Anatomical variations of the lateral collateral ligament of the ankle: Implications of sex and laterality on morphology and morphometry

A detailed understanding of the anatomical dimensions of the lateral collateral ligament (LCL) is essential in the surgical treatment of ankle joint injuries and ligament rehabilitation. While previous studies have explored the general morphology and morphometry of the LCL, there remains a gap in understanding how these characteristics vary based on sex and laterality. This study aimed to investigate the morphological and morphometric variations of the LCL, focusing on differences between sexes and between right and left ankles. Thirty-one ankles from sixteen human cadavers were dissected to investigate the LCL of the ankle. The LCL consists of the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL). Each ligament of the LCL was classified into three types according to the number of bands, i.e., Type I– single band, Type II– double bands (IIa-partially separated & IIb-completely separated), and Type III– triple bands for morphological observation. The length, width, and thickness of these ligaments were measured using a calliper for morphometric analysis and compared among sex and laterality. Type I was the most observed in all three ligaments (ATFL-61.3 %; CFL-87.1 %; PTFL-96.8 %). Significant sex differences were observed, with males having more Type I, while females had more Type II and III (p < 0.05). PTFL was significantly longer (25.31 ± 3.87 mm) and wider (7.05 ± 2.07 mm) in females (p < 0.05). CFL was significantly longer on the right (37.09 ± 4.57 mm; p < 0.05). Morphological and morphometric variations significantly exist in the ligaments that make up the LCL in relation to sex and laterality. These identified variations could improve diagnostic accuracy, enhance surgical planning, and inform sex-specific rehabilitation strategies. • Lateral collateral ligament (LCL) is essential in the surgical treatment of ankle joint injuries. • LCL play a significant role in maintaining ankle stability. • Variations were observed among the ligaments that make up the LCL in relation to sex and laterality. • These identified variations could improve diagnostic accuracy, enhance surgical planning, and inform sex-specific rehabilitation strategies.