Jafet Massri-Pugin1, Bart Lubberts1, Bryan G Vopat2, Jonathon C Wolf3, Christopher W DiGiovanni4, Daniel Guss4. 1. 1 Orthopaedic Foot and Ankle Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 2. 2 Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA. 3. 3 Orthopaedic Surgery, West Valley Medical Center, Caldwell, ID, USA. 4. 4 Orthopaedic Surgery, Massachusetts General Hospital & Newton Wellesley Hospital, Harvard Medical School, Waltham, MA, USA.
Abstract
BACKGROUND: The deltoid ligament (DL) is the principal ligamentous stabilizer of the medial ankle joint. Little is known, however, about the contribution of the DL toward stabilizing the syndesmosis. The aim of this study was to arthroscopically evaluate whether the DL contributes to syndesmotic stability in the coronal plane. METHODS: Eight above-knee cadaveric specimens were used in this study. A lateral hook test was performed by applying 100 N of lateral force to the fibula in the intact state and after sequential transection of the DL, anterior-inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), and posterior-inferior tibiofibular ligament (PITFL). At each stage, distal tibiofibular diastasis was measured arthroscopically at both the anterior and posterior third of the incisura and compared to stress measurements of the intact syndesmosis. Measurements were performed using probes ranging from 0.1 to 6.0 mm, with 0.1-mm increments. RESULTS: There was no significant increase in diastasis at either the anterior or posterior third of the tibiofibular articulation after isolated DL disruption, nor when combined with AITFL transection. In contrast, a significant increase in diastasis was observed following additional disruption of the IOL (anterior and posterior third diastasis, P= .012 and .026, respectively), and after transection of all 3 syndesmotic ligaments (anterior and posterior third diastasis, P=.001 and .001, respectively). CONCLUSION: When evaluating the syndesmosis arthroscopically in a cadaveric model under lateral stress, neither isolated disruption of the DL nor combined DL and AITFL injuries destabilized the syndesmosis in the coronal plane. In contrast, the syndesmosis became unstable if the DL was injured in conjunction with partial syndesmotic disruption that included the AITFL and IOL. CLINICAL RELEVANCE: Disruption of the DL appeared to destabilize the syndesmosis in the coronal plane when associated with partial disruption of the syndesmosis (AITFL and IOL).
BACKGROUND: The deltoid ligament (DL) is the principal ligamentous stabilizer of the medial ankle joint. Little is known, however, about the contribution of the DL toward stabilizing the syndesmosis. The aim of this study was to arthroscopically evaluate whether the DL contributes to syndesmotic stability in the coronal plane. METHODS: Eight above-knee cadaveric specimens were used in this study. A lateral hook test was performed by applying 100 N of lateral force to the fibula in the intact state and after sequential transection of the DL, anterior-inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), and posterior-inferior tibiofibular ligament (PITFL). At each stage, distal tibiofibular diastasis was measured arthroscopically at both the anterior and posterior third of the incisura and compared to stress measurements of the intact syndesmosis. Measurements were performed using probes ranging from 0.1 to 6.0 mm, with 0.1-mm increments. RESULTS: There was no significant increase in diastasis at either the anterior or posterior third of the tibiofibular articulation after isolated DL disruption, nor when combined with AITFL transection. In contrast, a significant increase in diastasis was observed following additional disruption of the IOL (anterior and posterior third diastasis, P= .012 and .026, respectively), and after transection of all 3 syndesmotic ligaments (anterior and posterior third diastasis, P=.001 and .001, respectively). CONCLUSION: When evaluating the syndesmosis arthroscopically in a cadaveric model under lateral stress, neither isolated disruption of the DL nor combined DL and AITFL injuries destabilized the syndesmosis in the coronal plane. In contrast, the syndesmosis became unstable if the DL was injured in conjunction with partial syndesmotic disruption that included the AITFL and IOL. CLINICAL RELEVANCE: Disruption of the DL appeared to destabilize the syndesmosis in the coronal plane when associated with partial disruption of the syndesmosis (AITFL and IOL).
Authors: N C Hagemeijer; B Lubberts; J Saengsin; R Bhimani; G Sato; G R Waryasz; G M M J Kerkhoffs; C W DiGiovanni; D Guss Journal: Knee Surg Sports Traumatol Arthrosc Date: 2022-07-26 Impact factor: 4.114
Authors: Bart Lubberts; Daniel Guss; Bryan G Vopat; Anne H Johnson; C Niek van Dijk; Hang Lee; Christopher W DiGiovanni Journal: Knee Surg Sports Traumatol Arthrosc Date: 2018-10-26 Impact factor: 4.342
Authors: Noortje C Hagemeijer; Mohamed Abdelaziz Elghazy; Gregory Waryasz; Daniel Guss; Christopher W DiGiovanni; Gino M M J Kerkhoffs Journal: Knee Surg Sports Traumatol Arthrosc Date: 2020-05-25 Impact factor: 4.342
Authors: Kiya Shazadeh Safavi; Aryan Rezvani; Cory F Janney; Jie Chen; Waleed Cassis; Navid Darayan; Vinod K Panchbhavi; Daniel C Jupiter Journal: Cureus Date: 2022-07-19