Abstract
BackgroundThere are several types of tenodesis reconstruction designed for subtalar instability. However, no comprehensive comparison has been conducted among these procedures in terms of their correcting power so far. The objective of this study is to evaluate the biomechanical behaviors of 5 representative procedures through finite element analysis.MethodsFinite element models were established and validated based on one of our previous studies. The Pisani interosseous talocalcaneal ligament (ITCL) reconstruction, Schon cervical ligament (CL) reconstruction and Choisne calcaneofibular ligament (CFL) reconstruction were compared on the model with the CFL, ITCL and CL sectioned. The Schon triligamentous reconstruction and Mann triligamentous reconstruction were compared on the model with the CFL, ITCL and CL, as well as the ATFL sectioned. The inversion and external/internal rotation were quantified at different ankle positions based on the rotational moment. Then, the stress in ligaments and reconstructed grafts and the contact characteristics of the subtalar joint under inversional stress test were calculated and compared accordingly.ResultsFor single ligament reconstruction, the Choisne CFL reconstruction provided the greatest degree of correction for subtalar instability, followed by the Schon CL reconstruction and then the Pisani ITCL reconstruction. For triligamentous reconstruction, the Mann procedure outperformed the Schon procedure in alleviating the subtalar instability.ConclusionThe finite element analysis showed that the Choisne CFL reconstruction and Mann triligamentous reconstruction provided the greatest degree of immediate postoperative subtalar stability. However, both procedures could not restore the biomechanical behaviors of the subtalar joint to normal. The long-term efficacy of these procedures warrants further investigation using a substantially larger sample of clinical cases.
Highlights
Subtalar instability is a common functional talocalcaneal instability always coupled with lateral ankle instability
Group 1 Kinematics of subtalar joint The section of calcaneofibular ligament (CFL), interosseous talocalcaneal ligament (ITCL) and cervical ligament (CL) led to obvious instability in the subtalar joint
No comprehensive comparison on their biomechanical behaviors has been conducted yet. We compared these 5 representative procedures in this numerical analysis, and the results suggested that the Choisne CFL and Mann triligamentous reconstructions were most effective in stabilizing the subtalar joint
Summary
Subtalar instability is a common functional talocalcaneal instability always coupled with lateral ankle instability. It was reported that about 10–25% of patients with lateral ankle instability suffered from subtalar instability [1, 2]. Subtalar instability mainly results in varus tilt and anterior translation of the calcaneus. Its clinical manifestation is often covered by the lateral ankle instability, for which, it is only recognized as a separate clinical condition that needs specific treatment in recent years [3]. The exact aetiology of subtalar instability is still unknown. Several cadaveric studies reported that the main. There are several types of tenodesis reconstruction designed for subtalar instability. The objective of this study is to evaluate the biomechanical behaviors of 5 representative procedures through finite element analysis
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