What ligament attaches at the lateral malleolus tip?

Ligament Attachment at the Lateral Malleolus Tip

The anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) both attach at the tip of the lateral malleolus. 1, 2

Anatomical Characteristics

• The ATFL, CFL, and posterior talofibular ligament (PTFL) connect at the anterior/inferior tip of the lateral malleolus 1
• The fibular attachment of the CFL is directly at the tip of the lateral malleolus, dorsal to the fibular attachment of the ATFL 3
• The ATFL and CFL are independent fibers with isolated attachments on the fibula, though they have connective fibers between them 2

Detailed Attachment Points

• The ATFL's fibular center of insertion is located approximately 25.45 ± 5.84 mm from the tip of the lateral malleolus 3
• The CFL's fibular attachment is directly at the tip of the lateral malleolus 3
• The distance between the ATFL attachment and the inferior tip of the fibula is approximately 14.3 ± 1.9 mm 2
• The distance between the CFL attachment and the inferior tip of the fibula is approximately 7.4 ± 1.7 mm 2

Clinical Significance

• In lateral ankle sprains, the ATFL is the most commonly torn ligament 4
• Inversion injuries of the ankle account for 25% of musculoskeletal system injuries and 50% of all sports-related injuries 4
• When evaluating ankle injuries, point tenderness over the lateral malleolus is one of the key indicators in the Ottawa Ankle Rules for determining the need for radiographic imaging 4
• MRI without IV contrast is considered the study of choice for assessment of ligament injuries when radiographs are negative for osseous injury 4

Anatomical Variations

• The ATFL can present in different configurations:
  • Single band (23.3% of cases) 2
  • Double bands divided into superior and inferior components (70.0% of cases) 2
  • Multiple bands (6.7% of cases) 2
• The CFL can appear as:
  • Cord-like (36.7% of cases) 2
  • Flat and fanning (63.3% of cases) 2

Surgical Considerations

• For ligament reconstruction in chronic lateral ankle instability, the precise anatomical attachment points are critical for successful outcomes 3
• Ossicles at the tip of the lateral malleolus are frequently found in patients with chronic lateral ankle instability and may affect surgical outcomes 5
• When performing lateral ligament reconstruction, the released flap (including the insertion of both the ATFL and CFL) can be reattached to the malleolus more proximally 6

Understanding the precise attachment points of these ligaments is essential for accurate diagnosis and effective surgical management of lateral ankle ligament injuries.