Cervical Ligament Research Articles

Artifact Induced by a Transponder During In Vivo Magnetic Resonance Imaging on Horse Brain

Magnetic resonance imaging (MRI) is now widely used in equine veterinary practice. However, the mandatory European legislation regarding horse identification imposes the implantation of a transponder within the fatty tissue of the neck cervical ligament. While performing brain MRI for scientific purposes in ponies, we faced artifacts produced by such transponder and reported here this problem. Indeed, pony mares were anesthetized for 2 hours and placed, bedded on their back, in a 3T MRI scanner. A four-element flexible antenna positioned around the head was used. Three MRI sequences were performed on each animal: three-dimensional T1, three-dimensional T2, and two-dimensional T1. The anesthesia allowed the acquisition of MRI for 2 hours. The images for the three MRI sequences for each pony exhibited great quality on all the anterior parts of the brain but began to become distorted posteriorly to the pineal pituitary axis and completely disappeared at the level of the cerebellum. To find the origin of the artifact, the transponder used for the identification of the animal was inserted in an inert gel and imaged in the same conditions as the ponies. The images obtained looked similar to the observed artifact. Our study thus advocates for the further exploration of such kind of artifact when using 3T MRI in brain imaging in horses.

Subtalar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series.

The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.

Grisel's syndrome associated with tonsillitis.

Non-traumatic subluxation of atlanto-axial joint known as Grisel's syndrome is a rare condition. The pathogenesis of Grisel syndrome in not clear but it seems laxity of cervical ligaments in children and an inflammatory process in neck might cause the syndrome. Here we present a case of Grisel's syndrome, a 9 -year- old boy presented with torticollis and discuss about clinical radiological and treatment aspects of the syndrome.

MRI in diagnosis of cervical posterior longitudinal ligament rupture

Magnetic resonance imaging (MRI) data of 87 patients with suspected cervical posterior longitudinal ligament (PLL) rupture, who underwent cervical spine surgery in Luoyang Orthopedic Hospital from January 2015 to September 2017, were analyzed retrospectively. The criteria of MRI diagnosis for PLL rupture were the low signal image of the PLL on the posterior margin of the vertebral body, the discontinuity or continuous interruption, or the local highlighting signal on the T2 weighted image. According to intraoperative findings, the diagnostic accuracy of MRI for PLL rupture was examined. Among 87 patients, 31 cases were diganosed as PLL rupture by preoperative MRI; and 38 cases were confirmed by intraoperative exploration, of whom 30 were diagnosed with MRI, and 8 were missed by MRI. The accuracy, sensitivity and specificity of MRI in the diagnosis of ruptured PLL were 0.90, 0.79 and 0.98 respectively. MRI has a good diagnostic efficiency in PLL rupture, which can be used for preoperative investigation. Key words: Magnetic resonance imaging; Longitudinal ligaments; Diagnosis

Biomechanics Among Various Techniques of the Cervical Laminoplasty

The nature of cervical spine motions consists of multiple components of the cervical spine, intervertebral disc, ligaments, and adjacent facet joints. Cervical spinal stenosis is disabling and this chronic degenerative disorder commonly occurs in middle age-elderly persons. Surgical options for those spinal cord disorders generally are the anterior or posterior approach. Historically, a conventional multi-level laminectomy was performed to decompress the spinal cord but there is a high rate of late biomechanical complications such as segmental instability, and kyphosis. Laminoplasty was developed to relieve the spinal cord compression and maintain the posterior elements. Lately, there are various techniques of the cervical laminoplasty, the biomechanical impact of these techniques will be described.

Biomechanics Among Various Techniques of the Cervical Laminoplasty

The nature of cervical spine motions consists of multiple components of the cervical spine, intervertebral disc, ligaments, and adjacent facet joints. Cervical spinal stenosis is disabling and this chronic degenerative disorder commonly occurs in middle age-elderly persons. Surgical options for those spinal cord disorders generally are the anterior or posterior approach. Historically, a conventional multi-level laminectomy was performed to decompress the spinal cord but there is a high rate of late biomechanical complications such as segmental instability, and kyphosis. Laminoplasty was developed to relieve the spinal cord compression and maintain the posterior elements. Lately, there are various techniques of the cervical laminoplasty, the biomechanical impact of these techniques will be described.

Clinical study of anterior controllable antedisplacement and fusion for the treatment of cervical ossification of posterior longitudinal ligament

Objective To investigate the clinical effect of anterior controllable antedisplacement and fusion (ACAF) for the treatment of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. Methods The data of 45 cases with cervical posterior longitudinal ligament ossification treated by ACAF from March 2017 to October 2017 were retrospectively analyzed, including 25 males and 20 females, age 45-68 years, average 57.5 years. There were 18 cases involving C3 vertebral body, 30 cases involving C4 vertebral body, 40 cases involving C5 vertebral body, 34 cases involving C6 vertebral body, and 7 cases involving C7 vertebral body. The function of the neural function was evaluated by the Japanese Orthopaedic Association (JOA) scoring system at preoperation and latest follow-up. The curvature of the cervical spine was measured on the lateral X-ray film of the cervical spine, the maximum occupying ratio of the spinal canal was measured on the cross section of the CT scan, and compression of the cervical spinal cord was evaluated by the cervical MRI. Results Patients were followed up for 3 to 6 months (average, 3.9 months). The improvement of neurological function was obtained in all the patients. The JOA score improvement rate at the latest follow-up was 71.3%±9.6%. The cervical lordosis was improved from preoperative 4.5°±3.8° to 10.3°±4.8° at the latest follow-up. The canal stenosis ratio was decreased from preoperative 54.3%±8.2% to 12.5%±5.3% at the latest follow-up. MRI showed that the cervical spinal cord was adequately decompressed in situ. No specific complications were identified that were associated with this technique. Conclusion The present study elaborates the surgical tips and demonstrates the satisfactory outcome of ACAF for the treatment of OPLL. This novel technique has the potential to serve as an alternative surgical technique for the treatment of cervical OPLL. Key words: Cervical vertebrae; Ossification of posterior longitudinal ligament; Treatment outcome

Anatomy of the Tarsal Canal and Sinus in Relation to the Subtalar Joint Capsule.

Anatomical knowledge of the tarsal canal and sinus is still unclear owing to the complexity of the ligamentous structures within them, particularly the relationship with the capsules of the subtalar joints. The aim of this study was to examine the anatomical relationship between the fibrous tissues of the tarsal canal and sinus and the articular capsules of the subtalar joint. We conducted a descriptive anatomical study of 21 embalmed cadaveric ankles. For a macroscopic overview of the subtalar joint, we removed the talus in 18 ankles and separated the fibrous tissues from the surrounding connective tissues to analyze the layered relationship between the inferior extensor retinaculum (IER) and the subtalar joint capsule. Additionally, we histologically analyzed the tarsal canal and the medial and lateral sides of the tarsal sinus using Masson's trichrome staining in 3 ankles. The medial and intermediate roots of the IER and interosseous talocalcaneal ligament (ITCL) were located in the same layer and were connected to each other, between the capsules of the posterior talocalcaneal and talocalcaneonavicular joints. The intermediate root of the IER and the cervical ligament (CL) had adjacent attachments on the tarsal sinus, and synovial tissues originating from the joint capsules filled the remaining area in the tarsal canal and sinus. We determined that the tarsal canal and sinus tarsi contained 3 layered structures: the anterior capsule of the posterior talocalcaneal joint, including the anterior capsule ligament; the layer of ITCL and IER; and the posterior capsule of the talocalcaneonavicular joint, including the CL. The results of this study may help with the understanding of the pathomechanism of subtalar instability and sinus tarsi syndrome, resulting in better treatment.

Differences Between Subtalar Instability and Lateral Ankle Instability Focusing on Subtalar Ligaments Based on Three Dimensional Isotropic Magnetic Resonance Imaging.

The purpose of this study was to assess the differences between subtalar instability (STI) and lateral ankle instability (LAI) focusing on subtalar ligaments using 3-dimensional (3D) isotropic magnetic resonance imaging (MRI). Preoperative MRIs of 10 patients with STI who failed nonoperative treatment and consequently underwent arthroscopic subtalar reconstruction were compared with preoperative MRIs of 23 patients with LAI who underwent ligament repair or reconstruction. Dimensions of anterior capsular ligament (ACL), interosseous talocalcaneal ligament (ITCL), calcaneofibular ligament (CFL), and anterior talofibular ligament (ATFL) were measured. Tears of ACL, ITCL, CFL, ATFL, cervical ligament, and inferior extensor retinaculum were analyzed. Patients with subtalar instability had significantly lower ACL thickness and width than patients with LAI (thickness: 1.48 vs 2.12 mm, P = 0.045; width: 7.30 vs 8.64 mm, P = 0.029). An ACL thickness of 1.8 mm or less had sensitivity and specificity both at 75.0%, and an ACL width of 8 mm or less had sensitivity of 75.0% and specificity of 85.0% for discriminating STI from LAI. Absence or complete tear of ACL was more frequent in patients with STI than in patients with LAI (60.0% vs 13.0%, P = 0.010). The ATFL thickness was significantly greater in patients with LAI (P = 0.001). Complete tear of ATFL was more common in patients with LAI (P = 0.008). Complete tear of CFL was common in both the STI and LAI groups without significant difference (20.0% vs 21.7%). There was no significant difference in thickness and width of ITCL and in CFL thickness. Complete tear of ITCL, cervical ligament, and inferior extensor retinaculum were rare without significant difference. In patients with STI, the ACL is thin and narrow and more commonly absent or torn compared with patients with LAI. Complete tear of ATFL was more common in patients with LAI. Complete tear of CFL was commonly encountered in both the STI and LAI groups.

Effect of Lateral Column Lengthening Calcaneal Osteotomy on Radiographic Measurements of Foot Alignment

Category: Hindfoot Introduction/Purpose: Lateral column lengthening (LCL) with calcaneal osteotomy has been increasingly used for reconstruction in flexible flat foot reconstruction. The aims of this study were to 1) evaluate the effects of variably sized LCL blocks on the restoration of alignment in an acute flat foot cadaveric model; 2) create a computer algorithm to more objectively measure foot alignment; and 3) develop an acute flat foot model that does not require cyclic loading for creating a type IIB flat foot. Determining if overcorrection with lateral column lengthening can occur would provide guidance surgeons to avoid lateral column overload. A computer guided measurement program could make studies more comparable. An acute flat foot model would clarify the ligament deficiencies necessary to create a type IIB flat foot. Methods: A type IIB flat foot model was used in which the medial and medial-plantar fibers of the calcaneonavicular (CN), the interosseous talo-calcaneal (ITCL) and the cervical (CL) ligaments were transected. Metallic markers were placed in the PF origin. 3D weightbearing CT scans were obtained with the specimens in a custom jig that permitted loading with 100 lbs. (445 N). The jig allowed full pronation under load. Scans were obtained: intact, flat, and with 6, 8 and 10 mm LCL blocks. Simulated AP and lateral radiographs were created using a custom MATLAB program. A custom ImageJ plugin was created which guided measurement of Meary’s angle, naviculo-cuneiform overlap, AP talo-first metatarsal angle, and a novel plantar fascia (PF) distance and PF angle. The program automatically calculated midpoints and perpendicular lines from guided user input. Four observers performed all measurements in blinded and randomized fashion on two occasions greater than 12 weeks apart. Results: The ligament sectioning model reliably produced a type IIB flat foot as noted by talo-navicular sag, increased talar head uncovering (forefoot abduction) and divergence of the talus and calcaneus as seen on the AP weightbearing view (Figure 1). Cyclic loading was not required in any specimens and the remaining medial column ligaments were not sectioned. Intraobserver and interobserver comparisons indicated naviculo-cuneiform overlap and plantar fascia distance had excellent interobserver agreement and Meary’s and plantar fascia angle had good interobserver agreement (Figure 1). Lateral column lengthening trended toward overcorrection at 10 mm suggesting a possible threshold for over-correction. Conclusion: The trend toward overcorrection with 10 mm LCL may indicate a threshold for lateral column overload. Computer guided measurement may improve consistency when comparing studies. The PF measurements are not possible in vivo. The use of a heel centering ring might be a surrogate for the implanted metallic beads. The CL sectioning was essential for creating type IIB flat foot without cyclic loading. The CL has been noted to be a main subtalar stabilizer, but has not entered into mainstream discussions regarding flat foot. Changes that occurred with cyclic loading performed in other flat foot studies have not been defined.

Ability of magnetic resonance imaging to accurately determine alar ligament integrity in patients with atlanto-occipital injuries.

Objective:The objective of this study is to evaluate the the reliability of magnetic resonance imaging (MRI) in diagnosing alar ligament disruption in patients with potential atlanto-occipital dissociation (AOD).Materials and Methods:Three-blinded readers performed retrospective review on 6 patients with intra-operative confirmed atlanto-occipital dissocation in addition to a comparison cohort of patients with other cervical injuries that did not involve the atlanto-occipital articulation. Ligament integrity was graded from 1 to 3 as described by Krakenes et al. The right and left ligaments were assessed separately. Inter-observer agreement by patient, by group (AOD vs. non-AOD), and intra-observer agreement was calculated using weighted Cohen's kappa.Results:Interobserver agreement of alar ligament grade for individual patients ranged from slight to fair (κ = 0.05–0.30). Interobserver agreement of alar ligament grade for each group (AOD vs. non-AOD) ranged from fair to substantial (κ = 0.37–0.66). No statistically significant difference in categorical analysis of groups (AOD vs. non-AOD) and grade (0–1 vs. 2–3) was observed. Intraobserver agreement of individual patient's alar ligament grade ranged from moderate to substantial (κ = 0.50–0.62).Conclusion:The use of MRI to detect upper cervical ligament injuries in AOD is imperfect. Our results show inconsistent and unsatisfactory interobserver and intraobserver reliability in evaluation of alar ligament injuries. While MRI has immense potential for detection of ligamentous injury at the craniovertebral junction, standardized algorithms for its use and interpretation need to be developed.

Anatomical and Physiological Differences between Children and Adults Relevant to Traumatic Brain Injury and the Implications for Clinical Assessment and Care.

General and central nervous system anatomy and physiology in children is different to that of adults and this is relevant to traumatic brain injury (TBI) and spinal cord injury. The controversies and uncertainties in adult neurotrauma are magnified by these differences, the lack of normative data for children, the scarcity of pediatric studies, and inappropriate generalization from adult studies. Cerebral metabolism develops rapidly in the early years, driven by cortical development, synaptogenesis, and rapid myelination, followed by equally dramatic changes in baseline and stimulated cerebral blood flow. Therefore, adult values for cerebral hemodynamics do not apply to children, and children cannot be easily approached as a homogenous group, especially given the marked changes between birth and age 8. Their cranial and spinal anatomy undergoes many changes, from the presence and disappearance of the fontanels, the presence and closure of cranial sutures, the thickness and pliability of the cranium, anatomy of the vertebra, and the maturity of the cervical ligaments and muscles. Moreover, their systemic anatomy changes over time. The head is relatively large in young children, the airway is easily compromised, the chest is poorly protected, the abdominal organs are large. Physiology changes—blood volume is small by comparison, hypothermia develops easily, intracranial pressure (ICP) is lower, and blood pressure normograms are considerably different at different ages, with potentially important implications for cerebral perfusion pressure (CPP) thresholds. Mechanisms and pathologies also differ—diffuse injuries are common in accidental injury, and growing fractures, non-accidental injury and spinal cord injury without radiographic abnormality are unique to the pediatric population. Despite these clear differences and the vulnerability of children, the amount of pediatric-specific data in TBI is surprisingly weak. There are no robust guidelines for even basics aspects of care in children, such as ICP and CPP management. This is particularly alarming given that TBI is a leading cause of death in children. To address this, there is an urgent need for pediatric-specific clinical research. If this goal is to be achieved, any clinician or researcher interested in pediatric neurotrauma must be familiar with its unique pathophysiological characteristics.

Subtalar instability: imaging features of subtalar ligaments on 3D isotropic ankle MRI

BackgroundMRI analysis of subtalar ligaments in the tarsal sinus has not been well performed. We retrospectively investigated the appearance of subtalar ligaments using 3D isotropic MRI and compared imaging findings of subtalar ligaments between patients with subtalar instability (STI) and controls.MethodsPreoperative MRIs of 23 STI patients treated with arthroscopic subtalar reconstruction were compared to MRIs of 23 age- and sex-matched control subjects without STI. Thickness and width of anterior capsular ligament (ACL) and interosseous talocalcaneal ligament (ITCL) as well as thickness of calcaneofibular ligament (CFL) and anterior talofibular ligament (ATFL) were measured. Abnormalities in ACL, ITCL, CFL, ATFL, cervical ligament, and inferior extensor retinaculum were analyzed.ResultsSTI patients had significantly smaller ACL thickness and ACL width than controls (ACL thickness: 1.73 mm vs. 2.22 mm, p = 0.007; ACL width: 7.21 mm vs. 8.80 mm, p = 0.004). ACL thickness of ≤2.1 mm had a sensitivity of 66.7% and a specificity of 66.7% for diagnosis of STI. ACL width of ≤7.9 mm had a sensitivity of 80.0% and a specificity of 76.2% for the diagnosis of STI. However, thickness and width of ITCL, thickness of CFL, or thickness of ATFL was not significantly different between the two groups. Absence or complete tear of ACL was significantly more frequent in STI patients than that in controls (34.8% vs. 8.7%, p = 0.035). Complete tear of CFL and ATFL was more common in STI patients than that in controls, although the difference between the two groups was not statistically significant. Abnormalities of ITCL, cervical ligament, or inferior extensor retinaculum were not significantly different between the two groups.ConclusionsMRI features of thin or narrow ACLs may suggest STI. Absence or complete tear of ACL was significantly more common in STI patients than that in controls.

Anatomical Study of the Cervical and Interosseous Talocalcaneal Ligaments of the Foot with Surgical Relevance.

There is conflicting evidence regarding the morphology and orientation of the cervical ligament (CL) and interosseous talocalcaneal ligament (ITCL). The morphology of the CL and its relationship to the ITCL were studied to obtain an understanding of these structures. Twenty-six feet (13 left, 13 right) were obtained from formalin-fixed cadavers (14 females, four males) with the mean standard deviation (SD) age at death 80.9 (12.9) years. All measurements were made with a digital caliper. The length and width of the foot, the width and height of the talus, were measured. The talus was cut coronally to expose the ITCL and qualitative observations were noted. The mean (SD) heights and widths of the CL at the anterior, posterior, superior, and inferior points were 8.27 (2.52), 13.95 (5.96), 9.15 (2.45), and 11.90 (4.30) mm, respectively. The mean (SD) thicknesses of the CL at the superoanterior, superoposterior, inferoanterior, inferoposterior, and central points were 0.62 (0.24), 1.05 (0.30), 0.70 (0.26), 1.20 (0.34), and 0.97 (0.31) mm, respectively. The fibers of the CL are oriented at a slight superoanterior to inferoposterior angle, whereas the fibers of the ITCL are oriented in a slight superomedial to inferolateral angle. The fibers of the CL and ITCL overlap inside the tarsal sinus with the CL positioned anteriorly, which helps to distinguish the two ligaments. In this study, we identified the morphometrics of the CL and described the CL and ITCL qualitatively. These results are relevant to introducing innovative techniques for reconstructive surgery of the subtalar ligaments in order to repair, for example, subtalar instability.

Evaluation of the Ossification of the Cervical Posterior Longitudinal Ligament Utilizing X-Ray, CT and MR Imaging

Evaluation of the Ossification of the Cervical Posterior Longitudinal Ligament Utilizing X-Ray, CT and MR Imaging

Influence of variations in stiffness of cervical ligaments on C5-C6 segment

The ligaments of the cervical spine each play a critical role in maintaining stability. Large variations in the mechanical behavior of each ligament have been reported, but it remains unclear how these variations influence cervical biomechanics. The objective of this study was to investigate the mechanical response of the cervical spine to variations in the properties of each cervical ligament. A finite element model of the C5-C6 spine was constructed with the average material properties. The stiffness of each ligament was then changed in turn by increasing or decreasing it per its designated maximum or minimum stiffness. The range of motion (ROM) and intradiscal pressure (IDP) were calculated and compared among the different models under pure moments. The results showed that the capsular ligament with the greatest stiffness caused a lower ROM in all anatomical planes. Varying the stiffness of the anterior longitudinal ligament had the greatest influence on ROM in extension, while the interspinous ligament was the most influential in flexion. During lateral bending or axial rotation, the capsular ligament with the minimum stiffness resulted in a higher IDP, while the capsular ligament with the maximum stiffness resulted in a lower IDP. Varying the capsular ligament stiffness had the greatest role on the C5-C6 ROM and therefore care must be taken to assign appropriate material properties. This study showed a less influence on the intervertebral disc with smaller ROM, especially when the ligaments were relaxed. This suggested that the control of the neck posture may be beneficial for patients with a degenerated cervical spine.

Commentary on: Characterization of the Cervical Retaining Ligaments During Subplatysmal Facelift Dissection and its Implications.

Commentary on: Characterization of the Cervical Retaining Ligaments During Subplatysmal Facelift Dissection and its Implications.

Characterization of the Cervical Retaining Ligaments During Subplatysmal Facelift Dissection and its Implications.

The cervical retaining ligaments anchor the platysma and soft tissues of the neck to the deep cervical fascia and deeper skeletal structures. The cervical retaining ligaments tether the platysma and prohibit free mobilization and redraping of the platysma muscle in rhytidectomy. This ligament system has previously been described in the literature only qualitatively. To define the anatomic dimensions of the cervical retaining ligaments and their relation to the platysma muscle in order to better understand the cervical retaining ligament system and how it limits motion of the platysma during rhytidectomy. Extended deep plane rhytidectomy was performed on 20 fresh cadaveric hemifaces. The extent cervical retaining ligaments were dissected and measured. The anterior extent (width) of the cervical ligament were recorded at three anatomic points on each hemiface: (1) at the level of the inferior border of the mandible; (2) at the top of the thyroid cartilage at the thyroid notch; and (3) at the level of the cricoid. The average width of the cervical retaining ligaments in the neck was 15.3 mm. The width significantly decreased as they became more inferiorly positioned from the top of the neck at the anatomic measurement points, measuring 17.1 mm, 16.1 mm, and 12.6 mm (P < 0.05). The cervical retaining ligaments are the support mechanisms of the platysma muscle in the neck. While previously described in only a qualitative manner, this study quantifies the anterior extent of these ligaments and how they invest the lateral platysma muscle. As these ligaments tether the platysma for an average of 1.5 cm, lateral platysma elevation of this distance during rhytidectomy surgery can improve platysmal redraping during rhytidectomy and potentially improve neck rejuvenation.

Effect of Direct Ligament Repair and Tenodesis Reconstruction on Simulated Subtalar Joint Instability.

Subtalar instability is associated with up to 80% of patients presenting with chronic ankle instability but is often not considered in the diagnosis or treatment. Operative procedures to repair ankle instability have shown good clinical results, but the effects of these reconstruction procedures on isolated subtalar instability are not well understood. The goal of this study was to investigate the effect of the Gould modification of the Broström procedure and a new tenodesis reconstruction procedure on ankle and subtalar joint kinematics after simulating a subtalar injury. Kinematic data were collected on 7 cadaveric ankles during inversion through the range of ankle flexion and during internal rotation. Testing was performed on the intact foot; after sectioning the calcaneofibular ligament, cervical ligament, and interosseous talocalcaneal ligament; after the Gould modification of the Broström procedure was performed; and after tenodesis was performed and sutures from the Gould modification removed. The Gould modification of the Broström procedure significantly decreased subtalar and ankle inversion motion and subtalar internal rotation compared to the unstable condition. The tenodesis method restricted internal rotation at the subtalar joint and ankle inversion compared to the intact state. Both operative procedures improved stability of the ankle complex, but tenodesis was unable to restore subtalar inversion and restricted ankle inversion in maximum plantarflexion. The Gould modification of Broström ligament repair may be a favorable operative procedure for the restoration of subtalar and ankle joint kinematics.

Evaluation of Cervical Capsular Ligament Injuries Following Whiplash Injury

Evaluation of Cervical Capsular Ligament Injuries Following Whiplash Injury