Biomechanical Comparison of 3 Current Ankle Syndesmosis Repair Techniques

2016 ◽  
Vol 38 (2) ◽  
pp. 200-207 ◽  
Author(s):  
Thomas O. Clanton ◽  
Scott R. Whitlow ◽  
Brady T. Williams ◽  
Daniel J. Liechti ◽  
Jonathon D. Backus ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Screw Fixation ◽  
External Rotation ◽  
Three Dimensional ◽  
Compressive Load ◽  
Rotational Stability ◽  
Suture Button ◽  
Biomechanical Comparison ◽  
Single Suture ◽  
Repair Techniques

Background: Significant debate exists regarding optimal repair for unstable syndesmosis injuries. Techniques range from screw fixation, suture-button fixation, or a combination of the two. In this study, 3 common repairs were compared using a simulated weightbearing protocol with internal and external rotation of the foot. Methods: Twenty-four lower leg specimens with mean age 54 years (range, 38-68 years) were used for testing. Following creation of a complete syndesmotic injury (AITFL, ITFL, PITFL, interosseous membrane), specimens were repaired using 1 of 3 randomly assigned techniques: (1) one 3.5-mm syndesmotic screw, (2) 1 suture-button construct, and (3) 2 divergent suture-button constructs. Repairs were cycled for 500 cycles between 7.5 Nm of internal/external rotation torque under a constant 750 N axial compressive load in a neutral dorsiflexion position. At 0, 10, 100, and 500 cycles, torsional cyclic loading was interrupted to assess torsional resistance to rotation within a physiologic range of motion (15 degrees external rotation to 10 degrees internal rotation). Torque (Nm), rotational position (degrees), and 3-dimensional data were collected throughout the testing to characterize relative spatial relationships of the tibiofibular articulation. Results: There were no significant differences between repair techniques in resistance to internal and external rotation with respect to the intact syndesmosis. Three-dimensional analysis revealed significant differences between repair techniques for sagittal fibular translation with external rotation of the foot. Screw fixation had the smallest magnitude of posterior sagittal translation (2.5 mm), and a single suture-button construct demonstrated the largest magnitude of posterior sagittal translation (4.6 mm). Screw fixation also allowed for significantly less anterior sagittal translation with internal rotation of the foot (0.1 mm) when compared to both 1 (2.7 mm) and 2 (2.9 mm) suture-button constructs. Conclusion: All repairs provided comparable rotational stability to the syndesmosis; however, no repair technique completely restored rotational stability and tibiofibular anatomic relationships of the preinjury state. Clinical Relevance: Constructs were comparable across most conditions; however, when repairing injuries with a suture-button construct, a single suture-button construct may not provide sufficient resistance to sagittal translation of the fibula.

Biomechanical Comparison of Syndesmotic Repair Techniques During External Rotation Stress

2018 ◽  
Vol 39 (11) ◽  
pp. 1345-1354 ◽  
Author(s):  
Jessica E. Goetz ◽  
Nathan P. Davidson ◽  
M. James Rudert ◽  
Nicole Szabo ◽  
Matthew D. Karam ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
External Rotation ◽  
Axial Plane ◽  
Lower Limbs ◽  
Rotational Stability ◽  
Deltoid Ligament ◽  
Fixation Device ◽  
Suture Button ◽  
Applied Torque ◽  
Repair Techniques

Background: The purpose of this study was to compare mechanical behavior of conventional syndesmosis fixation devices with new anatomic repair techniques incorporating various repair augmentations to determine which approach would return rotational ankle mechanics closer to those of an intact ankle. Methods: Ten pairs of fresh-frozen through-the-knee cadaveric lower limbs were subjected to 7.5 Nm of external rotation torque while under 750 N of axial compression. After testing specimens intact and with the deltoid and syndesmotic ligament complexes completely destabilized, specimens underwent syndesmotic fixation using a screw, a suture button construct, a prototype structurally augmented flexible trans-syndesmotic fixation device, or the prototype device plus suture repairs of the anterior-inferior tibiofibular ligament and deep deltoid ligament. Syndesmotic repair devices were exchanged between tests so that each specimen was tested with 2 different fixation techniques. Whole-foot rotation angles at 7.5 Nm of applied torque were measured for comparison of the different repair strategies, and reflective markers mounted on the tibia, fibula, and talus were used to track translations and rotations of the talus and the fibula relative to the tibia during testing. Results: Syndesmotic destabilization significantly ( P < .001) increased whole-foot, talus, and fibula rotation in an axial plane and posterior fibula translation under 7.5 Nm of torque. Neither the suture button nor the augmented flexible trans-syndesmotic fixation device reduced those increases. Screw fixation or addition of anatomic ligament repairs to the augmented flexible fixation device successfully reduced axial plane rotations and sagittal plane translations to near intact levels. Conclusion: Flexible trans-syndesmotic fixation alone was found to be insufficient for restoring rotational stability to the ankle/talus or preventing sagittal plane displacement of the fibula. Clinical Relevance: Repairs to simulate anatomic structures disrupted during a syndesmosis injury were required to restore rotational stability to the foot when using flexible trans-syndesmotic fixation that may have clinical applicability.

scholarly journals Hybrid Fixation Restores Tibiofibular Kinematics for Early Weightbearing after Syndesmotic Injury

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0009
Author(s):  
Neel Patel ◽  
Calvin Chan ◽  
Conor Murphy ◽  
Richard Debski ◽  
Volker Musahl ◽  
...  
Keyword(s):  
Screw Fixation ◽  
External Rotation ◽  
Syndesmotic Injury ◽  
Hybrid Fixation ◽  
Fixation Methods ◽  
Suture Button ◽  
Tibiofibular Ligament ◽  
Lateral Translation ◽  
Posterior Translation ◽  
Single Suture

Category: Ankle Introduction/Purpose: Injury to the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), and interosseous membrane (IOM) of the syndesmosis is a predictive measure of residual symptoms after an ankle injury. Unstable syndesmotic injuries are typically treated surgically with constructs consisting of cortical screw and/or suture button fixation. Previous studies have shown contradicting findings regarding the effects of different surgical fixation methods on tibiofibular kinematics. Thus, the objective of this study was to quantify tibiofibular joint motion with different syndesmotic screw and suture button fixation constructs after disruption of the syndesmosis compared to the intact ankle during simulated weight bearing. Methods: Five fresh-frozen human cadaveric specimens were tested using a six degree-of-freedom robotic testing system. After subtalar joint fusion, the tibia and calcaneus were rigidly fixed to a robotic manipulator, while complete fibular length was maintained and fibular motion was unconstrained. A constant 200 N compressive load was applied to the ankle while an additional 5 Nm external rotation and 5 Nm inversion moment applied independently to the ankle at 0°, 15°, and 30° plantarflexion and 10° dorsiflexion. Fibular motion with respect to the tibia was tracked using an optical tracking system. Outcome variables included fibular medial-lateral (ML) translation, anterior-posterior (AP) translation, and external rotation (ER) in the following states: intact ankle, complete injury (AITFL, PITFL, and IOM transected), single tricortical screw fixation double tricortical screw fixation, hybrid fixation (single tricortical screw and single suture button), suture button fixation, and divergent suture button fixation. Repeated measures ANOVA was performed for statistical analysis. Results: The external rotation moment produced significant differences in fibular motion between the injury and fixation states compared to the intact state. A complete syndesmotic injury caused significantly increased fibular lateral translation, posterior translation, and external rotation in all ankle positions except 30° plantarflexion compared to the intact ankle. Single suture button and single screw fixation resulted in significantly higher fibular lateral translation at 10° dorsiflexion compared the intact ankle, while single suture button fixation also resulted in significantly higher external rotation at 10° dorsiflexion compared the intact ankle. Fibular posterior translation was significantly higher with hybrid, suture button, and divergent suture button fixation at 0° flexion and with single tricortical screw and double screw fixation at 10° dorsiflexion compared to the intact ankle (Figure 1). Conclusion: Complete injury to the syndesmosis results in significantly higher fibular lateral translation, external rotation, and posterior translation compared to the intact ankle. Hybrid or divergent suture button fixation would be recommended to restore tibiofibular motion without over-constraint. However, none of the fixation methods were able to restore AP translation in all ankle positions. Thus, it is important to evaluate syndesmotic stability in the sagittal plane at different ankle positions. Findings of this study suggest that physicians should evaluate fibular AP translation in a neutral position when using suture button fixation constructs and in dorsiflexion when using tricortical screw fixation constructs.

scholarly journals Validity and reliability of smartphone applications for measurement of hip rotation, compared with three‐dimensional motion analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Phob Ganokroj ◽  
Nuchanun Sompornpanich ◽  
Pichitpol Kerdsomnuek ◽  
Bavornrat Vanadurongwan ◽  
Pisit Lertwanich
Keyword(s):  
Internal Rotation ◽  
Motion Analysis ◽  
Supine Position ◽  
External Rotation ◽  
Three Dimensional ◽  
Angle Measurement ◽  
Smartphone Applications ◽  
Rater Reliability ◽  
Link Type ◽  
Hip Rotation

Abstract Background Measurement of hip rotation is a crucial clinical parameter for the identification of hip problems and the monitoring of symptoms. The objective of this study was to determine whether the use of two smartphone applications is valid and reliable for the measurement of hip rotation. Methods An experimental, cross-sectional study was undertaken to assess passive hip internal and external rotation in three positions by two examiners. The hip rotational angles were measured by a smartphone clinometer application in the sitting and prone positions, and by a smartphone compass application in the supine position; their results were compared with those of the standard, three-dimensional, motion analysis system. The validities and inter-rater and intra-rater reliabilities of the smartphone applications were evaluated. Results The study involved 24 participants. The validities were good to excellent for the internal rotation angles in all positions (ICC 0.81–0.94), good for the external rotation angles in the prone position (ICC 0.79), and fair for the sitting and supine positions (ICC 0.70–0.73). The measurement of the hip internal rotation in the supine position had the highest ICC value of 0.94 (0.91, 0.96). The two smartphone applications showed good-to-excellent intra-rater reliability, but good-to-excellent inter-rater reliability for only three of the six positions (two other positions had fair reliability, while one position demonstrated poor reliability). Conclusions The two smartphone applications have good-to-excellent validity and intra-rater reliability, but only fair-to-good inter-rater reliability for the measurement of the hip rotational angle. The most valid hip rotational position in this study was the supine IR angle measurement, while the lowest validity was the ER angle measurement in the sitting position. The smartphone application is one of the practical measurements in hip rotational angles. Trial registration Number 20181022003 at the Thai Clinical Trials Registry (http://www.clinicaltrials.in.th) which was retrospectively registered at 2018-10-18 15:30:29.

scholarly journals A Kinematic Analysis of Fundamental Movement Skills

2016 ◽  
Vol 25 (3-4) ◽  
pp. 261-275 ◽  
Author(s):  
Cain C. T. Clark ◽  
Claire M. Barnes ◽  
Mark Holton ◽  
Huw D. Summers ◽  
Gareth Stratton
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Three Dimensional ◽  
Rotation Velocity ◽  
Building Blocks ◽  
Mass Range ◽  
Centre Of Mass ◽  
Movement Skills ◽  
Fundamental Movement Skills ◽  
The Relationship

Abstract Fundamental movement skills are considered the basic building blocks for movement and provide the foundation for specialized and sport-specific movement skills required for participation in a variety of physical activities. However, kinematic analyses of fundamental movement has not been performed. The aims of this study were to, (1) characterise the relationship between facets of fundamental movement and, (2) characterise the relationship between overall integrated acceleration and three-dimensional kinematic variables whilst performing fundamental movement skills. Eleven participants (10±0.8y, 1.41±0.07m, 33.4±8.6kg, body mass index; 16.4±3.1 kg·m2) took part in this study, had anthropometric variables recorded and performed a series of fundamental movement tasks, whilst wearing a tri-axial accelerometer and were recorded using a three-dimensional motion capture system. Maximum shoulder external rotation (°) and maximum shoulder internal rotation velocity (°.s−1) (r=0.86, p<0.001), mediolateral centre of mass range (cm) and centre of mass coefficient of variation (%) (r=0.83, p<0.001), maximum stride angle (°) in the jog and walk (r=0.74, p=0.01) and maximum sprint stride angle and maximum shoulder internal rotation velocity (°.s−1) (r=0.67, p<0.02) were significantly correlated. Maximum sprint stride angle (hip: r=0.96, p<0.001, ankle: r=0.97, p<0.001) and maximum internal rotation velocity (ankle: r=0.6, p=0.05) were significantly correlated to overall integrated acceleration. Overall integrated acceleration was comparable between participants (CV: 10.5), whereas three-dimensional variables varied by up to 65%. Although overall integrated acceleration was comparable between participants, three-dimensional variables were much more varied. Indicating that although overall activity may be correspondent, the characteristics of a child’s movement may be highly varied.

scholarly journals Biomechanical Comparison of 3 Syndesmosis Repair Techniques With Suture Button Implants

2018 ◽  
Vol 6 (10) ◽  
pp. 232596711880420 ◽  
Author(s):  
Andrew S. Parker ◽  
David P. Beason ◽  
Jonathan S. Slowik ◽  
Jefferson B. Sabatini ◽  
Norman E. Waldrop
Keyword(s):  
Suture Button ◽  
Biomechanical Comparison ◽  
Repair Techniques

Three-Dimensional Scapular Kinematics during the Throwing Motion

2008 ◽  
Vol 24 (1) ◽  
pp. 24-34 ◽  
Author(s):  
Kristin E. Meyer ◽  
Erin E. Saether ◽  
Emily K. Soiney ◽  
Meegan S. Shebeck ◽  
Keith L. Paddock ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Angular Position ◽  
Three Dimensional ◽  
Low Velocity ◽  
Dynamic Activity ◽  
Motion Data ◽  
Asymptomatic Subjects ◽  
Scapular Motion

Proper scapular motion is crucial for normal shoulder mechanics. Scapular motion affects glenohumeral joint function during throwing, yet little is known about this dynamic activity. Asymptomatic subjects (10 male and 10 female), ages 21 to 45, were analyzed. Electromagnetic surface sensors on the sternum, acromion, and humerus were used to collect 3-D motion data during three trials of low-velocity throwing. Scapular angular position data were described for five predetermined events throughout the throw corresponding with classic descriptions of throwing phases, and trial-to-trial reliability was determined. ANOVA compared scapular angles across events. Subjects demonstrated good to excellent reliability between trials of the throw (ICC 0.74–0.98). The scapula demonstrated a pattern of external rotation, upward rotation (peak of approx. 40°), and posterior tilting during the initial phases of the throw, progressing into internal rotation after maximum humeral horizontal abduction. During the arm acceleration phase, the scapula moved toward greater internal rotation and began anteriorly tilting. At maximum humeral internal rotation, the scapula ended in internal rotation (55°), upward rotation (20°), and anterior tilting (3°).

A 3-D CT Analysis of Screw and Suture-Button Fixation of the Syndesmosis

2016 ◽  
Vol 38 (2) ◽  
pp. 208-214 ◽  
Author(s):  
Jason M. Schon ◽  
Brady T. Williams ◽  
Melanie B. Venderley ◽  
Grant J. Dornan ◽  
Jonathon D. Backus ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Joint Space ◽  
Intact State ◽  
Suture Button ◽  
Repair Technique ◽  
Cortical Screw ◽  
Tibiofibular Joint ◽  
Ct Analysis ◽  
Mean Differences ◽  
Repair Techniques

Background: Historically, syndesmosis injuries have been repaired with screw fixation; however, some suggest that suture-button constructs may provide a more accurate anatomic and physiologic reduction. The purpose of this study was to compare changes in the volume of the syndesmotic space following screw or suture-button fixation using a preinjury and postoperative 3-D computed tomography (CT) model. The null hypothesis was that no difference would be observed among repair techniques. Methods: Twelve pairs of cadaveric specimens were dissected to identify the syndesmotic ligaments. Specimens were imaged with CT prior to the creation of a complete syndesmosis injury and were subsequently repaired using 1 of 3 randomly assigned techniques: (a) one 3.5-mm cortical screw, (b) 1 suture-button, and (c) 2 suture-buttons. Specimens were imaged postoperatively with CT. 3-D models of all scans and tibiofibular joint space volumes were calculated to assess restoration of the native syndesmosis. Analysis of variance and Tukey’s method were used to compare least squares mean differences from the intact syndesmosis among repair techniques. Results: For each of the 3 fixation methods, the total postoperative syndesmosis volume was significantly decreased relative to the intact state. The total mean decreases in volume compared with the intact state for the 1-suture-button construct, 2-suture-button construct, and syndesmotic screw were −561 mm3 (95% CI, −878 to −244), −964 mm3 (95% CI, −1281 to −647) and −377 mm3 (95% CI, −694 to −60), respectively. Conclusion: All repairs notably reduced the volume of the syndesmosis beyond the intact state. Fixation with 1 suture-button was not significantly different from screw or 2-suture-button fixation; however, fixation with 2 suture-buttons resulted in significantly decreased volume compared with screw fixation. Clinical Relevance: The results of this study suggest that the 1-suture-button repair technique and the screw fixation repair technique were comparable for reduction of syndesmosis injuries, although both may overcompress the syndesmosis.

scholarly journals Restoration of Tibiofibular Kinematics with a Tricortical Screw or Suture Button Fixation After Syndesmotic Ankle Injuries

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Conor Murphy ◽  
Thomas Pfeiffer ◽  
Jason Zlotnicki ◽  
Volker Musahl ◽  
Richard Debski ◽  
...  
Keyword(s):  
Screw Fixation ◽  
External Rotation ◽  
Tracking System ◽  
Optical Tracking ◽  
Ankle Injuries ◽  
Suture Button ◽  
Tibiofibular Ligament ◽  
Cortical Screw ◽  
Significant Difference ◽  
Posterior Translation

Category: Ankle, Sports, Trauma Introduction/Purpose: Anterior inferior tibiofibular ligament (AITFL), Posterior inferior tibiofibular ligament (PITFL) and Interosseous membrane (IOM) disruption is a predictive measure of residual symptoms after ankle injury. In unstable injuries, the syndesmosis is treated operatively with cortical screw fixation or a suture button apparatus. Biomechanical analyses of suture button versus cortical screw fixation methods show contradicting results regarding suture button integrity and maintenance of fixation. The objective of this study is to quantify tibiofibular joint motion in syndesmotic screw and suture button fixation models compared to the intact ankle. Methods: Five fresh-frozen human cadaveric specimens (mean age 58 yrs.; range 38-73 yrs.) were tested using a 6-degree-of- freedom robotic testing system. The tibia and calcaneus were rigidly fixed to the robotic manipulator and the subtalar joint was fused. The full fibular length was maintained and fibular motion was unconstrained. Fibular motion with respect to the tibia was tracked by a 3D optical tracking system. A 5 Nm external rotation moment and 5 Nm inversion moment were applied to the ankle at 0°, 15°, and 30° plantarflexion and 10° dorsiflexion. Outcome variables included fibular medial-lateral (ML) translation, anterior-posterior (AP) translation, and external rotation (ER) in the following states: 1) intact ankle, 2) AITFL transected, 3) PITFL and IOM transected, 4) 3.5 mm cannulated tricortical screw fixation, 5) suture button fixation. An ANOVA with a post-hoc Tukey analysis was performed for statistical analysis (*p<0.05). Results: Significant differences in fibular motion were only during the inversion moment. Fibular posterior translation was significantly higher with complete syndesmosis injury compared to the intact ankle at 0°, 15°, and 30° plantarflexion and the tricortical screw at 15° and 30°. Significantly higher fibular posterior translation was observed with the suture button compared to the intact ankle at 15° and 30 plantarflexion and to the tricortical screw at 15°. ER was significantly increased with complete injury compared to the tricortical screw at 0° and 30° plantarflexion. The suture button demonstrated significantly greater ER at 0° plantarflexion and 10° dorsiflexion compared to the intact ankle. The only significant difference in ML translation exists between the tricortical screw and complete injury at 30° plantarflexion. Conclusion: The suture button did not restore physiologic motion of the syndesmosis. It only restored fibular ML translation. Significant differences in AP translation and ER persisted compared to the intact ankle. The tricortical screw restored fibular motion in all planes. No significant differences were observed compared to the intact ankle. These findings are consistent with previous studies. This study utilized a novel setup to measure unconstrained motion in a full length, intact fibula. Physicians should evaluate AP translation and ER as critical fibular motions when reconstructing the syndesmosis with suture button fixation.

Cortical suture button fixation vs. bicortical screw fixation in the Latarjet procedure: a biomechanical comparison

2020 ◽  
Vol 29 (7) ◽  
pp. 1470-1478 ◽  
Author(s):  
Robert C. Williams ◽  
Randal P. Morris ◽  
Marc El Beaino ◽  
Nicholas H. Maassen
Keyword(s):  
Screw Fixation ◽  
Latarjet Procedure ◽  
Suture Button ◽  
Biomechanical Comparison ◽  
Bicortical Screw
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