Tibiotalar motion--effect of fibular displacement and deltoid ligament transection: in vitro study.

The purpose of this study was to quantify tibiotalar translation and rotation under various stages of fibular displacement and injury to the syndesmotic and deltoid ligaments. Ten unpaired specimens amputated below the knee were studied using an unconstrained testing apparatus. The specimens were moved through a dorsiflexing and plantarflexing arc of 55 degrees (20 degrees dorsiflexion and 35 degrees plantarflexion). Dorsiflexion of the intact lower leg was associated with an average of 4.2 degrees of external talar rotation, and plantarflexion was associated with an average of 1.4 degrees of internal talar rotation. Fibular osteotomy and displacement of the distal fibular fragment did not change the talar rotation significantly. Additional transection of the deltoid ligament, however, decreased external talar rotation significantly, to 1.4 degrees, and decreased talar internal rotation to 0.6 degrees. Talar shift was not affected in dorsiflexion or plantarflexion by fibular fracture, displacement of the distal fibular fragment, or transection of the deltoid ligament. These data may suggest that in dorsiflexion or plantarflexion, an intact lateral malleolus is not necessary for physiological talar tracking. They further suggest that in a fibular fracture with a significant injury to the deltoid ligament, healing of the ligament at its resting length is crucial to restoring physiological talar rotation.