de Asla Richard J, Kozánek Michal, Wan Lu, Rubash Harry E, Li Guoan
The Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street - GRJ 1215, Boston, MA 02114, USA.
J Orthop Surg Res. 2009 Mar 16;4:7. doi: 10.1186/1749-799X-4-7.
Despite the numerous in-vitro studies on the mechanical properties and simulated injury mechanisms of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), the in-vivo biomechanical behavior of these two ligaments has not yet been described.
Apparent length of the ATFL and CFL was measured in four ankles in healthy male subjects between 32 and 45 years of age (two left and two right) during a dorsiflexion-plantarflexion and supination-pronation arc of motion using a combined dual-orthogonal fluoroscopic and magnetic resonance imaging technique.
The ATFL elongated from the neutral position at 16.3 +/- 3.0 mm to 20.8 +/- 2.7 mm at maximal plantarflexion and shortened significantly from the neutral position to 13.9 +/- 2.9 mm at maximal dorsiflexion (p = 0.01). The CFL shortened from the neutral position at 28.0 +/- 2.9 mm to 26.6 +/- 2.2 mm at maximal plantarflexion (p = 0.08) and elongated significantly from the neutral position to 29.9 +/- 3.0 mm at maximal dorsiflexion (p = 0.003). The ATFL elongated significantly from 14.8 +/- 2.5 mm at maximal pronation to 17.4 +/- 3.0 mm at maximal supination (p = 0.08). At the same time, the CFL shortened from 31.0 +/- 3.8 mm at maximal pronation to 26.9 +/- 3.6 mm at maximal supination (p = 0.02).
The results showed that the ATFL elongates more during plantarflexion and supination whereas the CFL increases in length with dorsiflexion and pronation. Concurrently, these data also demonstrated the reciprocal function between the two ligaments. While one shortens, the other one elongates. The different elongation of the ATFL and CFL during the same motion arc suggests that under excessive loading conditions the ATFL might be more vulnerable in plantarflexion and supination while the CFL might be more susceptible to injury in dorsiflexion and pronation. Furthermore, in the case of surgical reconstruction the grafts used to reconstruct the two ligaments may need to be tensioned at different positions of the ankle in order to reproduce their natural in vivo function.
尽管针对距腓前韧带（ATFL）和跟腓韧带（CFL）的力学性能及模拟损伤机制进行了大量体外研究，但这两条韧带的体内生物力学行为尚未得到描述。
采用双正交荧光透视与磁共振成像相结合的技术，在32至45岁健康男性受试者的四个踝关节（两左两右）中，于背屈 - 跖屈以及旋前 - 旋后运动弧期间测量ATFL和CFL的表观长度。
ATFL从中立位的16.3±3.0毫米在最大跖屈时延长至20.8±2.7毫米，在最大背屈时从中立位显著缩短至13.9±2.9毫米（p = 0.01）。CFL从中立位的28.0±2.9毫米在最大跖屈时缩短至26.6±2.2毫米（p = 0.08），在最大背屈时从中立位显著延长至29.9±3.0毫米（p = 0.003）。ATFL在最大旋前时从14.8±2.5毫米显著延长至最大旋后时的17.4±3.0毫米（p = 0.08）。同时，CFL在最大旋前时从31.0±3.8毫米缩短至最大旋后时的26.9±3.6毫米（p = 0.02）。
结果表明，ATFL在跖屈和旋后时延长更多，而CFL在背屈和旋前时长度增加。同时，这些数据也证明了两条韧带之间的相互作用。当一条缩短时，另一条延长。在相同运动弧期间ATFL和CFL的不同延长表明，在过度负荷条件下，ATFL在跖屈和旋后时可能更易受损，而CFL在背屈和旋前时可能更易受伤。此外，在手术重建的情况下，用于重建两条韧带的移植物可能需要在踝关节的不同位置进行张紧，以恢复其天然的体内功能。
