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The anterior talofibular ligament ratio was greater in young men with generalized joint laxity than in those without generalized joint laxity

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

Abstract

Purpose

This study aimed to evaluate the relationship between generalized joint laxity (GJL) and stress ultrasonographic (US) findings of the anterior talofibular ligament (ATFL) of healthy young men.

Methods

The ATFL lengths of healthy young men were consecutively measured in the stress and nonstress positions. The ATFL ratio was calculated as an indicator of lateral ankle laxity. GJL was evaluated using the Beighton score (BS), and a BS of ≥ 5 was considered GJL. The manual anterior drawer test (ADT) was also performed. The results of stress US and ADT were compared between subjects with and without GJL, and the correlation between GJL and US findings was examined.

Results

A total of 13 subjects with GJL and 95 without GJL were included in the study. The mean BSs in the GJL and no-GJL groups were 5.9 ± 0.9 and 1.1 ± 1.3, respectively (p < 0.0001). The GJL group showed a higher grade of ADT than the no-GJL group (p < 0.0001). Significant differences were found in the stress ATFL length (23.6 ± 1.8 mm vs. 21.7 ± 1.8 mm, p = 0.002) and ATFL ratio (1.15 ± 0.06 vs. 1.07 ± 0.03, p < 0.0001) between the GJL and no-GJL groups. Spearman’s correlation coefficients showed a moderate correlation between the BS and ATFL ratio (r = 0.45, p < 0.0001).

Conclusion

The present study showed significant differences in the ATFL ratio and stress ATFL length between young men with and without GJL. The BS was moderately correlated with the lateral ankle laxity in this population.

Level of evidence

Level IV.

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Abbreviations

GJL:

Generalized joint laxity

US:

Ultrasonography

ATFL:

Anterior talofibular ligament

BS:

Beighton score

ADT:

Anterior drawer test

CLAI:

Chronic lateral ankle instability

BMI:

Body mass index

CI:

Confidence interval

References

  1. Attenborough AS, Sinclair PJ, Smith RM, Hiller CE (2014) The effect of exercise on ligament laxity during inversion/eversion rotations at the ankle joint. J Foot Ankle Res 7(suppl 1):A5

    Article  PubMed Central  Google Scholar 

  2. Beighton P, Horan F (1969) Orthopaedic aspects of the Ehlers-Danlos syndrome. J Bone Joint Surg Br 51(3):444–453

    Article  CAS  PubMed  Google Scholar 

  3. Brasseur JL, Luzzati A, Lazennec JY, Guerin-Surville H, Roger B, Grenier P (1994) Ultrasono-anatomy of the ankle ligaments. Surg Radiol Anat 16(1):87–91

    Article  CAS  PubMed  Google Scholar 

  4. Cao M, Liu S, Zhang X, Ren M, Xiao Z, Chen J et al (2022) Imaging diagnosis for anterior talofibular ligament injury: a systemic review with meta-analysis. Acta Radiol. https://doi.org/10.1177/02841851221080556

    Article  PubMed  Google Scholar 

  5. Cho JH, Lee DH, Song HK, Bang JY, Lee KT, Park YU (2016) Value of stress ultrasound for the diagnosis of chronic ankle instability compared to manual anterior drawer test, stress radiography, magnetic resonance imaging, and arthroscopy. Knee Surg Sports Traumatol Arthrosc 24(4):1022–1028

    Article  PubMed  Google Scholar 

  6. de Asla RJ, Kozanek M, Wan L, Rubash HE, Li G (2009) Function of anterior talofibular and calcaneofibular ligaments during in-vivo motion of the ankle joint complex. J Orthop Surg Res 4:7

    Article  PubMed  PubMed Central  Google Scholar 

  7. De Maeseneer M, Marcelis S, Jager T, Shahabpour M, Van Roy P, Weaver J et al (2009) Sonography of the normal ankle: a target approach using skeletal reference points. AJR Am J Roentgenol 192(2):487–495

    Article  PubMed  Google Scholar 

  8. Guerra-Pinto F, Côrte-Real N, Gomes TM, Consciência JG, Glazebrook M, Oliva XM (2020) Varus talar tilt combined with an internal rotation pivot stress assesses the supination instability vector in lateral ankle ligaments’ injury—cadaver study. Foot Ankle Surg 26(3):258–264

    Article  PubMed  Google Scholar 

  9. Higuchi S, Ogawa M, Masuda Y, Yamazaki T, Ozeki S (2021) 3D-CT stress test for the assessment of CFL insufficiency. J Orthop Sci 26(6):1074–1080

    Article  PubMed  Google Scholar 

  10. Hua Y, Yang Y, Chen S, Cai Y (2012) Ultrasound examination for the diagnosis of chronic anterior talofibular ligament injury. Ultrasound examination for the diagnosis of chronic anterior talofibular ligament injury. Acta Radiol 53(10):1142–1145

    Article  PubMed  Google Scholar 

  11. Ishii Y, Noguchi H, Sato J, Ishii H, Toyabe S (2019) Mediolateral coronal laxity does not correlate with knee range of motion after total knee arthroplasty. Arch Orthop Trauma Surg 139(6):851–858

    Article  PubMed  Google Scholar 

  12. Lee KT, Park YU, Jegal H, Park JW, Choi JP, Kim JS (2014) New method of diagnosis for chronic ankle instability: comparison of manual anterior drawer test, stress radiography and stress ultrasound. Knee Surg Sports Traumatol Arthrosc 22(7):1701–1707

    Article  PubMed  Google Scholar 

  13. Lim JR, Lee HM, Yoon TH, Lee HM, Chun YM (2021) Association between excessive joint laxity and a wider hill-sachs lesion in anterior shoulder instability. Am J Sports Med 49(14):3981–3987

    Article  PubMed  Google Scholar 

  14. Liu K, Gustavsen G, Royer T, Wikstrom EA, Glutting J, Kaminski TW (2015) Increased ligament thickness in previously sprained ankles as measured by musculoskeletal ultrasound. J Athl Train 50(2):193–198

    Article  PubMed  PubMed Central  Google Scholar 

  15. Malek S, Reinhold EJ, Pearce GS (2021) The Beighton score as a measure of generalised joint hypermobility. Rheumatol Int 41(10):1707–1716

    Article  PubMed  PubMed Central  Google Scholar 

  16. Malfait F, Francomano C, Byers P, Belmont J, Berglund B, Black J et al (2017) The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet 175(1):8–26

    Article  PubMed  Google Scholar 

  17. Martin A (2019) An acquired or heritable connective tissue disorder? A review of hypermobile Ehlers Danlos Syndrome. Eur J Med Genet 62(7):103672

    Article  PubMed  Google Scholar 

  18. Michels PH, Calder J, Matricali G, Glazebrook M, Guillo S et al (2018) Searching for consensus in the approach to patients with chronic lateral ankle instability: ask the expert. Knee Surg Sports Traumatol Arthrosc 26(7):2095–2102

    Article  PubMed  Google Scholar 

  19. Palmer S, Denner E, Riglar M, Scannell H, Webb S, Young G (2020) Quantitative measures of tissue mechanics to detect hypermobile Ehlers-Danlos syndrome and hypermobility syndrome disorders: a systematic review. Clin Rheumatol 39(3):715–725

    Article  PubMed  Google Scholar 

  20. Park KH, Lee JW, Suh JW, Shin MH, Choi WJ (2016) Generalized ligamentous laxity is an independent predictor of poor outcomes after the modified brostrom procedure for chronic lateral ankle instability. Am J Sports Med 44(11):2975–2983

    Article  PubMed  Google Scholar 

  21. Pearsall AW, Kovaleski JE, Heitman RJ, Gurchiek LR, Hollis JM (2006) The relationships between instrumented measurements of ankle and knee ligamentous laxity and generalized joint laxity. J Sports Med Phys Fitness 46(1):104–110

    CAS  PubMed  Google Scholar 

  22. Ranalletta M, Bongiovanni S, Suarez F, Ovenza JM, Maignon G (2012) Do patients with traumatic recurrent anterior shoulder instability have generalized joint laxity? Clin Orthop Relat Res 470(4):957–960

    Article  PubMed  Google Scholar 

  23. Roos KG, Kerr ZY, Mauntel TC, Djoko A, Dompier TP, Wikstrom EA et al (2017) The epidemiology of lateral ligament complex ankle sprains in National Collegiate Athletic Association sports. Am J Sports Med 45(1):201–209

    Article  PubMed  Google Scholar 

  24. Sacks HA, Prabhakar P, Wessel LE, Hettler J, Strickland SM, Potter HG et al (2019) Generalized joint laxity in orthopaedic patients: clinical manifestations, radiographic correlates, and management. J Bone Joint Surg Am 101(6):558–566

    Article  PubMed  Google Scholar 

  25. Saengsin J, Bhimani R, Sato G, Hagemeijer CN, Mirochnik K, Lubberts B et al (2022) Use of portable ultrasonography for the diagnosis of lateral ankle instability. J Orthop Res. https://doi.org/10.1002/jor.25256

    Article  PubMed  Google Scholar 

  26. Seok H, Lee SH, Yun SJ (2020) Diagnostic performance of ankle ultrasound for diagnosing anterior talofibular and calcaneofibular ligament injuries: a meta-analysis. Acta Radiol 61(5):651–661

    Article  PubMed  Google Scholar 

  27. Singh H, McKay M, Baldwin J, Nicholson L, Chan C, Burns J et al (2017) Beighton scores and cut-offs across the lifespan: cross-sectional study of an Australian population. Rheumatology 56(11):1857–1864

    Article  PubMed  Google Scholar 

  28. Smits-Engelsman B, Klerks M, Kirby A (2011) Beighton score: a valid measure for generalized hypermobility in children. J Pediatr 158(1):11–14

    Article  Google Scholar 

  29. Song JH, Kang C, Kim NS, Yi JW, Lee GS, Jang MG et al (2021) Evaluation of the uninjured anterior talofibular ligament by ultrasound for assessing generalized joint hypermobility. Foot Ankle Surg 27(3):256–262

    Article  PubMed  Google Scholar 

  30. Tang B, Zeng X, Fan C (2021) Is generalized ligamentous laxity a contraindication for a modified Broström operation to treat chronic lateral ankle instability? A systematic review. Foot Ankle Surg 27(3):271–277

    Article  PubMed  Google Scholar 

  31. Whitehead NA, Mohammed KD, Fulcher ML (2018) Does the Beighton score correlate with specific measures of shoulder joint laxity? Orthop J Sports Med 6(5):2325967118770633. https://doi.org/10.1177/2325967118770633

    Article  PubMed  PubMed Central  Google Scholar 

  32. Xu HX, Lee KB (2016) Modified Brostrom procedure for chronic lateral ankle instability in patients with generalized joint laxity. Am J Sports Med 44(12):3152–3157

    Article  PubMed  Google Scholar 

  33. Yeo ED, Park JY, Kim JH, Lee YK (2017) Comparison of outcomes in patients with generalized ligamentous laxity and without generalized laxity in the arthroscopic modified Broström operation for chronic lateral ankle instability. Foot ankle Int 38(12):1318–1323

    Article  PubMed  Google Scholar 

  34. Yokoe T, Tajima T, Kawagoe S, Yamaguchi N, Morita Y, Chosa E (2021) The ratio of stress to nonstress anterior talofibular ligament length on ultrasonography: normative values. Orthop J Sports Med 9(11):23259671211056304. https://doi.org/10.1177/23259671211056305

    Article  PubMed  PubMed Central  Google Scholar 

  35. Zakas A, Vergou A, Grammatikopoulou MG, Zakas N, Sentelidis T, Vamvakoudis S (2003) The efect of stretching during warming-up on the fexibility of junior handball players. J Sports Med Phys Fitness 43(2):145–149

    CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Koki Ouchi, PhD, for his statistical advice.

Funding

No funding was received for this study.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan

    Takuji Yokoe, Takuya Tajima, Nami Yamaguchi, Yudai Morita & Etsuo Chosa

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  1. Takuji Yokoe
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  2. Takuya Tajima
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  3. Nami Yamaguchi
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  5. Etsuo Chosa
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Contributions

TY conceptualized this study. TY and YM: performed clinical examinations. TY: mainly drafted the manuscript, and TT, NY, and EC: supervised it. All authors had complete access to all data used in this study and take responsibility for its accuracy. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Takuji Yokoe.

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The authors declare no conflicts of interest in association with the present study.

Ethical approval

Ethical approval of this study was obtained from the institutional review board at Miyazaki University Graduate School of Medicine (Approval No. O-0669).

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Informed consent was obtained from all individual participants included in the study.

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Yokoe, T., Tajima, T., Yamaguchi, N. et al. The anterior talofibular ligament ratio was greater in young men with generalized joint laxity than in those without generalized joint laxity. Knee Surg Sports Traumatol Arthrosc 31, 1994–2000 (2023). https://doi.org/10.1007/s00167-022-07109-w

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