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At least 19 recordsLinked to original sources
PubMed1996

[Weil's metatarsal osteotomy in the treatment of metatarsalgia].

The Weil distal shortening osteotomy of the lesser metatarsals has been used by the author since June 1992, particularly in the treatment of metatarsalgia. Its advantages are a direct approach to the metatarsophalangeal (MP) joint and the metatarsal head, providing not only correction of the deformity, but accurate control of the metatarsal shortening, primary healing and early functional recovery thanks to the strong fixation allowed by the twist-off screw. Its disadvantage is the limitation of MP articular range motion, which is temporary in most cases. The role of the Weil osteotomy in metatarsalgia is to bring the metatarsal head behind the callus and to provide an axial decompression resolving the hammer toe deformity or MP luxations that are increasing or resulting in metatarsalgia. In cases of metatarsalgia resulting from the first ray insufficiency, the Weil osteotomy is a fair, reliable and efficient procedure; it is also good in cases when the small metatarsal bones are too long. However, shortening the metatarsal bones has to be part of general forefoot therapeutic management. In isolated metatarsalgia, the indication may be slightly difficult, indicating a "slimming" resection. In contrast, both in important metatarsalgia, and generally in severe forefoot disorders, the Weil osteotomy, together with the scarf osteotomy, constitutes a real surgical improvement, opening a new means of articular conservative treatment of severe static disorders.

Bone Screws↗
PubMed1997

[Botulinum toxin in spastic infantile cerebral palsy: results in 27 cases during one year].

INTRODUCTION AND OBJECTIVES: Positive outcome of patients with spastic cerebral palsy treated with botulinum toxin reported in the last three years has led us to perform this study with the aim to show our experience in the management of spastic cerebral palsy with the toxin, determine its indications, analyze the results and propose new possible indications in the future. MATERIAL AND METHODS: We include 10 hemiplegic and 17 diplegic patients with an average age of 6 years and 7 months, followed up between 5 and 17 months. Clinical improvement was monitored using the PRS and EVFEL scales and articular motion range was measured 6 months before and after the injection while continuing physiotherapy. The injected muscles were adductor, hamstrings, triceps and posterior tibialis, and the doses were 1-2 U/muscle/kg body weight. RESULTS: The values on PRS improved an average of 24%, adductor angle 66% (p < 0.01), knee angle 40% (p = 0.05) and ankle angle 52% (p < 0.01); 96% of patients could get more physiological static or walking patterns because of the decrease of spasticity and those persisted after the effect of the toxin had worn off. It was maximum at 2 months, stabilized 4 to 6 months later and decreased during further 2 months. CONCLUSIONS: This experience leads us to propose higher starting dosage and to take into account the stability of postural pattern of each patient to choice the muscle to be injected. Other therapeutic possibilities are also proposed in children with fixed shortening e.g. combining the toxin with stretching casts.

Adolescent↗
PubMed2006

Evaluation of physiotherapy in the treatment of Legg-Calvé-Perthes disease.

INTRODUCTION: Physiotherapy using muscle strengthening and stretching exercises is claimed to have beneficial effects in the treatment of Legg-Calvé-Perthes disease; however, no scientific evidence is available concerning effectiveness of treatment. PURPOSE: The purpose of the present study was to clinically evaluate possible effects of the proposed physiotherapeutic effects compared to observational follow-up in patients with Legg-Calvé-Perthes disease. METHOD: A prospective follow-up study was conducted in 17 patients with unilateral Legg-Calvé-Perthes disease, divided into 2 groups: Group A (observational follow-up) and Group B (physiotherapeutic follow-up). In order to evaluate the outcome of the adopted treatments, the following parameters were assessed: articular range of motion, level of muscular strength, level of articular dysfunction, and radiographic status, both before and after the treatment. RESULTS: Group B exhibited significant improvement in articular range of motion concerning hip flexion, extension, abduction, adduction, medial rotation, and lateral rotation, while in Group A an equally significant worsening occurred concerning abduction, adduction, and medial rotation. Muscular strength also improved in Group B, mainly in the set of hip flexor muscles, while Group A showed no changes. Articular dysfunction after therapy compared to pretherapy was significantly reduced in Group B and increased in Group A. Patients undergoing physiotherapy exercises showed no changes in their radiographic features. CONCLUSION: Physiotherapy produced significant improvement in articular range of motion, muscular strength, and articular dysfunction in patients with Legg-Calvé-Perthes disease, but these improvements were not evident on radiographs.

Child↗
PubMed1998

Arthroscopic treatment of malunited and nonunited avulsion fractures of the anterior tibial spine.

Ten patients, presenting with a 10 degrees to 25 degrees deficit of knee extension after an avulsion fracture of the anterior tibial spine, were arthroscopically treated with debridement and abrasion of the anterior spine. Notchplasty was also performed in five cases where there was a more severe deficit of extension. At follow-up (mean: 39.4 months) eight patients had recovered the full articular range of motion of the knee whereas two had a slight residual deficit of extension of between 3 degrees and 5 degrees. In no case was ligament stability compromised as compared with preoperative assessment.

Adolescent↗
PubMed1995

Intra-articular pressure, elastance, and range of motion in flexion of the equine metacarpophalangeal joint.

A study was done to determine whether intra-articular pressure is increased in equine metacarpophalangeal joints with increasing degrees of synovial distention, and to correlate elastance of the soft tissue forming the dorsal pouch of the metacarpophalangeal joint to maximal range of motion in flexion. Sixty seven metacarpophalangeal joints in 36 horses were categorized by palpation and visual inspection of the palmar pouch into 1 of 4 increasing grades of distention. Intra-articular pressures were then measured, using 2 pressure transducers attached to 22 gauge needles, from the dorsal and palmar pouches simultaneously while horses stood squarely under mild sedation. Intra-articular pressure ranged from -13 to +78 mm of Hg. Mean (+/- SEM) palmar pouch pressure was subatmospheric (-2.53 +/- 2.78 mm of Hg) in joints in which the palmar pouch was not discernible (grade 0), and was markedly increased (+37.13 +/- 2.775 mm of Hg) in joints in which the palmar pouch was distended laterally beyond the lateral branch of the suspensory ligament (grade 3). Grade of distention was positively correlated with intra articular pressure (r = 0.758; P < 0.001). Significant compartmentation (P < 0.002) was observed between the dorsal and palmar pouches in all horses. In 25 of the aforementioned horses, (42 joints), which were active or retired Thoroughbred racehorses with variable degree of metacarpophalangeal joint injury/disease, a third needle was inserted into the dorsal pouch, and 0.5-ml increments of saline solution were added every 10 seconds to perform a pressure/volume (elastance) study of the dorsal pouch. The elastance study for each joint ended when leakage into the palmar pouch was detected by the pressure transducer placed in that region. A flexed lateral radio graphic view was taken of each metacarpophalangeal joint in maximal flexion. The maximal angle of flexion was measured from the radiograph, and this angle was subtracted from 180 degrees to acquire the range of motion in flexion. Range of motion in flexion has strong negative correlation (r= -0.68; P < 0.0001) with elastance (stiffness) of the dorsal pouch, and moderate pouches (r= -0.48; P < 0.0001). To adjust for the possible correlations resulting from repeated measures on limbs within horses, a normal linear mixed model was used to assess the effect of limb (right vs left), range of motion in flexion, and volume of saline solution added on the dependent variable (delta mm of Hg) in the elastance study. There was no significant limb effect, but a highly significant effect regarding volume of saline solution added (P < 0.00001) and range of motion in flexion (P < 0.00001). Loss of range of motion in flexion of this joint is associated with shortening or loss of the initial low elastance (flat) phase of the elastance profile. Measuring the elastance of the dorsal pouch or measuring maximal range of motion in flexion provides an objective measure of the degree of metacarpophalangeal joint stiffness secondary to joint disease.

Animals↗
PubMed1995

The scapholunate allograft: a biomechanical feasibility study.

The feasibility of a new method for reconstruction of the isolated scapholunate ligament tear with a scapholunate allograft was studied biomechanically using a fresh cadaver upper extremity model. Seven specimens were first tested intact for wrist range of motion, contact characteristics of the radiocarpal articulation, and relative motion of the scaphoid with respect to the lunate. Then a segment consisting of the radial third of the lunate, the adjoining scapholunate interosseus ligament, and the proximal pole of the scaphoid was resected. This segment was matched to a donor allograft of similar size and geometry, which was then placed into the recipient carpus and secured with one central transverse Kirschner wire and two shorter interfragmentary Kirschner wires placed into the lunate and scaphoid. The allografted specimen was subjected to the same tests as the intact wrist. Results showed that there were no significant differences in wrist range of motion, radiocarpal articular surface contact area and pressure, and relative flexion-extension rotation between the scaphoid and lunate during passive radioulnar deviation between the intact and allografted wrists.

Biomechanical Phenomena↗
PubMedDate not supplied

The effect of articular malposition after total shoulder arthroplasty on glenohumeral translations, range of motion, and subacromial impingement.

The articular surface of the normal humeral head has a variable posterior and medial offset with respect to the central axis of the humeral shaft. Recreation of the normal humeral head shaft offset is postulated to be an important consideration during shoulder arthroplasty. However, the effect of humeral head malposition is unknown. The purpose of this study was to determine the effect of articular malposition after total shoulder arthroplasty on glenohumeral translation, range of motion, and subacromial impingement. Twenty-one human cadavers were dissected and tested with the use of an active or passive shoulder model. Range of motion and translation were recorded by means of an electromagnetic tracking device. The experiment was performed in 2 phases. For kinematics study, 11 cadaver shoulders were positioned both passively and actively from maximum internal rotation to maximum external rotation at 90 degrees of total elevation in the scapular plane. Three rotator cuff and 3 deltoid muscle lines of action were simulated for active joint positioning. Passive joint positioning was accomplished with the use of a torque wrench and a nominal centering force. The testing protocol was used for the natural joint as well as for 9 prosthetic head locations: centered and 2- and 4-mm offsets in the anterior, posterior, inferior, and superior directions. Repeated-measures analysis of variance was used to test for significant differences in the range of motion and translation between active and passive positioning of the natural joint as well as all prosthetic head positions. (2) For impingement study, 10 cadaver shoulders were used in a passive model, loading the tendons of the rotator cuff with a 30-N centering force. The humerus was passively rotated from maximum internal rotation (1500 Nmm) to maximum external rotation (1500 Nmm) by means of a continuous-recording digital torque wrench. Trials were performed with the use of centered, 4-, 6-, and 8-mm offset heads in the anterior, posterior, superior, and inferior positions before and after removal of the acromion and coracoacromial ligament. The relation between change in mean peak torque (with and without acromion), passive range of motion, and humeral head offset was analyzed by means of repeated-measures analysis of variance. In the kinematics study, total range of motion and all humeral translations were greater with passive joint positioning than with active positioning (P =.01) except for total superior-inferior translation and superior-inferior translation in external rotation. Anterior to posterior humeral head offset was associated with statistically significant changes in total range of motion (P =.02), range of internal rotation (P =.02), range of external rotation (P =.0001), and total anterior-posterior translation (P =.01). Superior to inferior humeral head offset resulted in statistically significant changes in total range of motion (P =.02), range of internal rotation (P =.0001), anterior-posterior translation during external rotation (P =.01), and total superior-inferior translation (P =.03). In the impingement study, there was a significant increase in torque from centered to 4-mm inferior offset (P =.006), 6-mm inferior offset (P <.001), and 8-mm inferior offset (P <.001). There was no significant increase in torque with superior, anterior, and posterior offsets. Glenohumeral motion significantly decreased from 129 degrees for centered head to 119 degrees for 8-mm superior (P =.002), 119 degrees for 8-mm anterior (P =.014), 118 degrees for 8-mm inferior (P <.001), and 114 degrees for 8-mm posterior (P =.001). Humeral articular malposition of 4 mm or less during prosthetic arthroplasty of the glenohumeral joint may lead to small alterations in humeral translations and range of motion. Inferior malposition of greater than 4 mm can lead to increased subacromial contact; offset of 8 mm in any direction results in significant decreases in passive range of motion. Therefore if subacromial contact is to be minimized and glenohumeral motion maximized after shoulder replacement, anatomic reconstruction of the humeral head-humeral shaft offset to within 4 mm is desirable.

Adult↗
PubMed1998

Intra-articular pressure, elastance and range of motion in healthy and injured racehorse metacarpophalangeal joints.

The objective of this study was to determine if intraarticular pressure, elastance of the soft tissue forming the dorsal pouch, and range of motion in flexion measurements are significantly different in Thoroughbred metacarpophalangeal joints with clinical evidence of idiopathic synovitis, primary synovitis, synovitis/capsulitis, or osteoarthritis relative to clinically normal joints. Forty-two metacarpophalangeal joints, in 25 active or retired Thoroughbred racehorses, were categorised by palpation and visual inspection of the palmar pouch into one of 4 increasing grades of distention. Intra-articular pressures were then measured using 2 pressure transducers attached to 22-gauge needles from both the dorsal and palmar pouches simultaneously while the horses stood squarely under mild sedation. After obtaining baseline pressure measurements, a third needle was inserted into the dorsal pouch, and 0.5 ml increments of saline solution were added every 10 s to perform a pressure/volume (elastance) study of the dorsal pouch. The elastance study for each joint ended when leakage into the palmar pouch was detected by the pressure transducer placed in that region. A lateral radiographic view was taken of each metacarpophalangeal joint in maximal flexion. The maximum angle of flexion was measured from the radiograph, and this angle was subtracted from 180 degrees to acquire the range of motion in flexion. In this study, all Thoroughbreds with clinical evidence of lameness and/or sensitivity to flexion, referable to the metacarpophalangeal joint region, had fluid distention of the palmar pouch (grade 2 or 3 distention). The 16 metacarpophalangeal joints with no clinical abnormalities had a mean palmar pouch pressure of -1.25 mmHg. Joints afflicted with synovitis/capsulitis had the highest intraarticular pressures (mean +51.00 mmHg); however, joints with idiopathic synovitis (mean +15.71 mmHg), primary synovitis (mean +28.33 mmHg) and osteoarthritis (mean +26.20 mmHg) also had significantly elevated intraarticular pressures relative to the clinically normal group. Thoroughbred metacarpophalangeal joints diagnosed with synovitis/capsulitis, or osteoarthritis, had significantly increased elastance (stiffness) of the soft tissue forming the dorsal pouch relative to the normal group and, probably, as a result significantly decreased range of motion in flexion. The presence of primary synovitis alone did not have a significant immediate effect on elastance of the dorsal pouch and range of motion in flexion. The 16 Thoroughbred metacarpophalangeal joints assessed as having no clinical abnormalities had a mean range of motion in flexion of 60.81 degrees. The mean range of motion in flexion of Thoroughbred metacarpophalangeal joints with a clinical diagnosis of primary synovitis was 53.67 degrees; idiopathic synovitis 52.14 degrees; synovitis/capsulitis 44.20 degrees; and those with radiographic evidence of moderate to marked osteoarthritis 30.80 degrees. This study demonstrated that, as the severity of the clinical evidence of metacarpophalangeal joint injury/disease increased, the range of motion in flexion decreased.

Analysis of Variance↗
PubMed1995

Biomechanical changes after carpal tunnel release: a cadaveric model for comparing open, endoscopic, and step-cut lengthening techniques.

We used a previously described cadaveric model for evaluating changes in flexor tendon biomechanics after open carpal tunnel release to evaluate endoscopic and step-cut lengthening techniques. A 26% and 18% increase in tendon excursion consumed by wrist motion was demonstrated for flexor digitorum profundus and flexor digitorum superficialis tendons respectively after open transection of the transverse carpal ligament. A 21% and 15% increase in tendon excursion was demonstrated after endoscopic carpal tunnel release and a 21% and 16% increase after step-cut lengthening of the transverse carpal ligament. Increased excursion was noted after 20-30 degrees of wrist flexion as tendon bowstringing occurred. Although division of the transverse carpal ligament by all methods resulted in a significant increase in tendon excursion, the differences between methods of carpal tunnel release were not significant. This cadaveric study evaluates one potential cause for weakness after carpal tunnel release, palmar displacement of the flexor tendons, which results in increased flexor tendon excursion consumed by wrist motion.

Arthroscopy↗
PubMed1995

Ligamentous and tendinous support of the pisiform: anatomic and biomechanical study.

Twenty-five formalin-preserved cadaveric wrists were dissected and the relationship of the pisotriquetral joint (PTJ) and its surrounding soft tissue structures were defined. An additional 4 fresh frozen wrists were examined in longitudinal and transverse sections. These anatomical studies showed the extensor retinaculum to have a complex insertion into the pisiform, flexor carpi ulnaris, fifth metacarpal, pisometacarpal ligament, and the abductor digiti minimi muscle. A capsuloligamentous structure on the medial aspect of the pisotriquetral joint was also identified. Biomechanical testing was performed on 12 fresh cadaver wrists and the results were compared to the anatomical findings to determine the contribution of surrounding soft tissue structures to pisotriquetral joint stability. Mechanical testing showed the soft tissues around the pisotriquetral joint to be strongest proximally and distally and weakest medially. Transection of the transverse carpal ligament resulted in increased lateral motion of the pisiform, but there was no significant decrease in stiffness. This study provides insight into the etiology of pisotriquetral joint instability and dysfunction.

Biomechanical Phenomena↗
PubMed2002

Clinical application of advances in elbow and forearm anatomy and biomechanics.

The static and dynamic stabilizers of the elbow and forearm axis are closely interrelated in elbow and forearm unit motion and load handling. An [figure: see text] understanding of elbow and forearm anatomy is crucial to the surgeon evaluating and treating complex pathologies resulting from acute or remote trauma.

Biomechanical Phenomena↗
PubMed2005

Intervertebral motion after incremental damage to the posterior structures of the cervical spine.

STUDY DESIGN: Compare intervertebral motion after incremental damage to posterior cervical structures in whole cadavers to motion in asymptomatic subjects. OBJECTIVE: Determine if damage to the posterior structures of the cervical spine can be detected by quantitative analysis of flexion-extension radiographs. SUMMARY OF BACKGROUND DATA: Simulated damage to the posterior structures of the cervical spine can change intervertebral motion, if intervertebral motion before damage is known. It is not known if intervertebral motion measured from flexion-extension radiographs can be used to detect damage to the posterior structures if motion before damage is not known. METHODS: Incremental injury to posterior ligaments and facet joints was simulated in 12 whole cadavers. Intervertebral motion was measured from flexion-extension images using validated and clinically applicable software. Measurements were compared to previously published measurements for asymptomatic subjects. RESULTS: Extensive damage could be simulated in all the cervical spines without intervertebral motion exceeding the 95% confidence limits for asymptomatic subjects. After sectioning all posterior ligaments, destroying both facet joints, and then sectioning the posterior longitudinal ligaments, intervertebral motion exceeded the 95% confidence intervals in 69% of the cadavers. Intervertebral shear decreased with incremental damage to posterior structures. CONCLUSIONS: Radiographic assessment of the cervical spine may not be sufficient to exclude even extensive damage to the posterior structures of the cervical spine.

Arthrography↗
PubMed1993

Kinematics of the wrist and its ligaments.

Precise anatomic dissections of unembalmed physiologically intact cadaver specimens were carried out before proceeding with the kinematic investigations on further specimens. Carpal flexor and extensor tendons were used to move the wrist. The analysis of the carpal bone movements was performed according to the finite helical axis motion concept for increments of 10 degrees for each main carpal motion. Separate axes of rotation for each of the bones in the proximal carpal row were found; however, the axes for the lunate and triquetrum bones were close, and the magnitudes of rotation and translation almost equal. One finding was that the axes of rotation of the bones in the proximal carpal row often cross at some particular point. Because the axes of the scaphoid are differently oriented than those of the lunate and triquetrum, shear might occur during wrist motion. This indicates also that the scaphoid and lunate cannot be considered rigidly coupled elements. We also assume that the individual bones of the proximal carpal row self-align themselves as long as they are not constrained by torsion. Several potential mechanisms of flexion motion of the proximal carpal row during radioulnar deviations of the hand were considered. The ligament function is still an unsolved problem. Compensation mechanisms may mask clear correlations between a lesion and the instability pattern associated with it. The proximal carpal row should be studied as one system.

Cadaver↗
PubMed1991

A kinematic study of luno-triquetral dissociations.

An analysis of carpal motion after sectioning the ligamentous support of the luno-triquetral joints was done by use of stereoradiographic methods. The ligaments were sectioned in two stages. In stage I, a complete sectioning of both the dorsal and palmar luno-triquetral ligaments and the interosseous membrane was done. Stage II consisted of further sectioning of both the dorsal radio-triquetral and dorsal scapho-triquetral ligaments. After both stage I and stage II ligament sectioning, all of the intercarpal joints exhibited altered kinematics. The changes were especially marked at the luno-triquetral joint where motion was increased in all planes of wrist motion. The essential lesion in producing a static palmar flexed intercalated segment instability was division of the dorsal radio-triquetral and dorsal scapho-triquetral ligaments in association with the luno-triquetral ligaments and interosseous membrane sectioning.

Cadaver↗
PubMed1995

A six-degree-of-freedom test system for the study of joint mechanics and ligament forces.

A joint testing system was designed to transmit a specified motion or force to a joint in all six degrees of freedom (d.o.f.) using a spatial linkage system for position feedback. The precise reproducibility of position provided by this method of position feedback allows determination of in situ ligament forces for external joint loadings. Load on the structure of interest is calculated from six d.o.f. load cell output after the loaded position is reproduced with all other structures removed. In a test of this system, measured loads showed good agreement with applied loads.

Algorithms↗
PubMedDate not supplied

The stabilizing function of passive shoulder restraints.

UNLABELLED: The static restraints of the scapulohumeral joint provide stability for the humeral head in the glenoid cavity, limit extremes of motion of the glenohumeral joint, and guide positioning of the humerus during normal shoulder movement. Eleven fresh-frozen cadaver shoulders of unknown age were attached to a shoulder motion device that allowed measurement of motion in three planes with an accuracy to 0.5 degrees. Four shoulders underwent motion analysis and seven were used for strain gauge analysis of the static scapulohumeral ligamentous restraints. The results of the motion analysis demonstrated that any attempt at simple motion (flexion, extension, abduction, internal or external rotation) resulted in coupled motion in two additional planes. The strain gauge data, expressed as a percent of total tension for each ligament tested, demonstrated a reciprocal tension-sharing relationship among all ligament components and a transference of tension among these components when original and new joint positions were compared. These data provide an in vitro model of shoulder restraint function to explain primary restraint, tension sharing, and transference of tension functions in the in vivo scapulohumeral joint. CLINICAL RELEVANCE: These principles of shoulder function have application in the treatment of instability and frozen shoulder syndrome, and provide an in vitro model to better understand static restraint function in the throwing mechanism.

Biomechanical Phenomena↗
PubMed1996

Kinematics of the trapeziometacarpal joint: a biomechanical analysis comparing tendon interposition arthroplasty and total-joint arthroplasty.

The kinematics of the trapeziometacarpal joint were studied in 15 cadaver hands; normal joints were compared with simulated arthroplasties-either a total-joint arthroplasty of the ball-and-socket variety or a fibrous suspension arthroplasty of ligament reconstruction with tendon interposition. The motion of the thumb metacarpal was analyzed based on a trapezial coordinate system, using a magnetic tracking system. The pivot point (instantaneous center of rotation) for the thumb metacarpal changed during active and passive circumduction. Compared with normal trapeziometacarpal joint motion, the pivot point after ligament reconstruction with tendon interposition shifted significantly in palmar and ulnar directions in reference to the trapezial coordinate system, whereas after total-joint arthroplasty, the pivot point shifted slightly palmarly and radially. The axes of rotation were also compared for ligament reconstruction with tendon interposition and total-joint arthroplasty during thumb flexion-extension and abduction-adduction motions. After ligament reconstruction with tendon interposition, the center of flexion-extension shifted palmarly and the center of abduction-adduction shifted ulnarly. After total-joint arthroplasty, the center of rotation for flexion-extension shifted distally and palmarly and that for abduction-adduction shifted palmarly and proximally. In comparison with the normal joint, passive circumduction increased after tendon interposition arthroplasty but was less with total-joint arthroplasty. Changes in kinematics suggest a suspensory ligament function of ligament reconstruction with tendon interposition arthroplasty, whereas total-joint arthroplasty results in axes of rotation that reflect the joint replacement rather those of the normal joint.

Arthroplasty↗
PubMed2001

Anterior lateral ankle ligament damage and anterior talocrural-joint laxity: an overview of the in vitro reports in literature.

OBJECTIVE: To provide a clear overview of the literature on the relationship between increased lateral ankle ligament damage and anterior talocrural-joint laxity. DESIGN: A systematic review of the literature. BACKGROUND: Diagnostic methods for inversion injuries of the ankle have remained controversial throughout the years. An instrumented test for anterior talocrural-joint laxity could be a diagnostic tool for evaluation of anterior lateral ankle ligament function. METHODS: An advanced electronic database search using MEDLINE and EMBASE was performed to find studies describing the correlation between lateral ankle ligament damage and talocrural-joint laxity. Two reviewers assessed the methodological quality for each study and agreement was noted. Two reviewers extracted all relevant data with respect to methodology, motion constraints and laxity measurement. RESULTS: The quality assessment resulted in 5 studies being scored as high quality and 5 as low quality. Different test devices were used to apply the load and measure the displacement. All in vitro tests applied a load to the calcaneus and subsequently measured the translation of the talus and/or calcaneus relative to the tibial dome. Rotation in the transversal and frontal plane was restricted in 8 tests. After analysis of the results presented by nine different studies, the mean value of anterior talocrural-joint laxity with intact ligaments is 4.2 mm. After sectioning of the anterior talofibular ligament, the mean anterior laxity value is 6.5 mm. The mean anterior laxity value after sectioning of the calcaneofibular ligament increases to 8.4 mm. The mean anterior laxity value with the foot in dorsal flexion (3.1 mm) is less than the mean value with the foot in neutral position (4.5 mm) or in plantar flexion (4.7 mm). The applied load and the anterior laxity values between the different studies vary greatly. CONCLUSIONS: Each ligament section results in significantly increased talocrural-joint laxity. Talocrural-joint laxity can be used as a measure for damage to the anterior talofibular ligament and/or the calcaneofibular ligament. From this review, it is neither possible to give universal recommendations about the optimal flexion angle for testing talocrural-joint laxity as a measure for lateral ankle ligament function, nor to recommend the ideal load for performing the test. RELEVANCE: The development of an instrumented test as a diagnostic tool for anterior talocrural-joint laxity in the clinical setting is near at hand and practicable.

Ankle Injuries↗