scholarly journals The ACL of the Ankle Joint: A Cadaveric Evaluation of the Subtalar Intrinsic Ligaments and Optimal Surgical Approach

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0019
Author(s):  
Naven Duggal ◽  
Patrick M. Williamson ◽  
Ara Nazarian
Keyword(s):  
Ankle Joint ◽  
Subtalar Joint ◽  
Cruciate Ligament ◽  
Surgical Approaches ◽  
Ankle Sprains ◽  
Anterior Border ◽  
Lateral Ankle ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Anterior Cruciate

Category: Ankle; Basic Sciences/Biologics; Sports Introduction/Purpose: The biomechanics of ankle sprains involves a multiplanar-supination motion and not the strict inversion as is often described. During supination, calcaneal inversion occurs at the anatomic subtalar joint. The intrinsic subtalar ligaments include a series of broad thick ligaments situated in the tarsal canal that separate the anterior and posterior compartments. The subtalar intrinsic ligaments are damaged in an estimated 25% to 80% of all lateral ankle sprains. We hypothesize that the intrinsic subtalar ligaments have a multiplanar role in ankle joint stabilization similar to that of the anterior cruciate ligament at the knee. The purpose of this study is to evaluate the efficacy of four surgical approaches to the subtalar ligaments through cadaveric dissection. Methods: Four fresh-frozen cadaveric ankle specimens were utilized. Ability to access the extrinsic lateral ankle ligament (anterior talofibular), the extrinsic subtalar ligaments (calcaneofibular, lateral talocalcaneal) and the intrinsic subtalar ligaments (interosseous talocalcaneal, cervical) was evaluated. The first cadaveric specimen was dissected as a baseline to identify the extrinsic and intrinsic subtalar ligaments. The three remaining cadaveric specimens were utilized to evaluate the efficacy of three standard surgical approaches (a curvilinear incision made over the distal anterior border of lateral malleolus, a posterolateral longitudinal incision, and an extensile sinus tarsi approach) to access both the extrinsic ankle and subtalar ligaments as well as the intrinsic subtalar ligaments. Ability to access all ligaments as well as identification of neurovascular structures at risk during the dissection was recorded for each approach. Results: The curvilinear incision made over the distal anterior border of the lateral malleolus provided access to the anterior talofibular, calcaneofibular ligaments. Branches of the superficial peroneal nerve were noted to be at direct risk. The posterior longitudinal incision provided access to the calcaneofibular, lateral talocalcaneal ligaments. Branches of the sural nerve were noted to be at direct risk with this approach. An extensile posterolateral incision improved access to the anterior talofibular ligament. An extensile sinus tarsi approach provided the most direct access to the interosseous talocalcaneal and cervical ligaments. Visualization of the calcaneofibular and lateral talocalcaneal was also provided with this incision. The saphenous and superficial nerve branches and the sinus tarsi artery were noted to be at risk. Conclusion: We hypothesize that the intrinsic subtalar ligaments have a multiplanar role in ankle joint stabilization similar to that of the anterior cruciate ligament at the knee. Accurate identification and optimal surgical approach to these structures has not been well described in the orthopaedic foot and ankle literature. This cadaveric study provides evidence that an extensile sinus tarsi approach can provide access to the extrinsic ankle and subtalar ligaments as well as the intrinsic ligaments of the subtalar joint.

Randomized comparative study between extensile lateral and sinus tarsi approaches for the treatment of Sanders type 2 calcaneal fracture

2021 ◽  
pp. 1-8
Author(s):  
Chul Hyun Park ◽  
Hongfei Yan ◽  
Jeongjin Park
Keyword(s):  
Comparative Study ◽  
Subtalar Joint ◽  
Short Form ◽  
Operation Time ◽  
Wound Complications ◽  
Calcaneal Fractures ◽  
Aofas Score ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach

Aims No randomized comparative study has compared the extensile lateral approach (ELA) and sinus tarsi approach (STA) for Sanders type 2 calcaneal fractures. This randomized comparative study was conducted to confirm whether the STA was prone to fewer wound complications than the ELA. Methods Between August 2013 and August 2018, 64 patients with Sanders type 2 calcaneus fractures were randomly assigned to receive surgical treatment by the ELA (32 patients) and STA (32 patients). The primary outcome was development of wound complications. The secondary outcomes were postoperative complications, pain scored of a visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, 36-item Short Form health survey, operative duration, subtalar joint range of movement (ROM), Böhler’s angle and calcaneal width, and posterior facet reduction. Results Although four patients (12.5%) in the ELA groups and none in the STA group experienced complications, the difference was not statistically significant (p = 0.113). VAS and AOFAS score were significantly better in the STA group than in the ELA group at six months (p = 0.017 and p = 0.021), but not at 12 months (p = 0.096 and p = 0.200) after surgery. The operation time was significantly shorter in the STA group than in the ELA group (p < 0.001). The subtalar joint ROM was significantly better in the STA group (p = 0.015). Assessment of the amount of postoperative reduction compared with the uninjured limb showed significant restoration of calcaneal width in the ELA group compared with that in the STA group (p < 0.001). Conclusion The ELA group showed higher frequency of wound complications than the STA group for Sanders type 2 calcaneal fractures even though this was not statistically significant.

scholarly journals SPORTS INJURIES AMONG AMATEUR ATHLETES AT A BRAZILIAN UNIVERSITY

2017 ◽  
Vol 25 (2) ◽  
pp. 93-98 ◽  
Author(s):  
André Marangoni Asperti ◽  
Tiago Lazzaretti Fernandes ◽  
André Pedrinelli ◽  
Arnaldo José Hernandez
Keyword(s):  
Anterior Cruciate Ligament ◽  
National Collegiate Athletic Association ◽  
Sports Injuries ◽  
Cruciate Ligament ◽  
Ligament Injury ◽  
Ankle Sprains ◽  
Injury Surveillance System ◽  
Amateur Athletes ◽  
Amateur Athlete ◽  
Anterior Cruciate

ABSTRACT Objective: To obtain information on the incidence and nature of sports injuries at a Brazilian university. Method: Data from 396 student amateur athletes (61% male) playing 15 different sports during the 2013 season were retrospectively evaluated. Subjects completed the National Collegiate Athletic Association Injury Surveillance System questionnaire at the conclusion of the 2013 sports season. Injuries that resulted in at least one day of time lost were included. Exposure was defined as one student amateur athlete participating in one practice or game and is expressed as an athlete-exposure (A-E). Results: Injury rates were significantly greater in games (13.13 injuries per 1000 A-Es, 95% CI = 10.3-15) than in practices (4.47 injuries per 1000 A-Es, 95% CI = 3.9-5.1). The mechanisms that accounted for the most injuries in games and practices were player contact (52.9%) and non-contact (54.5%), respectively. Ankle ligament sprains were the most common injury (18.2% of all reported injuries). A relatively high incidence of anterior cruciate ligament injury was also observed (0.16 injuries per 1000 A-Es). Conclusion: Brazilian student amateur athletes are at great risk of sustaining non-contact injuries such as ankle sprains and anterior cruciate ligament injuries. Level III of Evidence, Study of non consecutive patients; without consistently applied reference ''gold'' standard.

scholarly journals The ankle ligament reconstruction-return to sport after injury (ALR-RSI) is a valid and reproducible scale to quantify psychological readiness before returning to sport after ankle ligament reconstruction

2020 ◽  
Vol 28 (12) ◽  
pp. 4003-4010
Author(s):  
François Sigonney ◽  
Ronny Lopes ◽  
Pierre-Alban Bouché ◽  
Elliott Kierszbaum ◽  
Aymane Moslemi ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Ankle Instability ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Ankle Sprains ◽  
Strongly Correlated ◽  
Level Of Evidence ◽  
Ankle Ligament ◽  
Significant Difference ◽  
Anterior Cruciate

Abstract Purpose Chronic ankle instability is the main complication of ankle sprains and requires surgery if non-operative treatment fails. The goal of this study was to validate a tool to quantify psychological readiness to return to sport after ankle ligament reconstruction. Methods The form was designed like the anterior cruciate ligament-return to sport after injury scale and “Knee” was replaced by the term “ankle”. The ankle ligament reconstruction-return to sport after injury (ALR-RSI) scale was filled by patients who underwent ankle ligament reconstruction and were active in sports. The scale was then validated according to the international COSMIN methodology. The AOFAS and Karlsson scores were used as reference questionnaires. Results Fifty-seven patients (59 ankles) were included, 27 women. The ALR-RSI scale was strongly correlated with the Karlsson score (r = 0.79 [0.66–0.87]) and the AOFAS score (r = 0.8 [0.66–0.87]). A highly significant difference was found in the ALR-RSI between the subgroup of 50 patients who returned to playing sport and the seven who did not: 68.8 (56.5–86.5) vs 45.0 (31.3–55.8), respectively, p = 0.02. The internal consistency of the scale was high (α = 0.96). Reproducibility of the test–retest was excellent (ρ = 0.92; 95% CI [0.86–0.96]). Conclusion The ALR-RSI is a valid, reproducible scale that identifies patients who are ready to return to the same sport after ankle ligament reconstruction. This scale may help to identify athletes who will find sport resumption difficult. Level of evidence III.

Tibial Spine Location Influences Tibial Tunnel Placement in Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction

2020 ◽  
Author(s):  
Takanori Iriuchishima ◽  
Bunsei Goto
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Single Bundle ◽  
Tunnel Placement ◽  
Anterior Border ◽  
Medial Border ◽  
Tibial Spine ◽  
Anterior Cruciate ◽  
Tibia Plateau

AbstractThe purpose of this study was to assess the influence of tibial spine location on tibial tunnel placement in anatomical single-bundle anterior cruciate ligament (ACL) reconstruction using three-dimensional computed tomography (3D-CT). A total of 39 patients undergoing anatomical single-bundle ACL reconstruction were included in this study (30 females and 9 males; average age: 29 ± 15.2 years). In anatomical single-bundle ACL reconstruction, the tibial and femoral tunnels were created close to the anteromedial bundle insertion site using a transportal technique. Using postoperative 3D-CT, accurate axial views of the tibia plateau were evaluated. By assuming the medial and anterior borders of the tibia plateau as 0% and the lateral and posterior borders as 100%, the location of the medial and lateral tibial spine, and the center of the tibial tunnel were calculated. Statistical analysis was performed to assess the correlation between tibial spine location and tibial tunnel placement. The medial tibial spine was located at 54.7 ± 4.5% from the anterior border and 41.3 ± 3% from the medial border. The lateral tibial spine was located at 58.7 ± 5.1% from the anterior border and 55.3 ± 2.8% from the medial border. The ACL tibial tunnel was located at 34.8 ± 7.7% from the anterior border and 48.2 ± 3.4% from the medial border. Mediolateral tunnel placement was significantly correlated with medial and lateral tibial spine location. However, for anteroposterior tunnel placement, no significant correlation was found. A significant correlation was observed between mediolateral ACL tibial tunnel placement and medial and lateral tibial spine location. For clinical relevance, tibial ACL tunnel placement might be unintentionally influenced by tibial spine location. Confirmation of the ACL footprint is required to create accurate anatomical tunnels during surgery. This is a Level III; case–control study.

Anterior Cruciate Ligament Insertions on the Tibia and Femur and Their Relationships to Critical Bony Landmarks Using High-Resolution Volume-Rendering Computed Tomography

2008 ◽  
Vol 36 (11) ◽  
pp. 2083-2090 ◽  
Author(s):  
Mark L Purnell ◽  
Andrew I. Larson ◽  
William Clancy
Keyword(s):  
Computed Tomography ◽  
Anterior Cruciate Ligament ◽  
Volume Rendering ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Anterior Border ◽  
Tibial Eminence ◽  
Bony Landmarks ◽  
Tibial Condyle ◽  
Anterior Cruciate

Background Controversy exists regarding the locations of the anterior cruciate ligament insertions on the femur and tibia and visualization of these insertions during surgical reconstruction. Hypothesis Anatomical insertions of the anterior cruciate ligament have relationships to bony landmarks of the tibia and femur. Study Design Descriptive laboratory study. Methods Eight cadaveric knees were scanned by computed tomography, reconstructed 3-dimensionally, and examined from simulated arthroscopic, sagittal, and axial perspectives. Volume-rendering software was used to document the relationship of the anterior cruciate ligament to the bony anatomy. Results A bony ridge (Resident's Ridge) at the anterior border of the anterior cruciate ligament was readily noted on the medial wall of the lateral femoral condyle. Superiorly, anterior cruciate ligament fibers inserted up to the roof of the notch and to 3 to 3.5 mm of the articular surface posteriorly and interiorly. The anterior cruciate ligament inserted into a fovea anterior to the tibial eminence. Posteriorly, anterior cruciate ligament fibers inserted up to a ridge between the medial and lateral intercondylar tubercles. Medially, anterior cruciate ligament fibers inserted onto the ridge at the lateral border of the medial tibial condyle. There was no distinct anterior or lateral bony border with anterior cruciate ligament fibers blending into the anterior horn of the lateral meniscus. Conclusion The anterior border of the femoral anterior cruciate ligament origin is Resident's Ridge. The ridge between the medial and lateral intercondylar tubercles at the base of the tibial eminence is the posterior margin of the anterior cruciate ligament on the tibia. Clinical Relevance Bony landmarks can be used to aid in anatomical anterior cruciate ligament reconstruction.

scholarly journals Sonographically Guided Posterior Subtalar Joint Injections via the Sinus Tarsi Approach

2015 ◽  
Vol 34 (1) ◽  
pp. 83-93 ◽  
Author(s):  
Jay Smith ◽  
Eugene Maida ◽  
Naveen S. Murthy ◽  
Eugene Y. Kissin ◽  
Jon A. Jacobson
Keyword(s):  
Subtalar Joint ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Joint Injections

Subtalar Fusion Preparation: What Are We Really Doing? A Cadaver Study

2019 ◽  
Vol 13 (3) ◽  
pp. 201-206 ◽  
Author(s):  
Eildar Abyar ◽  
Haley M. McKissack ◽  
Martim C. Pinto ◽  
Zachary L. Littlefield ◽  
Leonardo V. Moraes ◽  
...  
Keyword(s):  
Surface Area ◽  
Subtalar Joint ◽  
Cadaver Study ◽  
Joint Surface ◽  
Lateral Sinus ◽  
Total Percentage ◽  
Sinus Tarsi ◽  
Lateral Incision ◽  
Sinus Tarsi Approach ◽  
Fresh Frozen

Introduction. The open, lateral sinus tarsi approach is the most commonly used technique for subtalar arthrodesis. In this cadaver study, we measured the maximum joint surface area that could be denuded of cartilage and subchondral bone through this approach. Methods. Nine fresh frozen above-knee specimens were used. The subtalar joint was accessed through a lateral incision from the fibular malleolus distally over the sinus tarsi area to the level of the calcaneocuboid joint. Cartilage was removed from the anterior, middle, and posterior facets of the calcaneus and talus using an osteotome and/or curette. ImageJ was used to calculate the surface areas of undenuded cartilage. Results. No specimens were 100% denuded of cartilage on all 6 measured surfaces. The greatest percentages of unprepared surface area remained on the middle facet of the talus (18.66%) and the middle facet of the calcaneus (14.51%). The anterior facet of the talus was 100% denuded in 6 specimens, while the middle and posterior facets were 100% denuded in 3 specimens. The anterior facet of the calcaneus was also 100% denuded in 6 specimens, while the middle and posterior facets were 100% denuded in 3 and 4 specimens, respectively. The average total unprepared surface area per specimen was 8.67%. Conclusion. The lateral sinus tarsi approach provides adequate denudation of cartilage of the subtalar joint in most cases. Total percentage of unprepared joint surface may range from approximately 2% to 18%. Future clinical studies are warranted to assess whether this technique results in optimal union rates. Levels of Evidence:V, Cadaveric Study

Anterior Cruciate Ligament Injury in Female and Male Athletes

2007 ◽  
Vol 97 (5) ◽  
pp. 371-376 ◽  
Author(s):  
Walter L. Jenkins ◽  
Clyde B. Killian ◽  
D.S. Williams ◽  
Janice Loudon ◽  
Suzanne G. Raedeke
Keyword(s):  
Subtalar Joint ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Neutral Position ◽  
Basketball Players ◽  
Male Athletes ◽  
Foot Structure ◽  
Navicular Drop ◽  
Anterior Cruciate

Background: It has been shown that anterior cruciate ligament (ACL) injuries are more prevalent in female athletes than in male athletes. Soccer and basketball are considered high-risk sports for ACL injury in female athletes. Several studies have reported a relationship between ACL injury and measures of foot structure. This study was conducted to investigate the relationship between foot structure and ACL injury rates in female and male soccer and basketball players. Methods: One hundred five soccer and basketball players (53 women and 52 men) were recruited and divided into an ACL-normal group (n = 89) and an ACL-injured group (n = 16). Two measures of foot structure (subtalar joint neutral position and navicular drop test values) were recorded for each subject. An independent t test and a paired t test were used to analyze differences in ACL status, foot structure, and sex. A χ2 analysis determined whether the prevalence of ACL injury was independent of sport. Results: No statistically significant differences were found in the foot structure measures between women and men. Female soccer and basketball players had an ACL injury rate seven times that of male players. Conclusions: Values derived from subtalar joint neutral position measurement and the navicular drop test were not associated with ACL injury in collegiate female and male soccer and basketball players. (J Am Podiatr Med Assoc 97(5): 371–376, 2007)

Medial Compressible Forefoot Sole Elements Reduce Ankle Inversion in Lateral SSC Jumps

2013 ◽  
Vol 29 (3) ◽  
pp. 346-353 ◽  
Author(s):  
Jana Fleischmann ◽  
Guillaume Mornieux ◽  
Dominic Gehring ◽  
Albert Gollhofer
Keyword(s):  
Ankle Joint ◽  
Muscle Activity ◽  
Frontal Plane ◽  
Triceps Surae ◽  
Ankle Sprains ◽  
Joint Stability ◽  
Lateral Ankle ◽  
Foot Placement ◽  
3 Dimensional ◽  
Ankle Inversion

Sideward movements are associated with high incidences of lateral ankle sprains. Special shoe constructions might be able to reduce these injuries during lateral movements. The purpose of this study was to investigate whether medial compressible forefoot sole elements can reduce ankle inversion in a reactive lateral movement, and to evaluate those elements’ influence on neuromuscular and mechanical adjustments in lower extremities. Foot placement and frontal plane ankle joint kinematics and kinetics were analyzed by 3-dimensional motion analysis. Electromyographic data of triceps surae, peroneus longus, and tibialis anterior were collected. This modified shoe reduced ankle inversion in comparison with a shoe with a standard sole construction. No differences in ankle inversion moments were found. With the modified shoe, foot placement occurred more internally rotated, and muscle activity of the lateral shank muscles was reduced. Hence, lateral ankle joint stability during reactive sideward movements can be improved by these compressible elements, and therefore lower lateral shank muscle activity is required. As those elements limit inversion, the strategy to control inversion angles via a high external foot rotation does not need to be used.

Reproducibility of Anatomic Tibial Landmarks for Anterior Cruciate Ligament Reconstructions

2001 ◽  
Vol 29 (6) ◽  
pp. 777-780 ◽  
Author(s):  
Mark R. Hutchinson ◽  
Taran S. Bae
Keyword(s):  
Anterior Cruciate Ligament ◽  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Lateral Meniscus ◽  
Posterior Border ◽  
Anterior Border ◽  
Tibial Eminence ◽  
Anterior Cruciate ◽  
The Relationship

We evaluated the reproducibility of landmarks used for accurate anatomic placement of the tibial tunnel in anterior cruciate ligament reconstruction. Landmarks evaluated were the medial tibial eminence, the posterior cruciate ligament, the “over-the-back” position, the true posterior border of the tibia, and the posterior border of the lateral meniscus. Forty-two pairs of cadaveric knees were dissected, and anatomic measurements were made regarding the anterior cruciate ligament insertion and these various landmarks. Statistical analysis was used to confirm reproducibility and significance. Measurements based on the medial tibial eminence and posterior border of the meniscus were particularly erratic. The most reproducible anatomic landmark was the posterior cruciate ligament. The anterior border of the posterior cruciate ligament was consistently 6.7 mm posterior to the posterior border of the anterior cruciate ligament and 10.9 mm posterior to the central sagittal insertion point of the anterior cruciate ligament. The over-the-back position was consistently in contact with the anterior border of the posterior cruciate ligament if the knee was flexed with a posterior-directed force applied. In this position, the over-the-back position was equally reproducible as compared with the posterior cruciate ligament. Measurements gauged from the true posterior border of the tibia gave a second rigid bony landmark but with a wider standard deviation than the posterior cruciate ligament-based landmarks. The relative anterior-posterior dimension of the tibia did not correlate with the relationship between the anterior cruciate ligament and other anatomic landmarks.

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