The effects of damage to and surgical repair of the lateral ankle ligaments on the passive flexibility of the hindfoot

Le résumé fourni par la source

The purpose of this study was to investigate the effects of damage to the lateral collateral ligaments of the ankle and their subsequent surgical repair on the three dimensional passive flexibility characteristics of the hindfoot. For this purpose, tests were conducted on six fresh cadaver legs prior to and following serial sectioning of the anterior talofibular ligament (ATFL) followed by the calcaneofibular ligament (CFL) and after performing four surgical procedures (Evans, Watson-Jones, Chrisman-Snook and Burks). Five patients with ankle injuries were also tested for comparison with the in-vitro data. The tests were performed with a mechanical linkage that permitted the manual application of forces and torques about the ankle and recorded these values as well as the resulting motion. Flexibility parameters were defined and quantified in each direction from this data. The tests performed on the ankles included loading them in the internal/external rotation, inversion/eversion and anterior drawer directions. The results of the in-vitro study indicated that both an isolated rupture of the ATFL and combined ATFL & CFL damage produced statistically significant changes in flexibility. These flexibility parameters provided a basis for differentiating between an isolated ATFL injury and a combined ATFL & CFL injury as follows. For an isolated ATFL injury a significant increase in flexibility in anterior drawer direction is present. There was no significant increase in inversion flexibility or coupling with this injury. However, when both ligaments were involved the increase in inversion flexibility and in the amount of coupling became significant. Of the surgical procedures the Evans provided the closest approximation of the intact ankle in the inversion and anterior drawer directions. However, increases in stiffness beyond the normal ankle were seen in internal rotation with this procedure and the Chrisman-Snook and Watson-Jones. The Burks procedure, did improve the flexibility characteristics of the injured ankle without limiting flexibility in any direction. The results of the flexibility tests conducted on the five patients were consistent with the changes in flexibility seen in the in-vitro results of the ligament deficient ankles.

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