Ruan Yaokuan, Wang Shengli, Zhang Nan, Jiang Zhende, Mei Nan, Li Pu, Ren Lei, Qian Zhihui, Chang Fei
Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China.
Key Laboratory of Bionic Engineering (Ministry of Education, China), Jilin University, Changchun, China.
Front Bioeng Biotechnol. 2024 Aug 6;12:1441005. doi: 10.3389/fbioe.2024.1441005. eCollection 2024.
Chronic ankle instability (CAI) carries a high risk of progression to talar osteochondral lesions and post-traumatic osteoarthritis. It has been clinically hypothesized the progression is associated with abnormal joint motion and ligament elongation, but there is a lack of scientific evidence. A total of 12 patients with CAI were assessed during level walking with the use of dynamic biplane radiography (DBR) which can reproduce the positions of each bone. We evaluated the uninjured and CAI side of the tibiotalar and subtalar joint for three-dimensional kinematics differences. Elongation of the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL) were also calculated bilaterally. For patients with CAI, the dorsiflexion of the tibiotalar joint had reduced (21.73° ± 3.90° to 17.21° ± 4.35°), displacement of the talus increased (2.54 ± 0.64 mm to 3.12 ± 0.55 mm), and the inversion of subtalar joint increased (8.09° ± 2.21° to 11.80° ± 3.41°). Mean ATFL elongation was inversely related to mean dorsiflexion angle (CAI: rho = -0.82, < 0.001; Control: rho = -0.92, < 0.001), mean ATFL elongation was related to mean anterior translation (CAI: rho = 0.82, < 0.001; Control: rho = 0.92, < 0.001), mean CFL elongation was related to mean dorsiflexion angle (CAI: rho = 0.84, < 0.001; Control: rho = 0.70, < 0.001), and mean CFL elongation was inversely related to mean anterior translation (CAI: rho = -0.83, < 0.001; Control: rho = -0.71, < 0.001). Furthermore, ATFL elongation was significantly (CAI: rho = -0.82, < 0.001; Control: rho = -0.78, < 0.001) inversely correlated with CFL elongation. Patients with CAI have significant changes in joint kinematics relative to the contralateral side. Throughout the stance phase of walking, ATFL increases in length during plantarflexion and talar anterior translation whereas the elongation trend of CFL was the opposite. This understanding can inform the development of targeted therapeutic exercises aimed at balancing ligament tension during different phases of gait. The interrelationship between two ligaments is that when one ligament shortens, the other lengthens. The occurrence of CAI didn't change this trend. Surgeons might consider positioning the ankle in a neutral sagittal plane to ensure optimal outcomes during ATFL and CFL repair.
慢性踝关节不稳(CAI)进展为距骨骨软骨损伤和创伤后骨关节炎的风险很高。临床上曾推测这种进展与异常的关节运动和韧带延长有关,但缺乏科学证据。共有12例CAI患者在平地上行走时使用动态双平面X线摄影(DBR)进行评估,该技术可以重现每块骨头的位置。我们评估了胫距关节和距下关节未受伤侧与CAI侧的三维运动学差异。还双侧计算了距腓前韧带(ATFL)、跟腓韧带(CFL)和距腓后韧带(PTFL)的延长情况。对于CAI患者,胫距关节背屈减少(从21.73°±3.90°降至17.21°±4.35°),距骨移位增加(从2.54±0.64mm增至3.12±0.55mm),距下关节内翻增加(从8.09°±2.21°增至11.80°±3.41°)。平均ATFL延长与平均背屈角度呈负相关(CAI组:rho = -0.82,P < 0.001;对照组:rho = -0.92,P < 0.001),平均ATFL延长与平均向前平移有关(CAI组:rho = 0.82,P < 0.001;对照组:rho = 0.92,P < 0.001),平均CFL延长与平均背屈角度有关(CAI组:rho = 0.84,P < 0.001;对照组:rho = 0.70,P < 0.001),平均CFL延长与平均向前平移呈负相关(CAI组:rho = -0.83,P < 0.001;对照组:rho = -0.71,P < 0.001)。此外,ATFL延长与CFL延长显著负相关(CAI组:rho = -0.82,P < 0.001;对照组:rho = -0.78,P < 0.001)。与对侧相比,CAI患者的关节运动学有显著变化。在步行的整个站立阶段,ATFL在跖屈和距骨向前平移时长度增加,而CFL的延长趋势则相反。这一认识可为旨在平衡步态不同阶段韧带张力的针对性治疗性锻炼的开展提供依据。两条韧带之间的相互关系是,当一条韧带缩短时,另一条韧带延长。CAI的发生并未改变这一趋势。外科医生在进行ATFL和CFL修复时,可能会考虑将踝关节置于中立矢状面以确保最佳疗效。