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Isolated injuries to the lateral ankle ligaments have no direct effect on syndesmotic stability

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

Abstract

Purpose

This study aim was to detect the impact of lateral ankle ligaments injury on syndesmotic laxity when evaluated arthroscopically in a cadaveric model. The null hypothesis was that lateral ankle ligament injury does not affect the stability of syndesmosis.

Methods

Sixteen fresh-frozen above-knee amputated cadaveric specimens were divided into two groups of eight specimens that underwent arthroscopic evaluation of the distal tibiofibular joint. In both the groups, the assessment was first done with all syndesmotic and ankle ligaments intact. Thereafter, Group 1 underwent sequential transection of the three lateral ankle ligaments first to identify the effects of lateral ligament injury: (1) anterior talofibular ligament (ATFL), (2) calcaneofibular ligament (CFL), (3) posterior talofibular ligament (PTFL), then followed by the syndesmotic ligaments, (4) AITFL, (5) Interosseous ligament (IOL), and (6) PITFL. Group 2 underwent sequential transection of the (1) AITFL, (2) ATFL, (3) CFL, (4) IOL, (5) PTFL, and (6) PITFL, which represent the most commonly injured pattern in ankle sprain. In all scenarios, four loading conditions were considered under 100 N of direct force: (1) unstressed, (2) a lateral fibular hook test, (3) anterior to posterior (AP) fibular translation test, and (4) posterior to anterior (PA) fibular translation test. Distal tibiofibular coronal plane diastasis at the anterior and posterior third of syndesmosis, as well as AP and PA sagittal plane translation, were arthroscopically measured.

Results

The distal tibiofibular joint remained stable after transection of all lateral ankle ligaments (ATFL, CFL, and PTFL) as well as the AITFL. However, after additional transection of the IOL, the syndesmosis became unstable in both the coronal and sagittal plane. Syndesmosis laxity in the coronal plane was also observed after transection of the ATFL, CFL, AITFL, and IOL. Subsequent transection of the PITFL precipitated syndesmosis laxity in the sagittal plane, as well.

Conclusions

The findings from the present study suggest that lateral ankle ligament injuries itself do not directly affect the stability of syndesmosis. However, if it combines with IOL injuries, even partial injuries cause syndesmotic laxity. As a clinical relevance, accurate diagnosis is the key for surgeons to determine syndesmosis fixation whether there is only AITFL injury or combined IOL injury in concomitant acute syndesmotic and lateral ligament injury.

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Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this study was supported by a grant from the Arthroscopy Association of North America (grant 2017D009573). In addition, the author(s) received research support from Arthrex Inc.

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Authors and Affiliations

  1. Foot and Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Go Sato, Jirawat Saengsin, Rohan Bhimani, Noortje Hagemeijer, Bart Lubberts, Elaheh Ziaei Ziabari, Christopher DiGiovanni & Daniel Guss

  2. Department of Orthopaedic Surgery, Asahikawa Medical University, Mitdorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan

    Go Sato

  3. Department of Orthopaedic Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Jirawat Saengsin

  4. Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands

    Noortje Hagemeijer

  5. Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Christopher DiGiovanni & Daniel Guss

  6. Newton-Wellesley Hospital, Harvard Medical School, Boston, MA, USA

    Christopher DiGiovanni & Daniel Guss

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  1. Go Sato
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Correspondence to Go Sato.

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The author(s) report grants from the Arthroscopy Association of North America, during the conduct of the study. ICMJE forms for all authors are available online.

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Sato, G., Saengsin, J., Bhimani, R. et al. Isolated injuries to the lateral ankle ligaments have no direct effect on syndesmotic stability. Knee Surg Sports Traumatol Arthrosc 30, 3881–3887 (2022). https://doi.org/10.1007/s00167-022-06985-6

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  • DOI: https://doi.org/10.1007/s00167-022-06985-6

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