Abstract:Purpose
To assess the impact on ankle stability after repairing the ATFL alone compared to repairing both the ATFL and CFL in a biomechanical cadaver model.
Methods
Ten matched pairs of intact, fresh frozen human cadaver ankles (normal) were mounted to a test machine in 20.0° plantar flexion and 15.0° of internal rotation. Each ankle was loaded to body weight and then tested from 0.0° to 20.0° of inversion. The data recorded were torque at 20.0° and stiffness, peak pressure and contact area in the ankle joint … Show more
“…6 , 73 , 146 , 200 Repairing both the ATFL and the CFL simultaneously is the cornerstone of hindfoot and midfoot kinematics after combined injury. 15 When repairing the CFL and the ATFL simultaneously in a cadaveric model and applying an inversion torque from 0° to 20° of inversion, D’Hooghe et al 41 reported that the CFL failed first (before the ATFL) and at significantly lower torque (the ATFL failed at 40% more torque) and lower rotation angle (the ATFL failed at more 62% rotation), which indicated vulnerability of the repaired CFL. These findings suggest that we should allow sufficient time for ligament healing before loading the ankle in the rehabilitation course.…”
Section: Biomechanics Of the Subtalar Jointmentioning
Subtalar instability remains a topic of debate, and its precise cause is still unknown. The mechanism of injury and clinical symptoms of ankle and subtalar instabilities largely overlap, resulting in many cases of isolated or combined subtalar instability that are often misdiagnosed. Neglecting the subtalar instability may lead to failure of conservative or surgical treatment and result in chronic ankle instability. Understanding the accurate anatomy and biomechanics of the subtalar joint, their interplay, and the contributions of the different subtalar soft tissue structures is fundamental to correctly diagnose and manage subtalar instability. An accurate diagnosis is crucial to correctly identify those patients with instability who may require conservative or surgical treatment. Many different nonsurgical and surgical approaches have been proposed to manage combined or isolated subtalar instability, and the clinician should be aware of available treatment options to make an informed decision. In this current concepts narrative review, we provide a comprehensive overview of the current knowledge on the anatomy, biomechanics, clinical and imaging diagnosis, nonsurgical and surgical treatment options, and outcomes after subtalar instability treatment.
“…6 , 73 , 146 , 200 Repairing both the ATFL and the CFL simultaneously is the cornerstone of hindfoot and midfoot kinematics after combined injury. 15 When repairing the CFL and the ATFL simultaneously in a cadaveric model and applying an inversion torque from 0° to 20° of inversion, D’Hooghe et al 41 reported that the CFL failed first (before the ATFL) and at significantly lower torque (the ATFL failed at 40% more torque) and lower rotation angle (the ATFL failed at more 62% rotation), which indicated vulnerability of the repaired CFL. These findings suggest that we should allow sufficient time for ligament healing before loading the ankle in the rehabilitation course.…”
Section: Biomechanics Of the Subtalar Jointmentioning
Subtalar instability remains a topic of debate, and its precise cause is still unknown. The mechanism of injury and clinical symptoms of ankle and subtalar instabilities largely overlap, resulting in many cases of isolated or combined subtalar instability that are often misdiagnosed. Neglecting the subtalar instability may lead to failure of conservative or surgical treatment and result in chronic ankle instability. Understanding the accurate anatomy and biomechanics of the subtalar joint, their interplay, and the contributions of the different subtalar soft tissue structures is fundamental to correctly diagnose and manage subtalar instability. An accurate diagnosis is crucial to correctly identify those patients with instability who may require conservative or surgical treatment. Many different nonsurgical and surgical approaches have been proposed to manage combined or isolated subtalar instability, and the clinician should be aware of available treatment options to make an informed decision. In this current concepts narrative review, we provide a comprehensive overview of the current knowledge on the anatomy, biomechanics, clinical and imaging diagnosis, nonsurgical and surgical treatment options, and outcomes after subtalar instability treatment.
“…Its stability resides in the configuration of the anterior and posterior subtalar joint surfaces as well as several ligamentous structures (Fig. 1 ) [ 6 , 25 , 27 ]: the inferior extensor retinaculum (IER), the calcaneo-fibular ligament (CFL), the cervical ligament (CL) and finally the inter-talocalcaneal ligament (ITCL), which comprises an anterior and a posterior fascicle that rotate over each other regulating subtalar motion—similar to the cruciate ligaments of the knee [ 5 , 6 , 8 , 10 , 18 , 19 , 25 , 39 , 40 ]. Fig.…”
Purpose
The aim of this study was to assess the biomechanical effects of subtalar ligament injury and reconstruction on stability of the subtalar joint in all three spatial planes.
Methods
Fifteen fresh frozen cadaveric legs were used, with transfixed tibiotalar joints to isolate motion to the subtalar joint. An arthrometer fixed to the lateral aspect of the calcaneus measured angular displacement in all three spatial planes on the inversion and eversion stress tests. Stress manoeuvres were tested with the intact joint, and then repeated after sequentially sectioning the inferior extensor retinaculum (IER), cervical ligament (CL), interosseous talocalcaneal ligament (ITCL), arthroscopic graft reconstruction of the ITCL, and sectioning of the calcaneo-fibular ligament (CFL).
Results
Sectioning the ITCL significantly increased angular displacement upon inversion and eversion in the coronal and sagittal planes. Reconstruction of the ITCL significantly improved angular stability against eversion in the axial and sagittal planes, and against inversion in the axial and coronal planes, at the zero time point after reconstruction. After sectioning the CFL, resistance to eversion decreased significantly in all three planes.
Conclusion
Progressive injury of ligamentous stabilisers, particularly the ITCL, led to increasing angular displacement of the subtalar joint measured with the inversion and eversion stress tests, used in clinical practice. Reconstruction of the ITCL using tendon graft significantly stabilised the subtalar joint in the axial and sagittal planes against eversion and in the axial and coronal planes against inversion, immediately after surgery.
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