Gregersen Martin G, Fagerhaug Dalen Andreas, Nilsen Fredrik, Molund Marius
Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Grålum, Norway.
Orthopaedic Department, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway.
Foot Ankle Orthop. 2022 Jun 14;7(2):24730114221104078. doi: 10.1177/24730114221104078. eCollection 2022 Apr.
Deltoid ligament injury occurs often with supination-external rotation (SER) ankle trauma. SER fibula fractures with concomitant deltoid ligament injury are considered unstable-requiring operative fixation. Recent studies have questioned this general practice with emphasis on better defining the medial side ankle ligamentous injury. The function of the individual bands of the deltoid ligament, and the interplay between them, are not fully understood. We undertook this study to develop a better understanding of these complex ligamentous structures and ultimately aid assessment and treatment choice of SER ankle fractures with concomitant deltoid ligament injuries.
Ten fresh-frozen cadaveric foot and ankle specimens were studied. We identified the various ligament bands and did a functional analysis by assessment of ligament length and tension at predefined angles of ankle dorsi-plantarflexion combined with valgus/varus and rotation. The results were determined by manual evaluation with calipers and goniometers, manual stress, and direct visualization.
We recorded primarily 5 different bands of the deltoid ligament: the tibionavicular (TNL; 10/10) tibiospring (TSL; 9/10), tibiocalcaneal (TCL; 10/10), deep anterior tibiotalar (dATTL; 9/10), and deep posterior tibiotalar (dPTTL; 10/10) ligaments. The tibiospring ligament was tense in plantarflexion, while the tibiocalcaneal and deep posterior tibiotalar ligaments were tense in dorsiflexion. The superficial layer ligaments and the deep anterior tibiotalar ligament length and tension were largely affected by changes in varus/valgus and rotation. The deep posterior tibiotalar ligament length and tension was altered predominantly by changes in dorsi-plantarflexion; varus/valgus positioning had a minor effect on this band.
We confirmed the finding of previous studies that dorsi-plantarflexion affects the tensile engagement of the separate ligament bands differently. Likewise, combined movements with varus/valgus and rotation seem to affect the separate ligament bands differently. Our results suggest that the TNL, TSL, and dATTL are at risk of injury, whereas the TCL and particularly the dPTTL are protected in the event of an SER-type ankle fracture mechanism of injury.
Level V, cadaveric study.
三角韧带损伤常伴发于旋后-外旋型（SER）踝关节创伤。伴有三角韧带损伤的SER腓骨骨折被认为不稳定，需要手术固定。近期研究对这种普遍做法提出质疑，强调要更好地明确踝关节内侧韧带损伤情况。三角韧带各束的功能以及它们之间的相互作用尚未完全明确。我们开展这项研究以更深入了解这些复杂的韧带结构，并最终辅助评估和选择伴有三角韧带损伤的SER踝关节骨折的治疗方法。
对10个新鲜冷冻的尸体足踝标本进行研究。我们识别出不同的韧带束，并通过在踝关节背伸-跖屈的预定义角度联合外翻/内翻及旋转时评估韧带长度和张力进行功能分析。结果通过用卡尺和量角器进行手动评估、手动施加应力以及直接观察来确定。
我们主要记录到三角韧带的5条不同束：胫舟韧带（TNL；10/10）、胫弹簧韧带（TSL；9/10）、胫跟韧带（TCL；10/1）、胫距前深层韧带（dATTL；9/10）和胫距后深层韧带（dPTTL；10/10）。胫弹簧韧带在跖屈时紧张，而胫跟韧带和胫距后深层韧带在背伸时紧张。浅层韧带和胫距前深层韧带的长度和张力在很大程度上受内翻/外翻及旋转变化的影响。胫距后深层韧带的长度和张力主要受背伸-跖屈变化的改变；内翻/外翻定位对该束的影响较小。
我们证实了先前研究的发现，即背伸-跖屈对不同韧带束的拉伸参与情况影响不同。同样，内翻/外翻及旋转的联合运动似乎对不同韧带束的影响也不同。我们的结果表明，在SER型踝关节骨折损伤机制中，TNL、TSL和dATTL有损伤风险，而TCL尤其是dPTTL受到保护。
V级，尸体研究。
