Abstract
PurposeDespite the evidence on the role of gravity stress test to access the instability of other ankle injuries, there is limited literature regarding gravity stress on the lateral ankle ligament’s insufficiency. The objective of our study was to objectively measure the tibiotalar angular movement under gravity stress after progressive sectioning of the lateral ankle ligaments.MethodsWe performed sequential sectioning of the anterior talofibular (ATFL), calcaneofibular (CFL), and posterior talofibular ligaments (PTFL) in twelve ankle specimens. Under gravity stress, we measured the angular movement of the talus in relation to the tibia. The measuring device is based on a three-axis gyroscope and accelerometer.ResultsComparing to the intact condition, the plantar flexion increased on average 1.78° (95% confidence interval [CI] 1.15;2.42), 5.13° (95%CI 3.10;7.16) and 8.63° (95%CI 6.05;11.22), the rotation increased by 1.00° (95 CI -0.51;2.51), 3.68° (95%CI 1.97;5.40) and 15.62° (95%CI 10.09;21.14), and the varus increased 2.89° (95% CI 1.39, 4.39), 8.12° (95% CI 5.16, 11.07) and 11.68° (95% CI 7.91, 15.46), after sectioning the ATFL, CFL, and PTFL, respectively. The overall changes were statistically significant.ConclusionsThere was a significant tibiotalar laxity after sectioning of lateral ankle ligaments when the foot position is influenced only by gravity. The tibiotalar angular displacement was significant when the CFL and PTFL were cut which suggests that the gravity test could be used to assess combined lateral ankle ligament injury. This evidence might be a step forward in the development of lateral ankle ligaments gravity stress tests.Level of evidence5 (cadaver study)
Highlights
Ankle sprains are the most common ankle injuries [6]
After sectioning the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligaments (PTFL), talus plantar flexion increased on average 1.78°, 5.13° and 8.63°, respectively
After sectioning the ATFL, CFL, and PTFL, rotation increased 1.00°, 3.68° and 15.62°, respectively
Summary
Ankle sprains are the most common ankle injuries [6]. The ankle is one of the most traumatised anatomical regions during sports activities and accounts for 10–30% of all sports injuries [10]. Ankle sprains can damage several anatomic structures, including the ligaments [19]. 85% of sprained ankles involve the lateral ligament complex [5]. Lateral ligamentous injury is more prone to injury due to the oblique axis of the subtalar joint that favours supination trauma. In about 65% there is an isolated injury of the anterior talofibular ligament (ATFL) and in 20% both the ATFL and the calcaneofibular ligament (CFL) are involved [5, 6, 10, 19]
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