Syndesmotic Ankle Sprains in Large Males

Mait, Alexander

doi:10.18130/v35755

Cited by 1 publication

(3 citation statements)

References 64 publications

(356 reference statements)

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“…18 , 19 , 32 Others permitted fibular motion over a fixed foot 35 or constrained the foot with athletic tape, 31 thus creating an artificially restrictive boundary condition at the foot. Allowing natural fibular motion and foot translation affects bony kinematics and ligament recruitment in the ankle during foot rotation, 15 likely affecting resulting injury patterns and propagation sequences.…”

Section: Discussionmentioning

confidence: 99%

“…Although rotation rates are less than those seen clinically or on the playing field, low rotation rates were chosen to limit inertial effects and to be within physiological ranges. 15 , 32 The rotation rate was decreased after run 1 to limit binding in the test fixture for subsequent tests.…”

Section: Methodsmentioning

confidence: 99%

“…A group of biomechanical engineers, with consultation from orthopaedic surgeons, identified features of interest in the mechanical response (eg, moments/forces, strain, and audio) as possible injury events. 15 Large changes in the mechanical response, especially in the moment about the global Z-axis, were typically attributed to bone fractures and failure of large ligaments (eg, deep deltoid and ATiFL). Small changes in the mechanical response were attributed to failure of small ligaments (eg, superficial deltoid and ATaFL).…”

Section: Methodsmentioning

confidence: 99%

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Propagation of Syndesmotic Injuries During Forced External Rotation in Flexed Cadaveric Ankles

Mait

Forman

Nie

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Forced external rotation of the foot is a mechanism of ankle injuries. Clinical observations include combinations of ligament and osseous injuries, with unclear links between causation and injury patterns. By observing the propagation sequence of ankle injuries during controlled experiments, insight necessary to understand risk factors and potential mitigation measures may be gained.Hypothesis:Ankle flexion will alter the propagation sequence of ankle injuries during forced external rotation of the foot.Study Design:Controlled laboratory study.Methods:Matched-pair lower limbs from 9 male cadaveric specimens (mean age, 47.0 ± 11.3 years; mean height, 178.1 ± 5.9 cm; mean weight, 94.4 ± 30.9 kg) were disarticulated at the knee. Specimens were mounted in a test device with the proximal tibia fixed, the fibula unconstrained, and foot translation permitted. After adjusting the initial ankle position (neutral, n = 9; dorsiflexed, n = 4; plantar flexed, n = 4) and applying a compressive preload to the tibia, external rotation was applied by rotating the tibia internally while either lubricated anteromedial and posterolateral plates or calcaneal fixation constrained foot rotation. The timing of osteoligamentous injuries was determined from acoustic sensors, strain gauges, force/moment readings, and 3-dimensional bony kinematics. Posttest necropsies were performed to document injury patterns.Results:A syndesmotic injury was observed in 5 of 9 (56%) specimens tested in a neutral initial posture, in 100% of the dorsiflexed specimens, and in none of the plantar flexed specimens. Superficial deltoid injuries were observed in all test modes.Conclusion:Plantar flexion decreased and dorsiflexion increased the incidence of syndesmotic injuries compared with neutral matched-pair ankles. Injury propagation was not identical in all ankles that sustained a syndesmotic injury, but a characteristic sequence initiated with injuries to the medial ligaments, particularly the superficial deltoid, followed by the propagation of injuries to either the syndesmotic or lateral ligaments (depending on ankle flexion), and finally to the interosseous membrane or the fibula.Clinical Relevance:Superficial deltoid injuries may occur in any case of hyper–external rotation of the foot. A syndesmotic ankle injury is often concomitant with a superficial deltoid injury; however, based on the research detailed herein, a deep deltoid injury is then concomitant with a syndesmotic injury or offloads the syndesmosis altogether. A syndesmotic ankle injury more often occurs when external rotation is applied to a neutral or dorsiflexed ankle. Plantar flexion may shift the injury to other ankle ligaments, specifically lateral ligaments.

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