Lateral Ankle Ligament Injuries Affecting Syndesmotic Stability: A Finite Element Study

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ABSTRACT Background Lateral ankle ligament sprains are the most common ankle injuries and frequently result in chronic instability. As the syndesmotic ligament complex is crucial for maintaining ankle stability, this study employs finite element analysis to investigate how injuries to the lateral ligaments affect the stability of the syndesmotic. Method A finite element model of the ankle was developed from CT data of healthy adults. Sequential removal of ligament structures was performed to establish separate and combined injury models involving the lateral ligaments and the syndesmotic ligament. By simulating the anterior drawer test and the inversion stress test, the following parameters were evaluated: ligament von Mises stress, strain, talar displacement, and fibular movement. Results Under simulated inversion stress, lateral ligament injury significantly increased talar displacement and redistributed stress within the syndesmotic complex. Von Mises stress rose substantially in all primary syndesmotic structures: the anterior inferior tibiofibular ligament (1.11–4.03 MPa), the interosseous membrane (0.63–7.34 MPa), and the posterior inferior tibiofibular ligament (1.1–5.01 MPa). Combined injury models exhibited aggravated ankle instability with greater fibular motion. Adding an anterior talofibular ligament injury to a syndesmotic injury increased lateral fibular translation from 0.18 to 0.51 mm, posterior fibular translation from 0.019 to 0.153 mm, and fibular external rotation from 7.96 to 8.41°. Conclusions: Damage to the lateral ligaments significantly undermines syndesmotic stability, whereas isolated injuries to the syndesmosis itself have a negligible effect on overall ankle joint stability.

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