Adjunctive Lateral Ankle Stabilization in Midfoot Charcot Reconstruction for Ankle Joint Preservation

Category: Ankle; Basic Sciences/Biologics; Sports Introduction/Purpose: The biomechanics of ankle sprains involves a multiplanar-supination motion and not the strict inversion as is often described. During supination, calcaneal inversion occurs at the anatomic subtalar joint. The intrinsic subtalar ligaments include a series of broad thick ligaments situated in the tarsal canal that separate the anterior and posterior compartments. The subtalar intrinsic ligaments are damaged in an estimated 25% to 80% of all lateral ankle sprains. We hypothesize that the intrinsic subtalar ligaments have a multiplanar role in ankle joint stabilization similar to that of the anterior cruciate ligament at the knee. The purpose of this study is to evaluate the efficacy of four surgical approaches to the subtalar ligaments through cadaveric dissection. Methods: Four fresh-frozen cadaveric ankle specimens were utilized. Ability to access the extrinsic lateral ankle ligament (anterior talofibular), the extrinsic subtalar ligaments (calcaneofibular, lateral talocalcaneal) and the intrinsic subtalar ligaments (interosseous talocalcaneal, cervical) was evaluated. The first cadaveric specimen was dissected as a baseline to identify the extrinsic and intrinsic subtalar ligaments. The three remaining cadaveric specimens were utilized to evaluate the efficacy of three standard surgical approaches (a curvilinear incision made over the distal anterior border of lateral malleolus, a posterolateral longitudinal incision, and an extensile sinus tarsi approach) to access both the extrinsic ankle and subtalar ligaments as well as the intrinsic subtalar ligaments. Ability to access all ligaments as well as identification of neurovascular structures at risk during the dissection was recorded for each approach. Results: The curvilinear incision made over the distal anterior border of the lateral malleolus provided access to the anterior talofibular, calcaneofibular ligaments. Branches of the superficial peroneal nerve were noted to be at direct risk. The posterior longitudinal incision provided access to the calcaneofibular, lateral talocalcaneal ligaments. Branches of the sural nerve were noted to be at direct risk with this approach. An extensile posterolateral incision improved access to the anterior talofibular ligament. An extensile sinus tarsi approach provided the most direct access to the interosseous talocalcaneal and cervical ligaments. Visualization of the calcaneofibular and lateral talocalcaneal was also provided with this incision. The saphenous and superficial nerve branches and the sinus tarsi artery were noted to be at risk. Conclusion: We hypothesize that the intrinsic subtalar ligaments have a multiplanar role in ankle joint stabilization similar to that of the anterior cruciate ligament at the knee. Accurate identification and optimal surgical approach to these structures has not been well described in the orthopaedic foot and ankle literature. This cadaveric study provides evidence that an extensile sinus tarsi approach can provide access to the extrinsic ankle and subtalar ligaments as well as the intrinsic ligaments of the subtalar joint.

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Assessment of Ankle Joint Laxity After an Acute Lateral Ankle Sprain: An Exploration Clinical CASE Series

International Journal of Athletic Therapy & Training ◽

10.1123/ijatt.2018-0004 ◽

2019 ◽

Vol 24 (2) ◽

pp. 50-53

Author(s):

Gabrielle Stubblefield ◽

Jeffrey Tilly ◽

Kathy Liu

Keyword(s):

Ankle Joint ◽

Ankle Sprain ◽

Clinical Case ◽

Case Series ◽

Joint Laxity ◽

Lateral Ankle Sprain ◽

Lateral Ankle

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EVALUATION OF THE LATERAL ANKLE LIGAMENTS DURING ROTATIONAL FORCES ACROSS THE ANKLE JOINT

Southern Medical Journal ◽

10.1097/00007611-199309001-00218 ◽

1993 ◽

Vol 86 (Supplement) ◽

pp. 81

Author(s):

William H. DeVries ◽

Neven A. Popovic ◽

Michael E. Mulligan ◽

John S. Xenos ◽

William J. Hopkinson

Keyword(s):

Ankle Joint ◽

Ankle Ligaments ◽

Lateral Ankle ◽

Lateral Ankle Ligaments

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Ankle Disease in Juvenile Idiopathic Arthritis: Ultrasound Findings in Clinically Swollen Ankles

The Journal of Rheumatology ◽

10.3899/jrheum.080508 ◽

2009 ◽

Vol 36 (8) ◽

pp. 1725-1729 ◽

Cited By ~ 51

Author(s):

MADELEINE E. ROONEY ◽

CATHERINE McALLISTER ◽

JAMES F.T. BURNS

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Ankle Joint ◽

Ultrasound Examination ◽

Frequency Of Occurrence ◽

Lateral Ankle ◽

Tibiotalar Joint ◽

Systemic Jia ◽

Significant Difference ◽

Ultrasound Findings

Objective.The ankle joint is frequently involved in juvenile idiopathic arthritis (JIA), but it is unclear whether this is predominantly due to synovitis, tenosynovitis, or both. We performed clinic-based ultrasound examination to assess the prevalence of synovitis and tenosynovitis in children with JIA felt clinically to have active inflammatory disease of the ankle.Methods.Thirty-four patients with 49 clinically swollen ankles were studied (19 polyarticular JIA, 13 oligoarticular JIA, 1 systemic JIA, 1 psoriatic JIA). All cases had at least one clinically swollen ankle joint. The children were assessed clinically and had ultrasound examination during routine clinic appointments.Results.We found 71% of ankles had tenosynovitis and 39% had tenosynovitis alone. Only 29% of swollen ankles had a tibiotalar effusion alone. We found 33% had both tenosynovitis and a tibiotalar effusion. When results were analyzed by JIA subtype, we found 81% of oligoarticular JIA ankles had medial ankle tenosynovitis but only 19% had tibiotalar effusion alone. There was a significant difference between JIA subgroups for the frequency of occurrence of medial ankle tenosynovitis (p = 0.048) and lateral ankle tenosynovitis (p = 0.001).Conclusion.The tibiotalar joint was not involved in 39% of the swollen ankles; and tenosynovitis, sometimes in isolation, was the dominant finding. This has implications for therapeutic intervention and also for an improved classification of children with JIA, especially with ankle involvement.

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A new method of lateral ankle joint reconstruction for chronic instability: preliminary report

The Foot ◽

10.1016/0958-2592(95)90029-2 ◽

1995 ◽

Vol 5 (1) ◽

pp. 24-26 ◽

Cited By ~ 1

Author(s):

A. Et-titi ◽

A. Ismaiel

Keyword(s):

Ankle Joint ◽

Preliminary Report ◽

New Method ◽

Chronic Instability ◽

Lateral Ankle ◽

Joint Reconstruction

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Cryotherapy Does Not Affect Peroneal Reaction Following Sudden Inversion

Journal of Sport Rehabilitation ◽

10.1123/jsr.16.4.285 ◽

2007 ◽

Vol 16 (4) ◽

pp. 285-294 ◽

Cited By ~ 9

Author(s):

Christine L. Berg ◽

Joseph M. Hart ◽

Riann Palmieri-Smith ◽

Kevin M. Cross ◽

Christopher D. Ingersoll

Keyword(s):

Ankle Joint ◽

Outcome Measures ◽

Repeated Measures ◽

Treatment Time ◽

Post Treatment ◽

Emg Activity ◽

Root Mean Square Amplitude ◽

Lateral Ankle ◽

Repeated Measures Design ◽

And Control

Context:If ankle joint cryotherapy impairs the ability of the ankle musculature to counteract potentially injurious forces, the ankle is left vulnerable to injury.Objective:To compare peroneal reaction to sudden inversion following ankle joint cryotherapy.Design:Repeated measures design with independent variables, treatment (cryotherapy and control), and time (baseline, immediately post treatment, 15 minutes post treatment, and 30 minutes post treatment).Setting:University research laboratory.Patients or Other Participants:Twenty-seven healthy volunteers.Intervention(s):An ice bag was secured to the lateral ankle joint for 20 minutes.Main Outcome Measures:The onset and average root mean square amplitude of EMG activity in the peroneal muscles was calculated following the release of a trap door mechanism causing inversion.Results:There was no statistically significant change from baseline for peroneal reaction time or average peroneal muscle activity at any post treatment time.Conclusions:Cryotherapy does not affect peroneal muscle reaction following sudden inversion perturbation.

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