Background: Biomechanical data and contributions to ankle joint stability have been previously reported for the individual distal tibiofibular ligaments. These results have not yet been validated based on recent anatomic descriptions or using current biomechanical testing devices.
Methods: Eight matched-pair, lower leg specimens were tested using a dynamic, biaxial testing machine. The proximal tibiofibular joint and the medial and lateral ankle ligaments were left intact. After fixation, specimens were preconditioned and then biomechanically tested following sequential cutting of the tibiofibular ligaments to assess the individual ligamentous contributions to syndesmotic stability. Matched paired specimens were randomly divided into 1 of 2 cutting sequences: (1) anterior-to-posterior: intact, anterior inferior tibiofibular ligament (AITFL), interosseous tibiofibular ligament (ITFL), deep posterior inferior tibiofibular ligament (PITFL), superficial PITFL, and complete interosseous membrane; (2) posterior-to-anterior: intact, superficial PITFL, deep PITFL, ITFL, AITFL, and complete interosseous membrane. While under a 750-N axial compressive load, the foot was rotated to 15 degrees of external rotation and 10 degrees of internal rotation for each sectioned state. Torque (Nm), rotational position (degrees), and 3-dimensional data were recorded continuously throughout testing.
Results: Testing of the intact ankle syndesmosis under simulated physiologic conditions revealed 4.3 degrees of fibular rotation in the axial plane and 3.3 mm of fibular translation in the sagittal plane. Significant increases in fibular sagittal translation and axial rotation were observed after syndesmotic injury, particularly after sectioning of the AITFL and superficial PITFL. Sequential sectioning of the syndesmotic ligaments resulted in significant reductions in resistance to both internal and external rotation. Isolated injuries to the AITFL resulted in the most substantial reduction of resistance to external rotation (average of 24%). However, resistance to internal rotation was not significantly diminished until the majority of the syndesmotic structures had been sectioned.
Conclusion: The ligaments of the syndesmosis provide significant contributions to rotary stability of the distal tibiofibular joint within the physiologic range of motion.
Clinical Relevance: This study defined normal motion of the syndesmosis and the biomechanical consequences of injury. The degree of instability was increased with each additional injured structure; however, isolated injuries to the AITFL alone may lead to significant external rotary instability.
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http://dx.doi.org/10.1177/1071100716666277 | DOI Listing |
J Orthop Surg Res
January 2025
Department of Orthopedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Prof. Adam Gruca Orthopedic and Trauma Teaching Hospital, Konarskiego 13, Otwock, 05-400, Poland.
Background: Posterior malleolus fractures may be fixed to restore syndesmosis stability. However, these fractures are often accompanied by ruptures of other ligaments that stabilize the syndesmosis. This study investigates the frequency of anterior syndesmosis injury in posterior malleolus fractures and its effect on rotational stability.
View Article and Find Full Text PDFIntroduction: Fibular- and tibiofibular-based reconstructions are the gold standard treatment for posterolateral corner (PLC) injuries of the knee. This is the first report describing a wholly tibial-based PLC reconstruction.
Case Report: A 50-year-old female presented with knee instability following proximal fibular resection for a benign tumor, associated with chronic anterior cruciate ligament (ACL) deficiency from a previous injury.
Eur J Trauma Emerg Surg
January 2025
Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Purpose: (1) To evaluate the incidence and combination types of concomitant malleolar and fibular fractures in patients with distal spiral tibial shaft fractures. (2) To evaluate the risk factors for concomitant malleolar fractures in patients with distal spiral tibial shaft fractures.
Methods: A retrospective review was performed on 64 cases of surgically treated distal spiral tibial shaft fractures with complete radiographs and computed tomography (CT) scans.
Int Orthop
February 2025
Institute of Anatomy, First Faculty of Medicine, Charles University, U Nemocnice 3, Prague 2, Prague, Czech Republic.
Introduction: During 280 years of studies of the anatomy of the distal tibiofibular articulation, there have arisen many unclear issues regarding the description of individual structures and their terminology. These historical inaccuracies were subsequently reflected in the clinical practice.
Materials And Methods: A literature search of original publications and historical sources was performed.
J Orthop Sci
December 2024
Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan. Electronic address:
Background: The reproducibility of dynamic balance is an essential component of athletic performance and injury prevention, although it is affected by sex differences. This study aimed to confirm the reproducibility of repeated dynamic balance measurements and ultrasonography assessments of the anterior tibiofibular gap that may contribute to changes in dynamic balance for each sex.
Methods: This was a longitudinal study involving 48 feet, with 12 men and 12 women.
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