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Nakasa T, Ikuta Y, Kawabata S, Sakurai S, Moriwaki D, Ishibashi S, Silan AA, Adachi N. Clinical significance of posterior talofibular ligament injury in chronic lateral ankle instability. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05598-7. [PMID: 39347966 DOI: 10.1007/s00402-024-05598-7] [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: 06/04/2024] [Accepted: 09/22/2024] [Indexed: 10/01/2024]
Abstract
PURPOSE Although arthroscopic repair of the anterior talofibular ligament (ATFL) is widely performed, the effect of posterior talofibular ligament (PTFL) injury on clinical outcomes remains unclear. This study aimed to evaluate the magnetic resonance imaging (MRI) findings of the PTFL in chronic lateral ankle instability (CLAI) and determine whether the presence or absence of PTFL injury affected the postoperative outcomes of arthroscopic ATFL repair. MATERIALS AND METHODS Forty ankles of 35 patients who underwent arthroscopic repair for CLAI were included in this study as the experimental group, together with 25 ankles of 24 patients without CLAI as the control group. The PTFL thickness (PTFLT) and PTFL cross-sectional area (PTFLCSA) were measured using MRI and compared between the control and CLAI groups. The clinical outcomes of arthroscopic repair were compared between ankles with and without PTFL injuries. RESULTS The mean PTFLT and PTFLCSA values were significantly higher in the CLAI group than in the control group. The PTFLT and PTFLCSA in the PTFL injury group were significantly larger than those in the non-injury group in the CLAI group. Postoperatively, there were no significant differences in clinical scores and talar tilt angles on stress radiographs between ankles with and without PTFL injury; however, instability recurrence was frequently observed in ankles with PTFL injury (32.1%) compared to the ankles without PTFL injury (16.7%). Poor-quality ATFL remnant, ATFL inferior fascicle, and calcaneofibular ligament injuries were frequently observed in ankles with PTFL injuries. CONCLUSIONS Our findings indicate that PTFL injury is highly associated with CLAI but it does not affect postoperative clinical scores. However, postoperative instability recurrence was more often observed in ankles with PTFL injuries, given that they frequently have poor-quality ATFL remnants and CFL injuries. EVIDENCE LEVEL Level III.
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Affiliation(s)
- Tomoyuki Nakasa
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shingo Kawabata
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Satoru Sakurai
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Dan Moriwaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Saori Ishibashi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Asyumaredha Asril Silan
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Orthopaedic and Traumatology Division, Muhammad Djamil Central Hospital, Padang, Indonesia
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Kakegawa A, Sumitomo N, Nagira A, Ichinose Y, Fukushima N. The calcaneofibular ligament groove at the inferior fibula, an ultrasonographic anatomical landmark. Surg Radiol Anat 2024; 46:739-747. [PMID: 38573504 DOI: 10.1007/s00276-024-03346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Calcaneofibular ligament (CFL) injuries are harder to diagnose than anterior talofibular ligament (ATFL) ones. This study aimed to clarify the fibular attachment of the CFL and verify the bony landmark for evaluating the CFL on ultrasonography. METHODS Fifty-nine ankles were used in this anatomical study. To confirm the control function of the CFL, we performed passive movement manually using cadaveric ankles and observed the ankle positions where the CFLs were tense. Histological observation of CFL attachment of the fibula was performed using Masson's trichrome stain. The ATFL and CFL were removed, and the bone morphology of the CFL attachment and inferior fibular end was imaged using a stereomicroscope and a 3D scanner. Using ultrasonography, we evaluated the bone morphology of the fibular attachment of the CFL in short-axis images of 27 healthy adult ankles. RESULTS The CFL was tensed according to ankle motions: supination, maximum dorsi flexion, maximum plantar flexion, and mild plantar flexion-external rotation. Below the CFL attachment of the fibula was a slight groove between the inferior tip and the obscure tubercle of the fibula. This groove was observed in 81.5% of cases using short-axis ultrasonography. CONCLUSION The CFL was tensed in various ankle positions to control the movements of the talocrural and subtalar joints. There was a slight groove at the inferior end of the fibula where the CFL coursed downward. We called it the CFL groove and proposed that it could serve as a landmark for the short-axis image of ultrasonography.
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Affiliation(s)
- Akira Kakegawa
- Faculty of Human Care, Teikyo Heisei University, 2-51-4 Higashi-Ikebukuro, Toshimaku, Tokyo, Japan.
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan.
| | - Norimi Sumitomo
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Ayata Nagira
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Yuko Ichinose
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Nanae Fukushima
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
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Tan Y, Buedts K. Ankle Instability: Facts and Myths to Protect Your Cartilage Repairing. Foot Ankle Clin 2024; 29:321-331. [PMID: 38679442 DOI: 10.1016/j.fcl.2023.07.005] [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: 05/01/2024]
Abstract
The majority of patients with an osteochondral lesion of the talus (OLT) report a history of trauma. Therefore, it is important to assess for concomitant ankle instability when dealing with patients with a symptomatic OLT. The History; Alignment; Ligaments; Others "(HALO)" approach can be a helpful tool in the evaluation of patients with an OLT. If conservative treatment fails, surgery may be indicated. Although there is a lack of comparative studies investigating the effect of stabilization procedures on cartilage repair, we believe that addressing instability is a key factor in improving patient outcome.
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Affiliation(s)
- Yuhan Tan
- Department of Orthopaedics, ZNA Middelheim, Lindendreef 12020 Antwerp, Belgium; Department of Orthopaedics, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium.
| | - Kristian Buedts
- Department of Orthopaedics, ZNA Middelheim, Lindendreef 12020 Antwerp, Belgium
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Nekomoto A, Nakasa T, Ikuta Y, Shimamura Y, Kitamura N, Sumii J, Kawabata S, Adachi N. Quantitative evaluation of calcaneofibular ligament injury on the oblique coronal view of magnetic resonance imaging in chronic lateral ankle instability. J Orthop Sci 2023:S0949-2658(23)00280-4. [PMID: 37926615 DOI: 10.1016/j.jos.2023.10.008] [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] [Received: 07/28/2023] [Revised: 09/12/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND In the treatment of chronic lateral ankle instability (CLAI), the repair of the calcaneofibular ligament (CFL) and anterior talofibular ligament (ATFL) is still being discussed, possibly due to the difficulty in assessing CFL injuries. In particular, it is challenging to evaluate the extent of CFL deficiency quantitively. We hypothesized that CFL tension change would alter morphology of the CFL on magnetic resonance imaging (MRI) and that measuring this morphological change allows assessing CFL injury quantitatively. Thus, this study aimed to analyze the feasibility of quantitatively assessing CFL injuries using MRI. METHODS Sixty-four ankles with CLAI were included and divided into two groups: with (ATFL and CFL group, 31 ankles) or without CFL repair (ATFL group, 33 ankles) in addition to arthroscopic ATFL repair. The angle between the CFL and calcaneal axis (CFLCA) and the bending angles of the CFL was defined as the flexed CFL angle (FCA) were measured on the oblique CFL view of preoperative MRI. The diagnostic abilities of these angles for CFL injury and correlations between these angles and stress radiographs were analyzed. RESULTS The sensitivity and specificity of CFLCA were 86.7 % and 88.7 %, and those of FCA were 63.3 % and 77.4 %, respectively. The combination of CFLCA and FCA improved the sensitivity to 93.3 %. The cutoff points of CFLCA and FCA were 3.8° and 121.2°, respectively. There were significant moderate and weak correlations between the talar tilting angle and CFLCA or FCA (rs = -0.533, and rs = -0.402, respectively). The CFLCA and FCA were significantly smaller in the ATFL and CFL group than those in the other groups. CONCLUSIONS Measurement of CFLCA and FCA in oblique CFL view on MRI could be useful for the quantitative evaluation of CFL injury in patients with CLAI. LEVEL OF EVIDENCE: Level IV. case-control study.
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Affiliation(s)
- Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan.
| | - Yasunari Ikuta
- Sports Medical Center, Hiroshima University Hospital, Japan
| | | | | | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Shingo Kawabata
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
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Malakoutikhah H, Madenci E, Latt LD. A computational model of force within the ligaments and tendons in progressive collapsing foot deformity. J Orthop Res 2023; 41:396-406. [PMID: 35579076 DOI: 10.1002/jor.25380] [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: 01/21/2022] [Revised: 04/17/2022] [Accepted: 05/14/2022] [Indexed: 02/04/2023]
Abstract
Progressive collapsing foot deformity results from degeneration of the ligaments and posterior tibial tendon (PTT). Our understanding of the relationship between their failures remains incomplete. We sought to improve this understanding through computational modeling of the forces in these soft tissues. The impact of PTT and ligament failures on force changes in the remaining ligaments was investigated by quantifying ligament force changes during simulated ligament and tendon cutting in a validated finite element model of the foot. The ability of the PTT to restore foot alignment was also evaluated by increasing the PTT force in a foot with attenuated ligaments and comparing the alignment angles to the intact foot. We found that failure of any one of the ligaments led to overloading the remaining ligaments, except for the plantar naviculocuneiform, first plantar tarsometatarsal, and spring ligaments, where removing one led to unloading the other two. The combined attenuation of the plantar fascia, long plantar, short plantar, and spring ligaments significantly overloaded the deltoid and talocalcaneal ligaments. Isolated PTT rupture had no effect on foot alignment but did increase the force in the deltoid and spring ligaments. Moreover, increasing the force within the PTT to 30% of body weight was effective at restoring foot alignment during quiet stance, primarily through reducing hindfoot valgus and forefoot abduction as opposed to improving arch collapse. Our findings suggest that early intervention might be used to prevent the progression of deformity. Moreover, strengthening the PTT through therapeutic exercise might improve its ability to restore foot alignment.
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Affiliation(s)
- Hamed Malakoutikhah
- Department of Aerospace and Mechanical Engineering, University of Arizona, Tucson, Arizona, USA
| | - Erdogan Madenci
- Department of Aerospace and Mechanical Engineering, University of Arizona, Tucson, Arizona, USA
| | - Leonard Daniel Latt
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona, USA
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Sakakibara Y, Teramoto A, Takagi T, Yamakawa S, Shoji H, Okada Y, Kobayashi T, Kamiya T, Fujimiya M, Fujie H, Watanabe K, Yamashita T. Effects of the Ankle Flexion Angle During Anterior Talofibular Ligament Reconstruction on Ankle Kinematics, Laxity, and In Situ Forces of the Reconstructed Graft. Foot Ankle Int 2022; 43:725-732. [PMID: 35023381 DOI: 10.1177/10711007211069327] [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: 02/01/2023]
Abstract
BACKGROUND This study aimed to evaluate the effects of the ankle flexion angle during anterior talofibular ligament (ATFL) reconstruction on ankle kinematics, laxity, and in situ force of a graft. METHODS Twelve cadaveric ankles were evaluated using a 6-degrees of freedom robotic system to apply passive plantar flexion and dorsiflexion motions and multidirectional loads. A repeated measures experiment was designed using the intact ATFL, transected ATFL, and reconstructed ATFL. During ATFL reconstruction (ATFLR), the graft was fixed at a neutral position (ATFLR 0 degrees), 15 degrees of plantar flexion (ATFLR PF15 degrees), and 30 degrees of plantar flexion (ATFLR PF30 degrees) with a constant initial tension of 10 N. The 3-dimensional path and reconstructed graft tension were simultaneously recorded, and the in situ force of the ATFL and reconstructed grafts were calculated using the principle of superposition. RESULTS The in situ forces of the reconstructed grafts in ATFLR 0 degrees and ATFLR PF 15 degrees were significantly higher than those of intact ankles. The ankle kinematics and laxity produced by ATFLR PF 30 degrees were not significantly different from those of intact ankles. The in situ force on the ATFL was 19.0 N at 30 degrees of plantar flexion. In situ forces of 41.0, 33.7, and 21.9 N were observed at 30 degrees of plantar flexion in ATFLR 0, 15, and 30 degrees, respectively. CONCLUSION ATFL reconstruction with the peroneus longus (PL) tendon was performed with the graft at 30 degrees of plantar flexion resulted in ankle kinematics, laxity, and in situ forces similar to those of intact ankles. ATFL reconstructions performed with the graft fixed at 0 and 15 degrees of the plantar flexion resulted in higher in situ forces on the reconstructed graft. CLINICAL RELEVANCE Fixing the ATFL tendon graft at 30 degrees of plantar flexion results in an in situ force closest to that of an intact ankle and avoids the excessive tension on the reconstructed graft.
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Affiliation(s)
- Yuzuru Sakakibara
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Atsushi Teramoto
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tetsuya Takagi
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
| | - Satoshi Yamakawa
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
| | - Hiroaki Shoji
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yohei Okada
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Takuma Kobayashi
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tomoaki Kamiya
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Mineko Fujimiya
- Department of Anatomy, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Hiromichi Fujie
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
| | - Kota Watanabe
- Department of Physical Therapy, Sapporo Medical University School of Health Science, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Higuchi S, Ogawa M, Masuda Y, Yamazaki T, Ozeki S. 3D-CT stress test for the assessment of CFL insufficiency. J Orthop Sci 2021; 26:1074-1080. [PMID: 33298330 DOI: 10.1016/j.jos.2020.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/29/2020] [Accepted: 10/19/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND Following ankle sprains, some patients complain of their ankles "giving way," characterized by functional instability with no positive findings in traditional stress tests. The calcaneofibular ligament (CFL) may contribute to the stabilization of the subtalar and talocrural joints, and some functional instability may be due to CFL insufficiency. We aimed to clarify and quantitatively assess CFL insufficiency with three-dimensional stress computer tomography (CT) using the Pronation-External Rotation Stress Test (PERST). METHODS Ten patients who tested positive under PERST and underwent an isolated CFL reconstruction were included. Using a custom-made loading jig, we used the Supination-Internal Rotation Stress Test (SIRST) and PERST to assess the function of anterior talofibular ligament (ATFL) and CFL, respectively. 3D-CT in neutral position was used as a baseline, and we quantified the distance between the origin and insertion of the CFL and ATFL at 2 years pre- and postoperatively. RESULTS Postoperative scores improved in all patients with no giving way symptoms. The preoperative length of the CFL increased by 14.0% from baseline under PERST, while the postoperative length only increased by 2.0% and was significantly restricted (P < .01). The pre- and postoperative length of ATFL was increased by 7.5% and 9.0% from baseline under SIRST, respectively, with no significant difference (P = .41). The clinical function improved with significantly less change in distance between the origin and insertion under PERST and showed no difference under SIRST. CONCLUSION The 3D-CT stress test may be useful for quantifying pre- and postoperative CFL function. CFL insufficiency is one of the main causes of subtalar joint instability; therefore, measuring the distance between the origin and insertion of the CFL could provide the means to quantify the instability of the subtalar joint.
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Affiliation(s)
- Shohei Higuchi
- Department of Orthopaedics, Shinshu University School of Medicine, Japan.
| | - Masato Ogawa
- First Department of Orthopaedics, Dokkyo Medical University Saitama Medical Center, Japan
| | - Yoko Masuda
- First Department of Orthopaedics, Dokkyo Medical University Saitama Medical Center, Japan
| | - Takayuki Yamazaki
- First Department of Orthopaedics, Dokkyo Medical University Saitama Medical Center, Japan
| | - Satoru Ozeki
- First Department of Orthopaedics, Dokkyo Medical University Saitama Medical Center, Japan
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Edama M, Takabayashi T, Yokota H, Hirabayashi R, Sekine C, Maruyama S, Syagawa M, Togashi R, Yamada Y, Otani H. Number of fiber bundles in the fetal anterior talofibular ligament. Surg Radiol Anat 2021; 43:2077-2081. [PMID: 34379153 DOI: 10.1007/s00276-021-02816-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE For the anterior talofibular ligament (ATFL), a three-fiber bundle has recently been suggested to be weaker than a single or double fiber bundle in terms of ankle plantarflexion and inversion braking function. However, the studies leading to those results all used elderly specimens. Whether the difference in fiber bundles is a congenital or an acquired morphology is important when considering methods to prevent ATFL damage. The purpose of this study was to classify the number of fiber bundles in the ATFL of fetuses. METHODS This study was conducted using 30 legs from 15 Japanese fetuses (mean weight, 1764.6 ± 616.9 g; mean crown-rump length, 283.5 ± 38.7 mm; 8 males, 7 females. The ATFL was then classified by the number of fiber bundles: Type I, one fiber bundle; Type II, two fiber bundles; and Type III, three fiber bundles. RESULTS Ligament type was Type I in 5 legs (16.7%), Type II in 21 legs (70%), and Type III in 4 legs (13.3%). CONCLUSION The present results suggest that the three fiber bundles of the structure of the ATFL may be an innate structure.
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Affiliation(s)
- Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan.
| | - Tomoya Takabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Mayuu Syagawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Ryoya Togashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Yuki Yamada
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata, 950-3198, Japan
| | - Hiroki Otani
- Department of Developmental Biology, Faculty of Medicine, Shimane University, Izumo, Japan
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Takao M, Lowe D, Ozeki S, Oliva XM, Inokuchi R, Yamazaki T, Takeuchi Y, Kubo M, Matsui K, Katakura M, Glazebrook M. Strain patterns in normal anterior talofibular and calcaneofibular ligaments and after anatomical reconstruction using gracilis tendon grafts: A cadaver study. BMC Musculoskelet Disord 2021; 22:558. [PMID: 34144675 PMCID: PMC8214304 DOI: 10.1186/s12891-021-04444-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/31/2021] [Indexed: 12/26/2022] Open
Abstract
Background Inversion ankle sprains, or lateral ankle sprains, often result in symptomatic lateral ankle instability, and some patients need lateral ankle ligament reconstruction to reduce pain, improve function, and prevent subsequent injuries. Although anatomically reconstructed ligaments should behave in a biomechanically normal manner, previous studies have not measured the strain patterns of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) after anatomical reconstruction. This study aimed to measure the strain patterns of normal and reconstructed ATFL and CFLs using the miniaturization ligament performance probe (MLPP) system. Methods The MLPP was sutured into the ligamentous bands of the ATFLs and CTLs of three freshly frozen cadaveric lower-extremity specimens. Each ankle was manually moved from 15° dorsiflexion to 30° plantar flexion, and a 1.2-N m force was applied to the ankle and subtalar joint complex. Results The normal and reconstructed ATFLs exhibited maximal strain (100) during supination in three-dimensional motion. Although the normal ATFLs were not strained during pronation, the reconstructed ATFLs demonstrated relative strain values of 16–36. During the axial motion, the normal ATFLs started to gradually tense at 0° plantar flexion, with the strain increasing as the plantar flexion angle increased, to a maximal value (100) at 30° plantar flexion; the reconstructed ATFLs showed similar strain patterns. Further, the normal CFLs exhibited maximal strain (100) during plantar flexion-abduction and relative strain values of 30–52 during dorsiflexion in three-dimensional motion. The reconstructed CFLs exhibited the most strain during dorsiflexion-adduction and demonstrated relative strain values of 29–62 during plantar flexion-abduction. During the axial motion, the normal CFLs started to gradually tense at 20° plantar flexion and 5° dorsiflexion. Conclusion Our results showed that the strain patterns of reconstructed ATFLs and CFLs are not similar to those of normal ATFLs and CFLs.
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Affiliation(s)
- Masato Takao
- Clinical and Research Institute for Foot and Ankle Surgery, 341-1, Mangoku, Kisarazu, Chiba, 292-0003, Japan.
| | - Danielle Lowe
- Department of Orthopaedic Surgery, Lions Gate Hospital, North Vancouver, BC, Canada
| | - Satoru Ozeki
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Xavier M Oliva
- Department of Human Anatomy, University of Barcelona, Calle Casanova, 143, 08038, Barcelona, Spain
| | - Ryota Inokuchi
- Clinical and Research Institute for Foot and Ankle Surgery, 341-1, Mangoku, Kisarazu, Chiba, 292-0003, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, Japan
| | - Takayuki Yamazaki
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Yoshitaka Takeuchi
- Tokyo National College of Technology, 1220-2, Kunugida-machi, Hachioji, Tokyo, Japan
| | - Maya Kubo
- Department of Orthopaedic Surgery, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, Japan
| | - Kentaro Matsui
- Department of Orthopaedic Surgery, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, Japan
| | - Mai Katakura
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, Japan
| | - Mark Glazebrook
- Division of Orthopaedic Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Center Halifax Infirmary (Suite 4867), 1796 Summer Street, Halifax, NS, B3H3A7, Canada
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Takeuchi Y, Inokuchi R, Takao M, Glazebrook M, Martin Oliva X, Yamazaki T, Kubo M, Lowe D, Matsui K, Katakura M, Ozeki S. Three-dimensional analysis of anterior talofibular ligament strain patterns during cadaveric ankle motion using a miniaturized ligament performance probe. BMC Musculoskelet Disord 2021; 22:208. [PMID: 33610165 PMCID: PMC7897380 DOI: 10.1186/s12891-021-04058-2] [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: 02/21/2020] [Accepted: 02/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background Measuring the strain patterns of ligaments at various joint positions informs our understanding of their function. However, few studies have examined the biomechanical properties of ankle ligaments; further, the tensile properties of each ligament, during motion, have not been described. This limitation exists because current biomechanical sensors are too big to insert within the ankle. The present study aimed to validate a novel miniaturized ligament performance probe (MLPP) system for measuring the strain patterns of the anterior talofibular ligament (ATFL) during ankle motion. Methods Six fresh-frozen, through-the-knee, lower extremity, cadaveric specimens were used to conduct this study. An MLPP system, comprising a commercially available strain gauge (force probe), amplifier unit, display unit, and logger, was sutured into the midsubstance of the ATFL fibers. To measure tensile forces, a round, metal disk (a “clock”, 150 mm in diameter) was affixed to the plantar aspect of each foot. With a 1.2-Nm load applied to the ankle and subtalar joint complex, the ankle was manually moved from 15° dorsiflexion to 30° plantar flexion. The clock was rotated in 30° increments to measure the ATFL strain detected at each endpoint by the miniature force probe. Individual strain data were aligned with the neutral (0) position value; the maximum value was 100. Results Throughout the motion required to shift from 15° dorsiflexion to 30° plantar flexion, the ATFL tensed near 20° (plantar flexion), and the strain increased as the plantar flexion angle increased. The ATFL was maximally tensioned at the 2 and 3 o’clock (inversion) positions (96.0 ± 5.8 and 96.3 ± 5.7) and declined sharply towards the 7 o’clock position (12.4 ± 16.8). Within the elastic range of the ATFL (the range within which it can return to its original shape and length), the tensile force was proportional to the strain, in all specimens. Conclusion The MLPP system is capable of measuring ATFL strain patterns; thus, this system may be used to effectively determine the relationship between limb position and ATFL ankle ligament strain patterns.
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Affiliation(s)
- Yoshitaka Takeuchi
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Ryota Inokuchi
- Clinical and Research Institute for Foot and Ankle Surgery, 341-1, Mangoku, Kisarazu, 292-0003, Chiba, Japan.,Department of Health Services Research Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Ibaraki, Tsukuba, Japan
| | - Masato Takao
- Clinical and Research Institute for Foot and Ankle Surgery, 341-1, Mangoku, Kisarazu, 292-0003, Chiba, Japan.
| | - Mark Glazebrook
- Division of Orthopaedic Surgery, Dalhousie University and the Queen Elizabeth to health Sciences center, 1796 Summer St, Nova Scotia, Halifax, Canada
| | - Xavier Martin Oliva
- Department of Human Anatomy, University of Barcelona, Calle Casanova, 143, 08038, Barcelona, Spain
| | - Takayuki Yamazaki
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Maya Kubo
- Department of Orthopaedic Surgery, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, Japan
| | - Danielle Lowe
- Division of Orthopaedic Surgery, Lions Gate Hospital, 231 East 15th Street, BC, North Vancouver, Canada
| | - Kentaro Matsui
- Department of Orthopaedic Surgery, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, Japan
| | - Mai Katakura
- Clinical and Research Institute for Foot and Ankle Surgery, 341-1, Mangoku, Kisarazu, 292-0003, Chiba, Japan
| | - Satoru Ozeki
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minamikoshigaya, Koshigaya, Saitama, Japan
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11
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Diagnosis and Treatment of Chronic Lateral Ankle Instability: Review of Our Biomechanical Evidence. J Am Acad Orthop Surg 2021; 29:3-16. [PMID: 33347006 DOI: 10.5435/jaaos-d-20-00145] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 09/10/2020] [Indexed: 02/01/2023] Open
Abstract
Definitive diagnosis and optimal surgical treatment of chronic lateral ankle instability remains controversial. This review distills available biomechanical evidence as it pertains to the clinical assessment, imaging work up, and surgical treatment of lateral ankle instability. Current data suggest that accurate assessment of ligament integrity during physical examination requires the ankle to ideally be held in 16° of plantar flexion when performing the anterior drawer test and 18° of dorsiflexion when performing the talar tilt test, respectively. Stress radiographs are limited by their low sensitivity, and MRI is limited by its static nature. Surgically, both arthroscopic and open repair techniques appear biomechanically equivalent in their ability to restore ankle stability, although sufficient evidence is still lacking for any particular procedure to be considered a superior construct. When performing reconstruction, grafts should be tensioned at 10 N and use of nonabsorbable augmentations lacking viscoelastic creep must factor in the potential for overtensioning. Anatomic lateral ligament surgery provides sufficient biomechanical strength to safely enable immediate postoperative weight bearing if lateral ankle stress is neutralized with a boot. Further research and comparative clinical trials will be necessary to define which of these ever-increasing procedural options actually optimizes patient outcome for chronic lateral ankle instability.
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12
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Lee S, Oliveira I, Pressney I, Welck M, Saifuddin A. The horizontal calcaneofibular ligament: a sign of hindfoot valgus on ankle MRI. Skeletal Radiol 2020; 49:739-746. [PMID: 31811347 DOI: 10.1007/s00256-019-03347-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 11/05/2019] [Accepted: 11/10/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Hindfoot valgus malalignment has been assessed on coronal MRI by the measurement of the tibio-calcaneal (TC) angle and apparent moment arm (AMA). This study aimed to determine if the calcaneofibular ligament (CFL) angle could be used as a further marker of hindfoot valgus malalignment on routine non-weight-bearing ankle MRI. MATERIAL AND METHODS One hundred ninety-five consecutive 3-T ankle MRI studies were identified from the hospital PACS system. The TC and CFL angles could be measured in 155 cases (78%), and the AMA on 153 cases. RESULTS The study group comprised 56 males and 72 females with a mean age of 46 years (range 4-89 years). In 27 patients, both ankles had been imaged. The Pearson correlation between the TC and CFL angles was -0.43, with a corresponding p value of 0.001 indicating a strong negative correlation between the TC and CFL angles. The CFL angle was significantly lower in those with hindfoot valgus (113 ± 14) compared with those without (123° ± 15°) (p = 0.001). The optimal cut-off point of the CFL angle for hindfoot valgus was ≤119°, with a sensitivity and specificity of 66% and 63% respectively. The Pearson correlation between the CFL angle and AMA was -0.10, with a corresponding p value of 0.21 indicating a weak negative correlation that did not reach statistical significance. CONCLUSION Hindfoot valgus as estimated by the increased TC angle on coronal non-weight-bearing ankle MRI is associated with a reduced CFL angle on sagittal MR images, but is not associated with AMA. Therefore, a horizontal orientation of the CFL on sagittal MR images may be a further useful sign of hindfoot valgus.
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Affiliation(s)
- Sangoh Lee
- Department of Clinical Imaging, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK. .,Royal National Orthopaedic Hospital NHS Trust, Brockley Hill Stanmore, HA7 4LP, UK.
| | - Ines Oliveira
- Royal National Orthopaedic Hospital NHS Trust, Brockley Hill Stanmore, HA7 4LP, UK.
| | - Ian Pressney
- Royal National Orthopaedic Hospital NHS Trust, Brockley Hill Stanmore, HA7 4LP, UK
| | - Matthew Welck
- Royal National Orthopaedic Hospital NHS Trust, Brockley Hill Stanmore, HA7 4LP, UK.
| | - Asif Saifuddin
- Royal National Orthopaedic Hospital NHS Trust, Brockley Hill Stanmore, HA7 4LP, UK. .,Everlight Radiology, Level 6, West, 350 Euston Rd, London, UK.
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13
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Palazzi E, Siegler S, Balakrishnan V, Leardini A, Caravaggi P, Belvedere C. Estimating the stabilizing function of ankle and subtalar ligaments via a morphology-specific three-dimensional dynamic model. J Biomech 2020; 98:109421. [PMID: 31653506 DOI: 10.1016/j.jbiomech.2019.109421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/05/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022]
Abstract
Knowledge of the stabilizing role of the ankle and subtalar ligaments is important for improving clinical techniques such as ligament repair and reconstruction. However, this knowledge is incomplete. The goal of this study was to expand this knowledge by investigating the stabilizing function of the ligaments using multiple morphologically subject-specific computational models. Nine models were created from the lower extremities of nine donors. Each model consisted of the articulating bones, articular cartilage, and ligaments. Simulations were conducted in ADAMS™ - a dynamic simulation program. During simulation, tibia and fibula were fixed while cyclic moments in all three anatomical planes were applied to the calcaneus one-at-a-time. The resulting displacements between the bones and the forces in each ligament were computed. Simulations were conducted with all ligaments intact and after simulated ligament serial sectioning. Each model was validated by comparing the simulation results to experimental data obtained from the specimen used to construct the model. From the results the stabilizing role of each ligament was established and the effect of ligament sectioning on Range of Motion and Overall Laxity was identified. On the lateral side, ATFL provided stabilization in supination, CFL restrained inversion, external rotation and dorsiflexion and PTFL limited dorsiflexion and external rotation. On the medial side, PTTL restrained dorsiflexion and internal rotation, ATTL limited plantarflexion and external rotation, and TCL limited dorsiflexion, eversion and external rotation. At the subtalar joint, ITCL limited plantarflexion and its posterior-lateral bundle restrained subtalar inversion. CL restrained plantarflexion/dorsiflexion, and internal and external rotation. The large inter-model variability observed in the results indicate the importance of using multiple subject-specific models rather than relying on one "representative" model.
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Affiliation(s)
- Emanuele Palazzi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Industrial Engineering, University of Bologna, Italy; Department of Mechanical Engineering, Drexel University, Philadelphia, PA, USA
| | - Sorin Siegler
- Department of Mechanical Engineering, Drexel University, Philadelphia, PA, USA.
| | | | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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14
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Higashiyama R, Sekiguchi H, Takata K, Katagiri A, Inoue G, Takaso M. Anatomical Arthroscopic Anterior Talofibular Ligament Repair and Reconstruction Using a Free Tendon. Arthrosc Tech 2019; 9:e21-e28. [PMID: 32021769 PMCID: PMC6993106 DOI: 10.1016/j.eats.2019.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/23/2019] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic techniques for anterior talofibular ligament (ATFL) repair and reconstruction have been developed in recent years. We simultaneously performed anatomical arthroscopic ATFL repair and reconstruction using a free tendon graft. The ATFL remnant is carefully dissected only at the footprint of the superior limb of the ATFL, and a bone tunnel is created on each side of the fibula and talus. A soft suture anchor with 2 sets of threads is inserted into the fibular tunnel. One set of threads is used to grab the ATFL remnant via a lasso-loop technique, whereas the other set of threads is used to introduce the ATFL graft. The graft is first fixed with a screw in the talar tunnel. Subsequently, the ATFL remnant and the graft are tightened simultaneously by pulling the 2 sets of suture anchor threads at the fibular tunnel and are fixed with a screw. This technique provides the possible advantages of remnant preservation and promotion of load sharing by the repaired ATFL remnant and the reconstructed ATFL graft.
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Affiliation(s)
- Reiji Higashiyama
- Department of Orthopaedic Surgery, Shonantobu General Hospital, Chigasaki,Address correspondence to Reiji Higashiyama, M.D., Ph.D., Department of Orthopaedic Surgery, Shonantobu General Hospital, 500, Nishikubo, Chigasaki, Kanagawa, 253-0083, Japan.
| | - Hiroyuki Sekiguchi
- Department of Orthopaedic Surgery, Shonantobu General Hospital, Chigasaki
| | - Ken Takata
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara
| | - Akira Katagiri
- Department of Orthopaedic Surgery, Fuji Orthopaedic Surgery Hospital, Fuji, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara
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15
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Relationships between differences in the number of fiber bundles of the anterior talofibular ligament and differences in the angle of the calcaneofibular ligament and their effects on ankle-braking function. Surg Radiol Anat 2019; 41:675-679. [PMID: 30993419 DOI: 10.1007/s00276-019-02239-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/08/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim was to clarify the relationships between differences in the number of fiber bundles of the anterior talofibular ligament (ATFL) and differences in the angle of the calcaneofibular ligament (CFL) with respect to the long axis of the fibula and their effects on ankle braking function. METHODS The study sample included 110 Japanese cadavers. ATFLs were categorized as: Type I with one fiber bundle; Type II with two fiber bundles with incomplete separation and complete separation; and Type III with three fiber bundles. The CFLs were categorized according to the angles of the CFLs with respect to the long axis of the fibula and the number of fiber bundles. Six categories were established: CFL10° (angle of the CFL with respect to the long axis of the fibula from 10° to 19°); CFL20° (range 20°-29°); CFL30° (range 30°-39°); CFL40° (range 40°-49°); CFL50° (range 50°-59°); and CFL2 (CFLs with two crossing fiber bundles). RESULTS ATFL was Type I in 34 legs (31%), Type II in 66 legs (60%), and Type III in 10 legs (9%). Five CFL categories were identified: CFL10° in 4 feet (3.7%); CFL20° in 23 feet (20.9%); CFL30° in 34 feet (30.9%); CFL40° in 33 feet (30%); CFL50° in 15 feet (13.6%); and CFL2 in one foot (0.9%). Type III contained mainly CFL40° and CFL50° (7 of 10 feet). CONCLUSIONS ATFL and CFL appear to cooperate in the ankle joint braking function.
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16
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Li L, Gollhofer A, Lohrer H, Dorn-Lange N, Bonsignore G, Gehring D. Function of ankle ligaments for subtalar and talocrural joint stability during an inversion movement - an in vitro study. J Foot Ankle Res 2019; 12:16. [PMID: 30923576 PMCID: PMC6421682 DOI: 10.1186/s13047-019-0330-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background The lateral ankle ligament complex consisting of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL) is known to provide stability against ankle joint inversion. As injuries of the ankle joint have been reported at a wide range of plantarflexion/dorsiflexion angles, the aim of the present study was to evaluate the stabilizing function of these ligaments depending on the sagittal plane positioning of the ankle joint. Methods Eight fresh-frozen specimens were tested on a custom-built ankle deflection tester allowing the application of inversion torques in various plantarflexion/dorsiflexion positions. A motion capture system recorded kinematic data from the talus, calcaneus and fibula with bone-pin markers during inversion movements at 10° of dorsiflexion, at neutral position and at plantarflexion 10°. ATFL, CFL and PTFL were separately but sequentially sectioned in order to assess the contribution of the individual ligament with regard to ankle joint stability. Results Joint- and position-specific modulations could be observed when the ligaments were cut. Cutting the ATFL did not lead to any observable alterations in ankle inversion angle at a given torque. But subsequently cutting the CFL increased the inversion angle of the talocrural joint in the 10° plantarflexed position, and significantly increased the inversion angle of the subtalar joint in the 10° dorsiflexed position. Sectioning of the PTFL led to minor increases of inversion angles in both joints. Conclusions The CFL is the primary ligamentous stabilizer of the ankle joint against a forced inversion. Its functioning depends greatly on the plantar−/dorsiflexion position of the ankle joint complex, as it provides the stability of the talocrural joint primarily during plantarflexion and the stability of the subtalar joint primarily during dorsiflexion. Electronic supplementary material The online version of this article (10.1186/s13047-019-0330-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lu Li
- 1Department of Sport and Sport Science, University of Freiburg, Schwarzwaldstraße 175, 79117 Freiburg, Germany
| | - Albert Gollhofer
- 1Department of Sport and Sport Science, University of Freiburg, Schwarzwaldstraße 175, 79117 Freiburg, Germany
| | - Heinz Lohrer
- 1Department of Sport and Sport Science, University of Freiburg, Schwarzwaldstraße 175, 79117 Freiburg, Germany.,ESN - European Sportscare Network, Borsigstraße 2, D-65205 Wiesbaden, Germany.,Lilium Klinik, Borsigstraße 2, D-65205 Wiesbaden, Germany
| | | | | | - Dominic Gehring
- 1Department of Sport and Sport Science, University of Freiburg, Schwarzwaldstraße 175, 79117 Freiburg, Germany
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17
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Morphological evaluation of the calcaneofibular ligament in different ankle positions using a three-dimensional MRI sequence. Surg Radiol Anat 2018; 41:307-311. [PMID: 30539208 DOI: 10.1007/s00276-018-2152-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Evaluating images of the lateral ligament of the ankle is not easy, and evaluation of the calcaneofibular ligament (CFL) in particular is difficult. We prospectively conducted morphological measurements of the CFL in different ankle positions and obtain basic data for use in functional assessment of the CFL, diagnosis of CFL injury, and determination of treatment effects. METHODS The subjects were ten healthy volunteers (ten ankles) with a mean age of 27.8 years and no history of ankle disease. Imaging was done using a 3-T magnetic resonance imaging (MRI) machine and fast imaging employing steady-state acquisition cycled phases (FIESTA-C), a three-dimensional (3D) sequence, with the ankle in a neutral position, maximum dorsiflexion, and maximum plantar flexion. 3D images of the CFL, peroneal muscle tendons, fibula, and calcaneus were prepared at a workstation, and morphological measurements of the CFL were made. RESULTS In all positions, the CFL showed a gently curving course with the peroneal muscle tendons as a fulcrum. The tortuosity angle was significantly smaller in plantar flexion (30.0° ± 7.4°) than in the neutral position (41.7° ± 8.3°). CONCLUSIONS 3D MRI sequences showed that, in all positions, the CFL curved due to the influence of the peroneal muscle tendons. With maximum plantar flexion, the CFL tortuosity angle was small, which was thought to have been due to the tension in the CFL.
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18
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Edama M, Takabayashi T, Inai T, Kikumoto T, Ito W, Nakamura E, Hirabayashi R, Ikezu M, Kaneko F, Kageyama I. The effect of differences in the number of fiber bundles of the anterior tibial ligament on ankle braking function: a simulation study. Surg Radiol Anat 2018; 41:69-73. [PMID: 30402712 DOI: 10.1007/s00276-018-2133-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/31/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim was to clarify the effect of differences in the number of fiber bundles of the anterior tibial ligament (ATFL) on ankle braking function. METHODS The study sample included 81Japanese cadavers. ATFLs were categorized as: Type I with one fiber bundle; Type II with two fiber bundles that were completely separated; and Type III with three fiber bundles. Three-dimensional reconstructions of a single specimen from each category were then created. These were used to simulate and calculate ATFL strain during dorsiflexion (20°) and plantarflexion (30°) on the talocrural joint axis and inversion (20°) on the subtalar joint axis. RESULTS Almost all types of superior fiber lines were stretched with dorsiflexion and plantarflexion. Regardless of Type, the inferior fiber line was shortened with plantarflexion and stretched with dorsiflexion. The inferior fiber bundle of Type III was shortened only at plantarflexion 30° and inversion 20°, but in all others it was stretched. CONCLUSIONS The results suggest that Type III was weaker than Type I and Type II in terms of ankle plantarflexion and inversion braking function.
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Affiliation(s)
- Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, kita-ku, Niigata, 950-3198, Japan.
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan.
| | - Tomoya Takabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, kita-ku, Niigata, 950-3198, Japan
| | - Takuma Inai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, kita-ku, Niigata, 950-3198, Japan
| | - Takanori Kikumoto
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, kita-ku, Niigata, 950-3198, Japan
| | - Wataru Ito
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, kita-ku, Niigata, 950-3198, Japan
| | - Emi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, kita-ku, Niigata, 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, kita-ku, Niigata, 950-3198, Japan
| | - Masahiro Ikezu
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, kita-ku, Niigata, 950-3198, Japan
| | - Fumiya Kaneko
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, kita-ku, Niigata, 950-3198, Japan
| | - Ikuo Kageyama
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
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Mait AR, Forman JL, Nie B, Donlon JP, Mane A, Forghani AR, Anderson RB, Cooper MT, Kent RW. Propagation of Syndesmotic Injuries During Forced External Rotation in Flexed Cadaveric Ankles. Orthop J Sports Med 2018; 6:2325967118781333. [PMID: 30090832 PMCID: PMC6077923 DOI: 10.1177/2325967118781333] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Forced external rotation of the foot is a mechanism of ankle injuries. Clinical observations include combinations of ligament and osseous injuries, with unclear links between causation and injury patterns. By observing the propagation sequence of ankle injuries during controlled experiments, insight necessary to understand risk factors and potential mitigation measures may be gained. Hypothesis Ankle flexion will alter the propagation sequence of ankle injuries during forced external rotation of the foot. Study Design Controlled laboratory study. Methods Matched-pair lower limbs from 9 male cadaveric specimens (mean age, 47.0 ± 11.3 years; mean height, 178.1 ± 5.9 cm; mean weight, 94.4 ± 30.9 kg) were disarticulated at the knee. Specimens were mounted in a test device with the proximal tibia fixed, the fibula unconstrained, and foot translation permitted. After adjusting the initial ankle position (neutral, n = 9; dorsiflexed, n = 4; plantar flexed, n = 4) and applying a compressive preload to the tibia, external rotation was applied by rotating the tibia internally while either lubricated anteromedial and posterolateral plates or calcaneal fixation constrained foot rotation. The timing of osteoligamentous injuries was determined from acoustic sensors, strain gauges, force/moment readings, and 3-dimensional bony kinematics. Posttest necropsies were performed to document injury patterns. Results A syndesmotic injury was observed in 5 of 9 (56%) specimens tested in a neutral initial posture, in 100% of the dorsiflexed specimens, and in none of the plantar flexed specimens. Superficial deltoid injuries were observed in all test modes. Conclusion Plantar flexion decreased and dorsiflexion increased the incidence of syndesmotic injuries compared with neutral matched-pair ankles. Injury propagation was not identical in all ankles that sustained a syndesmotic injury, but a characteristic sequence initiated with injuries to the medial ligaments, particularly the superficial deltoid, followed by the propagation of injuries to either the syndesmotic or lateral ligaments (depending on ankle flexion), and finally to the interosseous membrane or the fibula. Clinical Relevance Superficial deltoid injuries may occur in any case of hyper-external rotation of the foot. A syndesmotic ankle injury is often concomitant with a superficial deltoid injury; however, based on the research detailed herein, a deep deltoid injury is then concomitant with a syndesmotic injury or offloads the syndesmosis altogether. A syndesmotic ankle injury more often occurs when external rotation is applied to a neutral or dorsiflexed ankle. Plantar flexion may shift the injury to other ankle ligaments, specifically lateral ligaments.
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Affiliation(s)
- Alexander Ritz Mait
- Center for Applied Biomechanics, University of Virginia, Charlottesville, Virginia, USA
| | - Jason Lee Forman
- Center for Applied Biomechanics, University of Virginia, Charlottesville, Virginia, USA
| | - Bingbing Nie
- Center for Applied Biomechanics, University of Virginia, Charlottesville, Virginia, USA
| | - John Paul Donlon
- Center for Applied Biomechanics, University of Virginia, Charlottesville, Virginia, USA
| | - Adwait Mane
- Center for Applied Biomechanics, University of Virginia, Charlottesville, Virginia, USA
| | - Ali Reza Forghani
- Center for Applied Biomechanics, University of Virginia, Charlottesville, Virginia, USA
| | | | - M Truitt Cooper
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Richard W Kent
- Center for Applied Biomechanics, University of Virginia, Charlottesville, Virginia, USA
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Edama M, Kageyama I, Kikumoto T, Nakamura M, Ito W, Nakamura E, Hirabayashi R, Takabayashi T, Inai T, Onishi H. The effects on calcaneofibular ligament function of differences in the angle of the calcaneofibular ligament with respect to the long axis of the fibula: a simulation study. J Foot Ankle Res 2017; 10:60. [PMID: 29299066 PMCID: PMC5745768 DOI: 10.1186/s13047-017-0242-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 12/15/2017] [Indexed: 11/13/2022] Open
Abstract
Background In the present study, CFLs harvested from cadavers were categorized according to the differences in the angle of the CFL with respect to the long axis of the fibula and their shape, and then three-dimensional reconstructions of the CFLs were used to simulate and examine the differences in the angles of the CFLs with respect to the long axis of the fibula and how they affect CFL function. Methods The study sample included 81 ft from 43 Japanese cadavers. CFLs were categorized according to their angle with respect to the long axis of the fibula and the number of fiber bundles. Five categories were subsequently established: CFL20° (angle of the CFL with respect to the long axis of the fibula from 20° to 29°); CFL30° (range 30–39°); CFL40° (range 40–49°); CFL50° (range 50–59°); and CFL2 (CLFs with two crossing fiber bundles). Three-dimensional reconstructions of a single specimen from each category were then created. These were used to simulate and calculate CFL strain during dorsiflexion (20°) and plantarflexion (30°) on the talocrural joint axis and inversion (20°) and eversion (20°) on the subtalar joint axis. Results In terms of proportions for each category, CFL20° was observed in 14 ft (17.3%), with CFL30° in 22 ft (27.2%), CFL40° in 29 ft (35.8%), CFL50° in 15 ft (18.5%), and CFL2 in one foot (1.2%). Specimens in the CFL20° and CFL30° groups contracted with plantarflexion and stretched with dorsiflexion. In comparison, specimens in the CFL40°, CFL50°, and CFL2 groups stretched with plantarflexion and contracted with dorsiflexion. Specimens in the CFL20° and CFL2 groups stretched with inversion and contracted with eversion. Conclusions CFL function changed according to the difference in the angles of the CFLs with respect to the long axis of the fibula.
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Affiliation(s)
- Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198 Japan.,Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
| | - Ikuo Kageyama
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
| | - Takanori Kikumoto
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198 Japan
| | - Masatoshi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198 Japan
| | - Wataru Ito
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198 Japan
| | - Emi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198 Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198 Japan
| | - Tomoya Takabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198 Japan
| | - Takuma Inai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198 Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198 Japan
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Edama M, Kageyama I, Kikumoto T, Nakamura M, Ito W, Nakamura E, Hirabayashi R, Takabayashi T, Inai T, Onishi H. Morphological features of the anterior talofibular ligament by the number of fiber bundles. Ann Anat 2017; 216:69-74. [PMID: 29196235 DOI: 10.1016/j.aanat.2017.11.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/06/2017] [Accepted: 11/08/2017] [Indexed: 11/26/2022]
Abstract
The aims of this study have been to clarify differences in morphological features based on the number of fiber bundles in the anterior talofibular ligament (ATFL), and to investigate the relationship between the ATFL and the calcaneofibular ligament (CFL). This study used 81 legs from 43 cadavers. The ATFL was classified according to differences in the number of fiber bundles as: Type I, with one fiber bundle; Type II-a, with two fiber bundles that were incompletely separated; Type II-b, with two fiber bundles that were completely separated; and Type III, with three fiber bundles. The morphological features measured were fiber bundle length, fiber bundle width, and fiber bundle angle. For the relationship between the ATFL and CFL, the positional relationship and attachment sites of the two ligaments were examined. Type I was present in 33%, Type II-a in 17%, Type II-b in 40%, and Type III in 10%. The morphological features of superior fiber bundles and inferior fiber bundles were significantly different within each type. Among types, there were significant differences in the morphological features of Type II-a and Type III inferior fiber bundles. In the relationship between the ATFL and CFL, there was a connection between the ATFL and CFL in all specimens. Various types were present in the positional relationship and attachment sites of the two ligaments. The results of this study suggest that, among different ligament types with two or three fiber bundles, the control function of the ankle may differ within each type and among types.
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Affiliation(s)
- Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan; Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata 951-8580, Japan.
| | - Ikuo Kageyama
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata 951-8580, Japan
| | - Takanori Kikumoto
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Masatoshi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Wataru Ito
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Emi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Tomoya Takabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Takuma Inai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, Niigata 950-3198, Japan
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Kobayashi T, Yamakawa S, Watanabe K, Kimura K, Suzuki D, Otsubo H, Teramoto A, Fujimiya M, Fujie H, Yamashita T. The in situ force in the calcaneofibular ligament and the contribution of this ligament to ankle joint stability. Clin Biomech (Bristol, Avon) 2016; 40:8-13. [PMID: 27771606 DOI: 10.1016/j.clinbiomech.2016.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 09/20/2016] [Accepted: 10/13/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Numerous biomechanical studies of the lateral ankle ligaments have been reported; however, the isolated function of the calcaneofibular ligament has not been clarified. We hypothesize that the calcaneofibular ligament would stabilize the ankle joint complex under multidirectional loading, and that the in situ force in the calcaneofibular ligament would change in each flexed position. METHODS Using seven fresh frozen cadaveric lower extremities, the motions and forces of the intact ankle under multidirectional loading were recorded using a 6-degree-of-freedom robotic system. On repeating these intact ankle joint complex motions after the calcaneofibular ligament transection, the in situ force in the calcaneofibular ligament and the contribution of the calcaneofibular ligament to ankle joint complex stability were calculated. Finally, the motions of the calcaneofibular ligament-transected ankle joint complex were recorded. FINDINGS Under an inversion load, significant increases of inversion angle were observed in all the flexed positions following calcaneofibular ligament transection, and the calcaneofibular ligament accounted for 50%-70% of ankle joint complex stability during inversion. The in situ forces in the calcaneofibular ligament under an anterior force, inversion moment, and external rotation moment were larger in the dorsiflexed position than in the plantarflexed position. INTERPRETATION The calcaneofibular ligament plays a role in stabilizing the ankle joint complex to multidirectional loads and the role differs with load directions. The in situ force of the calcaneofibular ligament is larger at the dorsiflexed position. This ligament provides the primary restraint to the inversion ankle stability.
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Affiliation(s)
- Takuma Kobayashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1 West-16 Chuo-ku, Sapporo, Hokkaido 060-8543, Japan.
| | - Satoshi Yamakawa
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, 6-6 Asahigaoka, Hino-shi, Tokyo 191-0065, Japan
| | - Kota Watanabe
- Department of Physical Therapy, Sapporo Medical University School of Health Sciences, South-1, West-17, Chuo-ku, Sapporo, Hokkaido 060-8556, Japan
| | - Kei Kimura
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, 6-6 Asahigaoka, Hino-shi, Tokyo 191-0065, Japan
| | - Daisuke Suzuki
- Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, South-1 West-16 Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Hidenori Otsubo
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1 West-16 Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1 West-16 Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Mineko Fujimiya
- Department of Anatomy, Sapporo Medical University School of Medicine, South-1 West-16 Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Hiromichi Fujie
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, 6-6 Asahigaoka, Hino-shi, Tokyo 191-0065, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1 West-16 Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
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Best R, Böhle C, Mauch F, Brüggemann PG. Preventive lateral ligament tester (PLLT): a novel method to evaluate mechanical properties of lateral ankle joint ligaments in the intact ankle. Knee Surg Sports Traumatol Arthrosc 2016; 24:963-70. [PMID: 25059338 DOI: 10.1007/s00167-014-3190-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 07/14/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE To construct and evaluate an ankle arthrometer that registers inversion joint deflection at standardized inversion loads and that, moreover, allows conclusions about the mechanical strain of intact ankle joint ligaments at these loads. METHODS Twelve healthy ankles and 12 lower limb cadaver specimens were tested in a self-developed measuring device monitoring passive ankle inversion movement (Inv-ROM) at standardized application of inversion loads of 5, 10 and 15 N. To adjust in vivo and in vitro conditions, the muscular inactivity of the evertor muscles was assured by EMG in vivo. Preliminary, test-retest and trial-to-trial reliabilities were tested in vivo. To detect lateral ligament strain, the cadaveric calcaneofibular ligament was instrumented with a buckle transducer. After post-test harvesting of the ligament with its bony attachments, previously obtained resistance strain gauge results were then transferred to tensile loads, mounting the specimens with their buckle transducers into a hydraulic material testing machine. RESULTS ICC reliability considering the Inv-ROM and torsional stiffness varied between 0.80 and 0.90. Inv-ROM ranged from 15.3° (±7.3°) at 5 N to 28.3° (±7.6) at 15 N. The different tests revealed a CFL tensile load of 31.9 (±14.0) N at 5 N, 51.0 (±15.8) at 10 N and 75.4 (±21.3) N at 15 N inversion load. CONCLUSIONS A highly reliable arthrometer was constructed allowing not only the accurate detection of passive joint deflections at standardized inversion loads but also reveals some objective conclusions of the intact CFL properties in correlation with the individual inversion deflections. The detection of individual joint deflections at predefined loads in correlation with the knowledge of tensile ligament loads in the future could enable more individual preventive measures, e.g., in high-level athletes.
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Affiliation(s)
- Raymond Best
- Department of Orthopedic and Sports Trauma Surgery, Sportklinik Stuttgart GmbH, Taubenheimstrasse 8, 70372, Stuttgart, Germany.
| | - Caroline Böhle
- Department of Orthopedics and Biomechanics, German Sports University Cologne, Cologne, Germany
| | - Frieder Mauch
- Department of Orthopedic and Sports Trauma Surgery, Sportklinik Stuttgart GmbH, Taubenheimstrasse 8, 70372, Stuttgart, Germany
| | - Peter G Brüggemann
- Department of Orthopedics and Biomechanics, German Sports University Cologne, Cologne, Germany
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Utilization of mobilization with movement for an apparent sprain of the posterior talofibular ligament: a case report. ACTA ACUST UNITED AC 2012; 18:e1-7. [PMID: 22579221 DOI: 10.1016/j.math.2012.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 03/22/2012] [Accepted: 03/30/2012] [Indexed: 12/26/2022]
Abstract
Ankle sprains are a common injury. According to the National Electronic Injury Surveillance System (NEISS), an estimated 630,891 ankle sprains occurred in 2009 (CPSC, 2011). The anterior talofibular ligament (AFTL) is frequently sprained as a result of a plantarflexion-inversion injury. Sometimes the calcaneofibular ligament or posterior talofibular ligament (PTFL) is also sprained (Komenda and Ferkel, 1999). The patient in this study presented with lateral ankle pain reproducible by passive plantarflexion and eversion, complaining of pain during exercise and playing sports. These findings are consistent with a sprain of the PTFL. Positional faults have also been shown to occur at tibiofibular joint, mimicking the symptoms of an ankle sprain. Brian Mulligan first hypothesized the occurrence of positional faults at the ankle. He developed a Mobilization with Movement (MWM) technique to treat these positional faults. Mulligan also hypothesized that a similar positional fault could occur in a posterior direction mimicking a sprain of the PTFL (Mulligan, 2010, p. 71, 96-97). The purpose of this case study is to present a patient with an apparent posterior talofibular ligament sprain who responded to an anterior glide MWM of the fibula. The two measurements used to assess function and pain were the Foot and Ankle Ability Measure (FAAM) and a 10-point numeric pain scale. Each measure was conducted prior to treatment, after treatment was discontinued, 6 months post treatment and 12 months post treatment. A positive response was achieved, as her symptoms were reduced and she was able return to her prior level of function.
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Lin CF, Chen CY, Lin CW. Dynamic ankle control in athletes with ankle instability during sports maneuvers. Am J Sports Med 2011; 39:2007-15. [PMID: 21622814 DOI: 10.1177/0363546511406868] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ankle sprain is a common sports injury. While the effects of static constraints in stabilizing the ankle joint are relatively well understood, those of dynamic constraints are less clear and require further investigation. PURPOSE This study was undertaken to evaluate the dynamic stability of the ankle joint during the landing phase of running and stop-jump maneuvers in athletes with and without chronic ankle instability (CAI). STUDY DESIGN Controlled laboratory study. METHODS Fifteen athletes with CAI and 15 age-matched athletes without CAI performed running and stop-jump landing tasks. The dynamic ankle joint stiffness, tibialis anterior (TA)/peroneus longus (PL) and TA/gastrocnemius lateralis (GL) co-contraction indices, ankle joint angle, and root-mean-square (RMS) of the TA, PL, and GL electromyographic signals were measured during each task. RESULTS During running, the CAI group exhibited a greater ankle inversion angle than the control group in the pre-landing phase (P = .012-.042) and a lower dynamic ankle joint stiffness in the post-landing phase (CAI: 0.109 ± 0.039 N·m/deg; control: 0.150 ± 0.068 N·m/deg; P = .048). In the stop-jump landing task, athletes with CAI had a significantly lower TA/PL co-contraction index during the pre-landing phase (CAI: 49.1 ± 19; control: 64.8 ± 16; P = .009). In addition, the CAI group exhibited a greater ankle inversion (P = .049), a lower peak eversion (P = .04), and a smaller RMS of the PL electromyographic signal in the post-landing phase (CAI: 0.73 ± 0.32; control: 0.51 ± 0.22; P = .04). CONCLUSION Athletes with CAI had a relatively inverted ankle, reduced muscle co-contraction, and a lower dynamic stiffness in the ankle joint during the landing phase of sports maneuvers and this may jeopardize the stability of the ankle. CLINICAL RELEVANCE Sports training or rehabilitation programs should differentiate between the pre-landing and post-landing phases of sports maneuvers, and should educate athletes to land with an appropriate ankle position and muscle recruitment.
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Affiliation(s)
- Cheng-Feng Lin
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan.
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Merian M, Glisson RR, Nunley JA. J. Leonard Goldner Award 2010. Ligament balancing for total ankle arthroplasty: an in vitro evaluation of the elongation of the hind- and midfoot ligaments. Foot Ankle Int 2011; 32:S457-72. [PMID: 21733454 DOI: 10.3113/fai.2011.0457] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The changes in length of the hindfoot ligaments in response to alterations in ankle and subtalar joint orientation under physiologic load in eight fresh-frozen cadaver limbs were documented. RESULTS In eversion, the tibiocalcaneal (11% ± 4%, mean ± SD], calcaneofibular (6% ± 4%), posterior talofibular (7% ± 4%), posterolateral talocalcaneal (21% ± 9%), posteromedial talocalcaneal (33% ± 45%) and calcaneonavicular (bifurcate) (8% ± 7%) ligaments were elongated relative to their lengths in inversion. In inversion, the anterior capsular (talocalcaneal) (5% ± 3%) and the plantar cuboidnavicular (5% ± 6%) ligaments were elongated relative to their everted lengths. In dorsiflexion, the superficial (26% ± 8%) and deep posterior tibiotalar (30% ± 13%), calcaneofibular (8% ± 4%), tibiocalcaneal (4% ± 2%) and lateral talocalcaneal (cervical) (2% ± 1%) ligaments were elongated. In plantarflexion, the tibionavicular (26% ± 5%) and the anterior talofibular (7% ± 4%) ligaments were lengthened. No statistically significant elongation was documented in any ankle position for the anterior tibiotalar, talocalcaneal interosseous, plantar calcaneocuboid, calcaneocuboid (bifurcate), all components of the spring ligament, and the dorsal cuboidnavicular ligaments. CONCLUSION Components of the deltoid ligament complex elongated largest at the ankle joint with any hindfoot movement but inversion. Therefore, selective release of components of the deltoid ligament complex may provide a means for achieving optimal ligament balancing in total ankle arthroplasty. Specifically, release of the superficial and deep posterior tibiotalar ligament may improve range of motion in total ankle arthroplasties, whereas the release of the tibiocalcaneal ligament may correct a varus talar tilt.
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Affiliation(s)
- Marc Merian
- Regina Pasqua Hospital, Surgery, 3988 Alberts St., Regina, Saskatchewan S4S 3R1, Canada.
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