Disruption of the ankle syndesmosis: Biomechanical study of the ligamentous restraints

Ogilvie-Harris, D.J.; Reed, Stephen C.; Hedman, Thomas P.

doi:10.1016/s0749-8063(05)80014-3

Cited by 273 publications

(152 citation statements)

References 8 publications

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“…The four main ligaments that contribute to the syndesmotic complex are the anterior tibiofibular ligament (ATFL), the posterior tibiofibular ligament (PTFL), the transverse ligament, and the interosseous ligament (Hermans et al 2010). The PTFL is the strongest part of the syndesmosis, and together with the associated transverse ligament it provides 42% of the overall syndesmotic resistance strength (Ogilvie- Harris et al 1994). It has been shown that the level of the fibular fracture does not necessarily correlate with the presence of syndesmotic instability (Ebraheim et al 2003, Nielson et al 2004).…”

Section: Syndesmosismentioning

confidence: 99%

Complications in ankle fracture surgery

Ovaska¹

2015

Acta Orthop

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Section: Syndesmosismentioning

confidence: 99%

Complications in ankle fracture surgery

Ovaska¹

2015

Acta Orthop

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“…35 Of the 4 syndesmotic ligaments, the AITFL and PITFL are considered the primary stabilizers of the distal tibiofibular articulation. 39,49 The PITFL has an extensive breadth to its attachment on the fibula and constrains excessive external rotation of the foot on the leg and excessive distal fibular motion on the tibia. 26 The role of the AITFL is similar to the PITFL, constraining excessive distal fibular motion relative to the tibia and excessive external rotation of the foot on the leg.…”

Section: Anatomy and Functionmentioning

confidence: 99%

Ankle Syndesmosis Injuries: Anatomy, Biomechanics, Mechanism of Injury, and Clinical Guidelines for Diagnosis and Intervention

Lin

Gross

Weinhold

2006

J Orthop Sports Phys Ther

174

150

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Syndesmosis injuries are rare, but very debilitating and frequently misdiagnosed. The purpose of this clinical commentary is to review the mechanisms of syndesmotic injuries, clinical examination methods, diagnosis, and management of the injuries. Cadaveric studies of the syndesmosis and deltoid ligaments are also reviewed for further understanding of stress transmission and the roles of different structures in stabilizing the distal syndesmosis. External rotation and excessive dorsiflexion of the foot on the leg have been reported as the most common mechanisms of injury. The injury is most often incurred by individuals who participate in skiing, football, soccer, and other sport activities played on turf. The external rotation and squeeze tests are reliable tests to detect this injury. The ability of imaging studies to assist in an accurate diagnosis may depend on the severity of the injury. The results of cadaveric studies indicate the importance of the deltoid ligament in maintaining stability of the distal tibiofibular syndesmosis and the congruency of the ankle mortise. Intervention programs with early rigid immobilization and pain relief strategies, followed by strengthening and balance training are recommended. Heel lift and posterior splint intervention can be used to avoid separation of the distal syndesmosis induced by excessive dorsiflexion of the ankle joint. Application of a rigid external device should be used with caution to prevent medial-lateral compression of the leg superior to the ankle mortise, thereby inducing separation of the distal syndesmosis articulation. Surgical intervention is an option when a complete tear of the syndesmotic ligaments is present or when fractures are observed.

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“…We did not address this directly, but as we did mention, the posterior malleolus alone accounts for 42% of the strength of the syndesmosis [2]. We believe that if the medial side is reconstructed, either by fixation of a medial malleolar fracture or by repair of a torn deltoid ligament, additional syndesmotic fixation is unnecessary, even in more unstable injury patterns.…”

Section: Replymentioning

confidence: 95%

Reply to Letter to the Editor: Posterior Malleolar Stabilization of Syndesmotic Injuries is Equivalent to Screw Fixation

Miller

Carroll

Helfet

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Reply:We appreciate the interest by Huang et al. in our article [1] and the opportunity to reply. The first concern of Dr. Huang and his colleagues regarded the patients we examined in our study population. They correctly note that supination-external rotation injuries do not always have syndesmotic involvement. In our case population, as noted in the article [1], all patients had a positive radiographic stress examination and preoperative MRI that confirmed syndesmotic involvement necessitating fixation.Their second point was whether our posterior malleolar fixation would provide sufficient stabilization for fractures with ''greater instability.'' We did not address this directly, but as we did mention, the posterior malleolus alone accounts for 42% of the strength of the syndesmosis [2]. We believe that if the medial side is reconstructed, either by fixation of a medial malleolar fracture or by repair of a torn deltoid ligament, additional syndesmotic fixation is unnecessary, even in more unstable injury patterns. Since reviewing the patients in our article [1], the senior author (DGL) has completely stopped augmenting posterior malleolar fixation with syndesmotic screws, even in fracturedislocations. Each of these patients has stress testing after fixation and they no longer have any sign of instability. Thus, they have anatomic fixation without screws across the syndesmosis.The third question also addresses this topic, asking why a combination of posterior malleolar fixation and transsyndesmotic screw fixation was used in the more unstable fracture-dislocations. During the time we were accumulating this series of patients, we were unsure if the construct would be stable enough for these more severe injuries, but after this study and its predecessors were published and after review of our subsequent patient series (as yet unpublished), we do not believe more severe injuries need supplemental syndesmotic fixation. We thank Dr. Huang and his colleagues for their interest in our article.

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Disruption of the ankle syndesmosis: Biomechanical study of the ligamentous restraints

Cited by 273 publications

References 8 publications

Complications in ankle fracture surgery

Complications in ankle fracture surgery

Ankle Syndesmosis Injuries: Anatomy, Biomechanics, Mechanism of Injury, and Clinical Guidelines for Diagnosis and Intervention

Reply to Letter to the Editor: Posterior Malleolar Stabilization of Syndesmotic Injuries is Equivalent to Screw Fixation

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