High-stress distribution in the lateral region of the subtalar joint in the patient with chronic lateral ankle instability

Abstract

Purpose Chronic lateral ankle instability (CLAI) is associated with osteoarthritis (OA). However, the characteristics of patients with CLAI who progress to OA are not clear. Measurement of Hounsfield Unit (HU) value on computed tomography (CT) is reported to be useful to evaluate the stress distribution. We aimed to evaluate the stress distribution in the ankle and subtalar joints and factors enhancing it in patients with CLAI. Materials and methods Thirty-three ankles with CLAI (CLAI group) and 26 ankles without CLAI (control group) were included. A mean age of CLAI was 35.2 years and control was 30.3 years. Color map was created in the ankle and subtalar joint according to the HU values using three-dimensional CT to identify the region with high HU values, and HU values in those regions were measured using two-dimensional CT and compared between control and CLAI groups. In CLAI group, the relationships between HU values and ankle activity score (AAS), OA, talar tilting angle (TTA), cartilage injury were assessed. ResultsThe HU values in the anteromedial region of the talus and lateral region in the subtalar joint were higher than those in the control. In CLAI, patients with an AAS of ≧ 6, over 10° of TTA, cartilage injury, and OA changes in the medial gutter had significantly higher HU values in the lateral region of the subtalar joint than those with an AAS of ≦5, less than 10° of TTA without cartilage injury and OA change. Conclusions CLAI patients, especially in the patients with high activity level, large TTA, cartilage injury, and OA changes at the medial gutter, have high HU values in the lateral region of the subtalar joint, which suggests that disruption of the subtalar compensation toward OA will occur. For these patients, instability should be completely eliminated to prevent ankle OA. Level of evidence Level III, comparative series.

Risk Factors for the Recurrence of Instability After Lateral Ankle Ligament Repair

“…20,29 However, a previous study reported that excessive stress to the lateral region of the ankle and subtalar joints might result if the CFL is not repaired, leading to ankle and subtalar joint arthritis. 3,25 Hunt et al 12 reported that a loose or incompetent CFL potentially mitigates long-term consequences, such as ankle or subtalar joint arthritis, indicating that the CFL repair may be beneficial during lateral ankle ligament repair. Several studies also found better stability after a combined ATFL and CFL repair than ATFL repair alone because CFL plays an essential role in resisting ankle inversion in the coronal plane.…”

“…7,10 In addition, CLAI can lead to osteoarthritis (OA) because of the abnormal high-stress distribution in the ankle and subtalar joints. 25,38 Therefore, mechanical instability should be eliminated to prevent OA development. With recent advances in technology, surgeons are showing more interest in arthroscopic procedures, and their clinical outcomes are comparable to those of traditional open Broström procedures.…”

MRI and Single-cell RNA Sequence Results Reveal the Influence of Anterior Talofibular Ligament Injury on Osteochondral Lesions of the Talus

“…It lacks self-healing ability when damaged, and in clinical practice, it usually manifests as persistent ankle pain. 24,25 As the injury gradually worsens, it will affect the upper surface of the talus, causing greater and irreversible damage to the entire ankle joint. [26][27][28] There is a research report that by collecting CT and MRI data of patients with ATFL rupture and 2-month follow-up after Broström surgery, by establishing nite element model of the foot and ankle to simulate the stress on the ankle joint of patients with ATFL injury before and after surgery during normal gait cycles (landing phase, neutral phase, off ground phase).…”

Distributional patterns of subchondral bone density and histopathological features of the first tarsometatarsal joint in hallux valgus feet

“…HU values are standardized linear attenuation coefficients for tissue [ 13 ]. Studies have reported the use of HU measurements to determine the subchondral bone density, in which specific stress distributional patterns of the medial gutter in the talocrural joint and the lateral aspect of the subtalar joints were studied in patients with chronic lateral ankle instability [ 14 , 15 ]. Previous studies on bone density analysis have revealed that the distal-dorsolateral area is the densest portion of the medial cuneiform [ 16 ].…”