Effect of Complete Syndesmotic Disruption and Deltoid Injuries and Different Reduction Methods on Ankle Joint Contact Mechanics

LaMothe, Jeremy M.; Baxter, Josh R.; Gilbert, Susannah L.; Murphy, Conor; Karnovsky, Sydney C.; Drakos, Mark C.

doi:10.1177/1071100717696360

Cited by 34 publications

(19 citation statements)

References 36 publications

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“…2,5,17,18 Despite permitting a flexible syndesmosis, suture button constructs have been shown insufficient for returning joint contact stresses to intact patterns. 16 Though patient-reported outcomes with flexible syndesmotic repairs are nearly always equivalent or superior to those reported for screw fixation, even after screw removal, 7,[13][14][15]34 these improved outcomes appear to be in spite of persistent abnormal ankle biomechanics.…”

Section: Introductionmentioning

confidence: 98%

Biomechanical Comparison of Syndesmotic Repair Techniques During External Rotation Stress

et al. 2018

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Section: Introductionmentioning

confidence: 98%

Biomechanical Comparison of Syndesmotic Repair Techniques During External Rotation Stress

et al. 2018

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“…28 , comparing the transfixation of syndesmosis using a positioning screw with and without conventional reduction forceps (manually combined with crossing K-wires) and the “suture button technique”, the combination with manual reduction and transient K-wire transfixation showed the best results. However, the authors described the differences as minor, similar to our results, and stated that none of the three reduction methods achieved optimal results 28 . Furthermore, in accordance to our study, a complete correction of syndesmosis without significant differences could not be achieved.…”

Section: Discussionmentioning

confidence: 99%

Comparison of three different reduction methods of the ankle mortise in unstable syndesmotic injuries

Vetter

Beisemann

Keil

et al. 2019

Sci Rep

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In order to achieve a clinically satisfying result and to prevent posttraumatic osteoarthritis in the treatment of unstable syndesmotic injuries, anatomically correct reduction is crucial. The objective of the study was to investigate three different reduction methods of the ankle mortise in unstable syndesmotic injuries. In a specimen model with 38 uninjured fresh-frozen lower legs, a complete syndesmotic dissection was performed. The ankle mortise was reduced with either a collinear reduction clamp, a conventional reduction forceps or manually with crossing K-wires. The reduction clamps and the K-wires were placed in a 0°-angle to the leg axis. The clamps were positioned on the posterolateral ridge of the fibula 20 mm proximal to the ankle joint line. A cone beam computed tomography was performed after dissection and after each reduction. Tibio-fibular distances and angles were determined. Despite significant differences in terms of overcompression (0.09–0.33 mm; p = 0.000–0.063) and the slight external rotation (0.29–0.47°; p = 0.014–0.07), the results show a satisfying reduction of the ankle mortise. There were no considerable differences between the reduction methods. It can therefore be concluded that the ankle mortise can be reduced with any of the methods used, but that the positioning and the contact pressure must be considered.

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“…All these increasing relative motion of the syndesmosis indicate its stability decreased under the non-anatomical fixation. LaMothe et al [19] demonstrated that the contact stress of the ankle joint was significantly increased after the ligaments were cut off, and the stress histogram revealed that the peak of the contact stress of the talus moved anteriorly and laterally. Moreover, in clinical practice, it was revealed that the unbalanced stress distribution was the main cause of ankle dysfunction and osteoarthritis [20].…”

Section: Discussionmentioning

confidence: 99%

Syndesmotic malreduction may decrease fixation stability: a biomechanical study

et al. 2020

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Background: This study aims to investigate the malreduction of syndesmosis and its effects on stability. Methods: The biomechanical tests, including the three-dimensional (3D) displacement of the syndesmotic incisura, fibular rotation angle, and torque resistance, were performed on six cadaver legs. These specimens were first tested intact (intact group), then cut all the syndesmotic ligaments and fixed in anatomical position (anatomical model group) and test again. After that, syndesmosis was fixed in 1 cm malreduction (anterior and posterior displacement group) to do the same test. Results: In internal or external load, there were significant differences in torque resistance and fibular rotation angle (internal t = 2.412, P = 0.036; external t = 2.412, P = 0.039) between the intact and post-malreduction groups. In internal rotation load, there were significant differences in sagittal displacement between the intact and postmalreduction groups (P = 0.011), and between the anatomical and post-malreduction groups (P = 0.020). In external rotation load, significant differences existed between the intact and ant-malreduction group (P = 0.034) in sagittal (anterior-posterior) displacement. Significant differences also existed between the intact and post-malreduction groups (P = 0.013), and between the anatomical and post-malreduction groups (P = 0.038) in coronal (medial-lateral) displacement.Conclusions: Malreduction in different conditions does affect the stability of the syndesmotic fixation. The result of the study may reveal the biomechanical mechanism of poor clinical outcome in syndesmosis malreduction patients and pathological displacement patterns of the ankle under syndesmotic malreduction conditions. Level of evidence: III

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Effect of Complete Syndesmotic Disruption and Deltoid Injuries and Different Reduction Methods on Ankle Joint Contact Mechanics

Abstract: Decreased contact area and force with disruption imply that other structures are likely receiving more loads (eg, medial and lateral gutters), which may have clinical implications such as the development of posttraumatic arthritis.

Cited by 34 publications

References 36 publications

Biomechanical Comparison of Syndesmotic Repair Techniques During External Rotation Stress

Biomechanical Comparison of Syndesmotic Repair Techniques During External Rotation Stress

Comparison of three different reduction methods of the ankle mortise in unstable syndesmotic injuries

Syndesmotic malreduction may decrease fixation stability: a biomechanical study

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