Biomechanical study of the strength of the reconstructed lateral ligaments of the ankle joint

Authors

  • Sergiy Krasnoperov
  • Maksim Golovakha

DOI:

https://doi.org/10.15674/0030-59872014275-82

Keywords:

ankle joint, damage of the ligaments, surgical treatment

Abstract

Arthroscopic techniques of reconstruction in cases of the anterior talofibular ligament (ATFL) and calcaneofibular  ligament (CFL) are widely known. However, biomechanical research of strength of restored ligaments under arthroscopic control using suture or anchor devices was not conducted. Objective: to find out the strength of restoration of lateral ligaments of the ankle joint with help of techniques under arthroscopic control (П-shaped suture, anchor devices). Materials: sixteen cadaver ankle joints were used. It was revealed that damage of the ATFL leads to significant increasing in anterior displacement of talus relative to the tibia and to slight increasing of its varus deviation. In case of damage of the CFL, conversely, varus deviation of talus increases significantly and its anterior dislocation increases insignificantly. The strength of the restored ATFL with using of the П-shaped suture was 85 N, and with help of the anchor device was 88.8 N, corresponding to 59 and 62 % of the strength of the intact ligament. The strength of the restored CFL using П-shaped suture was 83.8 N, and with help of the anchor device was 86.3 N, i.e. 24 and 25 % of the strength of the intact ligament. Strength characteristics revealed correspond to these ones in cases of reconstruction of the ligaments with using of the Brostrom technique. Therefore, we believe that early loading (except inversion) in special orthopedic shoes will not affect the outcomes of treatment.

References

  1. Chemiris A. I. The surgical and restorative treatment of patients with acute ankle ligament injuries / A. I. Chemiris, Y. М. Neryanov, A. V. Kudiyevskyy [et al.] // Orthopaedics, Traumatology and Prosthetics. — 2003. — № 4. — P. 118-122.
  2. Tyazhelov A. A. The role of soft tissue structures in the stabilization of the ankle joint / A. A. Tyazhelov, L. D. Goncharova // Lіtopis of travmatology and ortopaedіcs. — №142. — 2008. — 154-157.
  3. Anatomical reconstruction for chronic lateral ankle instability in the high-demand athlete: Functional outcomes after the modified Brostrom repair using suture anchors / X. Li, H. Killie, P. Guerrero [et al.] // Am. J. Sports Med. — 2009. — Vol. 37. — Р. 488–494.
  4. Anterior drawer test for acute anterior talofibular ligament injuries of the ankle. How much load should be applied during the test? / H. Tohyama, K. Yasuda, Y. Ohkoshi [et al.] //Am. J. Sports Med. — 2003. — Vol. 31 (2). — Р. 226–232.
  5. ATFL elongation after Brostrom procedure: a biomechanical investigation / K. L. Kirk, J. T. Campbell, B. G. Guyton [et al.] // Foot Ankle Int. — 2008. — Vol. 29. — Р. 1126–1130.
  6. Bell S. J. Twenty-six-year results after Brostrom procedure for chronic lateral ankle instability / S. J. Bell, T. S. Mologne, D. F. Sitler // Am. J. Sports Med. — 2006. — Vol. 34. — Р. 975–978.
  7. Biomechanical characteristics of human ankle ligaments / D. E. Attarian, H. J. McCrackin, D. P. DeVito [et al.] // Foot Ankle. — 1985. — Vol. 6 (2). — Р. 54–58.
  8. Biomechanics of ankle ligament reconstruction: an in vitro comparison of the Brostrom repair, Watson-Jones Reconstruction, and a new anatomic reconstruction technique / R. Bahr, F. Pena, J. Shine [et al.] // Am. J. Sports Med. — 1997. — Vol. 25. — Р. 424–432.
  9. Clinical evaluation of a dynamic test for lateral ankle ligament laxity / J. S. de Vries, G. M. Kerkhoffs, C. N. van Dijk [et al.] // Knee Surg. Sports Traumatol. Arthrosc. — 2010. — Vol. 18 (5). — Р. 628–633.
  10. Clinical evaluation of the modified Brostrom Evans procedure to restore ankle stability / P. Girard, R. B. Anderson, W. H. Davis [et al.] // Foot Ankle Int. — 1999. — Vol. 20. — Р. 246–252.
  11. Comparison of two anatomic reconstructions for chronic lateral instability of the ankle joint / J. Karlsson, B. I. Eriksson, T. Bergsten [et al.] // Am. J. Sports Med. — 1997. — Vol. 25. — Р. 48–53.
  12. Gould N. Early and late repair of the lateral ligament of the ankle / N. Gould, D. Seligson, J. Gassman // Foot Ankle. — 1980. — Vol. 1. — Р. 84–89.
  13. Effects of lateral ligament sectioning on the stability of the ankle and subtalar joint / S. I. Ringleb, A. Dhakal, C. D. Anderson [et al.] // J. Orthop. Res. — 2011. — Vol. 29 (10). — Р. 1459–1464.
  14. Krackow K. A. A new stitch for ligament-tendon fixation. Brief note / K. A. Krackow, S. C. Thomas, L. C. Jones // J. Bone Joint Surg. — 1986. — Vol. 68-А (5). — Р. 764–766.
  15. Outcomes of the Chrisman-Snook and modified Brostrom procedure for chronic lateral ankle instability. A prospective, randomized comparison / W. L. Hennrikus, R. C. Mapes, P. M. Lyins [et al.] // Am. J. Sports Med. — 1996. — Vol. 24. — Р. 400–404.
  16. Outcome of the modified Brostrom procedure for chronic lateral ankle instability using suture anchors / T. M. Messer, C. A. Cummins, J. Ahn [et al.] // Foot Ankle Int. — 2000. — Vol. 21. — Р. 996–1003.
  17. Pişkin A. Tendon repair with the strengthened modified Kessler, modified Kessler, and Savage suture techniques: a biomechanical comparison / A. Pişkin, A. Yücetürk, Y. Tomak // Acta Orthop. Traumatol. Turc. — 2007. — Vol. 41 (3). — Р. 238–243.
  18. Rubin G. The Talar-tilt angle and the fibular collateral ligaments a method for the determination of talar tilt / G. Rubin, M. Witten // J. Bone Joint Surg. — 1960. — Vol. 42 (2). — Р. 311–326.
  19. The effect of ankle ligament damage and surgical reconstructions on the mechanics of the ankle and subtalar joints revealed by three-dimensional stress MRI [Text] / S. I. Ringleb, J. K. Udupa, S. Siegler [et al.] // J. Orthop. Res. — 2005. — Vol. 23 (4). — Р. 743–749.

How to Cite

Krasnoperov, S., & Golovakha, M. (2014). Biomechanical study of the strength of the reconstructed lateral ligaments of the ankle joint. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (2), 75–82. https://doi.org/10.15674/0030-59872014275-82

Issue

Section

ORIGINAL ARTICLES