Biomechanical analysis of the ankle anterior drawer test for anterior talofibular ligament injuries

Tohyama, Harukazu; Beynnon, Bruce D.; Renström, Per; Theis, M.; Fleming, Braden C.; Pope, Malcolm H.

doi:10.1002/jor.1100130417

Cited by 52 publications

(65 citation statements)

References 22 publications

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“…Several investigators have reported similar increases in laxity after ATFL or CFL sectioning (Kjaersgaard-Andersen et al 1991, Johnson and Markolf 1983, Hollis et al 1995, Tohyama et al 1995, but have reached widely varying conclusions regarding the most sensitive flexion angle for testing. Apart from differences in experimental setup which could, in part, explain the different conclusions reached, the fact remains that individual variations in ligament orientation (Burks and Morgan 1994) may cause different laxity patterns in different patients.…”

Section: Discussionmentioning

confidence: 95%

“…However, some studies have concluded that the laxity increase resulting from ATFL injury is greater in dorsiflexion than in plantarflexion (Johnson andMarkolf 1983, Hollis et al 1995), whereas others advocate plantarflexion as the best testing position to detect isolated ATFL injury (Tohyama et al 1995). Kjzrsgaard-Andersen et al concluded that the laxity increase after an isolated ATIT injury are similar throughout the entire flexion range ( I 991).…”

Section: Discussionmentioning

confidence: 99%

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Mechanics of the anterior drawer and talar tilt tests: A cadaveric study of lateral ligament injuries of the ankle

Bahr¹,

Peña²,

Shine³

et al. 1997

Acta Orthopaedica Scandinavica

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Mechanics of the anterior drawer and talar tilt tests: A cadaveric study of lateral ligament injuries of the ankle

Bahr¹,

Peña²,

Shine³

et al. 1997

Acta Orthopaedica Scandinavica

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“…L ateral ligament stress testing after an inversion ankle sprain is used to identify the presence of increased laxity within the talocrural and subtalar joints (ankle complex) when compared with the contralateral ankle. 1 This assessment commonly involves the anterior drawer and inversion tests [2][3][4] and is performed by applying an anteriorly directed force or inversion torque to the foot. 5 In the biomechanical literature, researchers [6][7][8] have shown the anterior talofibular ligament (ATFL) is the major ligamentous structure preventing forward subluxation of the talus and the calcaneofibular ligament (CFL) is the primary restraint of talar inversion.…”

mentioning

confidence: 99%

“…9,10 Increases in ankle-complex motion with isolated and combined sectioning of the ATFL and CFL have been reported extensively. 2,8,[10][11][12] General consensus in the literature is that measuring the relationship between ligament damage and joint laxity by simulating ligamentous injury in the cadaver specimen improves our understanding of joint motion and the effect ligament damage has on producing instability in the ankle-subtalar complex. Thus, objective documentation that describes change in the passive mechanical properties of the ankle complex with lateral ligament injury could be important in the differential diagnosis of these injuries.…”

mentioning

confidence: 99%

“…4 Limited biomechanical information is available regarding passive end-range stiffness characteristics of the ankle complex with anterior loading after ankle injury. 2,3,13,14 With inversion loading, no authors of biomechanical studies have reported end-range stiffness characteristics for the intact ankle or for the ankle with combined lesions of the ATFL and CFL despite reporting increased instability. [14][15][16][17][18][19] Therefore, the mechanical property of stiffness may be important to understanding how injury affects joint stability.…”

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confidence: 99%

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Joint Stability Characteristics of the Ankle Complex After Lateral Ligamentous Injury, Part I: A Laboratory Comparison Using Arthrometric Measurement

Kovaleski

Heitman

Gurchiek

et al. 2014

Journal of Athletic Training

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. Dr Liu is currently at the School of Kinesiology, Auburn University, AL. Context:The mechanical property of stiffness may be important to investigating how lateral ankle ligament injury affects the behavior of the viscoelastic properties of the ankle complex. A better understanding of injury effects on tissue elastic characteristics in relation to joint laxity could be obtained from cadaveric study.Objective: To biomechanically determine the laxity and stiffness characteristics of the cadaver ankle complex before and after simulated injury to the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) during anterior drawer and inversion loading.Design: Cross-sectional study. Setting: University research laboratory.Patients or Other Participants: Seven fresh-frozen cadaver ankle specimens.Intervention(s): All ankles underwent loading before and after simulated lateral ankle injury using an ankle arthrometer. Main Outcome Measure(s):The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness.Results: Isolated ATFL and combined ATFL and CFL sectioning resulted in increased anterior displacement but not end-range stiffness when compared with the intact ankle. With inversion loading, combined ATFL and CFL sectioning resulted in increased range of motion and decreased end-range stiffness when compared with the intact and ATFL-sectioned ankles.Conclusions: The absence of change in anterior end-range stiffness between the intact and ligament-deficient ankles indicated bony and other soft tissues functioned to maintain stiffness after pathologic joint displacement, whereas inversion loading of the CFL-deficient ankle after pathologic joint displacement indicated the ankle complex was less stiff when supported only by the secondary joint structures.Key Words: ankle instability, joint laxity measurement, ankle sprains Key PointsThe injury mechanism consisted of serial sectioning of the major anatomic support structures of the lateral ankle complex. Anterior displacement was greater in the ankles with isolated anterior talofibular ligament (ATFL) sectioning and combined ATFL and calcaneofibular ligament (CFL) sectioning than in the intact ankles, but end-range stiffness did not increase after lateral ligament sectioning, indicating that bony and other soft tissues functioned to maintain anterior stiffness after pathologic joint displacement. With inversion loading, ankle-complex rotation increased and end-range stiffness decreased after CFL sectioning, indicating that the ankle complex was less stiff when supported only by the secondary joint structures.

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Changes in the flexibility characteristics of the ankle complex due to damage to the lateral collateral ligaments: An in vitro and in vivo study

LaPointe

Siegler

Hillstrom

et al. 1997

Journal Orthopaedic Research

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This study was part of a long-term effort to develop a reliable diagnostic procedure for ankle ligament injuries. Earlier efforts led to the development and validation of a six-degrees-of-freedom instrumented linkage capable of measuring the flexibility characteristics of the ankle complex in vitro and in vivo. The major goal of the present study was to determine if these flexibility measurements are sufficiently sensitive to detect the presence of damage to the lateral collateral ligaments of the ankle joint both in vitro and in vivo. The in vitro testing was conducted on the legs from six fresh cadavers before and after serial sectioning of the anterior talofibular ligament and the calcaneofibular ligament. The flexibility in inversion-eversion, anterior drawer, and internal-external rotation was measured before and after resection of the ligaments. The in vivo testing was conducted on five patients with unilateral injuries to the ankle ligament. The flexibility evaluation used for in vitro specimens was also performed on both the injured and the intact ankles. For the in vitro testing, the data analysis was based on comparison of flexibility values before and after resection of the ligaments, whereas the data analysis for the in vivo testing was based on comparison of the flexibility of the injured joint with that of the intact contralateral joint. The results of the in vitro study indicated that both an isolated rupture of the anterior talofibular ligament and combined damage of the anterior talofibular and calcaneofibular ligaments produce statistically significant changes in flexibility. Furthermore, the most sensitive parameters to the presence of ligament injuries were found to be early flexibility in anterior drawer, early flexibility in inversion, and the amount of coupling between internal rotation and inversion. These parameters provided a basis for differentiating between an isolated injury to the anterior talofibular ligament and a combined anterior talofibular and calcaneofibular ligament injury. For an isolated anterior talofibular ligament injury, a significant increase in flexibility in anterior drawer was present, whereas the increase in inversion flexibility or in the amount of coupling was insignificant. However, the increases in inversion flexibility and the amount of coupling became significant when both ligaments were involved. The results of the in vivo study indicated that significant changes in flexibility can be detected in patients with lateral ankle injuries. Finally, both the in vitro and in vivo results suggest that development of a reliable diagnostic test for ankle ligament injury based on changes in passive flexibility may be possible.

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Biomechanical analysis of the ankle anterior drawer test for anterior talofibular ligament injuries

Cited by 52 publications

References 22 publications

Mechanics of the anterior drawer and talar tilt tests: A cadaveric study of lateral ligament injuries of the ankle

Mechanics of the anterior drawer and talar tilt tests: A cadaveric study of lateral ligament injuries of the ankle

Joint Stability Characteristics of the Ankle Complex After Lateral Ligamentous Injury, Part I: A Laboratory Comparison Using Arthrometric Measurement

Changes in the flexibility characteristics of the ankle complex due to damage to the lateral collateral ligaments: An in vitro and in vivo study

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