Sage Journals: Discover world-class research

Abstract

Background:

Ligament repair and augmentation techniques can stabilize syndesmosis injuries. However, little is known about the mechanical behavior of syndesmotic ligaments. The aim of this study was to analyze full-field strain, strain trend under foot rotation, and subregional strain differences of the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), and interosseous membrane (IOM).

Methods:

Eleven fresh-frozen lower limbs were dissected to expose the AITFL, PITFL, and IOM. The foot underwent rotation from 0° to 25° internal and 35° external, with 3 ankle positions (neutral, 15° dorsiflexion, and 25° plantarflexion) and a vertical load of 430 N. Ligament strain was recorded using digital image correlation.

Results:

The mean strain on the AITFL with 35° external rotation was greater in the proximal portion compared with distal portion in the neutral position (P = .009) and dorsiflexion (P = .003). The mean strain in the tibial insertion and midsubstance near tibial insertion were greater when compared with other regions (P = .018 and P = .009). The subregions of mean strain in the PITFL and IOM groups were not significantly different. The strain trend of AITFL, PITFL, and IOM showed common transformation, just when the foot was externally rotated.

Conclusion:

The findings of this study show that a significantly high strain was observed on the proximal part and the midsubstance near the Chaput tubercle of the AITFL when the ankle was externally rotated. All 3 ligaments resisted the torque in the syndesmosis by external rotation of the foot.

Clinical Relevance:

This study allows for better understanding of the mechanical behavior of the syndesmosis ligaments, which could influence the repair technique and AITFL augmentation techniques

Keywords

syndesmosis ligament strain anterior inferior tibiofibular ligament strain distribution ligament augmentation

Get full access to this article

View all access options for this article.

References

Bartonicek

. Anatomy of the tibiofibular syndesmosis and its clinical relevance. Surg Radiol Anat. 2003;25(5-6):379-386.

Beumer

van Hemert

Swierstra

et al . A biomechanical evaluation of the tibiofibular and tibiotalar ligaments of the ankle. Foot Ankle Int. 2003;24(5):426-429.

. Some applications of the functional anatomy of the ankle joint. J Bone Joint Surg Am. 1956;38(4):761-781.

Colville

Marder

Boyle

et al . Strain measurement in lateral ankle ligaments. Am J Sports Med. 1990;18(2):196-200.

Gan

Yang

Zhang

Nakmali

. Mechanical properties of stapedial annular ligament. Med Eng Phys. 2011;33(3):330-339.

Gardner

Brodsky

Briggs

et al . Fixation of posterior malleolar fractures provides greater syndesmotic stability. Clin Orthop Relat Res. 2006;447:165-171.

Gardner

Demetrakopoulos

Briggs

et al . Malreduction of the tibiofibular syndesmosis in ankle fractures. Foot Ankle Int. 2006;27(10):788-792.

Grassi

Isaksson

et al . Extracting accurate strain measurements in bone mechanics: a critical review of current methods. J Mech Behav Biomed Mater. 2015;50(10):43-54.

Lin

Gross

Weinhold

et al . Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. J Orthop Sports Phys Ther. 2006;36:372-384.

10.

Lionello

Sirieix

Baleani

et al . An effective procedure to create a speckle pattern on biological soft tissue for digital image correlation measurements. J Mech Behav Biomed Mater. 2014;39(6):1-8.

11.

Little

Berkes

Schottel

et al . Anatomic fixation of supination external rotation type IV equivalent ankle fractures. J Orthop Trauma. 2015;29(5):250-255.

12.

Luyckx

Verstraete

De Roo

et al . Digital image correlation as a tool for three-dimensional strain analysis in human tendon tissue. J Exp Orthop. 2014;1(1):7.

13.

Luyckx

Verstraete

De Roo

et al . High strains near femoral insertion site of the superficial medial collateral ligament of the knee can explain the clinical failure pattern. J Orthop Res. 2016;34(11):2016-2024.

14.

Mak

Gartner

Pearce

. Management of syndesmosis injuries in the elite athlete. Foot Ankle Clin. 2013;18(2):195-214.

15.

Mendelsohn

Hoshino

Harris

et al . The effect of obesity on early failure after operative syndesmosis injuries. J Orthop Trauma. 2013;27(4):201-206.

16.

Miller

Carroll

Parker

et al . Posterior malleolar stabilization of syndesmotic injuries is equivalent to screw fixation. Clin Orthop Relat Res. 2010;468(4):1129-1135.

17.

Naqvi

Cunningham

Lynch

et al . Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction. Am J Sports Med. 2012;40(12):2828-2835.

18.

Ogilvie-Harris

Reed

Hedman

et al . Disruption of the ankle syndesmosis: biomechanical study of the ligamentous restraints. Arthroscopy. 1994;10(5):558-560.

19.

Okotie

Duenwald-Kuehl

Kobayashi

et al . Tendon strain measurements with dynamic ultrasound images: evaluation of digital image correlation. J Biomech Eng. 2012;134(2):24504.

20.

Sarsam

Hughes

. The role of the anterior tibio-fibular ligament in talar rotation: an anatomical study. Injury. 1988;19(2):62-64.

21.

Schottel

Baxter

Gilbert

et al . Anatomic ligament repair restores ankle and syndesmotic rotational stability as much as syndesmotic screw fixation. J Orthop Trauma. 2016;30(2):36-40.

22.

Stiehl

Skrade

Johnson

et al . Experimentally produced ankle fractures in autopsy specimens. Clin Orthop Relat Res. 1992;285:244-249.

23.

Tochigi

Rudert

Amendola

et al ., Tensile engagement of the peri-ankle ligaments in stance phase. Foot Ankle Int. 2005;26(12):1067-1073.

24.

Van Heest

Lafferty

. Injuries to the ankle syndesmosis. J Bone Joint Surg Am. 2014;96(7):603-613.

25.

von der Heide

Ebneter

Behrend

et al . Improvement of primary stability in ACL reconstruction by mesh augmentation of an established method of free tendon graft fixation. A biomechanical study on a porcine model. Knee. 2013;20(2):79-84.

26.

Williams

Jones

Amendola

et al . Syndesmotic ankle sprains in athletes. Am J Sports Med. 2007;35(7):1197-1207.

27.

Zhan

Yan

Xia

et al . Anterior-inferior tibiofibular ligament anatomical repair and augmentation versus trans-syndesmosis screw fixation for the syndesmotic instability in external-rotation type ankle fracture with posterior malleolus involvement: a prospective and comparative study. Injury. 2016;47(7):1574-1580.

28.

Zwipp

Rammelt

Grass

et al . Ligamentous injuries about the ankle and subtalar joints. Clin Podiatr Med Surg. 2002;19(2):195-229.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.30 MB