Association of Hindfoot Ligament Tears and Osteochondral Lesions

Background: This study aimed to identify the prevalence of ligament and joint surface anatomy variants, ligament tears, and osteochondral lesions (OCLs) in the hindfoot. These data were used to identify associations between anatomic variants or ligament tears and OCLs. Methods: Seventy-two cadaver hindfoot specimens were examined. Hindfoot ligament presence, number of ligament fascicles, variable ligament attachment sites, ligament tears, presence of joint facets, variable joint surface shape, and the location and grade of OCLs were identified in each specimen. The data were analyzed for significant associations between variables. Results: Fourteen of the 30 studied ligaments were always present and 14 had variable number of fascicles. The lateral talocalcaneal and dorsolateral calcaneocuboid ligaments had varying positional attachments. Osteochondral lesions were present in 86% of specimens with the majority in the talocrural joint. Of the 235 lesions identified, 31 were grade 3 or above. Ligament tears occurred in 2% of all ligaments observed. Tears in the lateral talocalcaneal, medial calcaneocuboid, and dorsolateral calcaneocuboid ligaments were associated with an increased number of hindfoot OCLs. Conclusion: We demonstrated the prevalence of morphologic ligament and joint surface variants, ligament tears, and osteochondral lesions in the hindfoot. Tears in ligaments stabilizing the calcaneocuboid joint were implicated in an increase in hindfoot joint damage. Clinical Relevance: We believe anatomic studies can be used to clarify the association between traumatic injuries and their sequelae.