The Anatomic Pattern of Injuries in Acute Inversion Ankle Sprains

Khor, Yuet Peng; Tan, Ken Jin

doi:10.1177/2325967113517078

Cited by 36 publications

(14 citation statements)

References 27 publications

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“…Eight of the 13 articles described diagnostic imaging findings, with MRI being the modality of focus in all of those articles. 5,6,[8][9][10]15,16,21,25 One study showed that there was increased medial space widening on radiography with external rotation of the ankle while holding the hindfoot in varus. Four articles included a classification scheme for their findings, which are summarized in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…14,19,22 The superficial ligament is the primary restraint against rotation, acting to prevent external rotation of the talus. 22 The included studies did not describe any physical examination maneuver that would 13 IV Chun et al, 2015 6 IV Wang et al, 2014 25 IV Jeong et al, 2014 15 IV Crim et al, 2015 8 IV Crim et al, 2011 9 IV Khor et al, 2013 16 IV Roemer et al, 2014 21 III Chhabra et al, 2010 5 IV Femino et al, 2013 10 IV Bucchorn et al, 2011 3 III Lack et al, 2012 17 V test for rotational instability or increased posterior translation. Given the function of the deltoid complex, these would arguably be the most important tests for clinically determining competence of the deltoid ligament.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis and Management of Deltoid Ligament Insufficiency

Sridharan

Dodd

2019

Foot & Ankle Orthopaedics

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Background: Surgical management of patients with acute and chronic ankle instability (CAI) has historically focused on the lateral ligament complex. Recent studies in CAI patients have shown that magnetic resonance imaging (MRI) and arthroscopy demonstrate concomitant injury to the deltoid ligament complex We performed a systematic review to determine if consistent clinical, diagnostic imaging, or arthroscopic findings of deltoid ligament injury in the setting of CAI have been described. In addition, we sought to determine if treatment options and/or clinical outcomes have been described. Methods: A systematic review was conducted using the PubMed, MEDLINE, and Embase databases. Articles were included if they had a majority of patients 18 years of age or older, focused on deltoid ligament injury in ankle instability, and reported diagnostic and/or treatment methods. Articles were excluded if the study focused on the deltoid ligament in the acute fracture setting. All included articles were assessed for diagnostic criteria, treatments, and patient outcomes. Results: Our search yielded 157 articles, of which a total of 13 were included in our study. Arthroscopy was described as the gold standard to diagnose and evaluate the severity of deltoid ligament injury, however, little objective data on the arthroscopic diagnosis of deltoid ligament insufficiency was reported. MRI was the imaging modality of choice to evaluate deltoid ligament injury and had a high sensitivity and specificity when compared with arthroscopy. No standard MRI diagnostic criteria for deltoid ligament injury were identified in the literature. Specific treatment techniques and long-term outcomes were not well described in the manuscripts included in this review. Conclusion: There is limited knowledge on deltoid ligament insufficiency in the setting of chronic ankle instability. Criteria for characterizing deltoid ligament damage with diagnostic imaging appear to be evolving, but there is no standard classification. Only 1 author has described a method to evaluate deltoid ligament competency on arthroscopic examination. There are currently no objective data to guide treatment decisions. Level of Evidence: Level III.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Deltoid Ligament Insufficiency

Sridharan

Dodd

2019

Foot & Ankle Orthopaedics

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“…In one study, there were anterior talofibular ligament (ATFL) injuries in 75% of patients after acute inversion ankle sprain with a combined ATFL and calcaneofibular ligament (CFL) in 41%. 2 In another study, the prevalence of DL injury in patients with chronic lateral ankle instability was 36%. 3 There are no studies to our knowledge investigating injury of the talonavicular ligament (TNL) in patients presenting with an ankle sprain.…”

Section: Introductionmentioning

confidence: 94%

Talonavicular ligament: prevalence of injury in ankle sprains, histological analysis and hypothesis of its biomechanical function

Dea

Loizou

Allen

et al. 2017

The British Journal of Radiology

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Objective: To assess the prevalence of injury of the talonavicular ligament (TNL) in ankle sprains, its anatomy and the stability of the talonavicular joint (TNJ) before and after dividing the TNL in a cadaver. Methods: During a prospective study of 100 patients to assess the outcome of ankle injuries, we noted high incidence of TNL injuries; we will discuss here the TNL findings. Each patient had undergone ultrasound and cone beam CT examination of the ankle. Six TNLs were dissected off fresh-frozen cadaveric feet for histological analysis. In further six cadaveric feet, the stability of the TNJ was assessed by mechanical stress before and after division of the TNL; movement at the joint was assessed by measuring the distance between the talus and navicular bone [talonavicular distance (TD)] using ultrasound. The TD was measured on ten randomly selected ultrasound images by three independent observers and repeated twice by a single observer to determine the inter-and intraobserver reliability. Results: 21% of the patients had an injury to the TNL. Histological examination demonstrated a dense connective tissue composed of bundles of collagen in parallel arrangement along the ligament length. The interobserver and intraobserver reliability of the TD showed almost perfect agreement. Displacement at the TNJ after stress with the TNL intact measured 0.18 6 0.08 cm and 0.29 6 0.07 cm (p , 0.005) when divided. Conclusion: The TNL is surprisingly commonly injured in ankle sprains. Its anatomy and histology suggest a role in tensile force transmission during the windlass mechanism in gait. Advances in knowledge: Injury to the TNL is common and has not been described. Its anatomy suggests resistance to tensile forces and its injury allows excessive movement at the TNJ. INTRODUCTIONAcute ankle injuries account for approximately 10% of all emergency department attendances.1 Several publications cover the incidence of ligament injuries, especially the lateral ligamentous complex and deltoid ligament (DL). In one study, there were anterior talofibular ligament (ATFL) injuries in 75% of patients after acute inversion ankle sprain with a combined ATFL and calcaneofibular ligament (CFL) in 41%. 2 In another study, the prevalence of DL injury in patients with chronic lateral ankle instability was 36%.3 There are no studies to our knowledge investigating injury of the talonavicular ligament (TNL) in patients presenting with an ankle sprain.

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“…Biomechanically, the ATFL is the weakest and most commonly injured of the 3 ligaments, whereas the PTFL is the strongest and is rarely injured except in the setting of ankle dislocation [6‐10]. Additional injuries that may occur with the inversion ankle sprain include the following: bone bruise or fracture (lateral malleolus, medial malleolus, tarsal, and metatarsal bones), deltoid ligament injury, tendon injury, osteochondral lesion, syndesmosis injury, and alterations of the sinus tarsi [11]. Khor et al identified an osteochondral lesion in 6 of 34 patients (18%) with concomitant lateral ligament injury following an inversion ankle sprain [11].…”

Section: Clinical Backgroundmentioning

confidence: 99%

“…Additional injuries that may occur with the inversion ankle sprain include the following: bone bruise or fracture (lateral malleolus, medial malleolus, tarsal, and metatarsal bones), deltoid ligament injury, tendon injury, osteochondral lesion, syndesmosis injury, and alterations of the sinus tarsi [11]. Khor et al identified an osteochondral lesion in 6 of 34 patients (18%) with concomitant lateral ligament injury following an inversion ankle sprain [11]. Osteochondral lesions are most common in the talus after an inversion injury, and can accelerate the development of osteoarthritis (Figure 2).…”

Section: Clinical Backgroundmentioning

confidence: 99%