title: An attachment-based description of the medial collateral and spring ligament complexes.
abstract: BACKGROUND
  Anatomy of the medial collateral and spring ligament complexes has been the cause of confusion. The anatomic description is highly dependent on the source studied and little agreement exists between texts. In addition, inconsistent nomenclature has been used to describe the components. This study attempted to clarify confusion through the creation of a 3D ligament map using attachment-based dissection.
  
  
  METHODS
  Nine fresh foot and ankle specimens were observed. The medial collateral ligament and spring ligament complexes were dissected using their attachment sites as a guide to define individual components. Each component's perimeter and thickness was measured and each bony attachment was mapped using a microscribe 3D digitizer.
  
  
  RESULTS
  Five components were identified contributing to the ligament complexes of interest: the tibiocalcaneonavicular, superficial posterior tibiotalar, deep posterior tibiotalar, deep anterior tibiotalar, and inferoplantar longitudinal ligaments. The largest component by total attachment area was the tibiocalcaneonavicular ligament followed by the deep posterior tibiotalar ligament. The largest ligament surface area of attachment to the tibia and talus was the deep posterior tibiotalar ligament. The largest attachment to the navicular and calcaneus was the tibiocalcaneonavicular ligament, which appeared to function in holding these bones in proximity while supporting the head of the talus.
  
  
  CONCLUSIONS
  By defining complex components by their attachment sites, a novel, more functional and reproducible description of the medial collateral and spring ligament complexes was created.
  
  
  CONCLUSIONS
  The linear measurements and 3D maps may prove useful when attempting more anatomically accurate reconstructions.
authors.affiliation: Department of Surgery, East Carolina University, Greenville, NC, USA cromeensb@ecu.edu.
authors.forename: Barrett P
authors.initials: BP
authors.lastname: Cromeens
authors.affiliation: Department of Integrative Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA.
authors.forename: Claire A
authors.initials: CA
authors.lastname: Kirchhoff
authors.affiliation: Department of Osteopathic Manipulative Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA.
authors.forename: Rita M
authors.initials: RM
authors.lastname: Patterson
authors.affiliation: Department of Orthopaedic Surgery, University of North Texas Health Science Center, Fort Worth, TX, USA.
authors.forename: Travis
authors.initials: T
authors.lastname: Motley
authors.affiliation: Arlington Orthopedic Associates P.A., Arlington, TX, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Stewart
authors.affiliation: Department of Integrative Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA.
authors.forename: Cara
authors.initials: C
authors.lastname: Fisher
authors.affiliation: Department of Integrative Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA.
authors.forename: Rustin E
authors.initials: RE
authors.lastname: Reeves
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000033:anatomy & histology*; D002102:Cadaver; D017885:Collateral Ligaments / Q000033:anatomy & histology*; D005260:Female; D005528:Foot / Q000033:anatomy & histology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008023:Ligaments, Articular / Q000033:anatomy & histology*; D008297:Male; D008875:Middle Aged; D012984:Software
keywords: 3D modeling; anatomy; ankle; deltoid ligament; mapping