Association between joint effusions and concomitant structural injuries (tendinitis and structural injury) on MRI in ankle trauma without fracture

2021 ◽  
pp. 028418512110210
Author(s):  
Yeon Gyu Choi ◽  
Hee Jin Park ◽  
Ji Na Kim ◽  
Myung Sub Kim ◽  
Se Jin Park ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Treatment Plan ◽  
Osteochondral Lesion ◽  
Joint Effusion ◽  
Tibialis Posterior ◽  
Flexor Hallucis Longus ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Tibiofibular Ligament ◽  
Ankle Trauma

Background The evaluation of correlations among joint effusion, ligament injuries, tenosynovitis and osteochondral lesion of talus (OLT) in the ankle joint is important for developing a treatment plan and predicting prognosis. Purpose To evaluate correlations among tibiotalar (anterior) and talocalcaneal (posterior) joint effusion, tenosynovitis of major flexor tendons, ligaments, and OLT in a group of patients with ankle trauma. Material and Methods This retrospective study included 101 patients with ankle trauma who underwent magnetic resonance imaging. Two radiologists assessed the presence and amount of effusion in the tibiotalar and talocalcaneal joints from grade 0 to 2, according to the amount of capsular distension. Concomitant structural injuries were assessed in the tibialis posterior (TP), flexor digitorum longus, flexor hallucis longus, and peroneus tendons, and the anterior talofibular ligament, calcaneofibular ligament, anteroinferior tibiofibular ligament, posteroinferior tibiofibular ligament, and OLT. Results The proportion of anterior and posterior joint effusion according to grade was 67.3% for anterior joint effusion grade 0, 22.8% for grade 1, and 9.9% for grade 2; for posterior joint effusion, grade 0 was 74.2%, grade 1 was 22.8%, and grade 2 was 3.0%. We found statistically significant correlations between posterior joint effusion and tenosynovitis of TP ( P < 0.05) and between posterior joint effusion and OLT ( P < 0.05). Conclusion Posterior joint effusion is correlated with TP injury and OLT; however, tendon injuries have no correlation with other structural injuries of the ankle joint in a general population with ankle trauma.

Mechanical actions of heterogenic reflexes among ankle stabilizers and their interactions with plantarflexors of the cat hindlimb

1996 ◽  
Vol 75 (5) ◽  
pp. 2050-2070 ◽  
Author(s):  
S. J. Bonasera ◽  
T. R. Nichols
Keyword(s):  
Ankle Joint ◽  
Muscle Force ◽  
Reciprocal Inhibition ◽  
Afferent Input ◽  
Short Latency ◽  
Tibialis Posterior ◽  
Flexor Hallucis Longus ◽  
Force Output ◽  
Long Latency ◽  
Long Latency Reflexes

1. The stretch-evoked reflex organization of muscles whose major action is to abduct [peroneus brevis (PB); peroneus longus (PL)] and adduct [tibialis posterior (TP); flexor digitorum longus (FDL); flexor hallucis longus (FHL)] the ankle, and their interactions with the hindlimb extensors gastrocnemius (G) and soleus (S), were studied in 27 unanesthetized decerebrate cats. Ramp-hold-release stretches of physiological amplitudes were applied to muscle tendons detached from their bony insertion, and muscle force output was measured in response to these perturbations. Flexion and crossed-extension reflexes were used to modulate baseline force. 2. PB and TP shared strong, length-dependent, short-latency inhibitory reflexes prominent when the muscles were either actively generating force or quiescent. The mechanical characteristics of this reflex suggest Ia reciprocal inhibition as the underlying mechanism. Just as reciprocal inhibition between S and tibialis anterior stiffens the ankle joint against sagittal perturbations, we propose that reciprocal inhibition between PB and TP stiffens the ankle joint against nonsagittal perturbations. 3. In all preparations (n = 7) and under all conditions examined, PB and PL shared well-demonstrated mutual excitation. The reflex responses were asymmetric (favoring excitation of PL), length dependent, and occurred simultaneously with the stretch reflex at a latency of 16-18 ms. Mutual monosynaptic projections previously described between these two muscles explain all of the above findings. Our data further demonstrate that, under certain conditions, the ensemble activity of this reflex interaction has a powerful effect on the mechanical behavior of the muscle. 4. The heterogenic reflex organization of the ankle adductors was as follows: FDL evoked a modest excitation on TP, whereas FHL evoked weak inhibition. Latency of the excitation from FDL onto TP (24 ms) was greater than expected if the reflex were mediated by heteronymous Ia afferents. In all preparations examined (n = 3), TP contributed no significant reflexes onto either FDL or FHL. 5. Mutual, asymmetric inhibition characterized interactions between PB and the plantarflexors S and G. Most remarkable was a novel, long-latency (72-74 ms) reflex inhibition evoked on both S and G by stretch of PB. When this inhibition occurred, it dramatically decreased the S (or G) stretch response. Longer PB lengths evoked greater inhibition of isometric S; regression analysis indicated that the model best predicting this inhibition contained muscle force and stiffness terms. No long-latency reflexes were noted from either G or S onto PB. The mechanism underlying long-latency inhibition is presently unknown; however, features of this interaction suggest interneurons receive either group II or group III afferent input. 6. G and TP shared short latency, mutually inhibitory, asymmetric reflexes favoring inhibition of TP. No long-latency interactions were noted, nor were there any mechanically significant interactions between S and TP. 7. Reflex interactions across the abduction/adduction axis thus favored inhibition of plantarflexion and adduction torques while emphasizing abduction torques: PB/S (or PB/G) interactions were mutual, asymmetric, and favored inhibition of G and S; TP/G interactions were mutual, asymmetric, and favored inhibition of TP; TP/PB interactions were approximately balanced. The overall mechanical outcome of these inhibitory interactions may partly underlie the global corrective strategy seen in intact cats subjected to linear perturbations. 8. No significant reflex interactions were demonstrated between PL and TP, G, or S, nor were any long-latency reflexes noted. Thus, whereas reflex interactions between the stereotypically activated PB and other stereotypically activated muscles (including TP, G, and S) were strong and well-demonstrated, interactions between the variably activated PL and these same muscles were far weaker.

scholarly journals The double fascicular variations of the anterior talofibular ligament and the calcaneofibular ligament correlate with interconnections between lateral ankle structures revealed on magnetic resonance imaging

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Paweł Szaro ◽  
Khaldun Ghali Gataa ◽  
Mateusz Polaczek ◽  
Bogdan Ciszek
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Tendon Sheath ◽  
Anterior Talofibular Ligament ◽  
Peroneal Tendon ◽  
Resonance Imaging ◽  
Calcaneofibular Ligament ◽  
Ankle Ligaments ◽  
Tibiofibular Ligament ◽  
Adjacent Structures

AbstractThe anterior talofibular ligament and the calcaneofibular ligament are the most commonly injured ankle ligaments. This study aimed to investigate if the double fascicular anterior talofibular ligament and the calcaneofibular ligament are associated with the presence of interconnections between those two ligaments and connections with non-ligamentous structures. A retrospective re-evaluation of 198 magnetic resonance imaging examinations of the ankle joint was conducted. The correlation between the double fascicular anterior talofibular ligament and calcaneofibular ligament and connections with the superior peroneal retinaculum, the peroneal tendon sheath, the tibiofibular ligaments, and the inferior extensor retinaculum was studied. The relationships between the anterior talofibular ligament’s and the calcaneofibular ligament’s diameters with the presence of connections were investigated. Most of the connections were visible in a group of double fascicular ligaments. Most often, one was between the anterior talofibular ligament and calcaneofibular ligament (74.7%). Statistically significant differences between groups of single and double fascicular ligaments were visible in groups of connections between the anterior talofibular ligament and the peroneal tendon sheath (p < 0.001) as well as the calcaneofibular ligament and the posterior tibiofibular ligament (p < 0.05), superior peroneal retinaculum (p < 0.001), and peroneal tendon sheath (p < 0.001). Differences between the thickness of the anterior talofibular ligament and the calcaneofibular ligament (p < 0.001), the diameter of the fibular insertion of the anterior talofibular ligament (p < 0.001), the diameter of calcaneal attachment of the calcaneofibular ligament (p < 0.05), and tibiocalcaneal angle (p < 0.01) were statistically significant. The presence of the double fascicular anterior talofibular ligament and the calcaneofibular ligament fascicles correlate with connections to adjacent structures.

scholarly journals Migratory Loose Bodies from the Ankle Joint into the Flexor Hallucis Longus Tendon Sheath

EMJ Radiology ◽  
2021 ◽  
Author(s):  
Jenn Shiunn Wong ◽  
PNM Tyrrell ◽  
B Tins ◽  
T Woo ◽  
N Winn ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Ankle Instability ◽  
Tendon Sheath ◽  
Flexor Hallucis Longus ◽  
Imaging Features ◽  
Loose Bodies ◽  
Ankle Osteoarthritis ◽  
Patient Demographics ◽  
Osteoarthritis Patient ◽  
Ankle Trauma

Objective: Loose bodies resulting from any form of osteochondral insult can migrate out of their intra-articular position to adjacent compartments. This retrospective study aims to illustrate the phenomenon of loose bodies migration from the ankle joint into the flexor hallucis longus (FHL) tendon sheath. Materials and Methods: Cases of loose bodies in the FHL tendon sheath were identified from the authors' radiological database by way of keyword interrogation, covering the modalities of CT, MRI, and ultrasound over a period of 11 years. The imaging features of the loose bodies were recorded, together with the presence of ankle instability and osteoarthritis. Patient demographics and relevant history, including trauma and surgery, were collected. Results: Thirty-four cases including 33 patients, with a total of 125 loose bodies in the FHL tendon sheath, were identified. There were 58 loose bodies (46.4%) in Zone 1 of the FHL tendon sheath, 65 loose bodies (52%) in Zone 2, and 2 loose bodies (1.6%) in Zone 3. All patients had features of ankle osteoarthritis on imaging, 14 of which had imaging features of ankle instability, and 19 patients had previous ankle trauma. Conclusion: Osteochondral loose bodies originating from the ankle joint can migrate into the FHL tendon sheath. It is important to recognise this phenomenon as a distinct entity, different from primary tenosynovial chondromatosis of the FHL tendon sheath, which may have a different surgical management and clinical outcome. Detection of FHL tendon sheath loose bodies should also prompt closer examination for articular disease in the ankle joint.

scholarly journals Deep-Learning-Based MRI Images for Analysis of Sport-Induced Ankle Joint Injury

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Wenbo Zhang
Keyword(s):  
Neural Network ◽  
Ankle Joint ◽  
Good Prognosis ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Joint Injury ◽  
The Neural Network ◽  
Number Of Patients ◽  
Magnetic Resonance Imaging Mri ◽  
Grade Iii

This study was to analyze the sport-induced ankle joint injury (AJI) images based on the neural network algorithms using the magnetic resonance imaging (MRI). 20 patients and 20 volunteers were included in the experimental and control groups, respectively. The hybrid diffusion equation (HDE) neural network (HDENN) algorithm was compared with the fully convolutional neural network (FCNN) and the FCNN preprocessing, and the HDE was applied to the MRI analysis of sport-induced AJI. The results showed that the total score of MRI image for the conventional position of the anterior talofibular ligament (ATFL) and posterior talofibular ligament (PTFL) was concentrated in 4 (55%) and 5 (65%), respectively. The number of patients with good prognosis with grade II injury (11 cases) was much higher than that of grade III injury (2 cases), and the number of patients with poor prognosis (4 cases) was lower than that of grade III injury (6 cases) ( P < 0.05 ). Conventional MRI was recommended to observe the ATFL and PTFL, and the valgus position MRI was recommended for the calcaneofibular ligament (CFL); conservative treatment was recommended for patients with grades I and II AJI, but surgical treatment was recommended for patients with grade III AJI.

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.

scholarly journals Anatomic Measurement and Variability Analysis of the Anterior Talofibular Ligament and Calcaneofibular Ligament of the Ankle

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110472
Author(s):  
Han Yang ◽  
Minghao Su ◽  
Zhimin Chen ◽  
Rongmei Qu ◽  
Zhirong Yuan ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Coefficient Of Variation ◽  
Articular Surface ◽  
Lateral Collateral Ligament ◽  
Anatomic Reconstruction ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Tissue Quality ◽  
Length Width ◽  
Lateral Ankle Ligaments

Background: The anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) contribute greatly to the overall stability of the ankle joint; however, ATFL and combined ATFL-CFL sprains are common. Anatomic reconstruction of the lateral collateral ligament with grafts has been proposed for patients with poor tissue quality or inadequate local tissue. Anatomic reconstruction of the lateral ankle ligaments requires a good understanding of their anatomic location. Purpose: To describe the anatomy of the ATFL and CFL ligaments quantitatively and qualitatively and explore the relationship of some morphological parameters. Study Design: Descriptive laboratory study. Methods: A total of 66 adult ankle specimens were analyzed for ATFL band type, origin, length, width, thickness, and angle between the ATFL and CFL, and 73 adult ankle specimens were used for measuring the origin of the CFL. The coefficient of variation was used to describe and compare the respective variability of angle, length, width, and thickness. The origin of the ATFL was labeled as point A, and the leading edge of the CFL intersection with the articular surface of the calcaneus was considered point B. Results: The ATFL had a variable number of bands. A high degree of variability (coefficient of variation >0.2) was seen for most morphological measurements of the ATFL. In addition, the length of distance AB also varied. The CFL originated at the tip of the fibula in only 9% of specimens. It was found more commonly at the anterior border of the lateral malleolus (4.94 ± 1.70 mm from the tip). The angle between the ATFL and CFL was consistent at 100° to 105º. Conclusion: A fair amount of variability of ATFL length, width, and thickness were found in our study, with less variability in the ATFL-CFL angle. Most CFLs attached anterior to the tip of the fibula. Clinical Relevance: Providing relevant anatomic data of ATFL and CFL is important in ensuring proper surgical treatment of ankle joint injuries.

scholarly journals Diagnostic value of ultrasonography in acute lateral and syndesmotic ligamentous ankle injuries

2020 ◽  
Author(s):  
Thomas P. A. Baltes ◽  
Javier Arnáiz ◽  
Liesel Geertsema ◽  
Celeste Geertsema ◽  
Pieter D’Hooghe ◽  
...  
Keyword(s):  
External Rotation ◽  
Diagnostic Value ◽  
Ankle Injuries ◽  
Anterior Talofibular Ligament ◽  
Neutral Position ◽  
Post Injury ◽  
Calcaneofibular Ligament ◽  
Tibiofibular Ligament ◽  
Anterior Inferior Tibiofibular Ligament ◽  
Dynamic Ultrasound

Abstract Objectives To determine the diagnostic value of ultrasonography for complete discontinuity of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the anterior inferior tibiofibular ligament (AITFL). Methods All acute ankle injuries in adult athletes (> 18 years old) presenting to the outpatient department of a specialised Orthopaedic and Sports Medicine Hospital within 7 days post-injury were assessed for eligibility. Using ultrasonography, one musculoskeletal radiologist assessed the ATFL, CFL and AITFL for complete discontinuity. Dynamic ultrasound measurements of the tibiofibular distance (mm) in both ankles (injured and contralateral) were acquired in the neutral position (N), during maximal external rotation (Max ER), and maximal internal rotation (Max IR). MR imaging was used as a reference standard. Results Between October 2017 and July 2019, 92 acute ankle injuries were included. Ultrasound diagnosed complete discontinuity of the ATFL with 87% (CI 74–95%) sensitivity and 69% (CI 53–82%) specificity. Discontinuity of the CFL was diagnosed with 29% (CI 10–56%) sensitivity and 92% (CI 83–97%) specificity. Ultrasound diagnosed discontinuity of the AITFL with 100% (CI 74–100%) sensitivity and 100% (CI 95–100%) specificity. Of the dynamic measurements, the side-to-side difference in external rotation had the highest diagnostic value for complete discontinuity of the AITFL (sensitivity 82%, specificity 86%; cut-off 0.93 mm). Conclusions Ultrasound has a good to excellent diagnostic value for complete discontinuity of the ATFL and AITFL. Therefore, ultrasound can be used to screen for injury of the ATFL and AITFL. Compared with ultrasound, dynamic ultrasound has inferior diagnostic value for complete discontinuity of the AITFL. Key Points • Ultrasound has a good to excellent diagnostic value for complete discontinuity of the anterior talofibular ligament (ATFL) and anterior inferior tibiofibular ligament (AITFL). • Ultrasound can be used to screen for injury of the ATFL and AITFL. • Compared with ultrasound, dynamic ultrasound has inferior diagnostic value for complete discontinuity of the AITFL.

The Effect of Damage to the Lateral Collateral Ligaments on the Mechanical Characteristics of the Ankle Joint—An In-Vitro Study

1990 ◽  
Vol 112 (2) ◽  
pp. 129-137 ◽  
Author(s):  
S. Siegler ◽  
Jie Chen ◽  
C. D. Schneck
Keyword(s):  
Ankle Joint ◽  
Diagnostic Procedure ◽  
Mechanical Characteristics ◽  
Three Dimensional ◽  
Lower Limbs ◽  
Anterior Talofibular Ligament ◽  
Collateral Ligaments ◽  
Ligament Injuries ◽  
Calcaneofibular Ligament ◽  
Lateral Collateral Ligaments

Injuries to the lateral collateral ligaments of the ankle joint are among the most frequently occurring injuries at the lower limb. The present study was conducted for the purpose of establishing the basis for the development of a quantitative diagnostic procedure for such injuries. To achieve this goal, the effect of four types of ligament injuries on the three-dimensional mechanical characteristics of the ankle were investigated. These types of injuries consisted of: 1) isolated tear of the anterior talofibular ligament; 2) isolated tear of the calcaneofibular ligament; 3) isolated tear of the posterior talofibular ligament; and 4) combined tear of both the anterior talofibular ligament and the calcaneofibular ligament. The experiments were conducted on 31 amputated lower limbs and consisted of comparing the three-dimensional load-displacement and flexibility characteristics of the ankle joint prior to and following sectioning of selected ligaments. The experimental and analytical procedures used to derive these characteristics was developed previously by the authors [3, 24]. From the results of this study it was concluded that the three-dimensional flexibility characteristics of the ankle joint are strongly influenced by damage to the lateral collateral ligaments. Furthermore, it was found that each type of ligament injury produced unique and identifiably changes in the flexibility characteristics of the ankle. These unique changes, which are described in detail in this paper, can be used to discriminate between the different types of ligament injuries. Consequently, it was concluded that it is feasible to develop a quantitative diagnostic procedure for ankle ligament injuries based on the effect of the injury on the flexibility characteristics of the ankle.

scholarly journals The Benefits of the Plastination Techniques for the Anatomo Clinical Studies of Ankle Joint Ligaments Injuries

2017 ◽  
Vol 54 (3) ◽  
pp. 487-490
Author(s):  
Alina Maria Sisu ◽  
Gheorghe Noditi ◽  
Dan Grigorescu ◽  
Sorin Floresc ◽  
Jenel Marian Patrascu ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Deltoid Ligament ◽  
Anterior Talofibular Ligament ◽  
Ligament Injuries ◽  
Calcaneofibular Ligament ◽  
Conventional Mri ◽  
Ankle Ligament ◽  
Ct And Mri ◽  
Second Degree

The present research was made by following three directions: dissection and plastination, clinical ankle joint ligament injuries and MRI and CT examination of the cases.191 cases of ankle joint ligament injuries have been studied during two years. They were examined clinically and radiologically, using CT and MRI testing. The classification of ankle sprain was based on the number of injured ligaments. Out of the 191 cases diagnosed with ligament injuries, 92 involved the anterior talofibular ligament, 54 in the calcaneofibular ligament, 40 involved the posterior talofibular ligament and 5 involved the deltoid ligament. First degree sprain involves the injury of the anterior talofibular ligament, the second degree sprain involves the injury of the anterior talofibular ligament and of the calcaneofibular ligament, and the third degree sprain involves the damaging of anterior and posterior talofibular ligaments, as well as the calcaneofibular ligament. In this paper we have diagnosed a number of 39 first degree springs, 12 of second degree springs and 41 of third degree springs. The standard X- ray examinations have a low diagnostic rate of the ankle ligament injuries. Conventional MRI has a higher accuracy in diagnosing ankle joint collateral ligaments lesions.

Ligament Function and Joint Stability Elucidated by a New Technique

1982 ◽  
Vol 11 (2) ◽  
pp. 77-81 ◽  
Author(s):  
O Rasmussen ◽  
K Andersen
Keyword(s):  
Ankle Joint ◽  
Strain Gauges ◽  
Anterior Talofibular Ligament ◽  
Joint Stability ◽  
Mobility Patterns ◽  
Partial Rupture ◽  
Calcaneofibular Ligament ◽  
Service Centre ◽  
A New Technique ◽  
Cutting Experiments

For analysing the ligaments of the ankle joint, their function, and the traumatic mechanisms which cause them to rupture, an apparatus was developed which enables graphic registration of rotatory movements in the ankle joint in two planes simultaneously, when a given torque is applied to the talus. In a modified form, this apparatus is applicable also for other joints. A lever with strain gauges and potentiometers is fixed in the talus of an osteoligamentous preparation. The lever is moved manually, and signals from the strain gauges and potentiometers are collected by a microcomputer for later transfer to a computer service centre where the mobility at the chosen torque is calculated and plotted as mobility patterns. The appearance of these patterns depends upon which ligaments are intact. The patterns plotted in any situation are reproducible, provided that the state of the ligaments is unchanged. In cutting experiments it was possible to demonstrate that rupture of the anterior talofibular ligament may occur simultaneously with partial rupture of the posterior talofibular ligament, although the calcaneofibular ligament remains intact. This occurs if the distortion trauma causing the rupture consists of an internal rotation of the talus, not if it consists mainly of a tilting of the talus in the ankle mortise.

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