Rotational ligamentous injuries to the ankle in football

Guise, Edwin R

doi:10.1177/036354657600400101

Cited by 56 publications

(51 citation statements)

References 8 publications

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“…High rotational tractions between shoes and the playing surface may also contribute to an increased frequency of ankle injury. 12 Villwock et al, 42 for example, used a mobile testing apparatus to measure shoe-surface interface torques for various cleat patterns and playing surfaces. Artificial surfaces yielded higher torques and rotational stiffnesses of the ankle than on natural grass surfaces.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Computational Model to Study the Effect of Foot Constraint on Ankle Injury due to External Rotation

et al. 2010

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Recent studies, using two different manners of foot constraint, potted and taped, document altered failure characteristics in the human cadaver ankle under controlled external rotation of the foot. The posterior talofibular ligament (PTaFL) was commonly injured when the foot was constrained in potting material, while the frequency of deltoid ligament injury was higher for the taped foot. In this study an existing multibody computational modeling approach was validated to include the influence of foot constraint, determine the kinematics of the joint under external foot rotation, and consequently obtain strains in various ligaments. It was hypothesized that the location of ankle injury due to excessive levels of external foot rotation is a function of foot constraint. The results from this model simulation supported this hypothesis and helped to explain the mechanisms of injury in the cadaver experiments. An excessive external foot rotation might generate a PTaFL injury for a rigid foot constraint, and an anterior deltoid ligament injury for a pliant foot constraint. The computational models may be further developed and modified to simulate the human response for different shoe designs, as well as on various athletic shoe-surface interfaces, so as to provide a computational basis for optimizing athletic performance with minimal injury risk.

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Section: Discussionmentioning

confidence: 99%

Development and Validation of a Computational Model to Study the Effect of Foot Constraint on Ankle Injury due to External Rotation

et al. 2010

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“…26,43 Most proposed mechanisms of injury are based on the observations of clinicians who have interviewed patients with these injuries. 9,10,22,24,26,43 The 3 proposed mechanisms of injury for the syndesmotic injury include external rotation of the foot, 9,22,24,26,43 eversion of the talus within the ankle mortise, 22,43 and excessive dorsiflexion. 9,24,43 Mechanisms of injury to the syndesmosis are quite different from the typical lateral ankle sprain in which the foot and ankle are plantar flexed and inverted.…”

Section: Mechanism Of Injurymentioning

confidence: 99%

“…19 Forceful eversion of the talus also effects widening of the mortise. 22,43 Forceful dorsiflexion tends to widen the ankle mortise as the wider anterior aspect of the talar dome enters the joint space ( Figure 2A). 19 In all cases, the distal fibula is pushed laterally away from its articulation with the distal tibia.…”

Section: Mechanism Of Injurymentioning

confidence: 99%

“…This injury is often more difficult to diagnose than lateral or medial ankle sprain injuries, and recovery from the injury can be very protracted and frustrating for both the injured individual and medical personnel who are involved in the treatment of the injur y. Several authors 9,22,49,56 have reported that syndesmotic injuries usually result in more time loss from athletic participation and longer treatment times compared to other ankle sprain injuries. Data from a 41-month retrospective study at the United States Military Academy in-dicate that the average recovery time for patients with incomplete injuries to the ankle syndesmosis was 55 days, almost twice the recovery time compared with patients with third-degree lateral ankle sprains.…”

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confidence: 99%

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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

149

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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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“…As opposed to a lateral ankle sprain, high and medial ankle sprains are more problematic due to their potential for resulting in significantly greater time lost and subsequent chronic ankle dysfunction [7][8][9][10][11]. The mechanism of injury in high and medial ankle sprains is commonly ascribed to excessive intemal rotation of the upper body, while the foot is planted on the playing surface [8].…”

Section: Introductionmentioning

confidence: 99%

Rotational Stiffness of Football Shoes Influences Talus Motion during External Rotation of the Foot

Wei

Meyer

Braman

et al. 2012

Journal of Biomechanical Engineering

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Shoe-surface interface characteristics have been implicated in the high incidence of ankle injuries suffered by athletes. Yet, the differences in rotational stiffness among shoes may also influence injury risk. It was hypothesized that shoes with different rotational stiffness will generate different patterns of ankle ligament strain. Four football shoe designs were tested and compared in terms of rotational stiffness. Twelve (six pairs) male cadaveric lower extremity limbs were externally rotated 30 deg using two selected football shoe designs, i.e., a flexible shoe and a rigid shoe. Motion capture was performed to track the movement of the talus with a reflective marker array screwed into the bone. A computational ankle model was utilized to input talus motions for the estimation of ankle ligament strains. At 30 deg of rotation, the rigid shoe generated higher ankle joint torque at 46.2 ± 9.3 Nm than the flexible shoe at 35.4 ± 5.7 Nm. While talus rotation was greater in the rigid shoe (15.9 ± 1.6 deg versus 12.1 ± 1.0 deg), the flexible shoe generated more talus eversion (5.6 ± 1.5 deg versus 1.2± 0.8 deg). While these talus motions resulted in the same level of anterior deltoid ligament strain (approxiamtely 5%) between shoes, there was a significant increase of anterior tibiofibular ligament strain (4.5± 0.4% versus 2.3 ± 0.3%) for the flexible versus more rigid shoe design. The flexible shoe may provide less restraint to the subtalar and transverse tarsal joints, resulting in more eversion but less axial rotation of the talus during foot∕shoe rotation. The increase of strain in the anterior tibiofibular ligament may have been largely due to the increased level of talus eversion documented for the flexible shoe. There may be a direct correlation of ankle joint torque with axial talus rotation, and an inverse relationship between torque and talus eversion. The study may provide some insight into relationships between shoe design and ankle ligament strain patterns. In future studies, these data may be useful in characterizing shoe design parameters and balancing potential ankle injury risks with player performance.

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Rotational ligamentous injuries to the ankle in football

Cited by 56 publications

References 8 publications

Development and Validation of a Computational Model to Study the Effect of Foot Constraint on Ankle Injury due to External Rotation

Development and Validation of a Computational Model to Study the Effect of Foot Constraint on Ankle Injury due to External Rotation

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

Rotational Stiffness of Football Shoes Influences Talus Motion during External Rotation of the Foot

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