Milstrey Alexander, Hoell Vivienne, Weigel Ann-Sophie C, Wermers Jens, Gartung Stella, Evers Julia, Raschke Michael J, Ochman Sabine
Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany.
Department of Trauma Surgery and Orthopedics, Protestant Hospital of the Bethel Foundation, Bielefeld University, 33615 Bielefeld, Germany.
Bioengineering (Basel). 2025 Jun 23;12(7):685. doi: 10.3390/bioengineering12070685.
: This study investigated syndesmotic stability after transection and the effects of stabilization using rigid and dynamic reconstruction techniques. : Syndesmotic stability was analyzed using a six-degree-of-freedom robotic arm on 14 human specimens. Stability was analyzed in the neutral position and during dorsiflexion and plantar flexion using an external rotation stress test under an axial load of 200 Newtons. The examination was performed on intact and sequentially transected syndesmosis in the following order: (1) anterior inferior tibiofibular ligament (AITFL); (2) interosseous ligament (IOL); and (3) posterior inferior tibiofibular ligament (PITFL). Then, reconstruction was performed using different syndesmotic screw techniques or a dynamic Suture Button system (Arthrex TightRope; n = 7). : A syndesmotic transection mainly caused sagittal instability of the fibula. While both static and dynamic reconstruction provided stabilization, screw fixation, particularly with two screws and a plate, demonstrated superior control of the fibular movement, especially in the sagittal and transverse planes, compared to one Suture Button. : The results suggest that syndesmotic stabilization with one Suture Button may be insufficient for cases involving three-ligamentous injuries, whereas two Suture Buttons may offer comparable biomechanical stability to syndesmotic screws. Additionally, the study suggests that lateral radiographs may provide additional clinical value in assessing syndesmotic stability.
本研究调查了横断后下胫腓联合的稳定性以及使用刚性和动态重建技术进行稳定的效果。使用六自由度机器人手臂对14个人体标本的下胫腓联合稳定性进行了分析。在中立位以及背屈和跖屈时，在200牛顿轴向载荷下通过外旋应力试验分析稳定性。检查按以下顺序在完整的和依次横断的下胫腓联合上进行：(1) 胫腓前下韧带（AITFL）；(2) 骨间韧带（IOL）；以及(3) 胫腓后下韧带（PITFL）。然后，使用不同的下胫腓联合螺钉技术或动态缝线纽扣系统（Arthrex TightRope；n = 7）进行重建。下胫腓联合横断主要导致腓骨矢状面不稳定。虽然静态和动态重建均提供了稳定性，但与一个缝线纽扣相比，螺钉固定，尤其是双螺钉加钢板固定，在控制腓骨运动方面表现更优，特别是在矢状面和横断面。结果表明，对于涉及三条韧带损伤的病例，使用一个缝线纽扣进行下胫腓联合稳定可能不足，而两个缝线纽扣可能提供与下胫腓联合螺钉相当的生物力学稳定性。此外，该研究表明，在评估下胫腓联合稳定性时，外侧位X线片可能具有额外的临床价值。
