Talofibular Interval Changes After Acute Ankle Sprain: A Stress Ultrasonography Study of Ankle Laxity

2013 ◽  
Vol 22 (4) ◽  
pp. 257-263 ◽  
Author(s):  
Theodore Croy ◽  
Susan Saliba ◽  
Ethan Saliba ◽  
Mark W. Anderson ◽  
Jay Hertel
Keyword(s):  
Ankle Sprain ◽  
Ankle Injuries ◽  
Anterior Talofibular Ligament ◽  
Talocrural Joint ◽  
Lateral Ankle ◽  
Female Age ◽  
Anterior Drawer ◽  
Main Effect ◽  
Ability Measure ◽  
And Inversion

Introduction:Quantifying talocrural joint laxity after ankle sprain is problematic. Stress ultrasonography (US) can image the lateral talocrural joint and allow the measurement of the talofibular interval, which may suggest injury to the anterior talofibular ligament (ATFL). The acute talofibular interval changes after lateral ankle sprain are unknown.Methods:Twenty-five participants (9 male, 16 female; age 21.8 ± 3.2 y, height 167.8 ± 34.1 cm, mass 72.7 ± 13.8 kg) with 27 acute, lateral ankle injuries underwent bilateral stress US imaging at baseline (<7 d) and on the affected ankle at 3 wk and 6 wk from injury in 3 ankle conditions: neutral, anterior drawer, and inversion. Talofibular interval (mm) was measured using imaging software and self-reported function (activities of daily living [ADL] and sports) by the Foot and Ankle Ability Measure (FAAM).Results:The talofibular interval increased with anterior-drawer stress in the involved ankle (22.65 ± 3.75 mm; P = .017) over the uninvolved ankle (19.45 ± 2.35 mm; limb × position F1,26 = 4.9, P = .035) at baseline. Inversion stress also resulted in greater interval changes (23.41 ± 2.81 mm) than in the uninvolved ankles (21.13 ± 2.08 mm). A main effect for time was observed for inversion (F2,52 = 4.3, P = .019, 21.93 ± 2.24 mm) but not for anterior drawer (F2,52 = 3.1, P = .055, 21.18 ± 2.34 mm). A significant reduction in the talofibular interval took place between baseline and week 3 inversion measurements only (F1,26 = 5.6, P = .026). FAAM-ADL and sports results increased significantly from baseline to wk 3 (21.9 ± 16.2, P < .0001 and 23.8 ± 16.9, P < .0001) and from wk 3 to wk 6 (2.5 ± 4.4, P = .009 and 10.5 ± 13.2, P = .001).Conclusions:Stress US methods identified increased talofibular interval changes suggestive of talocrural laxity and ATFL injury using anterior drawer and inversion stress that, despite significant improvements in self-reported function, only marginally improved during the 6 wk after ankle sprain. Stress US provides a safe, repeatable, and quantifiable method of measuring the talofibular interval and may augment manual stress examinations in acute ankle injuries.

scholarly journals Identifying Range-of-Motion Deficits and Talocrural Joint Laxity After an Acute Lateral Ankle Sprain

2021 ◽  
Vol 56 (4) ◽  
pp. 408-417
Author(s):  
Bethany A. Wisthoff ◽  
Carrie L. Docherty ◽  
Joseph Glutting ◽  
Geoff Gustavsen ◽  
Todd D. Royer ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Analysis Of Variance ◽  
Ankle Sprain ◽  
Talocrural Joint ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Residual Symptoms ◽  
Anterior Drawer ◽  
Over Time ◽  
Grade Iii

Context Approximately 72% of patients with an ankle sprain report residual symptoms 6 to 18 months later. Although 44% of patients return to activity in less than 24 hours after experiencing a sprain, residual symptoms should be evaluated in the long term to determine if deficits exist. These residual symptoms may be due to the quality of ligament tissue and motion after injury. Objective To compare mechanical laxity of the talocrural joint and dorsiflexion range of motion (DFROM) over time (24 to 72 hours, 2 to 4 weeks, and 6 months) after an acute lateral ankle sprain (LAS). Design Cross-sectional study. Setting Athletic training research laboratory. Patients or Other Participants A total of 108 volunteers were recruited. Fifty-five participants had an acute LAS and 53 participants were control individuals without a history of LAS. Main Outcome Measure(s) Mechanical laxity (talofibular interval and anterior talofibular ligament length) was measured in inversion (INV) and via the anterior drawer test. The weight-bearing lunge test was conducted and DFROM was measured. The data were analyzed using repeated-measures analysis of variance, independent-samples t tests, and 1-way analysis of variance. Results Of the 55 LASs, 21 (38%) were grade I, 27 (49%) were grade II, and 7 (13%) were grade III. Increases were noted in DFROM over time, between 24 and 72 hours, at 2 to 4 weeks, and at 6 months (P &lt; .05). The DFROM was less in participants with grade III than grade I LASs (P = .004) at 24 to 72 hours; INV length was greater at 24 to 72 hours than at 2 to 4 weeks (P = .023) and at 6 months (P = .035) than at 24 to 72 hours. The anterior drawer length (P = .001) and INV talofibular interval (P = .004) were greater in the LAS group than in the control group at 6 months. Conclusions Differences in range of motion and laxity were evident among grades at various time points and may indicate different clinical responses after an LAS.

LATERAL ANKLE SPRAIN — AN UPDATE

2013 ◽  
Vol 16 (04) ◽  
pp. 1330003
Author(s):  
Shibli Nuhmani ◽  
Moazzam Hussain Khan
Keyword(s):  
Ankle Sprain ◽  
Bone Fractures ◽  
Sports Injury ◽  
Ankle Injuries ◽  
Anterior Talofibular Ligament ◽  
Ankle Sprains ◽  
Calcaneofibular Ligament ◽  
Lateral Ankle ◽  
Major Loss ◽  
Sporting Activities

Ankle sprain injuries are the most common injury sustained during sporting activities. One-sixth of all sports injury loss time is from ankle sprains. Each year, an estimated 1 million people present to physicians with acute ankle injuries. Three-quarters of ankle injuries involve the lateral ligamentous complex, comprised of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). Lateral ankle sprains typically occur when the rearfoot undergoes excessive supination on an externally rotated lower leg. The diagnosis of a sprain relies on the medical history including symptoms, as well as making a differential diagnosis mainly in distinguishing it from strains or bone fractures. Despite their prevalence in society, ankle sprains still remain a difficult diagnostic and therapeutic challenge in the athlete, as well as in society in general. The high incidence of ligamentous ankle injuries requires clearly defined acute care and a broad knowledge of new methods in rehabilitation. In addition to rapid pain relief, the main objective of treatment is to quickly restore the range of motion of the ankle without any major loss of proprioception, thereby restoring full activity as soon as possible. The purpose of this article is to review the anatomy, pathomechanics, investigation, diagnosis and management of lateral ankle sprains.

scholarly journals Diagnosing the Impact of the Syndesmotic Injury on Lateral Ankle Stability using Dynamic Ultrasound

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0013
Author(s):  
Rohan Bhimani ◽  
Jirawat Saengsin ◽  
Go Sato ◽  
Noortje Hagemeijer ◽  
Bart Lubberts ◽  
...  
Keyword(s):  
Anterior Talofibular Ligament ◽  
Syndesmotic Injury ◽  
Lateral Ankle ◽  
Anterior Drawer ◽  
Intact State ◽  
Tibiofibular Ligament ◽  
Ankle Stability ◽  
Clear Space ◽  
Lateral Ankle Ligament ◽  
The Impact

Category: Ankle; Basic Sciences/Biologics; Sports; Trauma Introduction/Purpose: There is a high prevalence of coexisting lateral ankle ligament injuries and syndesmotic ligamentous injuries. However, it is unclear whether syndesmotic ligaments directly contribute toward the stability of the lateral ankle. Dynamic ultrasonography (US) is an imaging modality increasingly used for the care of orthopaedic foot and ankle patients because it allows dynamic evaluation of structures at the point of care with little risk to the patient and at low-cost. The aim of this study is to assess the effect of syndesmotic injury as well as combined syndesmotic and lateral ankle injury on the stability of the lateral ankle. Methods: Sixteen fresh frozen above-knee amputated cadaveric specimens, divided into two groups, underwent ultrasound evaluation for lateral ankle stability. In both the groups, the assessment was first done with all ligaments intact and later with sequential transection of anterior inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), posterior inferior tibiofibular ligament (PITFL), anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL). In all scenarios, two loading conditions were considered: (1) Anterior drawer test: 50N and 80N and (2) Lateral clear space (LCS): 1.7Nm torque. The talar translation and LCS to the fixed tibial plafond were measured using Image J. Wilcoxon rank-sum test was used to compare the findings of each ligamentous transection state to the intact state. A p-value <0.05 was considered statistically significant. Results: In group 1 after transection of the all syndesmotic ligament and ATFL, an increase in the anterior drawer and lateral clear space values were found as compared to the intact state. Similarly, in group 2 the anterior drawer and lateral clear space values significantly increased after transection of the AITFL and ATFL as compared to the intact state (p-values = 0.01). Conclusion: Ultrasound can be used to evaluate the impact of the syndesmotic injury on lateral ankle stability while performing dynamic stress maneuvers. Lateral ankle instability appears after injury to all syndesmotic ligaments and ATFL, or after one syndesmotic ligament rupture (AITFL) with a concomitant anterior talofibular ligament rupture (ATFL). These findings suggest that surgeons should lower their threshold for stabilizing the syndesmosis if there is a concomitant lateral ankle ligament injury. [Table: see text]

Radiological Assessment of a Modified Anterior Drawer Test of the Ankle

Foot & Ankle ◽  
1992 ◽  
Vol 13 (7) ◽  
pp. 400-403 ◽  
Author(s):  
M. Nyska ◽  
H. Amir ◽  
A. Porath ◽  
S. Dekel
Keyword(s):  
Ankle Sprain ◽  
Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Common Complication ◽  
Anterior Drawer ◽  
Lateral Tilt ◽  
Anterior Drawer Test ◽  
Significant Movement ◽  
Recurrent Ankle Sprain ◽  
Radiological Examinations

Chronic ankle instability is a common complication of ankle sprain. The clinical assessment of ankle instability is usually incomplete and difficult to interpret. Recently, more attention has been paid to the value of the anterior drawer test of the ankle. We assessed the accuracy of a modification of the anterior drawer test, comparing it with radiological stress view of the ankle in 25 patients with recurrent ankle sprain. The radiological examinations were performed by a TELOS instrument and included lateral and anteroposterior stress views. We found that the modified anterior drawer test correlated with the posterior opening of the tibiotalar joint and with the lateral tilt of the talus. We conclude that a slightly positive modified anterior drawer test may indicate injury to the anterior talofibular ligament. A significant movement of the ankle elicited by the modified anterior drawer test may indicate combined injury to anterior talofibular and calcaneofibular ligaments.

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.

Anterior Drawer Test for Acute Anterior Talofibular Ligament Injuries of the Ankle: How Much Load Should be Applied during the Test?

2003 ◽  
Vol 31 (2) ◽  
pp. 226-232 ◽  
Author(s):  
Harukazu Tohyama ◽  
Kazunori Yasuda ◽  
Yasumitu Ohkoshi ◽  
Bruce D. Beynnon ◽  
Per A. Renstrom
Keyword(s):  
Cadaver Study ◽  
Ankle Injuries ◽  
Ligament Injury ◽  
Normal Displacement ◽  
Anterior Talofibular Ligament ◽  
Anterior Drawer ◽  
Anterior Drawer Test ◽  
Ankle Ligament ◽  
Anterior Posterior

Background: There is a lack of consensus regarding the magnitude of load for performing the anterior drawer test in evaluating acute ankle injuries. Purpose: To determine how much load should be applied during the anterior drawer test to detect the integrity of the anterior talofibular ligament. Methods: First, the anterior-posterior load-displacement response of nine cadaveric ankles was measured. Second, anterior displacement of the ankle was measured at 30 and 60 N of anterior load in 14 patients with acute tears of the anterior talofibular ligament. Results: In the cadaver study, the increased displacement by sectioning of the ligament measured at 10, 20, 30, and 40 N of anterior load were significantly greater than those measured at 60 N. In vivo examination of the subjects without anesthesia demonstrated that the injured-to-normal displacement value at 30 N of anterior load was significantly greater than the value at 60 N. Conclusions: This study suggests that a large magnitude of anterior load is not necessary to detect the integrity of the ligament during the anterior drawer test. Clinical Relevance: When evaluating the integrity of the anterior talofibular ligament in cases of acute ankle ligament injury, a relatively low-magnitude load should be applied.

scholarly journals Joint Stability Characteristics of the Ankle Complex in Female Athletes With Histories of Lateral Ankle Sprain, Part II: Clinical Experience Using Arthrometric Measurement

2014 ◽  
Vol 49 (2) ◽  
pp. 198-203 ◽  
Author(s):  
John E. Kovaleski ◽  
Robert J. Heitman ◽  
Larry R. Gurchiek ◽  
J. M. Hollis ◽  
Wei Liu ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Soft Tissues ◽  
Complex Motion ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Anterior Displacement ◽  
History Of ◽  
Ankle Complex ◽  
And Inversion ◽  
Lateral Ankle Ligaments

Context: This is part II of a 2-part series discussing stability characteristics of the ankle complex. In part I, we used a cadaver model to examine the effects of sectioning the lateral ankle ligaments on anterior and inversion motion and stiffness of the ankle complex. In part II, we wanted to build on and apply these findings to the clinical assessment of ankle-complex motion and stiffness in a group of athletes with a history of unilateral ankle sprain. Objective: To examine ankle-complex motion and stiffness in a group of athletes with reported history of lateral ankle sprain. Design: Cross-sectional study. Setting: University research laboratory. Patients or Other Participants: Twenty-five female college athletes (age = 19.4 ± 1.4 years, height = 170.2 ± 7.4 cm, mass = 67.3 ± 10.0 kg) with histories of unilateral ankle sprain. Intervention(s): All ankles underwent loading with an ankle arthrometer. Ankles were tested bilaterally. Main Outcome Measure(s): The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness. Results: Anterior displacement of the ankle complex did not differ between the uninjured and sprained ankles (P = .37), whereas ankle-complex rotation was greater for the sprained ankles (P = .03). The sprained ankles had less anterior and inversion end-range stiffness than the uninjured ankles (P &lt; .01). Conclusions: Changes in ankle-complex laxity and end-range stiffness were detected in ankles with histories of sprain. These results indicate the presence of altered mechanical characteristics in the soft tissues of the sprained ankles.

Limited intrarater and interrater reliability of acute ligamentous ankle injuries on 3 T MRI

2020 ◽  
pp. jisakos-2020-000503
Author(s):  
Thomas P A Baltes ◽  
Javier Arnaiz ◽  
Maryam R Al-Naimi ◽  
Omar Al-Sayrafi ◽  
Celeste Geertsema ◽  
...  
Keyword(s):  
Interrater Reliability ◽  
Ankle Injuries ◽  
Grading System ◽  
Anterior Talofibular Ligament ◽  
Ankle Ligaments ◽  
Diagnostic Reliability ◽  
Lateral Ankle ◽  
Syndesmosis Injury ◽  
Ankle Complex ◽  
The Individual

ObjectivesTo determine the diagnostic reliability of the Schneck grading system for acute ligamentous injuries of (1) the three major ligamentous ankle complexes, (2) the individual ankle ligaments and (3) the Sikka classification for syndesmosis injury.MethodsAll acute ankle injuries in adult athletes (≥18 years), presenting to the outpatient department of a specialised Orthopaedic and Sports Medicine Hospital, within 7 days postinjury were screened for inclusion. Ankle injuries were excluded if imaging demonstrated a frank ankle fracture or if the 3 T MRI study could not be acquired within 10 days postinjury. Two radiologists graded the three major ligamentous complexes (lateral ankle complex, deltoid complex and syndesmosis complex) and their comprising individual ligaments according the four-grade Schneck grading system. Syndesmotic injuries were classified according the four-grade Sikka classification for consequent injury of the individual syndesmosis ligaments and the deltoid complex. Agreement and kappa (K) statistics were calculated to determine intrarater and interrater reliability.ResultsBetween September 2016 and September 2018, a total of 92 MR scans were obtained (87 patients). Interrater and intrarater reliability of the Schneck grading system was moderate to substantial for the lateral ankle complex (K=0.47–0.76), fair to almost perfect for the syndesmosis complex (K=0.37–0.89) and fair to moderate for the deltoid complex (K=0.14–0.51). For the individual ligaments, kappa values ranged from moderate to substantial for the anterior talofibular ligament (ATFL) (K=0.55–0.73), fair to substantial for the calcaneofibular ligament (K=0.31–0.62) and fair to almost perfect for the anteroinferior tibiofibular ligament (AITFL) (K=0.36–0.89). Diagnostic reliability of the Sikka classification ranged from moderate to almost perfect (K=0.51–0.95).ConclusionsGrading of the three major ligamentous complexes and of the individual ankle ligaments according the Schneck grading system resulted in limited diagnostic reliability. When dichotomised for the presence of complete discontinuity, the interrater reliability of the Schneck grading system improved to substantial and almost perfect for the ATFL and AITFL, respectively. Classification of syndesmosis injury according the Sikka classification resulted in moderate interrater reliability.

scholarly journals Dynamic Evaluation Of The Effect Of Syndesmotic Injury On Lateral Ankle Stability Using Fluoroscopy

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0002
Author(s):  
Rohan Bhimani ◽  
Go Sato ◽  
Jirawat Saengsin ◽  
Noortje Hagemeijer ◽  
Bart Lubberts ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Lateral Ankle ◽  
Anterior Drawer ◽  
Intact State ◽  
Tibiofibular Ligament ◽  
Clear Space ◽  
Lateral Ankle Ligament ◽  
Talar Tilt ◽  
The Stability

Category: Ankle; Sports; Trauma Introduction/Purpose: There is a high incidence of concomitance between lateral ankle ligament injuries and syndesmotic ligamentous injuries. However, it is unclear whether syndesmotic ligaments directly contribute toward the stability of the lateral ankle. Stress radiographs are an accepted technique to assess the degree of lateral ankle instability by providing a static view of the ankle when subjected to the anterior drawer (AD) and talar tilt (TT) tests. The aim of this study is to assess the effect of syndesmotic injury as well as combined syndesmotic and lateral ankle injury on the stability of the lateral ankle. Methods: Sixteen fresh frozen above-knee amputated cadaveric specimens, divided into two groups, underwent fluoroscopic evaluation for lateral ankle stability. In both the groups, the assessment was first done with all ligaments intact and later with sequential transection of anterior inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), posterior inferior tibiofibular ligament (PITFL), anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL). In all scenarios, two loading conditions were considered: (1) Anterior drawer test: 50N and 80N and (2) Talar tilt and Lateral clear space (LCS): 1.7Nm torque. The talar translation, talar tilt, and LCS were measured using Image J. Wilcoxon rank-sum test was used to compare the findings of each ligamentous transection state to the intact state. A p-value <0.05 was considered statistically significant. Results: In group 1 after transection of the AITFL and IOL, an increase in the anterior drawer, talar tilt, and lateral clear space values was found as compared to the intact state. Similarly, in group 2 the anterior drawer, talar tilt, and lateral clear space values significantly increased after transection of the AITFL and ATFL as compared to the intact state (p-values = 0.001). Conclusion: Lateral ankle instability appears after injury to two syndesmotic ligaments (AITFL and IOL), or after one syndesmotic ligament rupture (AITFL) with a concomitant anterior talofibular ligament rupture (ATFL). These findings suggest that surgeons should lower their threshold for stabilizing the syndesmosis if there is a concomitant lateral ankle ligament injury.

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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