In Vivo Kinematics of the Tibiotalar Joint After Lateral Ankle Instability

Abstract

BACKGROUND Previous studies have suggested injury to the anterior talofibular ligament may be linked to altered kinematics and the development of osteoarthritis of the ankle joint. However, the effects of ATFL injury on the in vivo kinematics of the ankle joint are unclear. HYPOTHESIS Based on the orientation of the ATFL fibers, we hypothesized that ATFL deficiency would lead to increased anterior translation and increased internal rotation of the talus relative to the tibia. STUDY DESIGN Controlled laboratory study. METHODS The ankles of 9 patients with unilateral ATFL injuries were compared as they stepped onto a level surface. Kinematic measurements were made as a function of increasing load. Using magnetic resonance imaging and orthogonal fluoroscopy, the in vivo kinematics of the tibiotalar joint were measured in the ATFL deficient and intact ankles from the same individuals. RESULTS A statistically significant increase in internal rotation, anterior translation, and superior translation of the talus was measured in ATFL deficient ankles as compared to intact, contralateral controls. For example, at 100% body weight, ATFL deficient ankles demonstrated a statistically significant increase in anterior translation of 0.9 ± 0.5mm (p = 0.008). At 100% body weight, the ATFL deficient ankle was internally rotated relative to the intact ankle by 5.7 ± 3.6° (p = 0.008). There was a slight increase of 0.2 ± 0.2mm in the superior translation of the ATFL deficient ankle compared to the intact ankle at 100% body weight (p = 0.02). CONCLUSIONS ATFL deficiency increases anterior translation, internal rotation, and superior translation of the talus. CLINICAL RELEVANCE Altered kinematics may contribute to the degenerative changes observed with chronic lateral ankle instability. These findings might help to explain the degenerative changes frequently observed on the medial talus in patients with chronic ATFL insufficiency and provide a baseline for improving ankle ligament reconstructions aimed at restoring normal joint motion.

Clinical presentation and manual therapy for lower quadrant musculoskeletal conditions

“…The exact mechanism of joint degeneration is unclear but likely due to both inflammatory factors and altered biomechanics. 78 Mechanical ankle instability (MAI) is a result of a ligamentous tear that results in pathological joint laxity 79 while CAI has been defined as a recurrent giving away of the ankle that occurs for greater than 1 year after an ankle sprain. 80 The CAI patient may present with pain, 81 recurrent ankle sprains, 82 diminished neuromuscular control, 83 weakness, 84 impaired joint position sense, 84 and decreased performance and self-report of functional and sport activity.…”

Anterior Talocrural Joint Laxity: Diagnostic Accuracy of the Anterior Drawer Test of the Ankle

“…Unlike Nyska et al, 37 we only observed a significant positive association between the clinical grades of laxity determined with the ADT and the amount of anterior laxity measured with the arthrometer in the group with acute lateral sprains. Caputo et al 8 also identified only a slight amount of anterior talar translation (0.2-0.4 mm) in control ankles, in contrast to a significant amount of anterior translation (0.9  0.6 mm) in individuals with chronic ankle instability, when measured in weight bearing using a 3-D magnetic resonance imaging and orthogonal fluoroscopic imaging method. Hubbard 24 documented a 5.5-mm increase in anterior ankle laxity following acute ankle sprain and also indicated that perceptible anterior laxity and symptoms of instability may persist for more than a year following an ankle sprain.…”

“…Alterations in fibular position, 26 as well as talar internal rotation and anterior displacement, which were not measured in this study, may explain the changes in the relative position of the bony landmarks. 8 We evaluated the laxity grade given with manual performance of the ADT against 2 standards of anterior talocrural laxity. The first standard was derived from the work of Kerkhoffs et al 31 and represents the results of 9 in vitro ligamentsectioning studies specifically designed to measure changes in talar motion in response to simulated ATFL injuries.…”

MRI Determination of Knee Effusion Volume: A Cadaveric Study

“…[5][6][7] One such tool used to create these 3D models is Rhinoceros (McNeel and Associates, Seattle, WA). Rhinoceros creates a 3D model based on 2D semiautomated manual tracings of objects on 2D MRI slices.…”