Effect of a Controlled Ankle Motion Walking Boot on Syndesmotic Instability During Weightbearing: A Cadaveric Study

Abstract

Background: Syndesmotic injuries can lead to long-term complications; hence, they require careful management. Conservative treatment is adequate when 1 syndesmotic ligament is injured, but surgery is often necessary to achieve articular congruity when 3 syndesmotic ligaments are ruptured. However, there is some controversy over the best treatment for 2-ligament injuries. Purpose: To evaluate the effect of a controlled ankle motion (CAM) walking boot on syndesmotic instability following iatrogenic isolated anterior inferior tibiofibular ligament (AiTFL) injury and combined AiTFL/interosseous ligament (IOL) injuries in a cadaveric simulated weightbearing model. Study Design: Controlled laboratory study. Methods: Ten cadaveric specimens were dissected to expose the tibial plateau and syndesmosis. The specimens were fitted to a custom-made device, and a reproducible axial load of 750 N was applied. Iatrogenic rupture of the syndesmotic ligaments (AiTFL + IOL) was done sequentially. Uninjured syndesmoses, isolated AiTFL rupture, and combined AiTFL/IOL rupture were compared with and without axial loading (AL) and CAM boot. The distal tibiofibular relationship was evaluated using a previously validated computed tomography scan measurement system. Wilcoxon tests for paired samples and nonparametric data were used. Results: The only difference noted in the distal tibiofibular relationship during AL was an increase in the external rotation of the fibula when using the CAM boot. This was observed with AiTFL rupture (8.40° vs 11.17°; P = .009) and combined AiTFL/IOL rupture (8.81° vs 11.97°; P = .005). Conclusion: AL did not cause a significant displacement between the tibia and fibula, even when 2 ligaments were ruptured. However, the CAM boot produced a significant external rotation with 1 or 2 injured ligaments. Clinical Relevance: Further studies are needed to assess the capacity of the CAM walking boot to prevent malreduction when external rotation forces are applied to the ankle. Moreover, special care should be taken during the fitting of the CAM boot to avoid overinflation of the cushions.

Implementation of Machine Learning and Deep Learning Algorithms with Dimensionality Reduction Methods for Internet of Things Gait Analysis and Monitoring Systems

“…The CAM boot is an adjustable device, which can be used with mild to severe leg, foot, and ankle injuries and is usually used to limit foot or ankle movement. (18) Consequently, a smaller difference in the orientation of the foot will be noticed while walking when wearing the boot. Here, the CAM boot was used as a platform to mount the sensors and collect the data.…”

Effect of Leg Length–Evening Device on Perceived Balance in Patients Wearing a Controlled Ankle Motion Boot

“…Controlled ankle motion (CAM) boots are used in the management of various foot and ankle conditions, including ankle fractures, 14 syndesmotic injuries, 17 lateral ankle sprains, 15 and plantar fasciitis. 6 The goal of weightbearing as tolerated (WBAT) in a CAM boot is to safely enable the patient to ambulate in as normal a fashion as possible with the limb protected and immobilized.…”

Tomografia computadorizada comparativa com manobras de estresse para avaliação de instabilidade da sindesmose tibiofibular distal na fase aguda pós-entorse do tornozelo: um estudo de acurácia diagnóstica

“…Recentemente, a tomografia com carga axial em posição ortostática emerge como uma nova modalidade diagnóstica e o seu papel na instabilidade da sindesmose ainda não é totalmente compreendido. Estudos em cadáveres mostram que a carga axial isolada não causa deslocamento entre a fíbula e a tíbia 14 , mesmo quando dois ligamentos estão rompidos 15 , e a rotação externa é essencial para mostrar instabilidade da sindesmose [16][17][18] . No entanto, os poucos estudos clínicos comparando a acurácia diagnóstica da TC com carga axial em posição ortostática e a TC convencional em decúbito dorsal apresentam resultados divergentes 19,20 Nossa hipótese foi que a TCME tem maior acurácia do que a TC em posição neutra (TCPN) para diagnóstico da instabilidade da sindesmose.…”

“…Na comparação entre os estudos, a força manual aplicada por Pansini 59 corresponde à medida de translação anteroposterior f realizada no nosso estudo.Uma ressalva importante é que, recentemente, a TC com carga axial em posição ortostática surgiu como um novo exame de imagem e o seu papel diagnóstico na instabilidade da sindesmose ainda está em evolução. Estudos em cadáver mostram que a carga axial isolada não causa deslocamento entre a fíbula e a tíbia14 , mesmo quando dois ligamentos estão rompidos15 , e a rotação externa é essencial para mostrar instabilidade da sindesmose[16][17][18] . No entanto, estudos in vivo apresentam resultados divergentes19,20 .…”