Strain measurement in lateral ankle ligaments

Abstract

We measured strain in the lateral ligaments of 10 human cadaver ankles while moving the ankle joint and applying stress in a variety of ways. We studied the anterior talofibular, calcaneofibular, posterior talofibular, anterior tibiofibular, and posterior tibiofibular ligaments. Strain measurements in the ligaments were recorded continuously while the ankle was moved from dorsiflexion into plantar flexion. We then repeated measurements while applying inversion, eversion, internal rotation, and external rotation forces. Strain in the anterior talofibular ligament increased when the ankle was moved into greater degrees of plantar flexion, internal rotation, and inversion. Strain in the calcaneofibular ligament increased as the talus was dorsiflexed and inverted. These findings support the concept that the anterior talofibular and calcaneofibular ligaments function together at all positions of ankle flexion to provide lateral ankle stability. We measured maximum strain in the posterior talofibular ligament when the ankle was dorsiflexed and externally rotated. The strain in the anterior and posterior tibiofibular ligaments increased when the ankle was dorsiflexed. External rotation increased strain in the anterior tibiofibular ligament and decreased strain in the posterior tibiofibular ligament. Based upon strain measurements in the lateral ankle ligaments in various ankle joint positions, we believe the anterior talofibular ligament is most likely to tear if the ankle is inverted in plantar flexion and internally rotated. Theoretically, the calcaneofibular ligament tears primarily in inversion if the ankle is dorsiflexed; the anterior tibiofibular ligament tears in dorsiflexion, especially if combined with external rotation; and the posterior tibiofibular ligament tears with extreme dorsiflexion.

Differences in Lateral Ankle Laxity Measured via Stress Ultrasonography in Individuals With Chronic Ankle Instability, Ankle Sprain Copers, and Healthy Individuals

“…The present study measured in vivo ATFL lengthening and found strain to be below 10% during both test conditions in the control group. The individuals in both the coper and CAI groups demonstrated greater ATFL strain than the control group for the anterior drawer and inversion test conditions, and these values were also greater than those measured by Colville et al 9 The present study differed in that it did not perform measurements in the fully plantar-flexed position but chose instead to use the anterior-drawer-stress condition and ankle inversion to mimic the clinical anterior drawer test and the ankle position most commonly associated with ATFL injury.…”

“…Ankle inversion, along with plantar flexion, has been shown to result in considerable ATFL strain over other ankle motions, such as dorsiflexion and eversion. 9 Its anatomic orientation indicates that the ATFL functions to restrain plantar flexion, inversion, and talar internal rotation. 34 The use of ultrasound imaging during either an anterior drawer or inversion stress maneuver to quantify the mechanical consequences of lateral ankle injury may be useful to clinicians as a method to better understand CAI and to further develop treatment protocols.…”

“…Although the calcaneofibular ligament works in conjunction with the ATFL to support the lateral ankle against inversion stress, it is oriented 132° relative to the ATFL and demonstrates low strain during plantar flexion and inversion compared to the ATFL. 9,15 This study used a heel clamp to apply inversion stress to the ankle to standardize positioning for ultrasound imaging, which covered the course of the calcaneofibular ligament, precluding application of the ultrasound probe over the ligament. Applying calcaneal inversion stress without this ankle stress device, while attempting to identify the calcaneofibular ligament with an ultrasound probe, is a technical challenge not addressed in the current study but one that further investigations may address to help better identify individuals with isolated calcaneofibular ligament injuries or combined ATFL/calcaneofibular ligament injuries.…”

Late-term reconstruction of lateral ankle ligaments using a split peroneus brevis tendon graft (Colville's technique) in patients with chronic lateral instability of the ankle

“…There are more than 50 surgical techniques recommended for the treatment of lateral instability of the ankle [2,5,7,13,17,24], and we believe that both the anterior talofibular and the calcaneofibular ligaments (CFLs) must be repaired in order to prevent recurrence and to correct completely the instability [8,9,10].…”

Usefulness Evaluation 'Ankle Stress View Compared with MRI scan' of Subacute Ankle Sprain

“…고유감각은 인대, 관절낭, 근육, 건, 그리고 피부와 관련된 감각으 로 갑작스러운 변화시 반사적 조절로 발목을 보호하 는 역할을 한다 [5] . 발목의 손상시 급성기에는 통증과 부종, 움직임의 제한이 나타나며 [6] [7] , 시간이 지남에 따라 관절 조직과 고유감각 수용기의 손상으로 이어 져 관절의 움직임과 관절위치감각의 정확성을 손상시 켜 자세조절에 영향을 줄 수 있다 [8] . 이에 발목의 불안 정성은 더욱 악화되어 관절의 재손상을 일으키는 악 순환을 유발한다 [9].…”