Umile Giuseppe Longo1, Mattia Loppini2,3, Caterina Fumo4, Angela Lanotte4, Ugo Trovato4, Laura Risi Ambrogioni4, Vincenzo Candela4, Francisco Forriol5, Christopher W DiGiovanni6, Vincenzo Denaro4. 1. Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Trigoria, Italy. g.longo@unicampus.it. 2. Humanitas University, Via Alessandro Manzoni 113, 20089, Milan, Rozzano, Italy. 3. Humanitas Clinical and Research Center, Via Alessandro Manzoni 56, 20089, Milan, Rozzano, Italy. 4. Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Trigoria, Italy. 5. Orthopaedic Surgery Department, University Foundation San Pablo CEU, Madrid, Spain. 6. Department of Orthopaedic Surgery, Massachusetts General Hospital and Newton Wellesley Hospital, Boston, Massachusetts, US.
Abstract
PURPOSE: In the athletic population, the prevalence of isolated syndesmotic lesions is high. To detect potential instability of the ankle is crucial to define those lesions in need of surgical management. The aim was to define how the extent of tibio-fibular syndesmotic ligament injury influences the overall stability of the ankle joint in a cadaver model. METHODS: Twenty fresh-frozen through knee cadaveric leg specimens were subjected to different simulated syndesmotic ligament lesions. In Group 1 (n = 10), the order of ligament sectioning was: anterior tibio-fibular ligament (ATFL), superficial deltoid ligament (SDL), deep deltoid ligament (DDL), posterior tibio-fibular ligament (PTFL), and progressive sectioning at 10, 50 and 100 mm of the distal interosseous membrane (IOM). In Group 2 (n = 10), the sequence was: ATFL, PITFL, 10 and then 50 mm of the distal IOM, SDL, DDL, and 100 mm of the distal IOM. Diastasis of 4 mm in the coronal or sagittal plane and external rotation of the ankle greater than 20° were considered indicative of instability. RESULTS: Both coronal and sagittal diastasis exceeded 4 mm with injury patterns characterized by IOM lesions extending beyond 5 cm. External rotation of the ankle exceeded 20° with injury patterns characterized by a DDL lesion. CONCLUSION: Coronal and sagittal plane diastases of the tibio-fibular syndesmosis are particularly affected by sequential lesions involving the IOM, whereas increased external rotation of the ankle most depends on DDL. The identification of the specific syndesmotic and deltoid ligament injuries is crucial to understanding which lesions need operative management. The knowledge of which pattern of tibio-fibular syndesmotic ligament injury influences the ankle joint stability is crucial in defining which lesions need for surgical management.
PURPOSE: In the athletic population, the prevalence of isolated syndesmotic lesions is high. To detect potential instability of the ankle is crucial to define those lesions in need of surgical management. The aim was to define how the extent of tibio-fibular syndesmotic ligament injury influences the overall stability of the ankle joint in a cadaver model. METHODS: Twenty fresh-frozen through knee cadaveric leg specimens were subjected to different simulated syndesmotic ligament lesions. In Group 1 (n = 10), the order of ligament sectioning was: anterior tibio-fibular ligament (ATFL), superficial deltoid ligament (SDL), deep deltoid ligament (DDL), posterior tibio-fibular ligament (PTFL), and progressive sectioning at 10, 50 and 100 mm of the distal interosseous membrane (IOM). In Group 2 (n = 10), the sequence was: ATFL, PITFL, 10 and then 50 mm of the distal IOM, SDL, DDL, and 100 mm of the distal IOM. Diastasis of 4 mm in the coronal or sagittal plane and external rotation of the ankle greater than 20° were considered indicative of instability. RESULTS: Both coronal and sagittal diastasis exceeded 4 mm with injury patterns characterized by IOM lesions extending beyond 5 cm. External rotation of the ankle exceeded 20° with injury patterns characterized by a DDL lesion. CONCLUSION: Coronal and sagittal plane diastases of the tibio-fibular syndesmosis are particularly affected by sequential lesions involving the IOM, whereas increased external rotation of the ankle most depends on DDL. The identification of the specific syndesmotic and deltoid ligament injuries is crucial to understanding which lesions need operative management. The knowledge of which pattern of tibio-fibular syndesmotic ligament injury influences the ankle joint stability is crucial in defining which lesions need for surgical management.
Authors: Ibarzabal-Gil Aitor; Elena Galvez-Sirvent; Jose M Martinez-Diez; Javier Pallares-Sanmartín; Carlos Kalbakdij-Sanchez; Sarah Mills; Juan C Rubio-Suarez; Enrique Gil-Garay; E Carlos Rodriguez-Merchan Journal: Arch Bone Jt Surg Date: 2022-08
Authors: Jari Dahmen; Sohaib Jaddi; Noortje C Hagemeijer; Bart Lubberts; Inger N Sierevelt; Sjoerd A S Stufkens; Pieter d'Hooghe; John G Kennedy; James D F Calder; Christopher W DiGiovanni; Gino M M J Kerkhoffs Journal: Cartilage Date: 2022 Apr-Jun Impact factor: 3.117