What is the Effect of Lateral Ankle Ligament Injury on Syndesmotic Stability? Arthroscopic evaluation

Category: Ankle; Arthroscopy; Sports; Trauma Introduction/Purpose: Numerous studies have shown a high incidence of associated lateral ankle and syndesmotic ligamentous injuries. It is unclear, however, if there is a direct contribution of the lateral ligaments towards stabilizing the syndesmosis. Using arthroscopy, we assessed to what extent lateral ankle ligaments contribute to syndesmotic stability in the coronal and sagittal plane. Our hypothesis was that lateral ankle ligament injury has effect on syndesmosis instability. Methods: Sixteen fresh frozen above-knee amputated cadaveric specimens were divided into two groups that underwent arthroscopic evaluation for syndesmotic stability. In both the groups, the assessment was done with all syndesmotic and ankle ligaments intact and later with sequential transection of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), the posterior talofibular ligament (PTFL), anterior inferior tibiofibular ligament (AITFL), the interosseous ligament (IOL) and the posterior inferior tibiofibular ligament (PITFL). In all scenarios, coronal and sagittal loading conditions were considered under 100N of direct force to fibula. The measurements of the distal tibiofibular coronal plane space at the anterior and posterior third of syndesmosis were performed using arthroscopic probes with increment of 0.2mm diameter. Further the sagittal translation were measured by arthroscopic scaled probe. Dunnett test was used to compare the findings of each ligamentous transection state to the intact state. A p-value < 0.05 was considered significantly defferent. Results: Compared with the intact ligamentous state, there was no difference in coronal and sagittal stability when the lateral ankle ligaments (ATFL, CFL, PTFL) and AITFL were transected (Table1 and 2, Group1). However, after subsequent transection of the IOL, or after transection of the lateral ankle ligaments (ATFL, CFL or and PTFL) alongside the AITFL and IOL, both coronal space and sagittal translation increased as compared with the intact state (p-values p<0.001 respectively) (Table1 and 2, Group2). Conclusion: Our findings suggest that lateral ankle ligaments do not directly contribute to syndesmotic stability in the coronal and sagittal plane. In concomitant acute syndesmotic and lateral ligament injury, surgeons should pay attention to whether there is combined IOL injury to determine the fixation of syndesmosis. [Table: see text][Table: see text]

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Effect of Early Physiotherapy after Lateral Ankle Ligament Injury on Pain and Function. Systematic Review

Reabilitacijos mokslai slauga kineziterapija ergoterapija ◽

10.33607/rmske.v1i16.741 ◽

2019 ◽

Vol 1 (16) ◽

Author(s):

Ieva Masiulytė ◽

Vygintė Gasiulytė ◽

Giedrė Jurgelaitienė

Keyword(s):

Ligament Injury ◽

Ligament Injuries ◽

Control Groups ◽

Ankle Ligaments ◽

Lateral Ankle ◽

Ankle Ligament ◽

Lateral Ankle Ligament ◽

And Function ◽

Lateral Ankle Ligaments ◽

Ankle Ligament Injury

Background. Lateral ankle ligament injuries are most common in sports, which affects athletes in all ages. It has been found that lateral ankle ligaments are injured in 1 of 10000 physically active people. Higher sports level professional players and amateurs need to return to sport early with no physical, psychological and economic consequences. Studies search for the most effective treatment after lateral ankle ligament injuries. Research aim – to perform a systematic review and determine the effect of early physiotherapy on pain and function after lateral ankle ligament injury. Methods. We conducted literature search using the Pubmed, Ebsco, Pedro, Google scholar databases, and chose controlled trials where early physiotherapy orientated to pain and function was used. Results. In control groups where traditional immobilization with RICE method was used, pain decreased to 1.96 ± 1.33 points, in the intervention groups who had early physiotherapy and RICE method, pain decreased to 1.53 ± 1.23 points. Effect size in control groups was r = 0.55 points, in the intervention groups it was r = 0.54 points. In control groups who had traditional immobilization with RICE method, function increased to 68.67 ± 16.79 point, in the intervention groups who had early physiotherapy and RICE method, function increased to 75.61 ± 13.27 points. Effect size in control groups was r = 0.82 points, in the intervention groups r = 0.88 point. Conclusions. Early physiotherapy orientated to pain and functions after lateral ankle ligaments injury helps to reduce pain faster and increases function, and helps return back to work and sports activities.Keywords: lateral ankle ligament, injuries, early physiotherapy.

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Using Portable Ultrasound to Measure the Effect of Lateral Ankle Ligament Injury on Syndesmotic Stability: A Cadaveric Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00423 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0042

Author(s):

Jirawat Saengsin ◽

Noortje Hagemeijer ◽

Rohan Bhimani ◽

Go Sato ◽

Bart Lubberts ◽

...

Keyword(s):

Sagittal Plane ◽

Point Of Care ◽

Intraclass Correlation ◽

Ligament Injury ◽

Ankle Ligaments ◽

Lateral Ankle ◽

Tibiofibular Ligament ◽

Lateral Ankle Ligament ◽

Group 2 ◽

Lateral Ankle Ligaments

Category: Ankle; Sports; Trauma Introduction/Purpose: About one-fifth of all patients diagnosed with an ankle sprain also suffer a ligamentous injury of the ankle syndesmosis. Despite the common concomitant injuries, it is still unclear whether there is a direct contribution of the lateral ligaments towards stabilizing the syndesmosis. Portable ultrasonography (PUS) has increasingly been used in the clinical setting, allowing dynamic and non-invasive evaluation at the point of care. The primary aim of this study was to assess to what extent lateral ankle ligaments contribute to syndesmotic stability in the sagittal and rotational plane using PUS. Secondary, we determine if PUS is a reliable tool for the assessment of syndesmotic instability. Our primary hypothesis was that lateral ankle ligaments contribute significantly to the stability of the ankle syndesmosis. Methods: 16 fresh-frozen cadaveric specimens were equally divided into 2 groups that underwent PUS evaluation for syndesmotic stability. The assessment was done at the intact state and later with sequential ligament transection. In group 1, the anterior talofibular ligament (ATFL) was transected, followed by the calcaneofibular ligament (CFL), the posterior talofibular ligament (PTFL), the anteroinferior tibiofibular ligament (AITFL), the interosseous ligament (IOL), and the posteroinferior tibiofibular ligament (PITFL). In group 2, the transection started with the AITFL then followed by the ATFL, the CFL, the IOL, the PTFL, and the PITFL. PUS measurements were performed during anterior to posterior (AP), posterior to anterior (PA), and external rotated loading condition (Figure 1). One-way ANOVA and post hoc Dunnett test were used to compare the findings of each state to the intact. Besides, we assessed the inter-rater and intra-rater reliability using the intraclass correlation coefficient (ICC) through a two-way mixed-effects model. Results: In group 1, showed that compared to the intact stage, fibular translation in the sagittal plane and the anterior tibiofibular clear space (TFCS) distance did not increase after transection of all three lateral ankle ligaments. However, the syndesmotic PUS measurements did increase after subsequent transection of the AITFL and IOL (p-values ranging from 0.047 to <0.001). In group 2, the AP translation of the fibula in sagittal plane, as well as the anterior TFCS distance, only increased significantly after transection of at least two syndesmotic ligaments (AITFL, IOL) together with two lateral ligaments (ATFL and CFL) (p-values ranging from 0.047 to <0.001). The ICCs Inter-rater and intra-rater reliability for syndesmotic PUS measurements ranged from 0.84-0.95, indicating excellent agreement. Conclusion: PUS is a reliable tool for the assessment of syndesmotic instability. Using PUS we found that lateral ankle ligaments contribute marginally to the stability of the ankle syndesmosis. Syndesmotic sagittal and rotational plane instability occurred after injury to all three syndesmotic ligaments or after partial syndesmotic injury (AITFL+IOL) with concomitant two or more lateral ankle ligament injury. The intraclass correlation coefficient for the sagittal and rotational plane assessment of syndesmosis using PUS indicated excellent inter- and intraobserver agreement, and thus, can be a valuable diagnostic tool at the point of care.

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