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Kim J, Kim GL, Kim T, Cho J. Evaluation of chronic ankle instability and subtalar instability using the angle between the anterior talofibular ligament and calcaneofibular ligament. Knee Surg Sports Traumatol Arthrosc 2023; 31:4539-4545. [PMID: 37286900 DOI: 10.1007/s00167-023-07433-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/20/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE A series of studies have reported a change in the length or thickness of the anterior talofibular (ATFL) and calcaneofibular (CFL) ligaments in patients with chronic ankle instability. However, no study has examined the changes in the angle between the ATFL and CFL in patients diagnosed with chronic ankle instability. Therefore, this study analyzed the change in the angle between the ATFL and CFL in patients diagnosed with chronic ankle instability to confirm its relevance. METHODS This retrospective study included 60 patients who had undergone surgery for chronic ankle instability. Stress radiographs comprising the anterior drawer test, varus stress test, Broden's view stress test, and magnetic resonance imaging (MRI) were performed in all patients. The angle between the ATFL and CFL was measured by indicating the vector at the attachment site, as seen on the sagittal plane. Three groups were classified according to the angle between the two ligaments measured by MRI: group I when the angle was > 90°, Group II when the angle was 71-90°, and Group III when the angle was ≤ 70°. The accompanying injuries to the subtalar joint ligament were analyzed via MRI. RESULTS A comparison of the angles between the ATFL and CFL measured on MRI in Group I, Group II, and Group III with the angles measured in the operating room revealed a significant correlation. Broden's view stress test revealed a statistically significant difference among the three groups (p < 0.05). The accompanying subtalar joint ligament injuries differed significantly among the three groups (p < 0.05). CONCLUSION The ATFL-CFL angle in patients with ankle instability is smaller than the average angle in ordinary people. Therefore, the ATFL-CFL angle might be a reliable and representative measurement tool to assess chronic ankle instability, and subtalar joint instability should be considered if the ATFL-CFL angle is 70° or less. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jiyoun Kim
- Department of Orthopedic Surgery, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Korea
| | - Gab Lae Kim
- Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University School of Medicine, Seong-an Ro 150, Kang-dong Gu, Seoul, 05355, Korea.
| | - Taeho Kim
- Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University School of Medicine, Seong-an Ro 150, Kang-dong Gu, Seoul, 05355, Korea
| | - Junghyun Cho
- Department of Orthopedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University School of Medicine, Seong-an Ro 150, Kang-dong Gu, Seoul, 05355, Korea
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2
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Fujimaki T, Kurokawa H, Ueno Y, Sasaki T, Pradana AS, Zainudin TNBT, Milo AM, Miyamoto T, Taniguchi A, Haro H, Tanaka Y. Assessment of Changes in Hindfoot Alignment of Total Ankle Arthroplasty for Ankle Osteoarthritis on Weightbearing Subtalar X-ray View. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231205299. [PMID: 37900557 PMCID: PMC10612447 DOI: 10.1177/24730114231205299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Background Recovering normal hindfoot alignment and correcting deformity of the ankle joint following total ankle arthroplasty (TAA) in osteoarthritis (OA) is essential for improving clinical outcomes and increasing long-term survival. We aim to evaluate hindfoot alignment following standard TAA compared to TAA with a total talar prosthesis ("combined TAA") in varus-type OA patients. Methods This retrospective study was conducted between 2010 and 2022. We included 27 patients (30 feet) who underwent standard TAA and 19 patients (22 feet) who underwent combined TAA. Hindfoot alignment at the subtalar joint was measured by weightbearing subtalar radiographic view before and after surgery. Results In the standard TAA, the angle between the tibial shaft axis and the articular surface of the talar dome joint (TTS) changed from 75 to 87 degrees (P < .01), the angle between the tibial axis and the surface on the middle facet (TMC) from 89 to 94 degrees (P < .01), and the angle between the tibial axis and the surface on the posterior facet (TPC) from 80 to 84 degrees (P < .01). The angle between the articular surface of the talar dome and the posterior facet of the calcaneus (SIA) decreased from 4.7 to -2.5 degrees (P < .01). In the combined TAA, TTS angle changed from 77 to 88 degrees (P < .01), TMC angle from 93 to 101 degrees (P < .01), TPC angle from 84 to 90 degrees (P < .05), and SIA from 6.6 to 2.1 degrees (P < .01). Varus deviation to the subtalar joint (TMC, TPC) significantly improved postoperatively in both groups. However, TPC was smaller than TTS and SIA was negative in standard TAA, and TPC was larger than TTS and SIA was positive in combined TAA. Conclusion The amount of correction of the subtalar joint differed depending on the ligament dissection of the subtalar joint and shape of the talar component. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Taro Fujimaki
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
- Department of Orthopedic Surgery, University of Yamanashi, Chou-shi, Yamanashi, Japan
| | - Hiroaki Kurokawa
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
| | - Yuki Ueno
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
| | - Takahide Sasaki
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Ananto Satya Pradana
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
| | | | - Anne Marie Milo
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
| | - Takuma Miyamoto
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
| | - Akira Taniguchi
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopedic Surgery, University of Yamanashi, Chou-shi, Yamanashi, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Chou-shi, Yamanashi, Japan
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Volmer E, Mittlmeier T, Weber MA. [Ligamentous injuries of the ankle joint : Importance of radiological imaging procedures]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:773-783. [PMID: 37642697 DOI: 10.1007/s00132-023-04436-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 08/31/2023]
Abstract
Injuries of the ankle joint show lesions of the lateral ligamentous apparatus with an incidence of 1 in 1000 cases. With a range of 0.3-0.7 in 1000 cases, injuries of the medial ligamentous apparatus occur more frequently than previously thought and are often overlooked. Correct imaging diagnostics of the ankle ligaments are mandatory for the prognosis and treatment planning. In cases of clinically strong suspicion of ligamentous injury or osteochondral lesions of the ankle joint, after primary radiographic evaluation magnetic resonance imaging (MRI) is primarily recommended for a more precise assessment. Additionally, the sensitivity for assessment of the ligaments with ultrasonography is good (91% vs. 97% with MRI) but its specificity is inferior compared to MRI (63% vs. 93% with MRI). Supination trauma is the most common ankle injury and attention should be paid to the anterior tibiofibular ligament and calcaneofibular ligament. In approximately 50%, injuries to the superficial layer of the medial collateral ligament complex are associated with lesions of the posterior tibiotalar ligament.
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Affiliation(s)
- Erik Volmer
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
| | - Thomas Mittlmeier
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Marc-André Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
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Volmer E, Mittlmeier T, Weber MA. [Ligamentous injuries of the ankle joint : Importance of radiological imaging procedures]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00117-023-01181-0. [PMID: 37490065 DOI: 10.1007/s00117-023-01181-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/26/2023]
Abstract
Injuries of the ankle joint show lesions of the lateral ligamentous apparatus with an incidence of 1 in 1000 cases. With a range of 0.3-0.7 in 1000 cases, injuries of the medial ligamentous apparatus occur more frequently than previously thought and are often overlooked. Correct imaging diagnostics of the ankle ligaments are mandatory for the prognosis and treatment planning. In cases of clinically strong suspicion of ligamentous injury or osteochondral lesions of the ankle joint, after primary radiographic evaluation magnetic resonance imaging (MRI) is primarily recommended for a more precise assessment. Additionally, the sensitivity for assessment of the ligaments with ultrasonography is good (91% vs. 97% with MRI) but its specificity is inferior compared to MRI (63% vs. 93% with MRI). Supination trauma is the most common ankle injury and attention should be paid to the anterior tibiofibular ligament and calcaneofibular ligament. In approximately 50%, injuries to the superficial layer of the medial collateral ligament complex are associated with lesions of the posterior tibiotalar ligament.
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Affiliation(s)
- Erik Volmer
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
| | - Thomas Mittlmeier
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Marc-André Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
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Bell KL, King BW, Sangeorzan BJ. Acute and Chronic Subtalar Joint Instability: Does It Really Exist? Foot Ankle Clin 2023; 28:427-444. [PMID: 37137632 DOI: 10.1016/j.fcl.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Acute and chronic subtalar instability and commonly coexistent with other hindfoot pathology but can be difficult to diagnose. A high degree of clinical suspicion is required as most imaging modalities and clinical maneuvers are poor at detecting isolated subtalar instability. The initial treatment is similar to ankle instability, and a wide variety of operative interventions have been presented in the literature for persistent instability. Outcomes are variable and limited.
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Affiliation(s)
- Kerri Lynne Bell
- Orthopaedic Surgery, Henry Ford Health, 2799 West Grand Boulevard K12, Detroit, MI 48202, USA
| | - Brandon William King
- Orthopaedic Surgery, Henry Ford Health, 2799 West Grand Boulevard K12, Detroit, MI 48202, USA.
| | - Bruce J Sangeorzan
- Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA
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Tan CY, Thevendran G. Subtalar instability. J Orthop Surg (Hong Kong) 2023; 31:10225536231182350. [PMID: 37449802 DOI: 10.1177/10225536231182350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Subtalar instability is a confusing yet important condition in patients with lateral ankle instability. The author will explore subtalar kinematics, and how they are closely related to the joint stability of the subtalar joint, both with respect to its intrinsic ligaments and its extrinsic ligaments. As subtalar instability is difficult to diagnose, this article will provide readers with a better understanding of its clinical presentation. Discussions will also include useful radiographic modalities and the most recent evidence regarding their accuracy. The last section discusses surgical options and what the readers need to know in order to make a decision.
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Michels F, Vereecke E, Matricali G. Role of the intrinsic subtalar ligaments in subtalar instability and consequences for clinical practice. Front Bioeng Biotechnol 2023; 11:1047134. [PMID: 36970618 PMCID: PMC10036586 DOI: 10.3389/fbioe.2023.1047134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 02/28/2023] [Indexed: 03/12/2023] Open
Abstract
Subtalar instability (STI) is a disabling complication after an acute lateral ankle sprain and remains a challenging problem. The pathophysiology is difficult to understand. Especially the relative contribution of the intrinsic subtalar ligaments in the stability of the subtalar joint is still controversial. Diagnosis is difficult because of the overlapping clinical signs with talocrural instability and the absence of a reliable diagnostic reference test. This often results in misdiagnosis and inappropriate treatment. Recent research offers new insights in the pathophysiology of subtalar instability and the importance of the intrinsic subtalar ligaments. Recent publications clarify the local anatomical and biomechanical characteristics of the subtalar ligaments. The cervical ligament and interosseous talocalcaneal ligament seem to play an important function in the normal kinematics and stability of the subtalar joint. In addition to the calcaneofibular ligament (CFL), these ligaments seem to have an important role in the pathomechanics of subtalar instability (STI). These new insights have an impact on the approach to STI in clinical practice. Diagnosis of STI can be performed be performed by a step-by-step approach to raise the suspicion to STI. This approach consists of clinical signs, abnormalities of the subtalar ligaments on MRI and intraoperative evaluation. Surgical treatment should address all the aspects of the instability and focus on a restoration of the normal anatomical and biomechanical properties. Besides a low threshold to reconstruct the CFL, a reconstruction of the subtalar ligaments should be considered in complex cases of instability. The purpose of this review is to provide a comprehensive update of the current literature focused on the contribution of the different ligaments in the stability of the subtalar joint. This review aims to introduce the more recent findings in the earlier hypotheses on normal kinesiology, pathophysiology and relation with talocrural instability. The consequences of this improved understanding of pathophysiology on patient identification, treatment and future research are described.
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Affiliation(s)
- Frederick Michels
- Orthopaedic Department AZ Groeninge, Kortrijk, Belgium
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
- ESSKA-AFAS Ankle Instability Group, Kortrijk, Belgium
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- EFAS European Foot and Ankle Society, Brussels, Belgium
- *Correspondence: Frederick Michels,
| | - Evie Vereecke
- Department Development and Regeneration, Faculty of Medicine, University of Leuven Campus Kortrijk, Kortrijk, Belgium
| | - Giovanni Matricali
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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8
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Michels F, Stockmans F, Pottel H, Matricali G. Reconstruction of the cervical ligament in patients with chronic subtalar instability. Foot Ankle Surg 2022; 28:1286-1292. [PMID: 35752537 DOI: 10.1016/j.fas.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/24/2022] [Accepted: 06/12/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Diagnosis and treatment of subtalar instability (STI) remains complicated and challenging. The purpose of this study was to investigate the outcome of an anatomical reconstruction of the cervical ligament in patients with suspected chronic STI. METHODS This prospective study assessed the results of a surgical reconstruction of the cervical ligament using a gracilis tendon graft in a group of 14 patients (16 feet). Diagnosis of STI was performed using a predefined algorithm including clinical signs, MRI and peroperative evaluation. All patients had symptoms of chronic hindfoot instability despite prolonged non-surgical treatment. At final follow-up the outcome was assessed using the Karlsson score, the Foot and Ankle Outcome Score and the American Orthopaedic Foot and Ankle Society score. RESULTS After an average follow up of 22.6 months (range, 15-36), all patients reported significant improvement compared to their preoperative symptoms. The mean preoperative Karlsson score improved from 36.4 ± 13.5 (median 37, range 10-55) to a mean postoperative Karlsson score was 89.6 ± 8.5 (median 90, range 72-100) (P < 0.0001). The cervical ligament reconstruction was combined with other procedures in 13 cases: calcaneofibular ligament (CFL) reconstruction (3), CFL and anterior talofibular ligament reconstruction (7), bifurcate ligament reconstruction (3). CONCLUSION Anatomical reconstruction of the cervical ligament is a valid technique to treat patients with STI. It is a safe procedure and produces good clinical results with minimal complications. This technique can be considered in more complex cases and can be combined with other procedures according to the specific location of the instability. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Frederick Michels
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium; MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France; EFAS (European Foot and Ankle Society); ESSKA-AFAS Ankle Instability Group, Belgium; Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium; Dept. Development and Regeneration, Faculty of Medicine, University of Leuven campus Kortrijk, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium.
| | - Filip Stockmans
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium; Dept. Development and Regeneration, Faculty of Medicine, University of Leuven campus Kortrijk, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium.
| | - Hans Pottel
- Department of Public Health and Primary Care, Catholic University Leuven, Kortrijk, Belgium.
| | - Giovanni Matricali
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
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9
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Kim JS, Amendola A, Barg A, Baumhauer J, Brodsky JW, Cushman DM, Gonzalez TA, Janisse D, Jurynec MJ, Lawrence Marsh J, Sofka CM, Clanton TO, Anderson DD. Summary Report of the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society's Symposium on Targets for Osteoarthritis Research: Part 2: Treatment Options. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221127013. [PMID: 36262470 PMCID: PMC9575443 DOI: 10.1177/24730114221127013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED This second of a 2-part series of articles recounts the key points presented in a collaborative symposium sponsored jointly by the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society with the intent to survey current treatment options for osteoarthritis (OA) of the foot and ankle. A meeting was held virtually on December 10, 2021. A group of experts were invited to present brief synopses of the current state of knowledge and research in this area. Topics were chosen by meeting organizers, who then identified and invited the expert speakers. Part 2 overviews the current treatment options, including orthotics, non-joint destructive procedures, as well as arthroscopies and arthroplasties in ankles and feet. Opportunities for future research are also discussed, such as developments in surgical options for ankle and the first metatarsophalangeal joint. The OA scientific community, including funding agencies, academia, industry, and regulatory agencies, must recognize the importance to patients of addressing the foot and ankle with improved basic, translational, and clinical research. LEVEL OF EVIDENCE Level V, review article/expert opinion.
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Affiliation(s)
- Jason S. Kim
- The Arthritis Foundation, Atlanta, GA,
USA,Jason S. Kim, PhD, The Arthritis
Foundation, 1355 Peachtree St NE, Suite 600, Atlanta, GA 30309, USA.
| | | | - Alexej Barg
- Department of Orthopaedics, University
of Utah, Salt Lake City, UT, USA
| | - Judith Baumhauer
- Department of Orthopaedic Surgery,
University of Rochester Medical Center, Rochester, NY, USA
| | | | - Daniel M. Cushman
- Division of Physical Medicine &
Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Tyler A. Gonzalez
- Department of Orthopaedic Surgery,
University of South Carolina, Lexington, SC, USA
| | | | - Michael J. Jurynec
- Department of Orthopaedics and Human
Genetics, University of Utah, Salt Lake City, UT, USA
| | - J. Lawrence Marsh
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Carolyn M. Sofka
- Department of Radiology and Imaging,
Hospital for Special Surgery, New York, NY, USA
| | | | - Donald D. Anderson
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
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10
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Liao LQ, Feng ZY, Li YK. Anatomical parameters of sustentaculum Tali screw placement in the Asian population: A retrospective radio-anatomical study. J Orthop Surg (Hong Kong) 2022; 30:10225536221082343. [PMID: 35388728 DOI: 10.1177/10225536221082343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: This study aimed to determine the anatomical parameters of successful Sustentaculum Tali (ST) screw placement in the Asian population. Method: CT scans of unilateral feet of 110 participants were reviewed, retrospectively. The 3 D reconstruction of the calcaneus and morphometric measurements were performed by Mimics Research 19.0 and 3-Matic Research 11.0. Finally, six cadaveric feet were used for verification of the accuracy of the measurements. Results: We discovered a method to help place ST screw successfully: (1) The entry point located at the middle section of the lateral wall of posterior talar articular surface (PTAS), and the perpendicular distance from the entry point to the lateral edge of PTAS (PDEL) was 10.78 mm, (2) Screw was perpendicular to the z-axis, 66.98° to the y-axis (the longitudinal axis of the foot), (3) The length of the ST screw should be approximately 44.74 mm in male and 41.14 mm in female, and (4) The diameter of the ST screw should be approximately 4.0 mm in male and 3.5 mm in female. With this new method, all screws in six cadaveric feet were placed successfully into the middle of ST. Conclusions: In this study, we discovered a general approach to safely place ST screws in the Asian population, which may potentially help surgeons improve their success rate in surgical practice.
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Affiliation(s)
- Li-Qing Liao
- Department of TCM Orthopedics and Traumatology, School of Traditional Chinese Medicine, 70570Southern Medical University, Guangzhou, China
| | - Zi-Yu Feng
- Department of TCM Orthopedics and Traumatology, School of Traditional Chinese Medicine, 70570Southern Medical University, Guangzhou, China
| | - Yi-Kai Li
- Department of TCM Orthopedics and Traumatology, School of Traditional Chinese Medicine, 70570Southern Medical University, Guangzhou, China
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Comparative Analysis of Subtalar Ligaments Between Patients With Talocalcaneal Coalition and Control Subjects Using 3-Dimensional Magnetic Resonance Imaging. J Comput Assist Tomogr 2022; 46:440-446. [DOI: 10.1097/rct.0000000000001290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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A high rate of talocalcaneal interosseous ligament tears was found in chronic lateral ankle instability with sinus tarsi pain. Knee Surg Sports Traumatol Arthrosc 2021; 29:3543-3550. [PMID: 34590165 DOI: 10.1007/s00167-021-06651-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the arthroscopic findings of subtalar joints, including interosseous talocalcaneal ligament (ITCL) tear, in patients with chronic lateral ankle instability (CLAI) and sinus tarsi pain. METHODS A total of 118 ankles (109 patients) having CLAI with sinus tarsi pain who had undergone subtalar arthroscopy and lateral ankle ligament surgery were evaluated. The medical records, radiologic images, and the arthroscopic images and videos were reviewed. ITCL tears were classified into 4 grades: grade 0 (no tear), grade 1 (mild), grade 2 (moderate), and grade 3 (severe). The efficacy of magnetic resonance imaging (MRI) in diagnosing ITCL tears was also evaluated by comparing preoperative official readings of MRI to arthroscopic findings. The pre- and postoperative functional scores were also assessed. RESULTS The overall tear rate of ITCL was 107/118 (90.7%). There were 29 ankles (23.6%) with grade 1, 42 ankles (35.6%) with grade 2, and 36 ankles (30.5%) with grade 3 tears. Isolated lateral ankle instability (LAI) was diagnosed in 43 ankles (36.4%), subtalar instability (STI) in 30 ankles (25.4%), and LAI with STI in 45 ankles (38.1%). There was a statistically significant relationship between the ITCL tear grade and the final diagnosis. ITCL tear was confirmed or suspected in 81 ankles (68.6%) on preoperative MRI. Pain Visual Analog Score and functional outcome scores including the American Orthopaedic Foot & Ankle Society and Karlsson-Peterson scores showed significant improvement after the surgery. CONCLUSION A high rate (90.7%) of ITCL tears was noted in CLAI patients with sinus tarsi pain. ITCL damage may play an important role in subtalar instability in patients with CLAI and sinus tarsi pain. Subtalar arthroscopic evaluation for ITCL tear is important for correct diagnosis for CLAI with sinus tarsi pain. LEVEL OF EVIDENCE IV.
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13
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Jung HG, Moon SG, Yoon DY, Jang H, Kang JH. Feasibility of MRI for the evaluation of interosseous ligament vertical segment via subtalar arthroscopy correlation: comparison of 2D and 3D MR images. BMC Musculoskelet Disord 2021; 22:869. [PMID: 34641837 PMCID: PMC8513297 DOI: 10.1186/s12891-021-04759-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022] Open
Abstract
Background Interosseous ligament vertical segment (IOLV) and calcaneofibular ligament (CFL) have been reported to be important in stabilizing the subtalar joint. Unlike CFL, there is not much information regarding the comparison of MRI results with surgical evaluation of IOLV and the comparison between 2D and 3D MRI on IOLV evaluation. The feasibility of MRI in IOLV evaluation has yet to be reported. The purpose of this study was to evaluate the validity and reliability of MRI in IOLV tear detection via correlation with arthroscopic results. We also compared the diagnostic performance of 2D and 3D MR images. Methods In this retrospective study, 52 patients who underwent subtalar arthroscopy after ankle MRI were enrolled. Arthroscopic results confirmed IOLV tear in 25 cases and intact IOLV in 27 cases. Two radiologists independently evaluated the IOLV tears using only conventional 2D images, followed by isotropic 3D images, and comparison with arthroscopic results. Results Only the 2D sequences interpreted by two readers showed a sensitivity of 64.0–96.0%, a specificity of 29.6–44.4%, a positive predictive value of 51.6–56.4%, and a negative predictive value of 57.1–88.9%. Addition of isotropic 3D sequences changed the sensitivity to 60.0–80.0%, specificity to 63.0–77.8%, positive predictive value to 64.3–76.9%, and negative predictive value to 66.7–80.8%. The overall diagnostic performance of isotropic 3D sequences (AUC values: 0.679–0.816) was higher than that of 2D sequences (AUC values: 0.568–0.647). Inter-observer and intra-observer agreement between the two readers was moderate-to-good for both 2D and 3D sequences. The diagnostic accuracy in 19 patients with tarsal sinus fat obliteration tended to increase from 26.3–42.1% to 57.9–73.7% with isotropic 3D sequences compared with 2D sequences. Conclusions Isotropic 3D MRI was feasible for the assessment of IOLV tear prior to subtalar arthroscopy. Additional 3D sequences showed higher diagnostic accuracy compared with conventional 2D sequences in IOLV evaluation. Isotropic 3D sequences may be more valuable in detecting IOLV tear in case of tarsal sinus fat obliteration.
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Affiliation(s)
- Hong-Geun Jung
- Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Gwangjin-gu, Seoul, South Korea
| | - Sung Gyu Moon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea.
| | - Deuk Young Yoon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea
| | - Hyemin Jang
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea
| | - Ji Hee Kang
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea
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14
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Liu P, Chen K, Wang S, Hua C, Zhang H, Yu J. A mouse model of ankle-subtalar joint complex instability induced post-traumatic osteoarthritis. J Orthop Surg Res 2021; 16:541. [PMID: 34470616 PMCID: PMC8408979 DOI: 10.1186/s13018-021-02683-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ankle-subtalar joint complex instability is not uncommonly presented in the clinic, but symptoms and signs similar to other conditions can easily lead to its misdiagnosis. Due to the lack of appropriate animal models, research on ankle-subtalar joint complex instability is limited. The aims of the present study were to establish an animal model of ankle-subtalar joint complex instability in mice and to explore its relationship with post-traumatic osteoarthritis (PTOA). METHODS Twenty-one male C57BL/6J mice were randomly divided into three groups: SHAM group (sham surgery group), transected cervical ligament + anterior talofibular ligament (CL+ATFL) group, and transected cervical ligament + deltoid ligament (CL+DL) group. Two weeks after surgery, all mice underwent cage running training. Balance beam and gait tests were used to evaluate the changes in self-movement in the mice after ankle-subtalar ligament injury. Micro-CT and histological staining were used to evaluate the progress of PTOA. RESULTS Compared with the SHAM group, balance and gait were affected in the ligament transection group. Twelve weeks after surgery, the time required to cross the balance beam in the CL+ATFL group was 35.1% longer and the mice slipped 3.6-fold more often than before surgery, and the mean step length on the right side was 7.2% smaller than that in the SHAM group. The time required to cross the balance beam in the CL+DL group was 32.1% longer and the mice slipped 3-fold more often than prior to surgery, and the average step length on the right side was 5.6% smaller than that in the SHAM group. CT images indicated that 28.6% of the mice in the CL+DL group displayed dislocation of the talus. Tissue staining suggested that articular cartilage degeneration occurred in mice with ligament transection 12 weeks after surgery. CONCLUSIONS Transected mice in the CL+ATFL and CL+DL groups displayed mechanical instability of the ankle-subtalar joint complex, and some mice in the CL+DL group also suffered from talus dislocation due to ligament injury leading to loss of stability of the bone structure. In addition, as time progressed, the articular cartilage displayed degenerative changes, which affected the ability of animals to move normally.
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Affiliation(s)
- Peixin Liu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, People's Republic of China.,Orthopedic Institute, Soochow University, 178 Ganjiangdong Rd, Suzhou, 215006, Jiangsu, People's Republic of China
| | - Kaiwen Chen
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, People's Republic of China.,Orthopedic Institute, Soochow University, 178 Ganjiangdong Rd, Suzhou, 215006, Jiangsu, People's Republic of China
| | - Shuo Wang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, People's Republic of China.,Orthopedic Institute, Soochow University, 178 Ganjiangdong Rd, Suzhou, 215006, Jiangsu, People's Republic of China
| | - Chunzhuo Hua
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, People's Republic of China.,Orthopedic Institute, Soochow University, 178 Ganjiangdong Rd, Suzhou, 215006, Jiangsu, People's Republic of China
| | - Hongtao Zhang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, People's Republic of China. .,Orthopedic Institute, Soochow University, 178 Ganjiangdong Rd, Suzhou, 215006, Jiangsu, People's Republic of China.
| | - Jia Yu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, People's Republic of China. .,Orthopedic Institute, Soochow University, 178 Ganjiangdong Rd, Suzhou, 215006, Jiangsu, People's Republic of China.
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15
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Whelan JH, Kiser CR, Lazoritz JP, Nelson P, Sikes J, Greenhagen RM. Arthroscopic Evaluation of the Subtalar Joint: A Review and Survey of Pathology. J Am Podiatr Med Assoc 2021; 111:436243. [PMID: 31549854 DOI: 10.7547/19-071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND A survey of pathology present in the subtalar joint by means of subtalar arthroscopy with anterolateral and middle portals has not been extensively explored in the literature. The focus of this study was to identify pathology in the subtalar joint with subtalar joint arthroscopy using this approach. We also compared these arthroscopic findings with those reported in the literature. METHODS We performed a retrospective review of 49 consecutive patients who had undergone 53 subtalar arthroscopic procedures. Data were obtained from intraoperative arthroscopic findings that were documented in the operative note or with arthroscopic photography. Additional procedures, including ankle arthroscopy, lateral ankle stabilization, and peroneal tendon repair, were recorded. Descriptive statistics were calculated and reported. RESULTS Subtalar arthroscopic examination revealed that all of the patients had intra-articular synovitis or adhesions present. Twenty-two procedures (42%) demonstrated subtalar joint instability, seven (13%) revealed chondromalacia, and one (2%) had an exostosis present. These observations are consistent with other reported findings in the literature. CONCLUSIONS This study found that the subtalar joint was most often affected by synovitis, adhesions, and instability in patients with symptomatic pathologies requiring subtalar arthroscopy. There was a relatively low incidence of chondromalacia or exostosis formation in the survey.
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16
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So E, Weber J, Berlet G, Bull P. Surgical Treatment of Subtalar Joint Instability: Safety and Accuracy of a New Technique in a Cadaver Model. J Foot Ankle Surg 2020; 59:38-43. [PMID: 31882145 DOI: 10.1053/j.jfas.2019.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 02/03/2023]
Abstract
New surgical strategies to treat symptomatic subtalar joint (STJ) instability are evolving. We modified a previously described reconstruction strategy and then refined our new surgical technique through simulated surgery and subsequent cadaver dissections. Our purpose was to show that a tunnel intended to facilitate STJ stabilization surgery could safely be drilled across the footprints of the interosseous talocalcaneal ligament (ITCL). A percutaneous fluoroscopically guided tunnel for the purpose of ITCL reconstruction was created in 10 cadaveric below-knee specimens. Accuracy of the tunnel with relation to the anatomic boundaries of the ITCL attachment sites as well as damage to relevant structures at risk were recorded. Two sets of 5 surgeries were performed to assess for improvement in technique. Mean distances from the tunnel to the ITCL on the calcaneus improved between groups 1 and 2: 4.04 and 1.80 mm, respectively (p = .04). Mean distances from the tunnel to the ITCL on the talus improved between groups 1 and 2: 6.2 and 1.8 mm, respectively (p = .08). With information obtained from this study, an osseous tunnel can be safely placed within 2 mm of the ITCL footprints.
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Affiliation(s)
- Eric So
- Fellowship-Trained Foot and Ankle Surgeon, The CORE Institute, Phoenix, AZ
| | - Jeffrey Weber
- Fellowship-Trained Foot and Ankle Surgeon, Milwaukee Foot and Ankle Specialists, Wauwatosa, WI
| | - Gregory Berlet
- Attending, Orthopedic Foot and Ankle Center, Worthington, OH
| | - Patrick Bull
- Attending, Orthopedic Foot and Ankle Center, Worthington, OH.
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17
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So E, Weber JS, Berlet GC, Bull PE. RETRACTED: Surgical Treatment of Subtalar Joint Instability With Reconstruction of the Interosseous Talocalcaneal Ligament: Safety and Accuracy of a New Technique in a Cadaver Model. Foot Ankle Spec 2020:1938640019899828. [PMID: 32028792 DOI: 10.1177/1938640019899828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eric So
- CORE Institute, Phoenix, Arizona (ES)
- Milwaukee Foot and Ankle Specialists, Wauwatosa, Wisconsin (JSW)
- Orthopedic Foot and Ankle Center, Westerville, Ohio (GCB, PEB)
| | - Jeffrey S Weber
- CORE Institute, Phoenix, Arizona (ES)
- Milwaukee Foot and Ankle Specialists, Wauwatosa, Wisconsin (JSW)
- Orthopedic Foot and Ankle Center, Westerville, Ohio (GCB, PEB)
| | - Gregory C Berlet
- CORE Institute, Phoenix, Arizona (ES)
- Milwaukee Foot and Ankle Specialists, Wauwatosa, Wisconsin (JSW)
- Orthopedic Foot and Ankle Center, Westerville, Ohio (GCB, PEB)
| | - Patrick E Bull
- CORE Institute, Phoenix, Arizona (ES)
- Milwaukee Foot and Ankle Specialists, Wauwatosa, Wisconsin (JSW)
- Orthopedic Foot and Ankle Center, Westerville, Ohio (GCB, PEB)
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18
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Debieux P, Wajnsztejn A, Mansur NSB. Epidemiology of injuries due to ankle sprain diagnosed in an orthopedic emergency room. EINSTEIN-SAO PAULO 2019; 18:eAO4739. [PMID: 31553355 PMCID: PMC6905160 DOI: 10.31744/einstein_journal/2020ao4739] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 04/25/2019] [Indexed: 01/28/2023] Open
Abstract
Objective To use magnetic resonance imaging to assess the prevalence of foot and ankle ligament injuries and fractures associated with ankle sprain and not diagnosed by x-ray. Methods We included 180 consecutive patients with a history of ankle sprain, assessed at a primary care service in a 12-month period. Magnetic resonance imaging findings were recorded and described. Results Approximately 92% of patients had some type of injury shown on the magnetic resonance imaging. We found 379 ligament injuries, 9 osteochondral injuries, 19 tendinous injuries and 51 fractures. Only 14 magnetic resonance imaging tests (7.8%) did not show any sort of injury. We observed a positive relation between injuries of the lateral complex, syndesmosis and medial ligaments. However, there was a negative correlation between ankle ligament injuries and midfoot injuries. Conclusion There was a high rate of injuries secondary to ankle sprains. We found correlation between lateral ligament injuries and syndesmosis and deltoid injuries. We did not observe a relation between deltoid and syndesmosis injuries or between lateral ligamentous and subtalar injuries. Similarly, no relation was found between ankle and midfoot injuries.
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Affiliation(s)
- Pedro Debieux
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Andre Wajnsztejn
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Nacime Salomão Barbachan Mansur
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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19
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Medina McKeon JM, Hoch MC. The Ankle-Joint Complex: A Kinesiologic Approach to Lateral Ankle Sprains. J Athl Train 2019; 54:589-602. [PMID: 31184957 DOI: 10.4085/1062-6050-472-17] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Copious research exists regarding ankle instability, yet lateral ankle sprains (LASs) persist in being among the most common recurrent musculoskeletal injuries. Key anatomical structures of the ankle include a triform articulating structure that includes the inferior tibiofibular, talocrural, and subtalar joints. Functionally, force absorption and propulsion through the ankle complex are necessary for any task that occurs in weight bearing. For optimal ankle performance and avoidance of injury, an intricate balance between stability and mobility is necessary to ensure that appropriate force transfer occurs during sports and activities of daily living. Consideration for the many structures that may be directly or indirectly involved in LASs will likely translate into advancements in clinical care. In this clinical review, we present the structure, function, and relevant pathologic states of the ankle complex to stimulate a better understanding of the prevention, evaluation, and treatment of LASs.
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Affiliation(s)
| | - Matthew C Hoch
- Sports Medicine Research Institute, University of Kentucky, Lexington
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20
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Comparison between subtalar joint quantitative kinematic 4-D CT parameters in healthy volunteers and patients with joint stiffness or chronic ankle instability: A preliminary study. Eur J Radiol 2019; 114:76-84. [DOI: 10.1016/j.ejrad.2019.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/06/2019] [Accepted: 03/04/2019] [Indexed: 11/18/2022]
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21
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Mansur NSB, Baumfeld TS, Lemos AVKC, Azevedo RMD, Fonseca LFD, Doering J, Nery CAS. Subtalar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series. ACTA ACUST UNITED AC 2019; 65:370-374. [PMID: 30994835 DOI: 10.1590/1806-9282.65.3.370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/10/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. METHODS This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). RESULTS All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. CONCLUSION The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.
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Affiliation(s)
| | - Tiago Soares Baumfeld
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, SP, Brasil
| | | | - Rafael Mohriak de Azevedo
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, SP, Brasil
| | - Lucas Furtado da Fonseca
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, SP, Brasil
| | - Juliana Doering
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, SP, Brasil
| | - Caio Augusto Souza Nery
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, SP, Brasil
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22
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23
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Choisne J, McNally A, Hoch MC, Ringleb SI. Effect of simulated joint instability and bracing on ankle and subtalar joint flexibility. J Biomech 2019; 82:234-243. [PMID: 30442430 DOI: 10.1016/j.jbiomech.2018.10.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 12/26/2022]
Abstract
It is clinically challenging to distinguish between ankle and subtalar joints instability in vivo. Understanding the changes in load-displacement at the ankle and subtalar joints after ligament injuries may detect specific changes in joint characteristics that cannot be detected by investigating changes in range of motion alone. The effect of restricting joints end range of motion with ankle braces was already established, but little is known about the effect of an ankle brace on the flexibility of the injured ankle and subtalar joints. Therefore, the purposes of this study were to (1) understand how flexibility is affected at the ankle and subtalar joints after sectioning lateral and intrinsic ligaments during combined sagittal foot position and inversion and during internal rotation and (2) investigate the effect of a semi-rigid ankle brace on the ankle and subtalar joint flexibility. Kinematics and kinetics were collected from nine cadaver feet during inversion through the range of ankle flexion and during internal rotation. Motion was applied with and without a brace on an intact foot and after sequentially sectioning the calcaneofibular ligament (CFL) and the intrinsic ligaments. Segmental flexibility was defined as the slope of the angle-moment curve for each 1 Nm interval. Early flexibility significantly increased at the ankle and subtalar joint after CFL sectioning during inversion. The semi-rigid ankle brace significantly decreased early flexibility at the subtalar joint during inversion and internal rotation for all ligament conditions and at the ankle joint after all ligaments were cut.
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Affiliation(s)
- Julie Choisne
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Anthony McNally
- Mechanical and Aerospace Engineering, Old Dominion University, Norfolk, VA, USA
| | - Matthew C Hoch
- Division of Athletic Training and Sports Medicine Research Institute, University of Kentucky, Lexinton, KY, USA
| | - Stacie I Ringleb
- Mechanical and Aerospace Engineering, Old Dominion University, Norfolk, VA, USA.
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24
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Affiliation(s)
- Ryan J Donegan
- 1 GRAD Institute, St Francis Hospital, Hartford, CT, USA
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25
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Abstract
Subtalar joint stability is ensured by the osseous geometry of the talocalcaneal joint and the complex array of the ligaments at the medial and lateral aspect of the ankle joint, the sinus and canalis tarsi, and the talocalcaneonavicular joint, respectively. There is still a substantial lack of knowledge about the interaction of the ankle and subtalar joint complex. Subtalar joint instability appears to be more frequent than is generally assumed. The diagnosis of chronic subtalar joint instability makes the application of a comprehensive algorithm necessary. There is ongoing debate about the preferable techniques for restoration of subtalar joint stability.
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Affiliation(s)
- Thomas Mittlmeier
- Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Schillingallee 35, Rostock D-18057, Germany.
| | - Stefan Rammelt
- University Center for Orthopedics and Traumatology, University Hospital "Carl Gustav Carus", TU Dresden, Fetscherstr. 74, Dresden D-01307, Germany
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26
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Kim TH, Moon SG, Jung HG, Kim NR. Subtalar instability: imaging features of subtalar ligaments on 3D isotropic ankle MRI. BMC Musculoskelet Disord 2017; 18:475. [PMID: 29162077 PMCID: PMC5696773 DOI: 10.1186/s12891-017-1841-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND MRI analysis of subtalar ligaments in the tarsal sinus has not been well performed. We retrospectively investigated the appearance of subtalar ligaments using 3D isotropic MRI and compared imaging findings of subtalar ligaments between patients with subtalar instability (STI) and controls. METHODS Preoperative MRIs of 23 STI patients treated with arthroscopic subtalar reconstruction were compared to MRIs of 23 age- and sex-matched control subjects without STI. Thickness and width of anterior capsular ligament (ACL) and interosseous talocalcaneal ligament (ITCL) as well as thickness of calcaneofibular ligament (CFL) and anterior talofibular ligament (ATFL) were measured. Abnormalities in ACL, ITCL, CFL, ATFL, cervical ligament, and inferior extensor retinaculum were analyzed. RESULTS STI patients had significantly smaller ACL thickness and ACL width than controls (ACL thickness: 1.73 mm vs. 2.22 mm, p = 0.007; ACL width: 7.21 mm vs. 8.80 mm, p = 0.004). ACL thickness of ≤2.1 mm had a sensitivity of 66.7% and a specificity of 66.7% for diagnosis of STI. ACL width of ≤7.9 mm had a sensitivity of 80.0% and a specificity of 76.2% for the diagnosis of STI. However, thickness and width of ITCL, thickness of CFL, or thickness of ATFL was not significantly different between the two groups. Absence or complete tear of ACL was significantly more frequent in STI patients than that in controls (34.8% vs. 8.7%, p = 0.035). Complete tear of CFL and ATFL was more common in STI patients than that in controls, although the difference between the two groups was not statistically significant. Abnormalities of ITCL, cervical ligament, or inferior extensor retinaculum were not significantly different between the two groups. CONCLUSIONS MRI features of thin or narrow ACLs may suggest STI. Absence or complete tear of ACL was significantly more common in STI patients than that in controls.
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Affiliation(s)
- Tae Hyung Kim
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea
| | - Sung Gyu Moon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea.
| | - Hong-Geun Jung
- Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Na Ra Kim
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea
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27
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Abstract
Subtalar joint anatomy is complex and can vary significantly between individuals. Movement is affected by several adjacent joints, ligaments and periarticular tendons. The subtalar joint has gained interest from foot and ankle surgeons in recent years, but its importance in hindfoot disorders is still under debate. The purpose of this article is to give a general overview of the anatomy, biomechanics and radiographic assessment of the subtalar joint. The influence of the subtalar joint on the evolution of ankle joint osteoarthritis is additionally discussed.
Cite this article: EFORT Open Rev 2017;2:309-316. DOI: 10.1302/2058-5241.2.160050
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Affiliation(s)
- Nicola Krähenbühl
- Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Tamara Horn-Lang
- Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Beat Hintermann
- Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Markus Knupp
- Mein Fusszentrum, Eichenstrasse 31, 4054 Basel, Switzerland
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28
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Mittlmeier T. Focus on osteo-ligamentous injuries around the ankle. Eur J Trauma Emerg Surg 2015; 41:585-6. [PMID: 26545905 DOI: 10.1007/s00068-015-0591-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/17/2015] [Indexed: 10/22/2022]
Affiliation(s)
- T Mittlmeier
- Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Rostock, Germany.
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