Botchu-Beale accessory ligament of lateral ankle

Indian Journal of Musculoskeletal Radiology ◽

10.25259/ijmsr_42_2021 ◽

2021 ◽

Vol 0 ◽

pp. 1-3

Author(s):

Ganesh Hegde ◽

Nagu Penakacherla ◽

David Beale ◽

Rajesh Botchu

Keyword(s):

Normal Variant ◽

Diagnostic Dilemma ◽

Lateral Ankle ◽

Tibiofibular Ligament

Variations in anatomy of the tendons and ligaments are not uncommon and cause a diagnostic dilemma. We describe a novel ligament encountered in the ankle extending from posterior inferior tibiofibular ligament to calcaneum. Awareness of normal variant is essential during evaluation of a study.

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Diagnosing the Impact of the Syndesmotic Injury on Lateral Ankle Stability using Dynamic Ultrasound

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00132 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0013

Author(s):

Rohan Bhimani ◽

Jirawat Saengsin ◽

Go Sato ◽

Noortje Hagemeijer ◽

Bart Lubberts ◽

...

Keyword(s):

Anterior Talofibular Ligament ◽

Syndesmotic Injury ◽

Lateral Ankle ◽

Anterior Drawer ◽

Intact State ◽

Tibiofibular Ligament ◽

Ankle Stability ◽

Clear Space ◽

Lateral Ankle Ligament ◽

The Impact

Category: Ankle; Basic Sciences/Biologics; Sports; Trauma Introduction/Purpose: There is a high prevalence of coexisting lateral ankle ligament injuries and syndesmotic ligamentous injuries. However, it is unclear whether syndesmotic ligaments directly contribute toward the stability of the lateral ankle. Dynamic ultrasonography (US) is an imaging modality increasingly used for the care of orthopaedic foot and ankle patients because it allows dynamic evaluation of structures at the point of care with little risk to the patient and at low-cost. The aim of this study is to assess the effect of syndesmotic injury as well as combined syndesmotic and lateral ankle injury on the stability of the lateral ankle. Methods: Sixteen fresh frozen above-knee amputated cadaveric specimens, divided into two groups, underwent ultrasound evaluation for lateral ankle stability. In both the groups, the assessment was first done with all ligaments intact and later with sequential transection of anterior inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), posterior inferior tibiofibular ligament (PITFL), anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL). In all scenarios, two loading conditions were considered: (1) Anterior drawer test: 50N and 80N and (2) Lateral clear space (LCS): 1.7Nm torque. The talar translation and LCS to the fixed tibial plafond were measured using Image J. Wilcoxon rank-sum test was used to compare the findings of each ligamentous transection state to the intact state. A p-value <0.05 was considered statistically significant. Results: In group 1 after transection of the all syndesmotic ligament and ATFL, an increase in the anterior drawer and lateral clear space values were found as compared to the intact state. Similarly, in group 2 the anterior drawer and lateral clear space values significantly increased after transection of the AITFL and ATFL as compared to the intact state (p-values = 0.01). Conclusion: Ultrasound can be used to evaluate the impact of the syndesmotic injury on lateral ankle stability while performing dynamic stress maneuvers. Lateral ankle instability appears after injury to all syndesmotic ligaments and ATFL, or after one syndesmotic ligament rupture (AITFL) with a concomitant anterior talofibular ligament rupture (ATFL). These findings suggest that surgeons should lower their threshold for stabilizing the syndesmosis if there is a concomitant lateral ankle ligament injury. [Table: see text]

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00426 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0042

Author(s):

Go Sato ◽

Jirawat Saengsin ◽

Rohan Bhimani ◽

Noortje Hagemeijer ◽

Bart Lubberts ◽

...

Keyword(s):

Sagittal Plane ◽

Ligament Injury ◽

Ankle Ligaments ◽

Lateral Ankle ◽

Intact State ◽

Tibiofibular Ligament ◽

Ankle Ligament ◽

Lateral Ankle Ligament ◽

Lateral Ankle Ligaments ◽

Ankle Ligament Injury

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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Dynamic Evaluation Of The Effect Of Syndesmotic Injury On Lateral Ankle Stability Using Fluoroscopy

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00023 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0002

Author(s):

Rohan Bhimani ◽

Go Sato ◽

Jirawat Saengsin ◽

Noortje Hagemeijer ◽

Bart Lubberts ◽

...

Keyword(s):

Ankle Instability ◽

Anterior Talofibular Ligament ◽

Lateral Ankle ◽

Anterior Drawer ◽

Intact State ◽

Tibiofibular Ligament ◽

Clear Space ◽

Lateral Ankle Ligament ◽

Talar Tilt ◽

The Stability

Category: Ankle; Sports; Trauma Introduction/Purpose: There is a high incidence of concomitance between lateral ankle ligament injuries and syndesmotic ligamentous injuries. However, it is unclear whether syndesmotic ligaments directly contribute toward the stability of the lateral ankle. Stress radiographs are an accepted technique to assess the degree of lateral ankle instability by providing a static view of the ankle when subjected to the anterior drawer (AD) and talar tilt (TT) tests. The aim of this study is to assess the effect of syndesmotic injury as well as combined syndesmotic and lateral ankle injury on the stability of the lateral ankle. Methods: Sixteen fresh frozen above-knee amputated cadaveric specimens, divided into two groups, underwent fluoroscopic evaluation for lateral ankle stability. In both the groups, the assessment was first done with all ligaments intact and later with sequential transection of anterior inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), posterior inferior tibiofibular ligament (PITFL), anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL). In all scenarios, two loading conditions were considered: (1) Anterior drawer test: 50N and 80N and (2) Talar tilt and Lateral clear space (LCS): 1.7Nm torque. The talar translation, talar tilt, and LCS were measured using Image J. Wilcoxon rank-sum test was used to compare the findings of each ligamentous transection state to the intact state. A p-value <0.05 was considered statistically significant. Results: In group 1 after transection of the AITFL and IOL, an increase in the anterior drawer, talar tilt, and lateral clear space values was found as compared to the intact state. Similarly, in group 2 the anterior drawer, talar tilt, and lateral clear space values significantly increased after transection of the AITFL and ATFL as compared to the intact state (p-values = 0.001). Conclusion: Lateral ankle instability appears after injury to two syndesmotic ligaments (AITFL and IOL), or after one syndesmotic ligament rupture (AITFL) with a concomitant anterior talofibular ligament rupture (ATFL). These findings suggest that surgeons should lower their threshold for stabilizing the syndesmosis if there is a concomitant lateral ankle ligament injury.

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Mammographic normal variant : the sternalis muscle

South African Journal of Radiology ◽

10.4102/sajr.v13i3.501 ◽

2009 ◽

Vol 13 (3) ◽

pp. 72

Author(s):

D Meerkotter

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Imaging Techniques ◽

Normal Variant ◽

Imaging Findings ◽

Resonance Imaging ◽

Diagnostic Dilemma ◽

Significant Pathology ◽

Magnetic Resonance Imaging Mri ◽

Sternalis Muscle

The imaging findings of a normal variant seen on mammography are presented in this article. The sternalis muscle is an uncommon normal variant, seen only in 8% of cadaveric studies. It is increasingly demonstrated with mammography as imaging techniques improve. This normal variant needs to be differentiated from significant pathology and can pose a diagnostic dilemma. In this article the anatomy of this muscle and the imaging findings are discussed. In selected cases computed tomography (CT) or magnetic resonance imaging (MRI) will be required to investigate the mammographic findings further and these modalities are described regarding the assessment of the sternalis muscle.

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Determination of In Situ Ankle Ligament Strains in Cases of High and Medial Ankle Sprains

ASME 2012 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2012-80378 ◽

2012 ◽

Author(s):

Keith D. Button ◽

Feng Wei ◽

Eric G. Meyer ◽

Kathleen Fitzsimons ◽

Roger C. Haut

Keyword(s):

Ankle Sprain ◽

Ankle Injury ◽

Ankle Injuries ◽

Deltoid Ligament ◽

Generic Model ◽

Ankle Sprains ◽

Ligament Injuries ◽

Lateral Ankle Sprain ◽

Lateral Ankle ◽

Tibiofibular Ligament

Ankle sprain is a common occurrence in sports, accounting for 10–30% of injuries [1]. While approximately 85% of ankle sprains are lateral ankle injuries, syndesmotic (high) and medial injuries typically result in more time off the field. In order to help limit or mitigate ankle injuries, it is important to understand the mechanisms of injury. While numerous biomechanical studies have been conducted to investigate ankle injuries, most of them are designed to study ankle fractures rather than sprains. Ankle sprains have been graded in the clinical literature and associated with the degree of damage to a ligament resulting from excessive strains [2]. Recently, there have been studies of lateral ankle sprain in laboratory settings [3,4] and based on investigation of game films [5], providing considerable insight into the mechanism of lateral ankle sprain. On the other hand, few biomechanical studies have been conducted on high and medial ankle sprains. A more recent study from our laboratory used human cadaver limbs to investigate such injuries [6]. The study showed that the type of ankle injury, whether medial or high, under excessive levels of external foot rotation depends on the extent of foot eversion [6]. Everted limbs showed isolated anterior tibiofibular ligament injuries (high ankle sprain) only, while neutral limbs mostly demonstrated deltoid ligament failures (medial ankle sprain). Additionally, the study documented grade II (partial tears) and grade III (ruptures) ligament injuries. While a computational ankle model has also been developed and validated to help understand the mechanisms of injury [7], it is a generic model. The objective of the current study was to develop computational, subject-specific models from those cadaver limbs and determine the levels of ligament strain generated in the medial and high ankle injury cases, as well as correlate the grades of injury with ligament strains from the computational model.

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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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