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Li Y, Tong J, Wang H, Ji X, Hua Y, Cheng CK. Investigation into the effect of deltoid ligament injury on rotational ankle instability using a three-dimensional ankle finite element model. Front Bioeng Biotechnol 2024; 12:1386401. [PMID: 38751867 PMCID: PMC11094218 DOI: 10.3389/fbioe.2024.1386401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
Background Injury to the lateral collateral ligament of the ankle may cause ankle instability and, when combined with deltoid ligament (DL) injury, may lead to a more complex situation known as rotational ankle instability (RAI). It is unclear how DL rupture interferes with the mechanical function of an ankle joint with RAI. Purpose To study the influence of DL injury on the biomechanical function of the ankle joint. Methods A comprehensive finite element model of an ankle joint, incorporating detailed ligaments, was developed from MRI scans of an adult female. A range of ligament injury scenarios were simulated in the ankle joint model, which was then subjected to a static standing load of 300 N and a 1.5 Nm internal and external rotation torque. The analysis focused on comparing the distribution and peak values of von Mises stress in the articular cartilages of both the tibia and talus and measuring the talus rotation angle and contact area of the talocrural joint. Results The dimensions and location of insertion points of ligaments in the finite element ankle model were adopted from previous anatomical research and dissection studies. The anterior drawer distance in the finite element model was within 6.5% of the anatomical range, and the talus tilt angle was within 3% of anatomical results. During static standing, a combined rupture of the anterior talofibular ligament (ATFL) and anterior tibiotalar ligament (ATTL) generates new stress concentrations on the talus cartilage, which markedly increases the joint contact area and stress on the cartilage. During static standing with external rotation, the anterior talofibular ligament and anterior tibiotalar ligament ruptured the ankle's rotational angle by 21.8% compared to an intact joint. In contrast, static standing with internal rotation led to a similar increase in stress and a nearly 2.5 times increase in the talus rotational angle. Conclusion Injury to the DL altered the stress distribution in the tibiotalar joint and increased the talus rotation angle when subjected to a rotational torque, which may increase the risk of RAI. When treating RAI, it is essential to address not only multi-band DL injuries but also single-band deep DL injuries, especially those affecting the ATTL.
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Affiliation(s)
- Yuandong Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
| | - Jiahui Tong
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Huizhi Wang
- Center for Intelligent Medical Equipment and Devices, Institute for Innovative Medical Devices, University of Science and Technology of China, Hefei, China
- Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, China
| | - Xiaoxi Ji
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Cheng-Kung Cheng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China
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Shi J, Chang Q, Ma M, Wang P, Li J. Diagnostic value of measuring the talofibular space using stress sonography in chronic lateral ankle instability. Eur J Radiol 2024; 170:111273. [PMID: 38113672 DOI: 10.1016/j.ejrad.2023.111273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To investigate the diagnostic value of measuring the talofibular space using stress sonography for chronic lateral ankle instability (CLAI). MATERIALS & METHODS We recruited patients who were clinically diagnosed with CLAI between October 2018 and December 2019 (CLAI group). A control group of healthy volunteers was also included for this study. Both groups underwent a preliminary stress sonographic examination. First, the ultrasonic characteristics of the anterior talofibular ligament (ATFL), including length, thickness, relaxation, calcification, and rupture, were observed using conventional sonography. Second, the talofibular space at the passive neutral position (D1) and maximum varus position (D2) was measured (by stress sonographic images), and the difference (ΔD = D1-D2) between them was determined. Third, the parameters of the two groups were statistically compared. Finally, receiver operating characteristic (ROC) curves and area under the curve (AUC) analyses were performed for parameters with significant differences. RESULTS The CLAI group comprised 60 patients, yielding data on 60 ankles, whereas the control group comprised 35 participants, yielding data for 70 ankles. Differences in D1, D2, and ΔD of the talofibular space between the two groups were significant, with ΔD proving to be the best diagnostic indicator (P < 0.001). Its AUC, optimal cutoff value, sensitivity, and specificity were 0.922, 0.11 cm, 73 %, and 94 %, respectively, followed by D2 (0.850, 0.47 cm, 67 %, and 94 %, respectively; P < 0.001) and D1 (0.635, 0.47 cm, 67 %, and 94 %, respectively; P = 0.006). CONCLUSION Measurement of talofibular space in stress sonography is a valuable diagnostic indicator for CLAI, especially the ΔD between the neutral and stress position.
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Affiliation(s)
- Jinjun Shi
- Department of Ultrasound, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
| | - Qin Chang
- Department of Orthopedics, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
| | - Ming Ma
- Department of Rehabilitation, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
| | - Pingping Wang
- Department of Ultrasound, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
| | - Jia Li
- Department of Ultrasound, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
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do Amaral E Castro A, Godoy-Santos AL, Taneja AK. Advanced Imaging in the Chronic Lateral Ankle Instability: An Algorithmic Approach. Foot Ankle Clin 2023; 28:265-282. [PMID: 37137622 DOI: 10.1016/j.fcl.2022.12.005] [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
Imaging examinations are a fundamental part of assessing chronic lateral ankle instability (CLAI). Plain radiographs are used in the initial examination, whereas stress radiographs can be requested to actively search for instability. Ultrasonography (US) and Magnetic Resonance Imaging (MRI) allow direct visualization of ligamentous structures, with the advantage of dynamic evaluation for US, and assessment of associated lesions and intra-articular abnormalities for MRI, which plays an essential role in surgical planning. This article reviews imaging methods to diagnose and follow up on CLAI, along with illustrative cases and an algorithmic approach.
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Affiliation(s)
- Adham do Amaral E Castro
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Jardim Leonor, São Paulo - SP, 05652-900, Brasil; Universidade Federal de São Paulo, Rua Napoleão de Barros, 800 - Vila Clementino - CEP 04024-002 - São Paulo, SP, Brasil
| | - Alexandre Leme Godoy-Santos
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Jardim Leonor, São Paulo - SP, 05652-900, Brasil; Faculdade de Medicina, USP, R. Dr. Ovídio Pires de Campos, 333 - Cerqueira César, São Paulo - SP, 05403-010, Brasil
| | - Atul K Taneja
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Jardim Leonor, São Paulo - SP, 05652-900, Brasil; Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9316, USA.
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Murahashi Y, Teramoto A, Takahashi K, Okada Y, Okimura S, Imamura R, Kawai M, Watanabe K, Yamashita T. High reproducibility of a novel supported anterior drawer test for diagnosing ankle instability. BMC Musculoskelet Disord 2023; 24:148. [PMID: 36849957 PMCID: PMC9969681 DOI: 10.1186/s12891-023-06246-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/15/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND The manual traditional anterior drawer test (ADT) is essential for deciding the treatment for chronic ankle instability, but it has been shown to have a comparatively low reproducibility and accuracy, especially in less experienced hands. To clarify the inter-examiner reproducibility, we compared the actual distance of anterior translation between junior and senior examiners in ADT. We also evaluated the diagnostic abilities of traditional ADT, and a novel modified ADT (supported ADT). METHODS Thirty ankles were included in this study, and ankle instability was defined using stress radiography. All subjects underwent two methods of manual ADT by junior and senior examiners, and ankle instability was judged in a blinded fashion. The anterior drawer distance was calculated from the lengthening measured using a capacitance-type sensor device. RESULTS The degree of anterior translation determined by the junior examiner was significantly lower than that determined by the senior examiner when traditional ADT was performed (3.3 vs. 4.5 mm, P = 0.016), but there was no significant difference in anterior translation between the two examiners when supported ADT was performed (4.6 vs. 4.1 mm, P = 0.168). The inter-examiner reliability of supported ADT was higher than that of traditional ADT. For the junior examiner, the diagnostic accuracy of supported ADT was higher than that of traditional ADT (sensitivity, 0.40 vs. 0.80; specificity, 0.75 vs. 0.80). CONCLUSION Supported ADT may have the advantage of being a simple manual test of ankle instability with less error between examiners.
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Affiliation(s)
- Yasutaka Murahashi
- grid.263171.00000 0001 0691 0855Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo, 060-8543 Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo, 060-8543, Japan.
| | - Katsunori Takahashi
- grid.263171.00000 0001 0691 0855Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo, 060-8543 Japan
| | - Yohei Okada
- grid.263171.00000 0001 0691 0855Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo, 060-8543 Japan
| | - Shinichiro Okimura
- grid.263171.00000 0001 0691 0855Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo, 060-8543 Japan
| | - Rui Imamura
- grid.470107.5Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, S-1, W-16, Chuo-Ku, Sapporo, 060-8543 Japan
| | - Makoto Kawai
- grid.470107.5Division of Rehabilitation, Sapporo Medical University Hospital, S-1, W-16, Chuo-Ku, Sapporo, 060-8543 Japan
| | - Kota Watanabe
- grid.263171.00000 0001 0691 0855Department of Physical Therapy, Sapporo Medical University School of Health Sciences, S-1, W-17, Chuo-Ku, Sapporo, 060-8556 Japan
| | - Toshihiko Yamashita
- grid.263171.00000 0001 0691 0855Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo, 060-8543 Japan
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Bhimani R, Sato G, Saengsin J, Lubberts B, Waryasz G, DiGiovanni CW, Guss D. Fluoroscopic Evaluation of the Role of Syndesmotic Injury in Lateral Ankle Instability in a Cadaver Model. Foot Ankle Int 2022; 43:1482-1492. [PMID: 36047450 DOI: 10.1177/10711007221116567] [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: 02/01/2023]
Abstract
BACKGROUND There is a high prevalence of concomitant lateral ankle ligament injuries and syndesmotic ligamentous injuries. However, it is unclear whether syndesmotic ligaments directly contribute toward the stability of the lateral ankle. Therefore, the aim of this study was to fluoroscopically evaluate the role of the syndesmotic ligaments in stabilizing the lateral ankle. METHODS Twenty-four cadaveric specimens were divided into 3 groups and fluoroscopically evaluated for lateral ankle stability with all syndesmotic and ankle ligaments intact and then following serial differential ligamentous transection. Group 1: (1) anterior talofibular ligament (ATFL), (2) calcaneofibular ligament (CFL), and (3) posterior talofibular ligament (PTFL). Group 2: (1) anterior inferior tibiofibular ligament (AITFL), (2) interosseous ligament (IOL), (3) posterior inferior tibiofibular ligament (PITFL), (4) ATFL, (5) CFL, and (6) PTFL. Group 3: (1) AITFL, (2) ATFL, (3) CFL, (4) IOL, (5) PTFL, and (6) PITFL. At each transection state, 3 loading conditions were used: (1) anterior drawer test performed using 50 and 80 N of direct force, (2) talar tilt <1.7 Nm torque, and (2) lateral clear space (LCS) <1.7 Nm torque. These measurements were in turn compared with those of the stressed intact ligamentous state. Wilcoxon rank-sum test was used to compare the findings of each ligamentous transection state to the intact state. A P value <.05 was considered statistically significant. RESULTS The lateral ankle remained stable after transection of all syndesmotic ligaments (AITFL, IOL, PITFL). However, after additional transection of the ATFL, the lateral ankle became unstable in varus and anterior drawer testing conditions (P values ranging from .036 to .012). Lateral ankle instability was also observed after transection of the ATFL and AITFL in varus and anterior drawer testing conditions (P values ranging from .036 to .012). Subsequent transection of the CFL and PTFL worsened the lateral ankle instability. CONCLUSION Our findings suggest that isolated syndesmosis disruption does not result in lateral ankle instability. However, the lateral ankle became unstable when the syndesmosis was injured along with ATFL disruption. CLINICAL RELEVANCE When combined with ATFL release, disruption of the syndesmosis appeared to destabilize the lateral ankle.
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Affiliation(s)
- Rohan Bhimani
- Foot & Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Go Sato
- Foot & Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Orthopaedic Surgery, Asahikawa medical university, Hokkaido, Japan
| | - Jirawat Saengsin
- Foot & Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Orthopedic Surgery, Faculty of Medicine, Chiang Mai University, Thailand
| | - Bart Lubberts
- Foot & Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Waryasz
- Foot & Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.,Newton-Wellesley Hospital, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher W DiGiovanni
- Foot & Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.,Newton-Wellesley Hospital, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel Guss
- Foot & Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.,Newton-Wellesley Hospital, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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Tsutsumi K, Nakaya U, Koshino Y, Tateno M, Matsumoto K, Tanaka M, Yokoyama M, Horie T, Samukawa M, Kamishima T, Tohyama H. Feasibility of an Ultrasound-Based Method for Measuring Talar Displacement during the Anterior Drawer Stress Test Using a Telos Device: A Preliminary Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042367. [PMID: 35206561 PMCID: PMC8874523 DOI: 10.3390/ijerph19042367] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 11/22/2022]
Abstract
This study was conducted to measured talar displacement using ultrasound during an anterior drawer test (ADT) with a Telos device. Five adults (3 men and 2 women; 8 ankles; mean age: 23.2 y) with a history of ankle sprain and eight adults (5 men and 3 women; 16 ankles; mean age: 22.1 y) without a history of ankle sprain were recruited into a history of ankle sprain (HAS) and a control group, respectively. Talar displacement was observed in response to load forces applied by a Telos device during the ultrasound stress imaging test. The ultrasound probe was placed 5 mm inside from the center of the Achilles tendon on the posterior ankle along the direction of the major axis. The inter-rater reliability for the present method was classified as good and excellent (ICC(2,2) = 0.858 and 0.957 at 120 N and 150 N, respectively) in the control group and excellent (ICC(2,2) = 0.940 and 0.905 at 120 N and 150 N, respectively) in the HAS group, according to specific intraclass correlation coefficient values. We found that talar displacement during the ADT was lower in the HAS group than in the control group. Analysis of the receiver operating characteristic curve revealed that the quantitative ultrasound-based ADT using a Telos device was superior to the X-ray-based test in detecting reduced ankle joint mobility during the ADT (area under the curve of 0.905 and 0.726 at a force of 150 N using ultrasound-based and X-ray-based tests, respectively). Further investigation is needed; nevertheless, this preliminary study suggests that the ultrasound-based quantitative ADT using a Telos device might detect talar displacement more sensitively than the conventional stress X-ray.
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Affiliation(s)
- Kaori Tsutsumi
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan; (Y.K.); (M.S.); (H.T.)
- Correspondence: (K.T.); (T.K.); Tel.: +81-11-706-3421 (K.T.); +81-11-706-2824 (T.K.)
| | - Utayo Nakaya
- Department of Radiological Technology, Hokkaido P.W.F.A.C. Sapporo-Kosei General Hospital, Sapporo 060-0033, Japan;
| | - Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan; (Y.K.); (M.S.); (H.T.)
- Rehabilitation Center, NTT Medical Center Sapporo, Sapporo 060-0061, Japan
| | - Mari Tateno
- Department of Radiological Technology, Nakamura Memorial Hospital, Sapporo 060-8570, Japan;
| | - Kazuhisa Matsumoto
- Department of Radiological Technology, Asahikawa Kosei General Hospital, Asahikawa 078-8211, Japan;
| | - Mai Tanaka
- Department of Radiological Technology, Sapporo Medical Center, Sapporo 064-0810, Japan;
| | - Mika Yokoyama
- Graduate School of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan;
| | - Tatsunori Horie
- Department of Radiological Technology, Hokkaido University Hospital, Sapporo 060-8648, Japan;
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan; (Y.K.); (M.S.); (H.T.)
| | - Tamotsu Kamishima
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan; (Y.K.); (M.S.); (H.T.)
- Correspondence: (K.T.); (T.K.); Tel.: +81-11-706-3421 (K.T.); +81-11-706-2824 (T.K.)
| | - Harukazu Tohyama
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan; (Y.K.); (M.S.); (H.T.)
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