Mechanics of the anterior drawer and talar tilt tests: A cadaveric study of lateral ligament injuries of the ankle

Bahr, Roald; Peña, Fernando; Shine, Joe; Lew, William D.; Lindquist, Conrad; Tyrdal, Stein; Engebretsen, Lars

doi:10.3109/17453679708996258

Cited by 98 publications

(99 citation statements)

References 18 publications

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“…L ateral ligament stress testing after an inversion ankle sprain is used to identify the presence of increased laxity within the talocrural and subtalar joints (ankle complex) when compared with the contralateral ankle. 1 This assessment commonly involves the anterior drawer and inversion tests [2][3][4] and is performed by applying an anteriorly directed force or inversion torque to the foot. 5 In the biomechanical literature, researchers [6][7][8] have shown the anterior talofibular ligament (ATFL) is the major ligamentous structure preventing forward subluxation of the talus and the calcaneofibular ligament (CFL) is the primary restraint of talar inversion.…”

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confidence: 99%

Joint Stability Characteristics of the Ankle Complex After Lateral Ligamentous Injury, Part I: A Laboratory Comparison Using Arthrometric Measurement

Kovaleski

Heitman

Gurchiek

et al. 2014

Journal of Athletic Training

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. Dr Liu is currently at the School of Kinesiology, Auburn University, AL. Context:The mechanical property of stiffness may be important to investigating how lateral ankle ligament injury affects the behavior of the viscoelastic properties of the ankle complex. A better understanding of injury effects on tissue elastic characteristics in relation to joint laxity could be obtained from cadaveric study.Objective: To biomechanically determine the laxity and stiffness characteristics of the cadaver ankle complex before and after simulated injury to the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) during anterior drawer and inversion loading.Design: Cross-sectional study. Setting: University research laboratory.Patients or Other Participants: Seven fresh-frozen cadaver ankle specimens.Intervention(s): All ankles underwent loading before and after simulated lateral ankle injury using an ankle arthrometer. Main Outcome Measure(s):The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness.Results: Isolated ATFL and combined ATFL and CFL sectioning resulted in increased anterior displacement but not end-range stiffness when compared with the intact ankle. With inversion loading, combined ATFL and CFL sectioning resulted in increased range of motion and decreased end-range stiffness when compared with the intact and ATFL-sectioned ankles.Conclusions: The absence of change in anterior end-range stiffness between the intact and ligament-deficient ankles indicated bony and other soft tissues functioned to maintain stiffness after pathologic joint displacement, whereas inversion loading of the CFL-deficient ankle after pathologic joint displacement indicated the ankle complex was less stiff when supported only by the secondary joint structures.Key Words: ankle instability, joint laxity measurement, ankle sprains Key PointsThe injury mechanism consisted of serial sectioning of the major anatomic support structures of the lateral ankle complex. Anterior displacement was greater in the ankles with isolated anterior talofibular ligament (ATFL) sectioning and combined ATFL and calcaneofibular ligament (CFL) sectioning than in the intact ankles, but end-range stiffness did not increase after lateral ligament sectioning, indicating that bony and other soft tissues functioned to maintain anterior stiffness after pathologic joint displacement. With inversion loading, ankle-complex rotation increased and end-range stiffness decreased after CFL sectioning, indicating that the ankle complex was less stiff when supported only by the secondary joint structures.

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confidence: 99%

Joint Stability Characteristics of the Ankle Complex After Lateral Ligamentous Injury, Part I: A Laboratory Comparison Using Arthrometric Measurement

Kovaleski

Heitman

Gurchiek

et al. 2014

Journal of Athletic Training

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show abstract

“…Anterior talar displacement or talar tilt angle is measured under stress loading. However, accuracy of these conventional stress tests is suspect [4][5][6][10][11][12][13][14][15]. Some limitations in the standard evaluation methods were because ankles were tested in various f dorsiflexion to a point at the peak of the motion curve positions and with different forces applied.…”

Section: Discussionmentioning

confidence: 99%

“…Some limitations in the standard evaluation methods were because ankles were tested in various f dorsiflexion to a point at the peak of the motion curve positions and with different forces applied. Different authors recommended stressing the ankle in dorsiflexion, in the neutral position, or in plantarflexion during the stress manoeuvre [6,10,16,17]. The foot position affects ankle stability because the relationship between ligamentous laxity and bony constraints vary with flexion angle during stress testing [7,9,[18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Analysis of ankle−hindfoot stability in patients with ankle instability and normals

Watanabe

Fujii

Kitaoka

et al. 2011

International Orthopaedics (SICOT)

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Purpose We devised a testing apparatus for in vivo analysis of ankle stability. The purpose of the study was to test the reliability of this apparatus and to determine the stability pattern of the ankle−hindfoot complex in healthy, asymptomatic volunteers and in patients with ankle instability. Methods Ten healthy individuals were studied, and testing was repeated on the same day and different days. Three patients with symptomatic, unstable ankles were also tested on both involved and uninvolved sides. Constant inversion torque was applied, then internal rotation torque, while moving the ankle throughout the range of sagittal motion. Three-dimensional kinematics of the ankle−hindfoot complex were measured by an electromagnetic tracking system. Results Measurements were repeatable, with intraclass correlation coefficients 0.9 or better. Variability was observed among controls, but motion curve patterns were consistent. Motion curve slopes were sensitive in differentiating between unstable and stable ankles. Conclusions Most previous reports are in vitro studies conducted with the ankle in one position, manual stress applied, or joint positions estimated with planar radiographs. Our study indicated that more accurate diagnosis of severity of ankle ligament injuries may be possible.

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“…112 • Cadaver model: when tested at between 10° and 20° of plantar flexion, anterior talar translation with inversion and internal rotation forces produced the greatest amount of talar translation/ligament laxity. 13,92,122 The anterior drawer performed in 20° of plantar flexion was not able to differentiate between intact and sectioned anterior talofibular ligament or between intact and sectioned anterior talofibular and calcaneofibular ligaments. 93 The anterior drawer test that emphasized rotatory instability had a correlation of 0.93 to direct anatomical measurements.…”

Section: Anterior Drawermentioning

confidence: 99%

“…13,42,122,144 • Instrument variations: joint arthrometers, such as the LigMaster 66 and Telos, 165 have been developed to quantify the degree of talar tilt.…”

mentioning

confidence: 99%

Ankle Stability and Movement Coordination Impairments: Ankle Ligament Sprains

Martin

Davenport²,

Paulseth

et al. 2013

Journal of Orthopaedic & Sports Physical Therapy

180

144

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The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these clinical practice guidelines is to describe the peer-reviewed literature and make recommendations related to ankle ligament sprain. J Orthop Sports Phys Ther 2013;43(9):A1–A40. doi:10.2519/jospt.2013.0305

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Mechanics of the anterior drawer and talar tilt tests: A cadaveric study of lateral ligament injuries of the ankle

Cited by 98 publications

References 18 publications

Joint Stability Characteristics of the Ankle Complex After Lateral Ligamentous Injury, Part I: A Laboratory Comparison Using Arthrometric Measurement

Joint Stability Characteristics of the Ankle Complex After Lateral Ligamentous Injury, Part I: A Laboratory Comparison Using Arthrometric Measurement

Analysis of ankle−hindfoot stability in patients with ankle instability and normals

Ankle Stability and Movement Coordination Impairments: Ankle Ligament Sprains

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