Why do the ankle sprains hurt months after injury?

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The Spanish researchers have defined a new anatomical structure in the ankle: the lateral fibulotalocalcaneal ligament complex.

Why do the ankle sprains hurt months after injury?

The discovery modifies the understanding of this joint and may explain why many ankle sprains produce pain even months or years after the initial injury.

the ligaments of the ankle joint they are structures that are grouped by two large ligamentous complexes: the lateral collateral ligament -Situated on the lateral part of the joint and formed by three independent ligaments one from the other- and the medial collateral ligament or deltoid ligament. Now, the scientists of the University of Barcelona, ​​UB, have defined a new anatomical structure in this articulation: the lateral fibulotalocalcaneo ligament complex -Lftcl, for its acronym in English.

The description of this anatomical structure was possible thanks to the examination of some fibers that connect two of the components of the lateral collateral ligament. Moreover, For the first time one of the parts of this new structure is described as intra-articular. These results, published in Knee surgery, Sports traumatology, Arthroscopy, the understanding of this articulation and change could explain why many ankle sprains produce pain even months or years after the initial injury.

the lateral ligaments of the ankle they are those they are injured more often in the human body, especially because of the ankle sprains. Moreover, Most people who suffer from this injury have an ankle discomfort that goes on over timeit's at tendency to undergo a new distortion that until now medicine has not been able to explain.

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"This lack of explanation was the key to changing the way we approach ligament dissection, and then we realized The ligand-binding fibers were removed in the usual way because they were thought to be not part of the ligament", Explains Miquel Dalmau Pastor, researcher of the Unit of Human Anatomy and Embryology and of the Department of Pathology and Experimental Therapies of UB.

According to the new work, these fibers connect the fascial-ligament-lower part fibers of the anterior talofibular ligament and the calcaneofibular ligament, two of the three components of the lateral collateral ligament. "This connection has never been described, and contrary to what was previously thought, suggests that the two ligaments it connects are a functional unit. these two linked ligaments could be considered as a unique anatomical structure, which we called the lateral fibulotalocalcaneo ligament complex ", explains Dalmau Pastor.

This description is also suitable for some clinical publications that have shown the good results of the isolated repair of the anterior talofibular ligament in cases of complete lesions of the anterior talofibular ligaments and the calcaneofibular ligament. "These publications made us think that if only the anterior talofibular ligament was repaired, the calcanofibular ligament was repaired, this could only happen if there was a connection between the ligaments," recalls Jordi Vega.


The new ligamentous complex described is always in tension in any position of the foot. / UB

Implications in the treatment of distortion

Accurate dissection of the ankle joint capsule It also allowed us to identify the intraarticular component of the anterior talofibular ligament for the first time. This ligament would consist of two fascicles, one upper and one lower, which are respectively inside and outside of the joint. The inferior fascicle, together with the calcaneofibular ligament and the arcuate fibers that join them, would form the lateral fibulotalocalcaneal complex, which would then be an extra-articular structure.

The fact that a part of the anterior talofibular ligament was an intra-articular structure it may have implications for the evolution and treatment of ankle injuries.

"This discovery makes us think that the behavior after an injury will be similar to that of other intra-articular ligaments, as the anterior cruciate ligament of the knee, that they are not able to heal themselves when they breakwhat does he do The joint is unstable and requires surgical intervention in many cases", Says Dalmau Pastor.

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These results would allow us to explain Because many distortions cause pain even if the person follows the treatment recommended by his doctor or physiotherapist. "Being intra-articular, the ligament does not heal and the instability of the joint continues to produce pain and it means that these patients have many chances to suffer more distortions and develop other ankle injuries, "says Francesc Malagelada.

In addition to the anatomical observation in the dissections carried out at the University of Barcelona, ​​the researchers studied how the ligaments behave dynamically.

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"The anterior fascial ligament of the anterior talofibular ligament, in addition to being intra-articular, is not an isometric structure, that is, that relaxes when the foot is in dorsiflexion and stiffens when it is in plantar flexion. In contrast, the inferior fascicle, the arched fibers and the calcaneofibular ligament – that is, the described ligament complex- they are extra-articular structures and yes they are isometric, so they are always in tension in any position of the foot ", concludes M.ª Cristina Manzanares.

Because of the great novelty that this structure represents, several research projects have been started on its biomechanics, histology and clinic, coordinated by this group of UB and in collaboration with Roure, of the Polytechnic of Catalonia; James Calder, of the Imperial College of London, and Gino Kerkhoffs, of the University of Amsterdam. It is a project funded by the research group and study on minimally invasive foot surgery, Grecmip.

Sinc. Agency

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