scholarly journals Weber B Fracture of the Lateral Malleolus with Concomitant Anterior Talofibular Ligament Injury following an Ankle Supination Injury

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Mohammed Khalid Faqi ◽  
Abdulla AlJawder ◽  
Fahad Alkhalifa ◽  
Ali H. Almajed
Keyword(s):  
Clinical Practice ◽  
Critical Review ◽  
Ankle Instability ◽  
Lateral Malleolus ◽  
Ankle Injuries ◽  
Ligament Injury ◽  
Anterior Talofibular Ligament ◽  
Prediction System ◽  
Mechanism Of Injury ◽  
Ligament Tear

The Lauge-Hansen (LH) classification attempts to predict patterns of ankle injuries based upon the preceding mechanism of injury. Although it is widely used in clinical practice, it has been criticized mainly due to numerous reports of cases conflicting the prediction system. Here, we report a case of a 32-year-old male who sustained a Weber B fracture of the lateral malleolus following a supination ankle injury, which was treated conservatively, following which the patient presented with ankle instability and was found to have concurrent anterior talofibular ligament tear. Critical review of the LH classification along with its shortcomings is discussed.

scholarly journals Characteristics and predictors of muscle strength deficit in mechanical ankle instability

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Zong-chen Hou ◽  
Xin Miao ◽  
Ying-fang Ao ◽  
Yue-lin Hu ◽  
Chen Jiao ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Strength Training ◽  
Ankle Instability ◽  
Plantar Flexion ◽  
Ligament Injury ◽  
Osteochondral Lesions ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Unaffected Side ◽  
Affected Side

Abstract Purpose Muscle strength training is a common strategy for treating chronic ankle instability (CAI), but the effectiveness decreases for mechanical ankle instability (MAI) patients with initial severe ligament injuries. The purpose of this study was to investigate the characteristics and the potential predictors of muscle strength deficit in MAI patients, with a view to proposing a more targeted muscle strength training strategy. Methods A total of 220 MAI patients with confirmed initial lateral ankle ligament rupture and a postinjury duration of more than 6 months were included. All patients underwent a Biodex isokinetic examination of the ankle joints of both the affected and unaffected sides. Then, the associations between the limb symmetry index (LSI) (mean peak torque of the injury side divided by that of the healthy side) and the patients’ sex, body mass index, postinjury duration, presence of intra-articular osteochondral lesions, presence of osteophytes and ligament injury pattern (i.e., isolated anterior talofibular ligament (ATFL) injury or combined with calcaneofibular ligament injury) were analysed. Results There was significantly weaker muscle strength on the affected side than on the unaffected side in all directions (p < 0.05). The LSI in plantar flexion was significantly lower than that in dorsiflexion at 60°/s (0.87 vs 0.98, p < 0.001). A lower LSI in eversion was significantly correlated with female sex (0.82 vs 0.94, p = 0.016) and isolated ATFL injury (0.86 vs 0.95, p = 0.012). No other factors were found to be associated with muscle strength deficits. Conclusion MAI patients showed significant muscle strength deficits on the affected side, especially in plantar flexion. There were greater strength deficits in eversion in females and individuals with an isolated ATFL injury. Thus, a muscle strength training programme for MAI patients was proposed that focused more on plantar flexion training and eversion training for females and those with an isolated ATFL injury.

scholarly journals Intelligent Localization and Quantitative Evaluation of Anterior Talofibular Ligament Injury using Magnetic Resonance Imaging of Ankle

2021 ◽  
Author(s):  
Wen Yan ◽  
Xianghong Meng ◽  
Jinglai Sun ◽  
Hui Yu ◽  
Zhi Wang
Keyword(s):  
Ankle Injuries ◽  
Ligament Injury ◽  
Lateral Ligament ◽  
Support Vector ◽  
Anterior Talofibular Ligament ◽  
Good Prediction ◽  
Feature Points ◽  
Characteristic Analysis ◽  
Prediction Ability ◽  
Mean Values

Abstract Background: There is a high incidence of injury to the lateral ligament of the ankle in daily living and sports activities. The anterior talofibular ligament (ATFL) is the most frequent types of ankle injuries. It is of great clinical significance to achieve intelligent localization and injury evaluation of ATFL due to its vulnerability.Methods: According to the specific characteristics of bones in different slices, the key slice was extracted by image segmentation and characteristic analysis. Then, the talus and fibula in the key slice were segmented by distance regularized level set evolution (DRLSE), and the curvature of their contour pixels was calculated to find useful feature points including the neck of talus, the inner edge of fibula, and the outer edge of fibula. ATFL area can be located using these feature points so as to quantify its first-order gray features and second-order texture features. Support vector machine (SVM) was performed for evaluation of ATFL injury.Results: Data were collected retrospectively from 158 patients who underwent MRI, and were divided into normal (68) and tear (90) group. The positioning accuracy and Dice coefficient were used to measure the performance of ATFL localization, and the mean values are 87.7% and 77.1%, respectively, which is helpful for the following feature extraction. SVM gave a good prediction ability with accuracy of 93.8%, sensitivity of 88.9%, specificity of 100%, precision of 100%, and F1 score of 94.2% in the test set.Conclusion: Experimental results indicate that the proposed method is reliable in diagnosing ATFL injury. This study may provide a potentially viable method for aided clinical diagnoses of some ligament injury.

scholarly journals Intelligent localization and quantitative evaluation of anterior talofibular ligament injury using magnetic resonance imaging of ankle

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wen Yan ◽  
Xianghong Meng ◽  
Jinglai Sun ◽  
Hui Yu ◽  
Zhi Wang
Keyword(s):  
Ankle Injuries ◽  
Ligament Injury ◽  
Lateral Ligament ◽  
Support Vector ◽  
Anterior Talofibular Ligament ◽  
Good Prediction ◽  
Feature Points ◽  
Characteristic Analysis ◽  
Prediction Ability ◽  
Mean Values

Abstract Background There is a high incidence of injury to the lateral ligament of the ankle in daily living and sports activities. The anterior talofibular ligament (ATFL) is the most frequent types of ankle injuries. It is of great clinical significance to achieve intelligent localization and injury evaluation of ATFL due to its vulnerability. Methods According to the specific characteristics of bones in different slices, the key slice was extracted by image segmentation and characteristic analysis. Then, the talus and fibula in the key slice were segmented by distance regularized level set evolution (DRLSE), and the curvature of their contour pixels was calculated to find useful feature points including the neck of talus, the inner edge of fibula, and the outer edge of fibula. ATFL area can be located using these feature points so as to quantify its first-order gray features and second-order texture features. Support vector machine (SVM) was performed for evaluation of ATFL injury. Results Data were collected retrospectively from 158 patients who underwent MRI, and were divided into normal (68) and tear (90) group. The positioning accuracy and Dice coefficient were used to measure the performance of ATFL localization, and the mean values are 87.7% and 77.1%, respectively, which is helpful for the following feature extraction. SVM gave a good prediction ability with accuracy of 93.8%, sensitivity of 88.9%, specificity of 100%, precision of 100%, and F1 score of 94.2% in the test set. Conclusion Experimental results indicate that the proposed method is reliable in diagnosing ATFL injury. This study may provide a potentially viable method for aided clinical diagnoses of some ligament injury.

The Role of Calcaneofibular Ligament Injury in Ankle Instability: Implications for Surgical Management

2018 ◽  
Vol 47 (2) ◽  
pp. 431-437 ◽  
Author(s):  
Kenneth J. Hunt ◽  
Helder Pereira ◽  
Judas Kelley ◽  
Nicholas Anderson ◽  
Richard Fuld ◽  
...  
Keyword(s):  
Contact Mechanics ◽  
Ankle Joint ◽  
Contact Area ◽  
Ankle Instability ◽  
Peak Torque ◽  
Ligament Injury ◽  
Lateral Ligament ◽  
Anterior Talofibular Ligament ◽  
Ankle Sprains ◽  
Calcaneofibular Ligament

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.

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 Characteristics and predictors of muscle strength deficit in mechanical ankle instability

2020 ◽  
Author(s):  
Zong-chen Hou ◽  
Xin Miao ◽  
Ying-fang Ao ◽  
Yue-lin Hu ◽  
Chen Jiao ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Strength Training ◽  
Ankle Instability ◽  
Plantar Flexion ◽  
Ligament Injury ◽  
Osteochondral Lesions ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Unaffected Side ◽  
Affected Side

Abstract Purpose: Muscle strength training is a common strategy for treating chronic ankle instability (CAI), but the effectiveness decreases for mechanical ankle instability (MAI) patients with initial severe ligament injuries. The purpose of this study was to investigate the characteristics and the potential predictors of muscle strength deficit in MAI patients, with a view to proposing a more targeted muscle strength training strategy.Methods: A total of 220 MAI patients with confirmed initial lateral ankle ligament rupture and a postinjury duration of more than 6 months were included. All patients underwent a Biodex isokinetic examination of the ankle joints of both the affected and unaffected sides. Then, the associations between the limb symmetry index (LSI) (mean peak torque of the injury side divided by that of the healthy side) and the patients’ sex, body mass index, postinjury duration, presence of intra-articular osteochondral lesions, presence of osteophytes and ligament injury pattern (i.e., isolated anterior talofibular ligament (ATFL) injury or combined with calcaneofibular ligament injury) were analysed.Results: There was significantly weaker muscle strength on the affected side than on the unaffected side in all directions (p<0.05). The LSI in plantar flexion was significantly lower than that in dorsiflexion at 60°/s (0.87 vs 0.98, p<0.001). A lower LSI in eversion was significantly correlated with female sex (0.82 vs 0.94, p=0.016) and isolated ATFL injury (0.86 vs 0.95, p=0.012). No other factors were found to be associated with muscle strength deficits.Conclusion: MAI patients showed significant muscle strength deficits on the affected side, especially in plantar flexion. There were greater strength deficits in eversion in females and individuals with an isolated ATFL injury. Thus, a muscle strength training programme for MAI patients was proposed that focused more on plantar flexion training and eversion training for females and those with an isolated ATFL injury.

scholarly journals Characteristics and predictors of muscle strength deficit in mechanical ankle instability

2020 ◽  
Author(s):  
Zong-chen Hou ◽  
Xin Miao ◽  
Ying-fang Ao ◽  
Yue-lin Hu ◽  
Chen Jiao ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Strength Training ◽  
Ankle Instability ◽  
Plantar Flexion ◽  
Ligament Injury ◽  
Osteochondral Lesions ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Unaffected Side ◽  
Affected Side

Abstract Purpose Muscle strength training is a common strategy for treating chronic ankle instability (CAI), but the effectiveness decreases for mechanical ankle instability (MAI) patients with initial severe ligament injuries. The purpose of this study was to investigate the characteristics and the potential predictors of muscle strength deficit in MAI patients, with a view to proposing a more targeted muscle strength training strategy. Methods A total of 220 MAI patients with confirmed initial lateral ankle ligament rupture and a postinjury duration of more than 6 months were included. All patients underwent a Biodex isokinetic examination of the ankle joints of both the affected and unaffected sides. Then, the associations between the limb symmetry index (LSI) (mean peak torque of the injury side divided by that of the healthy side) and the patients’ sex, body mass index, postinjury duration, presence of intra-articular osteochondral lesions, presence of osteophytes and ligament injury pattern (i.e., isolated anterior talofibular ligament (ATFL) injury or combined with calcaneofibular ligament injury) were analysed. Results There was significantly weaker muscle strength on the affected side than on the unaffected side in all directions ( p <0.05). The LSI in plantar flexion was significantly lower than that in dorsiflexion at 60°/s (0.87 vs 0.98, p <0.001). A lower LSI in eversion was significantly correlated with female sex (0.82 vs 0.94, p =0.016) and isolated ATFL injury (0.86 vs 0.95, p =0.012). No other factors were found to be associated with muscle strength deficits. Conclusion MAI patients showed significant muscle strength deficits on the affected side, especially in plantar flexion. There were greater strength deficits in eversion in females and individuals with an isolated ATFL injury. Thus, a muscle strength training programme for MAI patients was proposed that focused more on plantar flexion training and eversion training for females and those with an isolated ATFL injury.

scholarly journals Anatomical variations and interconnections of the superior peroneal retinaculum to adjacent lateral ankle structures: a preliminary imaging anatomy study

2021 ◽  
Vol 21 (84) ◽  
pp. e12-e21
Author(s):  
Eleni E. Drakonaki ◽  
◽  
Khaldun Ghali Gataa ◽  
Nektarios Solidakis ◽  
Paweł Szaro ◽  
...  
Keyword(s):  
Anatomical Variations ◽  
Tendon Sheath ◽  
Lateral Malleolus ◽  
Ankle Injuries ◽  
Anterior Talofibular Ligament ◽  
Peroneal Tendon ◽  
Extensor Retinaculum ◽  
Lateral Ankle ◽  
Starting Point ◽  
Inferior Extensor Retinaculum

Aim: This imaging anatomy study aimed at detecting anatomical variations and potential interconnections of the superior peroneal retinaculum to other lateral stabilizing structures. Materials and methods: We retrospectively reviewed the imaging archives of 63 patients (38 females, 25 males, mean age 32.7, range 18–58 years) with available ankle US, MR and CT images to detect whether US and MR can detect the presence of interconnections between the superior peroneal retinaculum and the anterior talofibular ligament, inferior extensor retinaculum and peroneal tendon sheath. We evaluated the presence of common anatomical variations including low peroneus brevis muscle belly, peroneal tubercle, os peroneum, and retromalleolar fibular groove shape in relation to the presence of superior peroneal retinaculum connections. Results: The connections of the superior peroneal retinaculum can be revealed on magnetic resonance imaging (MRI) and ultrasound (US). The connection to the anterior talofibular ligament was located (a) inferior to the lateral malleolus, (b) at the level of the lateral malleolus and (c) on both levels, respectively (a) 49.2% on MRI and 39.7% on US, p <0.05, (b) 44.4% and 58.7%, p <0.05, 36.5% and (c) 27%, p <0.05. Superior peroneal retinaculum–inferior extensor retinaculum (MRI 47.6%, US 28.6% p <0.001) and superior peroneal retinaculum–peroneal tendon sheath (MRI 22.2%, US 25.4% p >0.05) connections were also found both on MR and US. Conclusion: Ankle US and MR revealed interconnections between the superior peroneal retinaculum and the anterior talofibular ligament, inferior extensor retinaculum, and superior peroneal retinaculum. Our results are a starting point for further studies on the connections of the superior peroneal retinaculum and the applicability of ultrasound and MRI in assessing their occurrence. Knowledge of the anatomical connections of the superior peroneal retinaculum may help radiologists with the assessment of lateral ankle injuries, and surgeons with treatment planning.

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