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Deep deltoid ligament injury is related to rotational instability of the ankle joint: a biomechanical study

  • ANKLE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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.

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Availability of data and material

All the data are reported in manuscript and tables.

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No external source of funding was used.

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Trigoria, Italy

    Umile Giuseppe Longo, Caterina Fumo, Angela Lanotte, Ugo Trovato, Laura Risi Ambrogioni, Vincenzo Candela & Vincenzo Denaro

  2. Humanitas University, Via Alessandro Manzoni 113, 20089, Milan, Rozzano, Italy

    Mattia Loppini

  3. Humanitas Clinical and Research Center, Via Alessandro Manzoni 56, 20089, Milan, Rozzano, Italy

    Mattia Loppini

  4. Orthopaedic Surgery Department, University Foundation San Pablo CEU, Madrid, Spain

    Francisco Forriol

  5. Department of Orthopaedic Surgery, Massachusetts General Hospital and Newton Wellesley Hospital, Boston, Massachusetts, US

    Christopher W. DiGiovanni

Authors
  1. Umile Giuseppe Longo
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  2. Mattia Loppini
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  3. Caterina Fumo
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  4. Angela Lanotte
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  5. Ugo Trovato
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  6. Laura Risi Ambrogioni
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  7. Vincenzo Candela
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  8. Francisco Forriol
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  9. Christopher W. DiGiovanni
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  10. Vincenzo Denaro
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Contributions

Conceptualization, U.G.L.; investigation, L.R.A.; methodology, V.D.; resources, V.C.; visualization, A.L.; data curation, C.F.; supervision, C.W.D.; writing-original draft preparation, F.F.; writing-review and editing, M.L.; project administration, U.T..

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Correspondence to Umile Giuseppe Longo.

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Longo, U.G., Loppini, M., Fumo, C. et al. Deep deltoid ligament injury is related to rotational instability of the ankle joint: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 29, 1577–1583 (2021). https://doi.org/10.1007/s00167-020-06308-7

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  • DOI: https://doi.org/10.1007/s00167-020-06308-7

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