Strain in the Lateral Ligaments of the Ankle

Foot & Ankle ◽  
1988 ◽  
Vol 9 (2) ◽  
pp. 59-63 ◽  
Author(s):  
P. Renstrom ◽  
M. Wertz ◽  
S. Incavo ◽  
M. Pope ◽  
H.C. Ostgaard ◽  
...  
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Anterior Talofibular Ligament ◽  
Neutral Position ◽  
Calcaneofibular Ligament ◽  
Ankle Ligaments ◽  
Significant Difference ◽  
Ligament Strain ◽  
Pronation External Rotation ◽  
Relaxing Effect

Strain was measured in the normal anterior talofibular ligament (ATF) and the calcaneofibular ligament (CF) using Hall effect strain transducers in five cadaveric ankles. These measurements were made in both ligaments with the ankle in neutral position and with the foot moving from 10° dorsiflexion to 40° plantarflexion in an apparatus that permits physiologic motion. The ankle ligaments were then tested with the foot placed in six different positions that combined supination, pronation, external rotation, and internal rotation. In the neutral position, through a range of motion of 10° dorsiflexion to 40° plantarflexion, the anterior talofibular ligament underwent an increasing strain of 3.3%. No significant strain increase was found with internal rotation. The only significant difference from the strains at the neutral position was in external rotation, which decreased strain 1.9%. In all positions, increased strain occurred with increased plantarflexion. The calcaneofibular ligament was essentially isometric in the neutral position throughout the flexion arc. The calcaneofibular ligament strain was significantly increased by supination and external rotation. However, with increasing plantarflexion in these positions, the strain in the calcaneofibular ligament decreased. Therefore, plantarflexion has a relaxing effect on the calcaneofibular ligament. Thus, the anterior talofibular and calcaneofibular ligaments are synergistic, such that when one ligament is relaxed, the other is strained and vice versa.

scholarly journals Pressure Change Of Fixed Rotational Deformities In The Femur In Human Cadaver Knees-A Biomechanical Study

2020 ◽  
Author(s):  
Peizhi Yuwen ◽  
Hongzhi Lv ◽  
Yanbin Zhu ◽  
Wenli Chang ◽  
Ning Wei ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Contact Pressure ◽  
Tibial Plateau ◽  
External Rotation ◽  
Pressure Change ◽  
Lateral Side ◽  
Neutral Position ◽  
Relative Pressure ◽  
Rotational Deformity ◽  
Significant Difference

Abstract Objective: To reveal the contact pressure change on tibial plateau in malalignment femur. Methods: Fourteen adult cadaver were selected, after autopsy, 14 cadaveric knee were established and fixed at neutral position (0°, anatomically reduced), 5°, 10°, 15° of external rotation, and 5°, 10°, 15° of internal rotation. Connect the rotatory fixation model on the biomechanical machine and apply a vertical load to 400N. The contact pressure on medial and lateral tibial plateau was quantitatively measured using ultra-low-pressure sensitive film technology. FPD-305E density meter and FPD-306E pressure converter were used to read relative pressure value. Data were analyzed using SPSS software. Results: The medial group show a significant difference on tibial plateau ( F =92.114, P <0.01), further test showed statistically significant differences of pairwise comparisons between 0°, 5°, 10°, 15° internal rotation deformity ( P <0.05). There is no significant difference in lateral group ( c 2 =9.967, P <0.01). The medial contact pressure is 0.940±0.177 MPa and the lateral is 1.008±0.219 MPa at neutral position, no statistically significant was found, so is 5° of internal rotational deformity. But the medial contact pressure are all higher than the lateral side at 5°, 10°, 15° of external rotation, and 10°, 15° of internal rotation. Conclusion: Obvious contact pressure changes on tibial plateau were observed in rotatory deformity femur, which is closely related to the occurrence of knee osteoarthritis. Doctors should detect rotational deformity as much as possible during operation and perform anatomical reduction, for patients with residual rotational deformities, indication of osteotomy should not be too broad.

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.

Simultaneous Strain Measurement With Determination of a Zero Strain Reference for the Medial and Lateral Ligaments of the Ankle

2002 ◽  
Vol 23 (9) ◽  
pp. 825-832 ◽  
Author(s):  
Satoru Ozeki ◽  
Kazunori Yasuda ◽  
Kiyoshi Kaneda ◽  
Kenichi Yamakoshi ◽  
Takahiro Yamanoi
Keyword(s):  
Plantar Flexion ◽  
Full Range ◽  
Length Change ◽  
Anterior Talofibular Ligament ◽  
Neutral Position ◽  
Calcaneofibular Ligament ◽  
Ankle Ligaments ◽  
Ankle Motion ◽  
Ankle Ligament ◽  
Fresh Frozen

The strain changes of the central part of the anterior talofibular ligament (ATFL), the posterior talofibular ligament (PTFL), the calcaneofibular ligament (CFL), and the tibiocalcaneal ligament (TCL) were measured simultaneously for a full range of ankle motion. Twelve fresh frozen amputated ankles were used. To measure the strain changes of the ligaments, a Galium-lndium-filled silastic strain transducer was implanted in the center of each ligament. The zero strain reference was determined immediately after the measurement of strain changes in five of the 12 ankles by tensile testing of each bone-ligament-bone preparation. The maximum strain change of the ATFL, the PTFL, the CFL and the TFL were 7.9%, 5.9%, 5.3% and 5.2%, respectively. The ATFL was elongated in plantar flexion and shortened in dorsiflexion. The PTFL and the CFL were shortened in plantar flexion and elongated in dorsiflexion. The TCL was the longest around the neutral position and became shorter in planter flexion and dorsiflexion. The results showed that the ATFL was taut in plantar flexion over 16.2°, the PTFL and the CFL were taut in dorsiflexion over 18° and 17.8° respectively, and the TCL was taut between 9.5° of dorsiflexion and 9.5° of plantar flexion. The length change pattern was different among the ankle ligaments, although there was only a slight difference between that of the PTFL and the CFL. This study provides fundamental data useful in studying ankle ligament reconstruction.

scholarly journals A New Landmark for Positioning the Anatomical Insertions of Lateral Ankle Ligaments under Arthroscopy: A Preliminary Study

2021 ◽  
Author(s):  
Yun-Feng Zhou ◽  
Bin Song ◽  
Zheng-Zheng Zhang ◽  
Da-Zheng Xu ◽  
Ruo-Qi Xie ◽  
...  
Keyword(s):  
Spatial Information ◽  
Average Distance ◽  
Intraclass Correlation ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Significant Difference ◽  
Preliminary Study ◽  
Lateral Ankle Ligaments

Abstract Background: Several landmarks are used to ascertain the insertions of lateral ankle ligaments, however, few could be discerned under arthroscopy. The objective of this study was to assess the feasibility and reliability of labeling the anterior process of fibular cartilage surface (FCAP) under arthroscopy, and to compare the distances from the new or conventional landmark to the ligament insertion.Methods: Twenty paired ankles from ten Chinese cadavers were included. A senior and a junior surgeon randomly performed the arthroscopic FCAP marking procedures for the paired ankles of a single cadaver using a Kirchner wire. The distance and direction from the anatomical FCAP' to the marked FCAP were recorded after open dissection. Reliability analysis were calculated using the intraclass correlation coefficient (ICC) and independent sample t test. Moreover, the distance from the upper landmarks (anterior fibular tubercle or FCAP) to the anterior talofibular ligament (ATFL) insertion center (distance “a” or “c”), and from the ATFL to calcaneofibular ligament (CFL) footprint center was measured at the anterolateral side (distance “b”) and lateral groove (distance “d”), respectively.Results: The FCAP was located 1.23±0.29 (range, 0.77–1.67) mm) and 1.52±0.41 (range, 0.92–2.03) mm from the anatomical FCAP' in the senior and junior surgeons’ operations, respectively, which showed no significant difference between the two groups (t=-1.773, P=0.093). And the calculated ICC was 0.767 (P=0.003). The average distance “a” was 19.03±1.47 (range, 16.29–21.3) mm, significantly longer than distance “c”, 15.98±0.97 (range, 14.48–18.02) mm (t=-7.72, P<0.001). However, the distance “b” (7.43±0.54 mm; range, 6.47–8.47) and distance “d” (7.78±0.67 mm; range, 6.42–9.03) showed no statistical difference (t=1.8, P=0.08).Conclusions: The FCAP may be a useful landmark that can be utilized to ascertain anatomical insertions of lateral ankle ligaments under arthroscopy. The measured distances from the landmark to the ligament footprint center could provide spatial information that assist in endoscopic anatomical repair or reconstruction.

scholarly journals An MRI-Based Patient-Specific Computational Framework for the Calculation of Range of Motion of Total Hip Replacements

2021 ◽  
Vol 11 (6) ◽  
pp. 2852
Author(s):  
Maeruan Kebbach ◽  
Christian Schulze ◽  
Christian Meyenburg ◽  
Daniel Kluess ◽  
Mevluet Sungu ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Computer Aided Design ◽  
External Rotation ◽  
Patient Specific ◽  
Computational Framework ◽  
Total Hip ◽  
Total Hip Replacements ◽  
Significant Difference ◽  
Hip Replacements

The calculation of range of motion (ROM) is a key factor during preoperative planning of total hip replacements (THR), to reduce the risk of impingement and dislocation of the artificial hip joint. To support the preoperative assessment of THR, a magnetic resonance imaging (MRI)-based computational framework was generated; this enabled the estimation of patient-specific ROM and type of impingement (bone-to-bone, implant-to-bone, and implant-to-implant) postoperatively, using a three-dimensional computer-aided design (CAD) to visualize typical clinical joint movements. Hence, patient-specific CAD models from 19 patients were generated from MRI scans and a conventional total hip system (Bicontact® hip stem and Plasmacup® SC acetabular cup with a ceramic-on-ceramic bearing) was implanted virtually. As a verification of the framework, the ROM was compared between preoperatively planned and the postoperatively reconstructed situations; this was derived based on postoperative radiographs (n = 6 patients) during different clinically relevant movements. The data analysis revealed there was no significant difference between preoperatively planned and postoperatively reconstructed ROM (∆ROM) of maximum flexion (∆ROM = 0°, p = 0.854) and internal rotation (∆ROM = 1.8°, p = 0.917). Contrarily, minor differences were observed for the ROM during maximum external rotation (∆ROM = 9°, p = 0.046). Impingement, of all three types, was in good agreement with the preoperatively planned and postoperatively reconstructed scenarios during all movements. The calculated ROM reached physiological levels during flexion and internal rotation movement; however, it exceeded physiological levels during external rotation. Patients, where implant-to-implant impingement was detected, reached higher ROMs than patients with bone-to-bone impingement. The proposed framework provides the capability to predict postoperative ROM of THRs.

scholarly journals Isokinetic strength of shoulder internal and external rotators in cricket bowlers

2002 ◽  
Vol 58 (2) ◽  
Author(s):  
X.M. Mabasa ◽  
A. Stewart ◽  
C. Fleishman
Keyword(s):  
External Rotation ◽  
Peak Torque ◽  
Isokinetic Strength ◽  
Neutral Position ◽  
Joint System ◽  
Rotational Strength ◽  
Significant Difference ◽  
Position Data ◽  
Torque Values ◽  
Rotation Strength

The strength of the shoulder internal and external rotators incricket bowlers, may not be sufficient to cope with the demands of bowling.As very little research has been done on cricketers, this study was done to establish the isokinetic strength profile of the shoulder internal andexternal rotators in cricket bowlers.Isokinetic, shoulder rotational strength was evaluated in thirty malecricket volunteers with a mean age of 23.9 years and mean body weight of 70.3 kgs. The Cybex 340 dynamometer multi joint system was used to collect data on shoulder rotation strength in a standing neutral position. Data were collected at four different speeds (60,90,180 and 300deg/sec) and were computed for peak torque values for internal and external ratios for both dominant and non dominant shoulders.The results showed no statistically significant difference in the mean shoulder rotational torque between the bowlingand non-bowling shoulders for external rotation (p>0.05), and indicated statistically significant differences in themean shoulder rotational torque between the bowling and non-bowling shoulders for internal rotation (p<0.05). Therewas a significant decrease in isokinetic peak torque production for the external/internal rotator muscles as the speedof contraction increased (p<0.05). The peak torque ratio for the external/internal rotator muscles of the bowling armwere significantly less than of the non-bowling arm (p<0.05). These findings suggest that the strength ratios of thebowling arm need to be considered when managing young cricketers and their injuries.

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.

Measurement of Glenohumeral Internal Rotation in Asymptomatic Tennis Players and Swimmers

2009 ◽  
Vol 37 (5) ◽  
pp. 1017-1023 ◽  
Author(s):  
Renato Rangel Torres ◽  
João Luiz Ellera Gomes
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Control Group ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Tennis Players ◽  
Glenohumeral Internal Rotation Deficit ◽  
Significant Difference ◽  
Overhead Sports ◽  
The Difference

Background Glenohumeral internal rotation deficit, often diagnosed in players of overhead sports, has been associated with the development of secondary shoulder lesions. Hypothesis Asymptomatic players of different overhead sports will exhibit variable degrees of glenohumeral internal rotation deficit. Study Design Cross-sectional study; Level of evidence, 3. Methods Fifty-four asymptomatic male volunteers (108 shoulders) divided into 3 groups (tennis players, swimmers, control group) underwent measurements of glenohumeral internal and external rotation using clinical examination with scapular stabilization. Measurements of dominant and nondominant shoulders were compared within and between groups. Glenohumeral internal rotation deficit (GIRD) was defined as the difference in internal rotation between the nondominant and dominant shoulders. Results In tennis players, mean GIRD was 23.9° ± 8.4° (P < .001); in swimmers, 12° ± 6.8° (P < .001); and in the control group, 4.9° ± 7.4° (P = .035). Dominant shoulders showed significant difference between all groups, and the difference in internal rotation of the dominant shoulder between the group of tennis players in comparison with the control group (27.6°, P < .001) was greater than the difference in internal rotation of the dominant shoulder found in the group of swimmers compared with the control group (17.9°, P < .001). Between tennis players and swimmers, the difference in internal rotation of the dominant shoulder was 9.7° (P = .002). Conclusion Dominant limbs showed less glenohumeral internal rotation than the nondominant limbs in all groups, with the deficit in the group of tennis players about twice the deficit found for swimmers. Mean difference between limbs in the control group was less than 5°, which is within normal parameters according to most studies. There were statistically significant differences between all groups when dominant shoulders were compared with each other, differences that were not compensated by external rotation gain. Tennis players had the least range of motion, followed by swimmers.

Pronation External Rotation Stress Test for calcaneofibular ligament insufficiency

2017 ◽  
Vol 23 ◽  
pp. 136
Author(s):  
S. Ozeki ◽  
Y. Tochigi ◽  
M. Ogawa ◽  
T. Yamazaki ◽  
Y. Masuda
Keyword(s):  
External Rotation ◽  
Stress Test ◽  
Calcaneofibular Ligament ◽  
Pronation External Rotation ◽  
Rotation Stress

scholarly journals The Effect of Straight-Line Long-Toss Versus Ultra-Long-Toss Throwing on Passive Glenohumeral Range of Motion Recovery After Pitching

2021 ◽  
pp. 194173812098001
Author(s):  
T. David Luo ◽  
Aaron D. Sciascia ◽  
Austin V. Stone ◽  
Chukwuweike U. Gwam ◽  
Christopher A. Grimes ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
National Collegiate Athletic Association ◽  
External Rotation ◽  
Level Of Evidence ◽  
Left Hand ◽  
Right Hand ◽  
Straight Line ◽  
Significant Difference ◽  
Baseball Pitchers

Background: Repetitive throwing in baseball pitchers can lead to pathologic changes in shoulder anatomy, range of motion (notably glenohumeral internal rotation deficit), and subsequent injury; however, the ideal strengthening, recovery, and maintenance protocol of the throwing shoulder in baseball remains unclear. Two strategies for throwing shoulder recovery from pitching are straight-line long-toss (SLT) throwing and ultra-long-toss (ULT) throwing, although neither is preferentially supported by empirical data. Hypothesis: ULT will be more effective in returning baseline internal rotation as compared with SLT in collegiate pitchers after a pitching session. Study Design: Cohort study. Level of Evidence: Level 3. Methods: A total of 24 National Collegiate Athletic Association Division I baseball pitchers with mean age 20.0 ± 1.1 years were randomized to either the ULT group (n = 13; 9 right-hand dominant, 4 left-hand dominant) or SLT group (n = 11; 10 right-hand dominant, 1 left-hand dominant). Measurements (dominant and nondominant, 90° abducted external rotation [ER], internal rotation [IR], and total range of motion [TROM]) were taken at 5 time points across 3 days: before and immediately after a standardized bullpen session on day 1; before and immediately after a randomized standardized ULT or SLT session on day 2; and before practice on Day 3. Results: ULT demonstrated significantly greater final ER compared with baseline (+10°; P = 0.05), but did not demonstrate significant IR changes. Similarly, SLT demonstrated significantly greater post-SLT ER (+12°; P = 0.02) and TROM (+12°; P = 0.01) compared with baseline, but no significant IR changes. Final ER measurements were similar between ULT (135° ± 14°) and SLT (138° ± 10°) ( P = 0.59). There was also no statistically significant difference in final IR between ULT (51° ± 14°) and SLT (56° ± 8°) ( P = 0.27). Conclusion: The routine use of postperformance, ULT throwing to recover from range of motion alterations, specifically IR loss, after a pitching session is not superior to standard, SLT throwing. Based on these findings, the choice of postpitching recovery throwing could be player specific based on experience and comfort. Clinical Relevance: The most effective throwing regimens for enhancing performance and reducing residual impairment are unclear, and ideal recovery and maintenance protocols are frequently debated with little supporting data. Two strategies for throwing shoulder recovery from pitching are SLT and ULT throwing. These are employed to help maintain range of motion and limit IR loss in pitchers. The routine use of ULT throwing for recovery and to limit range of motion alterations after a pitching session is not superior to SLT throwing.

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