different histological features. LEVEL OF EVIDENCE: Descriptive Laboratory Study. SN - 2197-1153 UR - https://www.unboundmedicine.com/medline/citation/30689117/Anatomic_study_of_the_medial_side_of_the_ankle_base_on_the_joint_capsule:_an_alternative_description_of_the_deltoid_and_spring_ligament_ L2 - https://dx.doi.org/10.1186/s40634-019-0171-y DB - PRIME DP - Unbound Medicine ER -
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