The effect of ankle ligament damage and surgical reconstructions on the mechanics of the ankle and subtalar joints revealed by three‐dimensional stress MRI

Abstract

Common image-based diagnostic techniques used to detect ankle ligament injuries or the effects of those injuries (e.g., mechanical instability) include magnetic resonance imaging (MRI) and stress radiography. Each of these techniques has limitations. The interpretation of the results obtained through stress radiography, a two-dimensional technique, is highly controversial. MRI can facilitate visualization of soft tissue, but three-dimensional visualization of the full length of the ligaments or detecting partial ligament damage is difficult. This work is part of a long-term study aimed at improving the diagnostic ability of MRI by utilizing it not only to visualize the ligaments but also to detect the mechanical instability produced at the ankle and subtalar joints due to ligament damage. The goal of the present study was to evaluate the ability of a previously developed technique called 3D stress MRI (sMRI) to detect in vitro the effect of damage to the lateral collateral ligaments and the stabilizing effect produced by two common surgical reconstruction techniques. MRI data were collected from eight cadaver limbs in a MR compatible ankle-loading device in neutral, inversion, and anterior drawer. Each specimen was tested intact, after cutting the anterior talo-fibular ligament followed by the calcaneo-fibular ligament and after applying two reconstructions. Ligament injuries produced significant changes in the response of the ankle and subtalar joints to load as detected by the 3D stress MRI technique. Both surgical procedures restored mechanical stability to the joints but they differed in the amount and type of stabilization achieved. We concluded that 3D sMRI can extend the diagnostic power of MRI from the current practice of slice-by-slice visualization to the assessment of mechanical function, the compromise in this function due to injury, and the effects of surgery.

Influence of kinematic analysis methods on detecting ankle and subtalar joint instability

“…Similarly, significant differences were found in ankle motion after ATFL injury when internal rotation torque was applied (Bahr et al, 1997;Caputo et al, 2009;Fujii et al, 2010) and anterior drawer (Bahr et al, 1997;Caputo et al, 2009;Lapointe et al, 1997). When the ATFL and CFL were damaged significant increases in inversion have also been observed (Fujii et al, 2010;Lapointe et al, 1997;Ringleb et al, 2005).…”

“…Therefore, increased understanding of the mechanics of an unstable subtalar joint may improve the diagnosis and treatment of this joint instability. Subtalar joint kinematics have been studied for many years (Beimers et al, 2008;Caputo et al, 2009;Cass et al, 1984;Engsberg, 1987;Fujii et al, 2010;Kirby, 1987;Ramakrishnan and Kadaba, 1991;Ringleb et al, 2011Ringleb et al, , 2005Scott and Winter, 1991;Sheehan, 2010;Siegler et al, 1988Siegler et al, , 2005Tuijthof et al, 2009;Weindel et al, 2010;Wong et al, 2005;Ying et al, 2004). Some of these studies (Caputo et al, 2009;Cass et al, 1984;Fujii et al, 2010;Ramakrishnan and Kadaba, 1991;Ringleb et al, 2011;Wong et al, 2005;Ying et al, 2004) described bone motion using the Euler angles.…”

“…The sequence dependency of rotation is the main disadvantage of the Euler angles and the JCS methods because it may lead to some errors. A third method that can be used to describe joint kinematics is the helical axis method (Beimers et al, 2008;Engsberg, 1987;Kirby, 1987;Ringleb et al, 2005;Sheehan, 2010;Siegler et al, 1988Siegler et al, , 2005Tuijthof et al, 2009). The helical axis is a screw axis that can describe the motion of a body in reference to another expressed by a rotation about, and a translation along a unique axis (Cappozzo and Berme, 1990).…”

In vivo cartilage contact strains in patients with lateral ankle instability

“…Disruption of the ATFL increases the anterior translation (Caputo et al 2009, Hollis et al 1995, Hollis et al 1995, Ringleb et al 2005) and internal rotation (Caputo et al 2009, Stormont et al 1985) of the talus relative to the tibia. Although a causal link between LAI and osteoarthritis has yet to be established, altered stress distributions have been theorized to contribute to cartilage damage (Hirose et al 2004, Omori et al 2004, Valderrabano et al 2006, Van Dijk CN 1996).…”

Assessment of stress distribution in ankle joint: simultaneous application of experimental and finite element methods

“…In some studies, finite element method was used and validated by comparing the computed pressure distribution with those derived by various experimental methods (Anderson et al, 2007). Magnetic resonance imaging (MRI) and CT data, which are used for generating finite element modes (FEMs), can facilitate pre-operative planning in many surgeries (Arbabi et al, 2007;Gilles et al, 2006;Ringleb et al, 2005).…”