scholarly journals Strain patterns in normal anterior talofibular and calcaneofibular ligaments and after anatomical reconstruction using gracilis tendon grafts: A cadaver study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Masato Takao ◽  
Danielle Lowe ◽  
Satoru Ozeki ◽  
Xavier M. Oliva ◽  
Ryota Inokuchi ◽  
...  
Keyword(s):  
Plantar Flexion ◽  
Three Dimensional ◽  
Anatomical Reconstruction ◽  
Anterior Talofibular Ligament ◽  
Ankle Sprains ◽  
Axial Motion ◽  
Calcaneofibular Ligament ◽  
Lateral Ankle ◽  
Relative Strain ◽  
Maximal Strain

Abstract Background Inversion ankle sprains, or lateral ankle sprains, often result in symptomatic lateral ankle instability, and some patients need lateral ankle ligament reconstruction to reduce pain, improve function, and prevent subsequent injuries. Although anatomically reconstructed ligaments should behave in a biomechanically normal manner, previous studies have not measured the strain patterns of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) after anatomical reconstruction. This study aimed to measure the strain patterns of normal and reconstructed ATFL and CFLs using the miniaturization ligament performance probe (MLPP) system. Methods The MLPP was sutured into the ligamentous bands of the ATFLs and CTLs of three freshly frozen cadaveric lower-extremity specimens. Each ankle was manually moved from 15° dorsiflexion to 30° plantar flexion, and a 1.2-N m force was applied to the ankle and subtalar joint complex. Results The normal and reconstructed ATFLs exhibited maximal strain (100) during supination in three-dimensional motion. Although the normal ATFLs were not strained during pronation, the reconstructed ATFLs demonstrated relative strain values of 16–36. During the axial motion, the normal ATFLs started to gradually tense at 0° plantar flexion, with the strain increasing as the plantar flexion angle increased, to a maximal value (100) at 30° plantar flexion; the reconstructed ATFLs showed similar strain patterns. Further, the normal CFLs exhibited maximal strain (100) during plantar flexion-abduction and relative strain values of 30–52 during dorsiflexion in three-dimensional motion. The reconstructed CFLs exhibited the most strain during dorsiflexion-adduction and demonstrated relative strain values of 29–62 during plantar flexion-abduction. During the axial motion, the normal CFLs started to gradually tense at 20° plantar flexion and 5° dorsiflexion. Conclusion Our results showed that the strain patterns of reconstructed ATFLs and CFLs are not similar to those of normal ATFLs and CFLs.

scholarly journals Strain patterns in normal anterior talofibular and calcaneofibular ligaments and after anatomical reconstruction using gracilis tendon grafts: A cadaver study

2021 ◽  
Author(s):  
Masato Takao ◽  
Danielle Lowe ◽  
Satoru Ozeki ◽  
Xavier M Oliva ◽  
Ryota Inokuchi ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Plantar Flexion ◽  
Three Dimensional ◽  
Anatomical Reconstruction ◽  
Axial Motion ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Strain Measurements ◽  
Relative Strain ◽  
Lateral Ankle Ligaments

Abstract BackgroundInversion sprains of the lateral ankle ligaments often result in symptomatic lateral ankle instability, and some patients need lateral reconstruction surgeries to reduce pain, improve function, and prevent subsequent injuries. Although anatomically reconstructed ligaments should behave in a biomechanically normal manner, previous studies have not measured the strain patterns of the anterior talofibular (ATFL) and calcaneofibular ligaments (CFL) after anatomical reconstruction. This study aimed to measure the strain patterns of normal and reconstructed ATFL and CFLs using a miniaturization ligament performance probe (MLPP) system.MethodsThe MLPP was sutured into the ligamentous bands of the ATFLs and CTLs of three fresh-frozen, lower extremity, cadaveric specimens. Each ankle was manually moved from 15° dorsiflexion to 30° plantar flexion, and a 1.2-N m force was applied to the ankle and subtalar joint complex.ResultsThe normal and reconstructed ATFLs exhibited maximal strain (100) during supination in three-dimensional motion. Although the normal ATFLs were not strained during pronation, the reconstructed ATFLs demonstrated relative strain values of 16–36. During axial motion, the normal ATFLs began to gradually tense at 0° plantarflexion, with the strain increasing, as the plantarflexion angle increased, to a maximal value (100) at 30° plantarflexion; the reconstructed ATFLs showed similar strain patterns. The normal CFLs exhibited maximum strain (100) during plantarflexion-abduction and relative strain measurements of 30–52 during dorsiflexion in three-dimensional motion. The reconstructed CFLs exhibited the most strain during dorsiflexion-adduction and demonstrated relative strain measurements of 29–62 during plantarflexion-abduction. During axial motion, the normal CFLs began to gradually tense at 20° plantarflexion and 5° dorsiflexion.ConclusionOur results showed that the strain patterns of reconstructed ATFLs and CFLs are not exactly the same as those in the normal ligaments.

scholarly journals The Role of the Calcaneofibular Ligament in Chronic Ankle Pain Following Severe Ankle Sprains

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0014
Author(s):  
Richard Alvarez ◽  
Randall Marx ◽  
Mark Mizel ◽  
Loren Latta ◽  
Paul Clifford
Keyword(s):  
Ankle Sprain ◽  
Plantar Flexion ◽  
Neutral Position ◽  
Peroneal Tendon ◽  
Ankle Sprains ◽  
Ankle Pain ◽  
Calcaneofibular Ligament ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Peroneal Tendons

Category: Sports Introduction/Purpose: Lateral ankle pain persists in 10%-20% of patients following severe ankle sprains treated non-operatively. The authors hypothesize that the peroneal tendons may become interposed between the ruptured ends of the calcaneofibular ligament (CFL). Though previously visualized and noted in the literature, no studies have evaluated this lesion biomechanically and anatomically. The purpose of this study is to demonstrate that following a severe lateral ankle sprain that the interposition of the peroneal tendons between the ruptured ends of the CFL can occur. Methods: Eight fresh-frozen cadaveric lower extremity specimens (defrosted) were secured by the foot to a wooden board in the method of Lauge-Hansen. A manual inversion force was then applied to the ankle, both with the ankle in plantar flexion and also in a neutral position to approximate a severe ankle sprain. Magnetic resonance imaging (MRI) was then performed on each ankle. Each specimen was then dissected to observe the integrity and relationship of the lateral ankle structures. Results: Four of the eight specimens sustained CFL tears as viewed by MRI and confirmed through anatomic dissection. One of the four specimens with a CFL tear had a mid substance ligament rupture with the proximal half of the ligament positioned superficial to the peroneal tendon complex. This relationship was observed using the MRI. Conclusion: Creating severe lateral ankle sprain produced ruptures of the CFL with interposition of the peroneal tendon complex between the torn ends of the ligament was seen and identified. This phenomenon may prevent primary ligament healing of the CFL and may be a contributing factor in the chronic ankle pain of non-surgically treated lateral ankle sprains. Perhaps surgical intervention should be considered if clinical suspicion exists, such as with a Stener lesion of the hand.

LATERAL ANKLE SPRAIN — AN UPDATE

2013 ◽  
Vol 16 (04) ◽  
pp. 1330003
Author(s):  
Shibli Nuhmani ◽  
Moazzam Hussain Khan
Keyword(s):  
Ankle Sprain ◽  
Bone Fractures ◽  
Sports Injury ◽  
Ankle Injuries ◽  
Anterior Talofibular Ligament ◽  
Ankle Sprains ◽  
Calcaneofibular Ligament ◽  
Lateral Ankle ◽  
Major Loss ◽  
Sporting Activities

Ankle sprain injuries are the most common injury sustained during sporting activities. One-sixth of all sports injury loss time is from ankle sprains. Each year, an estimated 1 million people present to physicians with acute ankle injuries. Three-quarters of ankle injuries involve the lateral ligamentous complex, comprised of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). Lateral ankle sprains typically occur when the rearfoot undergoes excessive supination on an externally rotated lower leg. The diagnosis of a sprain relies on the medical history including symptoms, as well as making a differential diagnosis mainly in distinguishing it from strains or bone fractures. Despite their prevalence in society, ankle sprains still remain a difficult diagnostic and therapeutic challenge in the athlete, as well as in society in general. The high incidence of ligamentous ankle injuries requires clearly defined acute care and a broad knowledge of new methods in rehabilitation. In addition to rapid pain relief, the main objective of treatment is to quickly restore the range of motion of the ankle without any major loss of proprioception, thereby restoring full activity as soon as possible. The purpose of this article is to review the anatomy, pathomechanics, investigation, diagnosis and management of lateral ankle sprains.

scholarly journals Characteristics and predictors of muscle strength deficit in mechanical ankle instability

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Zong-chen Hou ◽  
Xin Miao ◽  
Ying-fang Ao ◽  
Yue-lin Hu ◽  
Chen Jiao ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Strength Training ◽  
Ankle Instability ◽  
Plantar Flexion ◽  
Ligament Injury ◽  
Osteochondral Lesions ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Unaffected Side ◽  
Affected Side

Abstract Purpose Muscle strength training is a common strategy for treating chronic ankle instability (CAI), but the effectiveness decreases for mechanical ankle instability (MAI) patients with initial severe ligament injuries. The purpose of this study was to investigate the characteristics and the potential predictors of muscle strength deficit in MAI patients, with a view to proposing a more targeted muscle strength training strategy. Methods A total of 220 MAI patients with confirmed initial lateral ankle ligament rupture and a postinjury duration of more than 6 months were included. All patients underwent a Biodex isokinetic examination of the ankle joints of both the affected and unaffected sides. Then, the associations between the limb symmetry index (LSI) (mean peak torque of the injury side divided by that of the healthy side) and the patients’ sex, body mass index, postinjury duration, presence of intra-articular osteochondral lesions, presence of osteophytes and ligament injury pattern (i.e., isolated anterior talofibular ligament (ATFL) injury or combined with calcaneofibular ligament injury) were analysed. Results There was significantly weaker muscle strength on the affected side than on the unaffected side in all directions (p < 0.05). The LSI in plantar flexion was significantly lower than that in dorsiflexion at 60°/s (0.87 vs 0.98, p < 0.001). A lower LSI in eversion was significantly correlated with female sex (0.82 vs 0.94, p = 0.016) and isolated ATFL injury (0.86 vs 0.95, p = 0.012). No other factors were found to be associated with muscle strength deficits. Conclusion MAI patients showed significant muscle strength deficits on the affected side, especially in plantar flexion. There were greater strength deficits in eversion in females and individuals with an isolated ATFL injury. Thus, a muscle strength training programme for MAI patients was proposed that focused more on plantar flexion training and eversion training for females and those with an isolated ATFL injury.

scholarly journals Sex and Occupation Are Salient Risk Factors for Lateral Ankle Sprain Among Military Tactical Athletes

2020 ◽  
Author(s):  
John J Fraser ◽  
Andrew J MacGregor ◽  
Camille P Ryans ◽  
Mark A Dreyer ◽  
Michael D Gibboney ◽  
...  
Keyword(s):  
Lower Risk ◽  
Armed Forces ◽  
Population Based ◽  
Military Occupation ◽  
Ankle Sprains ◽  
Calcaneofibular Ligament ◽  
Occupational Groups ◽  
Lateral Ankle ◽  
The Military ◽  
Female Officers

Introduction: Lateral ankle sprains (LAS) are ubiquitous among tactical athletes and a substantial burden in the military. With the changes in operational demand and the beginning of integration of women into previously closed occupations, an updated assessment of the burden of ankle sprains in the military is warranted. Methods: A population-based epidemiological retrospective cohort study of all service members in the US Armed Forces was performed assessing risk of sex and military occupation on the outcome of LAS incidence. The Defense Medical Epidemiology Database was queried for the number of individuals with ICD-9 diagnosis codes 845.00 (sprain of ankle, unspecified) and 845.02 (calcaneofibular ligament sprain) on their initial encounter from 2006 to 2015. Relative risk (RR) and chi-square statistics were calculated in the assessment of sex and occupational category. Results: A total of 272,970 enlisted males (27.9 per 1000 person-years), 56,732 enlisted females (34.5 per 1000 person-years), 24,534 male officers (12.6 per 1000 person-years), and 6020 female officers (16.4 per 1000 person-years) incurred LAS. Enlisted females in all occupational groups were at significantly higher risk for LAS than their male counterparts (RR 1.09-1.68; p < 0.01), except for Engineers (p = 0.15). Female officers had consistently higher risk for LAS in all occupational groups (RR 1.10-1.42; p < 0.01) compared with male officers, except Ground/Naval Gunfire (p =0.23). Contrasted with Infantry, enlisted members in the Special Operations Forces, Mechanized/Armor, Aviation, Maintenance, and Maritime/Naval Specialties were at lower risk (RR, 0.38-0.93; p < 0.01), Artillery, Engineers, and Logistics Specialties were at higher risk (RR 1.04-1.18; p < 0.01), and Administration, Intelligence, and Communications were no different (p = 0.69). Compared with Ground/Naval Gunfire officers, Aviation officers were at significantly lower risk (RR, 0.75; p < 0.01), and Engineers, Maintenance, Administration, Operations/Intelligence, and Logistics officers were at higher risk (RR, 1.08-1.20; p < 0.01). Conclusion: Sex and military occupation were salient factors for LAS risk. Colocation of interdisciplinary neuromusculoskeletal specialists to provide targeted preventive interventions should be considered in practice and policy.

scholarly journals A Case Report of Tarsal Navicular Body Fracture with Lateral Ankle Ligament Complex Tear – a New Injury Combination

2021 ◽  
Vol 11 (8) ◽  
Author(s):  
Ankur Singh ◽  
Peter Gföller ◽  
Patryk Ulicki
Keyword(s):  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Mri Scan ◽  
Rare Injury ◽  
Lateral Ankle ◽  
Body Fracture ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
Tarsal Navicular Bone ◽  
Lateral Ankle Ligament Complex

Introduction: Fractures of tarsal navicular bone are a rare injury. A navicular fracture can occur either in isolation or associated with other bony or ligamentous injuries, depending on the severity and mechanism of trauma at the time of impact. We report a previously undescribed injury combination of navicular fracture with tear of the lateral ankle ligament complex. Case Report: An 18-year-old professional long jump athlete presented with a history of twisting injury immediately before taking off, while attempting a jump. A detailed clinical examination and radiological assessment with computed tomography (CT) and magnetic resonance imaging (MRI) scan were performed. She was diagnosed to have a navicular body fracture with complete rupture of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Acute fixation of navicular body fracture along with primary repair of ATFL and CFL was done. The final outcome of the patient was good with return to unrestricted physical activities after 4 months. Conclusion: A new injury combination of navicular fracture along with lateral ankle ligament complex tear is reported in a professional athlete. A high index of clinical suspicion and early detection using CT and MRI scan can identify this rare injury combination. Surgical treatment can result in favorable outcomes. Keywords: Tarsal navicular bone, fracture, anterior talofibular ligament, calcaneofibular ligament, computed tomography scan, magnetic resonance imaging scan.

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.

Anatomical Reconstruction of the Lateral Ligaments of the Ankle with a Gracilis Autograft

2005 ◽  
Vol 33 (6) ◽  
pp. 814-823 ◽  
Author(s):  
Masato Takao ◽  
Kazunori Oae ◽  
Yuji Uchio ◽  
Mitsuo Ochi ◽  
Haruyasu Yamamoto
Keyword(s):  
Anatomical Reconstruction ◽  
Anterior Talofibular Ligament ◽  
Stress Radiography ◽  
Lateral Instability ◽  
Calcaneofibular Ligament ◽  
Interference Fit ◽  
Lateral Ligaments ◽  
Anchoring System ◽  
The Mean ◽  
Talar Tilt

Background Few anatomical and minor invasive procedures have been reported for surgical reconstruction of the lateral ligaments to treat lateral instability of the ankle. Furthermore, there are no standards according to which ligaments should be reconstructed. Hypothesis A new technique for anatomically reconstructing the lateral ligaments of the ankle using an interference fit anchoring system and determining which ligaments need to be reconstructed according to the results of standard stress radiography of the talocrural and subtalar joints will be effective for treating lateral instability of the ankle. Study Design Case series; level of evidence, 4. Methods Twenty-one patients with lateral instability of the ankle underwent surgery using the proposed interference fit anchoring system. Standard stress radiographs of the subtalar joint were performed, and if the talocalcaneal angle was less than 10°, only the anterior talofibular ligament was reconstructed; if there was a 10° or greater opening of the talocalcaneal angle, both the anterior talofibular ligament and the calcaneofibular ligament were reconstructed. Results In the 17 patients who received only the anterior talofibular ligament reconstruction, the mean talar tilt angle on standard stress radiography of the talocrural joint was 14.5°± 1.7° before surgery and 2.6°± 0.8° 2 years after surgery (P <. 0001). For the 4 patients who had both the anterior talofibular ligament and calcaneofibular ligament reconstructed, the mean talar tilt angle was 16.5°± 1.5° before surgery and 3.0°± 0.5° 2 years after surgery (P =. 0015). The overall mean talocalcaneal angle on standard stress radiography of the subtalar joint was 11.3°± 1.4° before surgery and 3.5°± 0.8° 2 years after surgery (P =. 0060). Conclusion The proposed system has several advantages, including anatomical reconstruction with normal stability and range of motion restored, the need for only a small incision during the reconstruction, and sufficient strength at the tendon graft-bone tunnel junction, in comparison with the tension strength of the lateral ligaments of the ankle.

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