Differential diagnosis of ruptures of the lateral ligaments of the ankle joint

Abstract

Ruptures of the lateral ligaments of the ankle joint occur very frequently in young persons and this subject is therefore one which deserves more attention. Once a fracture or avulsion of a ligamentary insertion has been excluded the nature and extent of the ligamentary lesion should be precisely assessed. The only objective criterion of rupture of a ligament is demonstrable instability of the joint. Since the anterior talo-fibular ligament is always found to be torn immediately following supination-inversion injury to the ligaments the talar drawer sign will be demonstratable both clinically and radiologically in such cases. This test causes almost no pain and can be carried out without anesthesia. The radiological visualization of ligamentary instability with the aid of a simple jig which stresses the ankle joint provides diagnostic information which is definitely superior to that obtained from an a-p roentegenogram of the stressed joint. This conclusion was reached by statistical analysis of 384 roentgenograms.

Stability of the Ankle Joint

“…It is often interpreted as a sign of rupture of the ATaFL, but it can also be produced on an intact ankle joint. At intact ligaments the ADS has been reported to range between 1.5 and more than 9 mm (Landeros et al 1968, Delplace and Castaing 1975, Laurin and Matthieu 1975, Hackenbruch and Noesberger 1976, Larsen 1976, Dannegger 1979, Hackenbruch et al 1979, Frolich et al 1980, depending presumably upon the force used to induce the movement, but also varying according to the method by which it has been measured (Fig. 4). 2.4.2 Movement in the frontal plane takes place around a sagittal axis and consists in adduction or abduction of the talus in the ankle mortise.…”

“…Giittner (1941) and Freeman (1965) have rarely been able to induce it, while Sanders (1977) admitted that it does occur, but dared not attribute to it any diagnostic importance. On the other hand, Castaing and Delplace (1972), Hackenbruch et al (1976), Dannegger (1979), Noesberger (1979) state that on the basis of its size it is possible to deduce which ligaments are injured.…”

“…Reversely, abduction instability indicates rupture of the TCL and ITTL. 7.6.5 Internal rotatory instability Numerous authors have reported internal rotatory instability following rupture of the ATaFLoften in association with an ADS (Dehne 1934, Hendelberg 1943, Leonard 1949, Anderson et al 1952, Brostrom 1964, Cedell 1967, Olerud 1967, Percy et al 1969, Robichon et al 1972, Delplace and Castaing 1975, Lindstrand et al 1978, Hackenbruch et al 1979, Glasgow et al 1980. On the other hand, the role of the CFL and PTaFL in internal rotation has not been elucidated.…”

Chronic lateral instability of the ankle Roentgen stereophotogrammetry of talar position

“…Mechanical instability of the ankle or the subtalarjoints (4,5), muscle weakness (6-81, subtalar adhesions (9), or proprioceptive defects (8,lO-12) may be of etiologic importance in these cases. Some authors (13-1 5 ) have focused on the varus instability of the talus (talar tilt), whereas others (16)(17)(18)(19)(20), have used the anterior laxity of the talus to document the mechanical instability. The concept of anterolateral instability of the ankle was introduced after in vitro studies (20-24) and indicated that the talusnot only displacedanteriorly, butalso rotated internally, when subjected to an anteriorly directed force.…”

Radiographic Instability of the Ankle Joint After Evans' Repair

“…The difficulties of evaluating the seriousness and degree of ligamentous injuries in the ankle joint are generally agreed (Brostrom 1966, Lindstrand 1976, Hackenbruch et al 1979. Inadequately treated lesions cause later instability in the ankle joint with subjectively disabling symptoms and degenerative changes (Harrington 1979, Glassgow et al 1980.…”