Ankle joint evertor–invertor muscle torque ratio decrease due to recurrent lateral ligament sprains

2004 ◽  
Vol 19 (7) ◽  
pp. 760-762 ◽  
Author(s):  
Inese Pontaga
Injury ◽  
1986 ◽  
Vol 17 (6) ◽  
pp. 380-IN2 ◽  
Author(s):  
Cyrus L. Muwanga ◽  
David N. Quinton ◽  
John P. Sloan ◽  
Pam Gillies ◽  
Andrew F. Dove

2017 ◽  
Vol 5 (3) ◽  
pp. 232596711769506 ◽  
Author(s):  
James Calder ◽  
Adam Mitchell ◽  
Adam Lomax ◽  
Moez S. Ballal ◽  
John Grice ◽  
...  

Background: Subcircumferential periosteal edema above the ankle joint is frequently present on magnetic resonance imaging (MRI) with syndesmosis injuries but has not been previously reported. Fluid height within the interosseous membrane also has not previously been shown to be associated with syndesmosis injury severity. Purpose: To investigate whether a new sign on MRI and measurement of the length of fluid within the interosseous membrane above the ankle may be used to enable identification of a syndesmosis injury and allow differentiation from lateral ligament injury. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Three groups of patients (those with an isolated syndesmosis injury [SI group], isolated lateral ligament injury [LLI group], and no injury [NI group]) who had an ankle MRI for another reason were identified from a patient notes database and the MRI scans retrieved. The scans were anonymized and independently assessed by 8 clinicians (surgeons and radiologists) who were blinded to the diagnosis. The maximum length of fluid above the ankle within the intraosseous membrane was measured for each patient. The presence or absence of distal anterior, lateral, and posterior tibial periosteal edema was recorded (broken “ring of fire”). Results: Measurement of the length of fluid above the ankle had excellent intraobserver reliability (intraclass correlation coefficient, 0.97; 95% CI, 0.93-0.99) but poor interobserver reliability. Fluid extended higher in both the LLI group ( P = .0043) and SI group ( P = .0058) than the NI group, but there was no significant difference between the LLI and SI groups ( P = .3735), indicating that this measurement cannot differentiate between the injuries. The presence of the broken “ring of fire” around the distal tibia was significantly more frequent in the SI group when compared with both LLI and NI groups ( P < .00001). The sensitivity of this sign is 49%, but when present, this sign has a 98% specificity for syndesmosis injury. Conclusion: The presence of tibial subcircumferential periosteal edema 4 to 6 cm above the ankle joint (the “ring of fire”) is highly suggestive of a syndesmosis injury. This new radiological sign can assist with early identification of such injuries. The measurement of height of fluid above the ankle within the interosseous membrane is variable and cannot differentiate severe ankle sprains from high ankle sprains involving the syndesmosis.


2001 ◽  
Vol 44 (4) ◽  
pp. 1082-1088 ◽  
Author(s):  
Kensaku KAWAKAMI ◽  
Go OMORI ◽  
Shojiro TERASHIMA ◽  
Makoto SAKAMOTO ◽  
Toshiaki HARA

2018 ◽  
Vol 47 (2) ◽  
pp. 431-437 ◽  
Author(s):  
Kenneth J. Hunt ◽  
Helder Pereira ◽  
Judas Kelley ◽  
Nicholas Anderson ◽  
Richard Fuld ◽  
...  

Background: Acute inversion ankle sprains are among the most common musculoskeletal injuries. Higher grade sprains, including anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) injury, can be particularly challenging. The precise effect of CFL injury on ankle instability is unclear. Hypothesis: CFL injury will result in decreased stiffness, decreased peak torque, and increased talar and calcaneal motion and will alter ankle contact mechanics when compared with the uninjured ankle and the ATFL-only injured ankle in a cadaveric model. Study Design: Descriptive laboratory study. Methods: Ten matched pairs of cadaver specimens with a pressure sensor in the ankle joint and motion trackers on the fibula, talus, and calcaneus were mounted on a material testing system with 20° of ankle plantarflexion and 15° of internal rotation. Intact specimens were axially loaded to body weight and then underwent inversion along the anatomic axis of the ankle from 0° to 20°. The ATFL and CFL were sequentially sectioned and underwent inversion testing for each condition. Linear mixed models were used to determine significance for stiffness, peak torque, peak pressure, contact area, and inversion angles of the talus and calcaneus relative to the fibula across the 3 conditions. Results: Stiffness and peak torque did not significantly decrease after sectioning of the ATFL but decreased significantly after sectioning of the CFL. Peak pressures in the tibiotalar joint decreased and mean contact area increased significantly after CFL release. Significantly more inversion of the talus and calcaneus as well as calcaneal medial displacement was seen with weightbearing inversion after sectioning of the CFL. Conclusion: The CFL contributes considerably to lateral ankle instability. Higher grade sprains that include CFL injury result in significant decreases in rotation stiffness and peak torque, substantial alteration of contact mechanics at the ankle joint, increased inversion of the talus and calcaneus, and increased medial displacement of the calcaneus. Clinical Relevance: Repair of an injured CFL should be considered during lateral ligament reconstruction, and there may be a role for early repair in high-grade injuries to avoid intermediate and long-term consequences of a loose or incompetent CFL.


Foot & Ankle ◽  
1993 ◽  
Vol 14 (9) ◽  
pp. 500-504 ◽  
Author(s):  
Haruyasu Yamamoto ◽  
Toshiro Ishibashi ◽  
Takeshi Muneta ◽  
Kohtaro Furuya

Between 1986 and 1989, 40 patients with acute lateral ligament injury of the ankle joint were treated by immobilizing their affected feet in a plaster cast with a heel for 4 weeks, followed by a brace for the next 2 months. The average follow-up time was 29 months. Ninety-eight percent of the patients were rated as having satisfactory functional results. Stress radiographs at the latest follow-up showed good stability even in ankles that were severely unstable at injury. Posttreatment stress radiographs taken periodically showed that stability was maintained 6 months after treatment.


Radiology ◽  
1975 ◽  
Vol 114 (3) ◽  
pp. 587-590 ◽  
Author(s):  
Peter K. Spiegel ◽  
O. Sherwin Staples

1996 ◽  
Vol 75 (2) ◽  
pp. 678-679 ◽  
Author(s):  
T. V. Trank ◽  
J. L. Smith

1. We compared the dynamics of the metatarsophalangeal (MTP) joint of the cat's hind paw and the motor patterns of two short and four long muscles of the digits for two walking forms, forward (FWD) and backward (BWD). Kinematic (angular displacements) data digitized from high-speed cine film and electromyographic (EMG) data were synchronized and assessed for bouts of treadmill walking. Kinetic data (joint forces) were calculated from kinematic and anthropometric data with the use of inverse-dynamic calculations in which the MTP joint net torque was divided into gravitational, motion-dependent, ground contact (absent for swing), and muscle torque components. Swing-phase kinetics were calculated from treadmill steps and stance-phase kinetics from overground steps in which one hind paw contacted a miniature force platform embedded in the walkway. 2. The plantar angle at the intersection of the metatarsal and phalangeal segmental lines was used to measure MTP angular displacements. During swing for both walking forms, the MTP joint flexed (F) and then extended (E); however, the F-E transition occurred at the onset of FWD swing and at the end of BWD swing. For FWD walking, the MTP joint extended at a constant velocity during most of stance as the cat's weight rotated forward over the paw. During the unweighting phase at the end of stance, the MTP joint flexed rapidly before paw lift off. For BWD walking, the MTP joint extended briefly at stance onset (similar to a yield) and then flexed at a constant velocity as the cat's weight rotated backward over the paw. At the end of stance, the MTP joint extended and then flexed slightly as the paw was unweighted before paw lift off. 3. For both forms of walking, three of the six muscles tested were recruited just before paw contact and remained active for most (75-80%) of stance for both walking forms: plantaris (PLT), flexor hallucis longus (FHL), and flexor digitorum brevis (FDB). Their recruitment contributed to the flexor muscle torque at the MTP joint during most of FWD and BWD stance and was responsible for the absorption of mechanical power at the MTP joint for FWD stance and generation of mechanical power at the MTP joint during BWD stance. Also, the FHL and PLT, along with the soleus (SOL; also recorded in this study), contributed to an extensor muscle torque (described in paper IV of this series) and the generation of mechanical power at the ankle joint during stance of FWD and BWD walking. 4. The timing of activity for three muscles recruited during FWD swing was distinct for the two walking forms. The hallmark burst of the flexor digitorum longus (FDL)--a single burst, brief in duration and high in amplitude--occurred at the end of FWD swing (as the toes flexed rapidly) but shifted to the onset of BWD stance (as the claws protruded and toes extended) during paw weighting. The extensor digitorum longus (EDL) was recruited after paw off and was active for most of FWD swing; its activity contributed to an extensor muscle torque at the MTP joint and a flexor muscle torque at the ankle joint. For BWD walking, EDL recruitment shifted to an earlier phase in the step cycle and coincided with toe extension, which occurred at the end of stance before paw lift off. This pre-lift off activity continued into the first part of swing and contributed to an extensor muscle torque at the MTP joint and a flexor muscle torque at the ankle.(ABSTRACT TRUNCATED AT 250 WORDS)


The Lancet ◽  
1964 ◽  
Vol 284 (7362) ◽  
pp. 720-723 ◽  
Author(s):  
David Caro ◽  
J.B. Howells ◽  
I.L. Craft ◽  
P.C. Shaw ◽  
D. Caplin

1999 ◽  
Vol 13 (1_suppl) ◽  
pp. 16-22 ◽  
Author(s):  
CS Nyanzi ◽  
J. Langridge ◽  
Jrc Heyworth ◽  
R. Mani

Objective: To determine the efficacy of a fixed dose of ultrasound energy to treat acute lateral ligament sprains of the ankle joint. Study design: Double-blind randomised controlled trial. Setting: Accident and Emergency department of University Teaching Hospital. Subjects: Patients presenting at Accident and Emergency with ankle injuries. Intervention: Ultrasound or placebo, and Tubigrip. Outcome measures: Pain measured with visual analogue scales, swelling using a tape measure, range of movement using a fluid-filled goniometer, and weight bearing using two scales simultaneously. Results: Patients in both groups improved symptomatically. There were no statistically significant differences between groups in any outcome measure. Within groups, statistically significant differences were detected in pain perceived, and range of movement (dorsiflexion). Conclusion: At the dose and duration used, ultrasound therapy is no better than placebo in the management of lateral ligament injuries.


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