Sagittal instability with inversion is important to evaluate after syndesmosis injury and repair: a cadaveric robotic study
Abstract Purpose Disruption of the syndesmosis, the anterior-inferior tibiofibular ligament (AITFL), the posterior-inferior tibiofibular ligament (PITFL), and the interosseous membrane (IOM), leads to residual symptoms after an ankle injury. The objective of this study was to quantify tibiofibular j...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2020-03-01
|
| Series: | Journal of Experimental Orthopaedics |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40634-020-00234-w |
| _version_ | 1797331388523872256 |
|---|---|
| author | Neel K. Patel Conor I. Murphy Thomas R. Pfeiffer Jan-Hendrik Naendrup Jason P. Zlotnicki Richard E. Debski MaCalus V. Hogan Volker Musahl |
| author_facet | Neel K. Patel Conor I. Murphy Thomas R. Pfeiffer Jan-Hendrik Naendrup Jason P. Zlotnicki Richard E. Debski MaCalus V. Hogan Volker Musahl |
| author_sort | Neel K. Patel |
| collection | DOAJ |
| description | Abstract Purpose Disruption of the syndesmosis, the anterior-inferior tibiofibular ligament (AITFL), the posterior-inferior tibiofibular ligament (PITFL), and the interosseous membrane (IOM), leads to residual symptoms after an ankle injury. The objective of this study was to quantify tibiofibular joint motion with isolated AITFL- and complete syndesmotic injury and with syndesmotic screw vs. suture button repair compared to the intact ankle. Methods Nine fresh-frozen human cadaveric specimens (mean age 60 yrs.; range 38–73 yrs.) were tested using a six degree-of-freedom robotic testing system and three-dimensional tibiofibular motion was quantified using an optical tracking system. A 5 Nm inversion moment was applied to the ankle at 0°, 15°, and 30° plantarflexion, and 10° dorsiflexion. Outcome measures included fibular medial-lateral translation, anterior-posterior translation, and external rotation in each ankle state: 1) intact ankle, 2) AITFL transected (isolated AITFL injury), 3) AITFL, PITFL, and IOM transected (complete injury), 4) tricortical screw fixation, and 5) suture button repair. Results Both isolated AITFL and complete injury caused significant increases in fibular posterior translation at 15° and 30° plantarflexion compared to the intact ankle (p < 0.05). Tricortical screw fixation restored the intact ankle tibiofibular kinematics in all planes. Suture button repair resulted in 3.7 mm, 3.8 mm, and 2.9 mm more posterior translation of the fibula compared to the intact ankle at 30° and 15° plantarflexion and 0° flexion, respectively (p < 0.05). Conclusion Ankle instability is similar after both isolated AITFL and complete syndesmosis injury and persists after suture button fixation in the sagittal plane in response an inversion stress. Sagittal instability with ankle inversion should be considered when treating patients with isolated AITFL syndesmosis injuries and after suture button fixation. Level of evidence Controlled laboratory study, Level V. |
| first_indexed | 2024-03-08T07:33:45Z |
| format | Article |
| id | doaj.art-0670c876d602480da4811dbec229eef5 |
| institution | Directory Open Access Journal |
| issn | 2197-1153 |
| language | English |
| last_indexed | 2024-03-08T07:33:45Z |
| publishDate | 2020-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Journal of Experimental Orthopaedics |
| spelling | doaj.art-0670c876d602480da4811dbec229eef52024-02-02T19:30:22ZengSpringerOpenJournal of Experimental Orthopaedics2197-11532020-03-01711710.1186/s40634-020-00234-wSagittal instability with inversion is important to evaluate after syndesmosis injury and repair: a cadaveric robotic studyNeel K. Patel0Conor I. Murphy1Thomas R. Pfeiffer2Jan-Hendrik Naendrup3Jason P. Zlotnicki4Richard E. Debski5MaCalus V. Hogan6Volker Musahl7Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of PittsburghOrthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of PittsburghOrthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of PittsburghOrthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of PittsburghOrthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of PittsburghOrthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of PittsburghOrthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of PittsburghOrthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of PittsburghAbstract Purpose Disruption of the syndesmosis, the anterior-inferior tibiofibular ligament (AITFL), the posterior-inferior tibiofibular ligament (PITFL), and the interosseous membrane (IOM), leads to residual symptoms after an ankle injury. The objective of this study was to quantify tibiofibular joint motion with isolated AITFL- and complete syndesmotic injury and with syndesmotic screw vs. suture button repair compared to the intact ankle. Methods Nine fresh-frozen human cadaveric specimens (mean age 60 yrs.; range 38–73 yrs.) were tested using a six degree-of-freedom robotic testing system and three-dimensional tibiofibular motion was quantified using an optical tracking system. A 5 Nm inversion moment was applied to the ankle at 0°, 15°, and 30° plantarflexion, and 10° dorsiflexion. Outcome measures included fibular medial-lateral translation, anterior-posterior translation, and external rotation in each ankle state: 1) intact ankle, 2) AITFL transected (isolated AITFL injury), 3) AITFL, PITFL, and IOM transected (complete injury), 4) tricortical screw fixation, and 5) suture button repair. Results Both isolated AITFL and complete injury caused significant increases in fibular posterior translation at 15° and 30° plantarflexion compared to the intact ankle (p < 0.05). Tricortical screw fixation restored the intact ankle tibiofibular kinematics in all planes. Suture button repair resulted in 3.7 mm, 3.8 mm, and 2.9 mm more posterior translation of the fibula compared to the intact ankle at 30° and 15° plantarflexion and 0° flexion, respectively (p < 0.05). Conclusion Ankle instability is similar after both isolated AITFL and complete syndesmosis injury and persists after suture button fixation in the sagittal plane in response an inversion stress. Sagittal instability with ankle inversion should be considered when treating patients with isolated AITFL syndesmosis injuries and after suture button fixation. Level of evidence Controlled laboratory study, Level V.http://link.springer.com/article/10.1186/s40634-020-00234-wAnkle syndesmosisTricortical screwSuture buttonDistal tibiofibular kinematics |
| spellingShingle | Neel K. Patel Conor I. Murphy Thomas R. Pfeiffer Jan-Hendrik Naendrup Jason P. Zlotnicki Richard E. Debski MaCalus V. Hogan Volker Musahl Sagittal instability with inversion is important to evaluate after syndesmosis injury and repair: a cadaveric robotic study Journal of Experimental Orthopaedics Ankle syndesmosis Tricortical screw Suture button Distal tibiofibular kinematics |
| title | Sagittal instability with inversion is important to evaluate after syndesmosis injury and repair: a cadaveric robotic study |
| title_full | Sagittal instability with inversion is important to evaluate after syndesmosis injury and repair: a cadaveric robotic study |
| title_fullStr | Sagittal instability with inversion is important to evaluate after syndesmosis injury and repair: a cadaveric robotic study |
| title_full_unstemmed | Sagittal instability with inversion is important to evaluate after syndesmosis injury and repair: a cadaveric robotic study |
| title_short | Sagittal instability with inversion is important to evaluate after syndesmosis injury and repair: a cadaveric robotic study |
| title_sort | sagittal instability with inversion is important to evaluate after syndesmosis injury and repair a cadaveric robotic study |
| topic | Ankle syndesmosis Tricortical screw Suture button Distal tibiofibular kinematics |
| url | http://link.springer.com/article/10.1186/s40634-020-00234-w |
| work_keys_str_mv | AT neelkpatel sagittalinstabilitywithinversionisimportanttoevaluateaftersyndesmosisinjuryandrepairacadavericroboticstudy AT conorimurphy sagittalinstabilitywithinversionisimportanttoevaluateaftersyndesmosisinjuryandrepairacadavericroboticstudy AT thomasrpfeiffer sagittalinstabilitywithinversionisimportanttoevaluateaftersyndesmosisinjuryandrepairacadavericroboticstudy AT janhendriknaendrup sagittalinstabilitywithinversionisimportanttoevaluateaftersyndesmosisinjuryandrepairacadavericroboticstudy AT jasonpzlotnicki sagittalinstabilitywithinversionisimportanttoevaluateaftersyndesmosisinjuryandrepairacadavericroboticstudy AT richardedebski sagittalinstabilitywithinversionisimportanttoevaluateaftersyndesmosisinjuryandrepairacadavericroboticstudy AT macalusvhogan sagittalinstabilitywithinversionisimportanttoevaluateaftersyndesmosisinjuryandrepairacadavericroboticstudy AT volkermusahl sagittalinstabilitywithinversionisimportanttoevaluateaftersyndesmosisinjuryandrepairacadavericroboticstudy |