Anteroinferior Tibiofibular Ligament Injury: Not Just Another Ankle Sprain

1989 ◽  
Vol 17 (11) ◽  
pp. 63-69 ◽  
Author(s):  
William W. Briner ◽  
Daniel E. Carr ◽  
Kevin M. Lavery
Keyword(s):  
Ankle Sprain ◽  
Ligament Injury ◽  
Tibiofibular Ligament

scholarly journals In Different Gender Groups, What Is the Impact of the Fibular Notch on The Severity of High Ankle Sprain: A Retrospective Study of 240 Cases

2021 ◽  
Author(s):  
Xiaoyao Peng ◽  
Fan Su ◽  
Xiangyu Tang ◽  
Yuening Yang ◽  
Junyao Chen ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Normal Group ◽  
Ligament Injury ◽  
Control Group ◽  
Level Of Evidence ◽  
Tibiofibular Ligament ◽  
Flat Type ◽  
Retrospective Comparative Study ◽  
High Ankle Sprain ◽  
The Impact

Abstract Background: The function of the distal tibiofibular ligament on the ankle in the occurrence of high ankle sprain (HAS) has been widely studied. Then, in different genders, the effect of the anatomical morphology of fibular notch (FN) on HAS is unclear. Therefore, on the basis of excluding the anatomical differences caused by gender, we explore the impact of different types of FN on the severity of HAS.Methods: We selected 120 patients and further classified these 120 patients into four HAS groups according to FN depth with deep concave type FN ≥ four mm and shallow flat type FN < four mm. A further 120 normal individuals were served as a control group. FN morphological indicators, tibiofibular distance (TFD), and ankle mortise indexes were measured and compared between patients and control groups.Results: In males with shallow flat type, the Anterior tibiofibular distance (aTFD), Middle tibiofibular distance (mTFD), Posterior tibiofibular distance (pTFD), Front tibial width (FTiW), Middle tibial width (MTiW), Posterior tibial width (PTiW) and Depth of ankle mortise (DOAM) of HAS group were higher than those in normal group (P < 0.05). In males with deep concave type, the aTFD, mTFD and DOAM of patients were significantly higher (P < 0.05). Among females with shallow flat type, the aTFD, mTFD, pTFD, FTiW and MTiW in HAS group were greater than those in normal group (P < 0.05). Among the females with deep concave type, the mTFD and pTFD of patients were higher (P < 0.05).Conclusions: After analyzing the morphological indicators of FN, it is found that in both males and females, HAS patients have significant differences in TFD and certain ankle mortise indexes compared with normal people. But more importantly, the above abnormalities are often more common in HAS patients with shallow flat FN, indicating that shallow flat FN may be related to more serious distal tibiofibular ligament injury and ankle mortise widening, resulting in a worse prognosis.Level of evidence: Level III, retrospective comparative study.

scholarly journals What is the Effect of Lateral Ankle Ligament Injury on Syndesmotic Stability? Arthroscopic evaluation

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0042
Author(s):  
Go Sato ◽  
Jirawat Saengsin ◽  
Rohan Bhimani ◽  
Noortje Hagemeijer ◽  
Bart Lubberts ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Ligament Injury ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Intact State ◽  
Tibiofibular Ligament ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
Lateral Ankle Ligaments ◽  
Ankle Ligament Injury

Category: Ankle; Arthroscopy; Sports; Trauma Introduction/Purpose: Numerous studies have shown a high incidence of associated lateral ankle and syndesmotic ligamentous injuries. It is unclear, however, if there is a direct contribution of the lateral ligaments towards stabilizing the syndesmosis. Using arthroscopy, we assessed to what extent lateral ankle ligaments contribute to syndesmotic stability in the coronal and sagittal plane. Our hypothesis was that lateral ankle ligament injury has effect on syndesmosis instability. Methods: Sixteen fresh frozen above-knee amputated cadaveric specimens were divided into two groups that underwent arthroscopic evaluation for syndesmotic stability. In both the groups, the assessment was done with all syndesmotic and ankle ligaments intact and later with sequential transection of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), the posterior talofibular ligament (PTFL), anterior inferior tibiofibular ligament (AITFL), the interosseous ligament (IOL) and the posterior inferior tibiofibular ligament (PITFL). In all scenarios, coronal and sagittal loading conditions were considered under 100N of direct force to fibula. The measurements of the distal tibiofibular coronal plane space at the anterior and posterior third of syndesmosis were performed using arthroscopic probes with increment of 0.2mm diameter. Further the sagittal translation were measured by arthroscopic scaled probe. Dunnett test was used to compare the findings of each ligamentous transection state to the intact state. A p-value < 0.05 was considered significantly defferent. Results: Compared with the intact ligamentous state, there was no difference in coronal and sagittal stability when the lateral ankle ligaments (ATFL, CFL, PTFL) and AITFL were transected (Table1 and 2, Group1). However, after subsequent transection of the IOL, or after transection of the lateral ankle ligaments (ATFL, CFL or and PTFL) alongside the AITFL and IOL, both coronal space and sagittal translation increased as compared with the intact state (p-values p<0.001 respectively) (Table1 and 2, Group2). Conclusion: Our findings suggest that lateral ankle ligaments do not directly contribute to syndesmotic stability in the coronal and sagittal plane. In concomitant acute syndesmotic and lateral ligament injury, surgeons should pay attention to whether there is combined IOL injury to determine the fixation of syndesmosis. [Table: see text][Table: see text]

Arthroscopic Assessment for Intra-articular Disorders in Residual Ankle Disability after Sprain

2005 ◽  
Vol 33 (5) ◽  
pp. 686-692 ◽  
Author(s):  
Masato Takao ◽  
Yuji Uchio ◽  
Kohei Naito ◽  
Ikuo Fukazawa ◽  
Mitsuo Ochi
Keyword(s):  
Ankle Sprain ◽  
Ankle Arthroscopy ◽  
Diagnostic Tools ◽  
Osteochondral Lesions ◽  
Anterior Talofibular Ligament ◽  
Ligament Injuries ◽  
Level Of Evidence ◽  
Double Blind ◽  
Talocrural Joint ◽  
Tibiofibular Ligament

Background After ankle sprain, there can be many causes of disability, the origins of which cannot be determined using standard diagnostic tools. Hypothesis Ankle arthroscopy is a useful tool in identifying intra-articular disorders of the talocrural joint in cases of residual ankle disability after sprain. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods The authors gathered the independent diagnostic results of physical examination, standard mortise and lateral radiography, stress radiography of the talocrural joint, and magnetic resonance imaging for 72 patients with residual ankle disability lasting more than 2 months after injury (mean, 7 months after injury). They performed arthroscopic procedures and compared the double-blind results. Results In all cases, the arthroscopic results matched those of other means of diagnosis. In 14 cases, the arthroscopic approach exceeded the capabilities of the other methods. Including duplications, 39 patients (54.2%) had anterior talofibular ligament injuries, 17 patients (23.6%) had distal tibiofibular ligament injuries, 29 patients (40.3%) had osteochondral lesions, 13 patients (18%) had symptomatic os subfibulare, 3 patients (4.2%) had anterior impingement exostosis, and 3 patients (4.2%) had impingement due to abnormally fibrous bands. There were only 2 cases in which the cause of symptoms could not be detected by ankle arthroscopy, compared with 16 cases in which the cause of disability could not be detected using standard methods. In 3 cases (17.6%) of distal tibiofibular ligament injuries, 8 cases (27.6%) of osteochondral lesions, and all 3 cases (100%) of impingement of an abnormal fibrous band, ankle arthroscopy was the only method capable of diagnosing the cause of residual ankle pain after a sprain. Conclusion The present results suggest that arthroscopy can be used to diagnose the cause of residual pain after an ankle sprain in most cases that are otherwise undiagnosable by clinical examination and imaging study.

Arthroscopic Assessment of Syndesmotic Instability in the Sagittal Plane in a Cadaveric Model

2019 ◽  
Vol 41 (2) ◽  
pp. 237-243 ◽  
Author(s):  
Bart Lubberts ◽  
Jafet Massri-Pugin ◽  
Daniel Guss ◽  
Jonathon C. Wolf ◽  
Rohan Bhimani ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Cutoff Point ◽  
Ligament Injury ◽  
Deltoid Ligament ◽  
Optimal Cutoff ◽  
Distal Fibula ◽  
Interosseous Ligament ◽  
Tibiofibular Ligament ◽  
Optimal Cutoff Point ◽  
Cadaveric Model

Background: Syndesmotic instability is multidirectional, occurring in the coronal, sagittal, and rotational planes. Despite the multitude of studies examining such instability in the coronal plane, other studies have highlighted that syndesmotic instability may instead be more evident in the sagittal plane. The aim of this study was to arthroscopically assess the degree of syndesmotic ligamentous injury necessary to precipitate fibular translation in the sagittal plane. Methods: Twenty-one above-knee cadaveric specimens underwent arthroscopic evaluation of the syndesmosis, first with all syndesmotic and ankle ligaments intact and subsequently with sequential sectioning of the anterior inferior tibiofibular ligament (AITFL), the interosseous ligament (IOL), the posterior inferior tibiofibular ligament (PITFL), and deltoid ligament (DL). In all scenarios, an anterior to posterior (AP) and a posterior to anterior (PA) fibular translation test were performed under a 100-N applied force. AP and PA sagittal plane translation of the distal fibula relative to the fixed tibial incisura was arthroscopically measured. Results: Compared with the intact ligamentous state, there was no difference in sagittal fibular translation when only 1 or 2 ligaments were transected. After transection of all the syndesmotic ligaments (AITFL, IOL, and PITFL) or after partial transection of the syndesmotic ligaments (AITFL, IOL) alongside the DL, fibular translation in the sagittal plane significantly increased as compared with the intact state ( P values ranging from .041 to <.001). The optimal cutoff point to distinguish stable from unstable injuries was equal to 2 mm of fibular translation for the total sum of AP and PA translation (sensitivity 77.5%; specificity 88.9%). Conclusion: Syndesmotic instability appears in the sagittal plane after injury to all 3 syndesmotic ligaments or after partial syndesmotic injury with concomitant deltoid ligament injury in this cadaveric model. The optimal cutoff point to arthroscopically distinguish stable from unstable injuries was 2 mm of total fibular translation. Clinical Relevance: These data can help surgeons arthroscopically distinguish between stable syndesmotic injuries and unstable ones that require syndesmotic stabilization.

Lateral Ankle Sprain and Chronic Ankle Instability

2014 ◽  
Vol 7 (4) ◽  
pp. 298-326 ◽  
Author(s):  
Takumi Kobayashi ◽  
Kazuyoshi Gamada
Keyword(s):  
Postural Control ◽  
Ankle Sprain ◽  
Ankle Instability ◽  
Scientific Evidence ◽  
Chronic Ankle Instability ◽  
Ligament Injury ◽  
High Recurrence Rate ◽  
Contributing Factors ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle

Many studies investigated the contributing factors of chronic ankle instability, but a consensus has not yet been obtained. The objective of this critical review is to provide recent scientific evidence on chronic ankle instability, including the epidemiology and pathology of lateral ankle sprain as well as the causative factors of chronic ankle instability. We searched MEDLINE from 1964 to December 2013 using the terms ankle, sprain, ligament, injury, chronic, functional, mechanical, and instability. Lateral ankle sprain shows a very high recurrence rate and causes considerable economic loss due to medical care, prevention, and secondary disability. During the acute phase, patients with ankle sprain demonstrate symptoms such as pain, range of motion deficit, postural control deficit, and muscle weakness, and these symptoms may persist, leading to chronic ankle instability. Although some agreement regarding the effects of chronic ankle instability with deficits in postural control and/or concentric eversion strength exists, the cause of chronic ankle instability remains controversial.Levels of Evidence: Therapeutic Level IV: Review of Level IV studies

scholarly journals High ankle sprain: sonographic demonstration of a posterior inferior tibiofibular ligament avulsion

2020 ◽  
Vol 23 (3) ◽  
pp. 431-433
Author(s):  
Marco Becciolini ◽  
Giovanni Bonacchi ◽  
Salvatore Massimo Stella ◽  
Stefano Galletti ◽  
Vincenzo Ricci
Keyword(s):  
Ankle Sprain ◽  
Tibiofibular Ligament ◽  
High Ankle Sprain ◽  
Sonographic Demonstration

scholarly journals BANDHANA WITH MANJISHTADI LEPA IN THE MANAGEMENT OF ANKLE SPRAIN – A CASE REPORT

2021 ◽  
Vol 9 (10) ◽  
pp. 2637-2640
Author(s):  
Dhanya M ◽  
N. Madhuri Devi ◽  
Sreelekha M. P.
Keyword(s):  
Ankle Joint ◽  
Ankle Sprain ◽  
The Body ◽  
Ligament Injury ◽  
Medical Attention ◽  
Joint Injuries ◽  
Keywords Ankle ◽  
The Right ◽  
Present Case Study

The ankle joint is the most common site for a ligament injury in the body. Some ankle joint injuries are minor and heal with some rest from activities, but some are serious and require immediate medical attention. An ankle sprain refers to ligament injuries of the ankle. In classics, there is no direct reference regarding sprain and its manage- ment. In Susrutha Samhitha Chikitsa Sthana 3rdchapter, Bhagna Chikitsitham, Acharya Susruta has mentioned the application of Manjishtadi Lepa for traumatic joint injuries. In the present case study, a 22 years old male pa- tient visited the OPD with severe pain and swelling of the right ankle following a twisting injury of the foot. He was diagnosed with a grade 1 ankle sprain and was bandaged with Manjishtadi Lepa. Management with Man- jishtadi Lepa has shown significant relief in pain and swelling as well as in the restoration of normal movements. Keywords: Ankle sprain, Manjishtadi Lepa

Diagnostic performance of ankle ultrasound for diagnosing anterior talofibular and calcaneofibular ligament injuries: a meta-analysis

2019 ◽  
Vol 61 (5) ◽  
pp. 651-661
Author(s):  
Hosik Seok ◽  
Sun Hwa Lee ◽  
Seong Jong Yun
Keyword(s):  
Subgroup Analysis ◽  
Diagnostic Performance ◽  
Operating Characteristic ◽  
Ligament Injury ◽  
Ligament Injuries ◽  
Summary Receiver Operating Characteristic ◽  
Calcaneofibular Ligament ◽  
Ligament Tear ◽  
Tibiofibular Ligament ◽  
Ankle Ultrasound

Background Ankle ultrasound imaging could be an option with higher priority due to its lack of radiation, and cost- and time-effectiveness. However, previous studies regarding anterior tibiofibular ligament and calcaneofibular ligament injuries have shown varied results. Purpose To evaluate the diagnostic performance of ankle ultrasound for anterior tibiofibular ligament and calcaneofibular ligament injuries. Material and Methods PubMed and EMBASE databases were searched for diagnostic accuracy studies that used ultrasound for diagnosing anterior tibiofibular ligament and calcaneofibular ligament injuries. Bivariate and hierarchical summary receiver operating characteristic modeling were used to evaluate diagnostic performance. Subgroup analysis was performed using studies according to severity of the injury (complete and partial anterior tibiofibular ligament tear). We performed meta-regression analyses for heterogeneity exploration. Results Ten articles involving a total of 380 patients were included. For anterior tibiofibular ligament injury, the summary sensitivity, summary specificity, and area under the hierarchical summary receiver operating characteristic curve (AUC) were 0.99, 0.92, and 0.99, respectively. For calcaneofibular ligament injury, the summary sensitivity, summary specificity, and AUC were 0.95, 0.99, and 0.95, respectively. In subgroup analysis, for complete anterior tibiofibular ligament tear, the summary sensitivity, summary specificity, and AUC were 0.96, 0.82, and 0.96, respectively. For partial anterior tibiofibular ligament tear, the summary sensitivity, summary specificity, and AUC were 0.90, 0.82, and 0.93, respectively. Among the various potential covariates, proportion of anterior tibiofibular ligament tear, ultrasound interpreter, and reference standard were associated with specificity heterogeneity. Conclusion Ankle ultrasound demonstrates high diagnostic performance in the diagnosis of anterior tibiofibular ligament and calcaneofibular ligament injuries. We recommend ultrasound performed by a musculoskeletal radiologist as a first-line diagnostic tool to diagnose anterior tibiofibular ligament and calcaneofibular ligament injuries.

Determination of In Situ Ankle Ligament Strains in Cases of High and Medial Ankle Sprains

2012 ◽  
Author(s):  
Keith D. Button ◽  
Feng Wei ◽  
Eric G. Meyer ◽  
Kathleen Fitzsimons ◽  
Roger C. Haut
Keyword(s):  
Ankle Sprain ◽  
Ankle Injury ◽  
Ankle Injuries ◽  
Deltoid Ligament ◽  
Generic Model ◽  
Ankle Sprains ◽  
Ligament Injuries ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Tibiofibular Ligament

Ankle sprain is a common occurrence in sports, accounting for 10–30% of injuries [1]. While approximately 85% of ankle sprains are lateral ankle injuries, syndesmotic (high) and medial injuries typically result in more time off the field. In order to help limit or mitigate ankle injuries, it is important to understand the mechanisms of injury. While numerous biomechanical studies have been conducted to investigate ankle injuries, most of them are designed to study ankle fractures rather than sprains. Ankle sprains have been graded in the clinical literature and associated with the degree of damage to a ligament resulting from excessive strains [2]. Recently, there have been studies of lateral ankle sprain in laboratory settings [3,4] and based on investigation of game films [5], providing considerable insight into the mechanism of lateral ankle sprain. On the other hand, few biomechanical studies have been conducted on high and medial ankle sprains. A more recent study from our laboratory used human cadaver limbs to investigate such injuries [6]. The study showed that the type of ankle injury, whether medial or high, under excessive levels of external foot rotation depends on the extent of foot eversion [6]. Everted limbs showed isolated anterior tibiofibular ligament injuries (high ankle sprain) only, while neutral limbs mostly demonstrated deltoid ligament failures (medial ankle sprain). Additionally, the study documented grade II (partial tears) and grade III (ruptures) ligament injuries. While a computational ankle model has also been developed and validated to help understand the mechanisms of injury [7], it is a generic model. The objective of the current study was to develop computational, subject-specific models from those cadaver limbs and determine the levels of ligament strain generated in the medial and high ankle injury cases, as well as correlate the grades of injury with ligament strains from the computational model.

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