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The role of the medial ligaments in lateral stabilization of the ankle joint: an in vitro study

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

Abstract

Purpose

The deltoid ligament complex is known as medial stabilizer in the ankle against pronation/eversion. Lateral dual-ligament laxity often results in chronic ankle instability with recurring ankle sprain trauma. The goal of this study is to examine the lateral stabilizing role of the deltoid ligament complex against supination/inversion in case of existing lateral ligament instability.

Methods

A torsion simulation was performed on 12 fresh human lower leg cadaver specimens in a loading frame and a specially designed mounting platform. The preset torsion between tibia and calcaneus was primarily set at 30° of internal rotation on specimen in plantar flexion and hind foot inversion. The measured variable was the resisting torque recorded around mechanical tibial axis, which ensures stability in ankle sprain trauma. The first series of measurements were performed on healthy specimens and the following after transecting structures in following order: anterior talofibular ligament (ATFL) in combination with calcaneofibular ligament (CFL), followed by anterior tibiotalar ligament and posterior tibiotalar ligament and finally tibiocalcaneal ligament (TCL).

Results

The combined lateral ATFL and CFL instability showed a decrease in the resisting torque, which ensures stability in ankle sprain trauma. Only a transection of TCL (superficial layer of deltoid ligament complex) with existing lateral dual-ligament instability results in a significant decrease in torque (p < 0.0001).

Conclusion

The goal of the study was to provide the orthopaedic and/or trauma surgeon with quantitative data that may be referred to the substantial stabilizing effect of TCL against supination/inversion in the ankle joint in case of repetitive sprain trauma at a present lateral ligament lesion. Diagnostics of and treatment for lateral ligament instability need to consider the deltoid ligament complex, especially TCL in clinical routine.

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Acknowledgments

The authors would like to thank Constantin E. Dlaska from the Department of Trauma Surgery, Medical University of Vienna.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Pejman Ziai, Emir Benca, Gobert V. Skrbensky & Reinhard Windhager

  2. Student School of Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Florian Wenzel

  3. Department of Traumatology and Sports Injuries of the Paracelsus Medical University, Muellber Hauptstraße 48, 5020, Salzburg, Austria

    Alexander Auffarth

  4. Department of Orthopaedic Surgery and Traumatology, Clinical Center University of Sarajevo, Bolnička 25, 71000, Sarajevo, Bosnia and Herzegovina

    Selma Krpo

  5. Sporthopaedicum Straubing, Bahnhofsplatz 27, 94315, Straubing, Germany

    Tomas Buchhorn

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  1. Pejman Ziai
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  2. Emir Benca
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  3. Gobert V. Skrbensky
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  4. Florian Wenzel
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  7. Reinhard Windhager
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  8. Tomas Buchhorn
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Corresponding author

Correspondence to Pejman Ziai.

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Ziai, P., Benca, E., Skrbensky, G.V. et al. The role of the medial ligaments in lateral stabilization of the ankle joint: an in vitro study. Knee Surg Sports Traumatol Arthrosc 23, 1900–1906 (2015). https://doi.org/10.1007/s00167-013-2708-4

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  • DOI: https://doi.org/10.1007/s00167-013-2708-4

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