Strain patterns in normal anterior talofibular and calcaneofibular ligaments and after anatomical reconstruction using gracilis tendon grafts: A cadaver study

Masato Takao,Maya Kubo,Kentaro Matsui,Xavier M Oliva,Yoshitaka Takeuchi,Mai Katakura,Mark Glazebrook,Takayuki Yamazaki,Satoru Ozeki,Danielle Lowe,Ryota Inokuchi

doi:10.1186/s12891-021-04444-w

Abstract

BackgroundInversion ankle sprains, or lateral ankle sprains, often result in symptomatic lateral ankle instability, and some patients need lateral ankle ligament reconstruction to reduce pain, improve function, and prevent subsequent injuries. Although anatomically reconstructed ligaments should behave in a biomechanically normal manner, previous studies have not measured the strain patterns of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) after anatomical reconstruction. This study aimed to measure the strain patterns of normal and reconstructed ATFL and CFLs using the miniaturization ligament performance probe (MLPP) system.MethodsThe MLPP was sutured into the ligamentous bands of the ATFLs and CTLs of three freshly frozen cadaveric lower-extremity specimens. Each ankle was manually moved from 15° dorsiflexion to 30° plantar flexion, and a 1.2-N m force was applied to the ankle and subtalar joint complex.ResultsThe normal and reconstructed ATFLs exhibited maximal strain (100) during supination in three-dimensional motion. Although the normal ATFLs were not strained during pronation, the reconstructed ATFLs demonstrated relative strain values of 16–36. During the axial motion, the normal ATFLs started to gradually tense at 0° plantar flexion, with the strain increasing as the plantar flexion angle increased, to a maximal value (100) at 30° plantar flexion; the reconstructed ATFLs showed similar strain patterns. Further, the normal CFLs exhibited maximal strain (100) during plantar flexion-abduction and relative strain values of 30–52 during dorsiflexion in three-dimensional motion. The reconstructed CFLs exhibited the most strain during dorsiflexion-adduction and demonstrated relative strain values of 29–62 during plantar flexion-abduction. During the axial motion, the normal CFLs started to gradually tense at 20° plantar flexion and 5° dorsiflexion.ConclusionOur results showed that the strain patterns of reconstructed ATFLs and CFLs are not similar to those of normal ATFLs and CFLs.

Highlights

Inversion ankle sprains, or lateral ankle sprains, often result in symptomatic lateral ankle instability, and some patients need lateral ankle ligament reconstruction to reduce pain, improve function, and prevent subsequent injuries
The reconstructed calcaneofibular ligament (CFL) was under the most strain during dorsiflexion-adduction and exhibited less strain (29–62) during plantar flexion-abduction, which was opposite of the normal strain pattern (Fig. 6b)
A previous study evaluated the tensile patterns of normal anterior talofibular ligament (ATFL) and CFLs during three-dimensional motion and reported that the maximal tensile force in the ATFL was observed during supination with plantar flexion and that in the CFL occurred during pronation with plantar flexion [22]

Summary

Introduction

Lateral ankle sprains, often result in symptomatic lateral ankle instability, and some patients need lateral ankle ligament reconstruction to reduce pain, improve function, and prevent subsequent injuries. Lateral ankle ligament repair or reconstruction may be indicated to reduce pain, improve function, and prevent subsequent injuries should more conservative treatment measures fail. Anatomic reconstruction of the lateral ankle ligaments using tendon grafts is the most commonly used surgical technique [12, 13], and it has evolved to become a minimally invasive arthroscopic procedure [14,15,16,17,18]. The anatomically reconstructed ligament is assumed to behave in a biomechanically normal manner, there have not been any publications documenting this assumption

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