{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T09:58:08Z","timestamp":1793354288455,"version":"4.5.0"},"reference-count":37,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,6,9]],"date-time":"2020-06-09T00:00:00Z","timestamp":1591660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,6,9]],"date-time":"2020-06-09T00:00:00Z","timestamp":1591660800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2020,6,9]],"date-time":"2020-06-09T00:00:00Z","timestamp":1591660800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>ATFL\u2019s superior fascicle injury has been considered to be the underlying cause in cases of ankle microinstability. As its clinical diagnosis can be difficult, arthroscopic examination may be the only objective diagnostic tool. The purpose of this study was to determine what types of injuries to the ATFL\u2019s superior fascicle are associated with ankle microinstability, and to provide the reader with an arthroscopic classification of the types of microinstability affecting the ankle.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Ankle arthroscopy video records obtained during a four\u2010year period from 232 patients with the diagnosis of ankle microinstability were reviewed. The characteristics of the ATFL\u2019s superior fascicle injury were identified, described and recorded along with any concomitant intra\u2010articular pathology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Four different injury patterns were consistently seen affecting the ATFL\u2019s superior fascicle. These ranged from ligament attenuation associated with loss of tension (type I), through to partial detachment (type II) or total detachment (type III) from the fibula. Finally, a total or partial resorption of the ATFL\u2019s superior fascicle (type IV) was also observed. There was a statistically significant association between the type of injury identified and the rate of intra\u2010articular pathology observed arthroscopically. Equally, the higher the type in the classification, the higher the rate of loose bodies, lateral talar OCD, deltoid \u201copen book\u201d tears, and anterior soft\u2010tissue formation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Different types of ATFL\u2019s superior fascicle injury can be observed in patients with ankle microinstability, ranging from ligament attenuation associated with a loss of tension (8.2%) to different degrees of partial (69.1%) and total (16.8%) ligament detachment from the fibula, or ligament remnant resorption (5.9%). As the type of injury progresses along with the proposed classification, the rate of intra\u2010articular injuries also increases. The clinical relevance of this study is that a morphological ATFL\u2019s superior fascicle tear is recognized in patients with the diagnosis of ankle microinstability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-020-06089-z","type":"journal-article","created":{"date-parts":[[2020,6,9]],"date-time":"2020-06-09T13:03:08Z","timestamp":1591707788000},"page":"1294-1303","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["Ankle microinstability: arthroscopic findings reveal four types of lesion to the anterior talofibular ligament\u2019s superior fascicle"],"prefix":"10.1002","volume":"29","author":[{"given":"Jordi","family":"Vega","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Laboratory of Arthroscopic and Surgical Anatomy. Department of Pathology and Experimental Therapeutics (Human Anatomy Unit) University of Barcelona Via Augusta, 281 08023 Barcelona Spain"},{"name":"<!--<label>2<\/label>--> Foot and Ankle Unit iMove Tres Torres, and Hospital Quir\u00f3n Barcelona Barcelona Spain"},{"name":"<!--<label>3<\/label>--> GRECMIP\u2010MIFAS (Groupe de Recherche et d\u2019Etude en Chirurgie Mini\u2010Invasive du Pied\u2010Minimally Invasive Foot and Ankle Society) Merignac France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesc","family":"Malagelada","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Department of Trauma and Orthopedic Surgery, Royal London Hospital Barts Health NHS Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miki","family":"Dalmau\u2010Pastor","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Laboratory of Arthroscopic and Surgical Anatomy. Department of Pathology and Experimental Therapeutics (Human Anatomy Unit) University of Barcelona Via Augusta, 281 08023 Barcelona Spain"},{"name":"<!--<label>3<\/label>--> GRECMIP\u2010MIFAS (Groupe de Recherche et d\u2019Etude en Chirurgie Mini\u2010Invasive du Pied\u2010Minimally Invasive Foot and Ankle Society) Merignac France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,9]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110078500600202"},{"issue":"4","key":"e_1_2_7_3_2","first-page":"458","article-title":"Surgical considerations in the treatment of ankle instability","volume":"37","author":"Baumhauer JF","year":"2002","journal-title":"J Athl 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March 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 June 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 June 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance of ethical interest"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"No funding was obtained.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"The study was approved by the Ethical committee of the institution.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}