The role of the medial ligaments in lateral stabilization of the ankle joint: an in vitro study.

PURPOSE: The deltoid ligament complex is known as medial stabilizer in the ankle against pronation/eversion. Lateral dual-ligament laxity often results in chronic ankle instability with recurring ankle sprain trauma. The goal of this study is to examine the lateral stabilizing role of the deltoid ligament complex against supination/inversion in case of existing lateral ligament instability.
METHODS: A torsion simulation was performed on 12 fresh human lower leg cadaver specimens in a loading frame and a specially designed mounting platform. The preset torsion between tibia and calcaneus was primarily set at 30° of internal rotation on specimen in plantar flexion and hindfoot inversion. The measured variable was the resisting torque recorded around mechanical tibial axis, which ensures stability in ankle sprain trauma. The first series of measurements were performed on healthy specimens and the following after transecting structures in following order: anterior talofibular ligament (ATFL) in combination with calcaneofibular ligament (CFL), followed by anterior tibiotalar ligament and posterior tibiotalar ligament and finally tibiocalcaneal ligament (TCL).
RESULTS: The combined lateral ATFL and CFL instability showed a decrease in the resisting torque, which ensures stability in ankle sprain trauma. Only a transection of TCL (superficial layer of deltoid ligament complex) with existing lateral dual-ligament instability results in a significant decrease in torque (p<0.0001).
CONCLUSION: The goal of the study was to provide the orthopaedic and/or trauma surgeon with quantitative data that may be referred to the substantial stabilizing effect of TCL against supination/inversion in the ankle joint in case of repetitive sprain trauma at a present lateral ligament lesion. Diagnostics of and treatment for lateral ligament instability need to consider the deltoid ligament complex,especially TCL in clinical routine.