Systematic Quantification of Stabilizing Effects of Subtalar Joint Soft-Tissue Constraints in a Novel Cadaveric ModelReport as inadecuate

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Background: Distinguishing between ankle instability and subtalar joint instability is challenging because the contributionsof the subtalar joint’s soft-tissue constraints are poorly understood. This study quantified the effects on jointstability of systematic sectioning of these constraints followed by application of torsional and drawer loads simulating amanual clinical examination.Methods: Subtalar joint motion in response to carefully controlled inversion, eversion, internal rotation, and externalrotation moments and multidirectional drawer forces was quantified in fresh-frozen cadaver limbs. Sequential measurementswere obtained under axial load approximating a non-weight-bearing clinical setting with the foot in neutral,10 of dorsiflexion, and 10 and 20 of plantar flexion. The contributions of the components of the inferior extensorretinaculum were documented after incremental sectioning. The calcaneofibular, cervical, and interosseous talocalcanealligaments were then sectioned sequentially, in two different orders, to produce five different ligament-insufficiencyscenarios.Results: Incremental detachment of the components of the inferior extensor retinaculum had no effect on subtalarmotion independent of foot position. Regardless of the subsequent ligament-sectioning order, significant motion increasesrelative to the intact condition occurred only after transection of the calcaneofibular ligament. Sectioning of thisligament produced increased inversion and external rotation, which was most evident with the foot dorsiflexed.Conclusions: Calcaneofibular ligament disruption results in increases in subtalar inversion and external rotation thatmight be detectable during a manual examination. Insufficiency of other subtalar joint constraints may result in motionincreases that are too subtle to be perceptible.Clinical Relevance: If calcaneofibular ligament insufficiency is established, its reconstruction or repair should receivepriority over that of other ankle or subtalar periarticular soft-tissue structures.Indización

Artículo de publicación ISI

Author: Pellegrini Pucci, Manuel; - Glisson, Richard R.; - Wurm, Markus; - Ousema, Paul H.; - Romash, Michael M.; - Nunley, James A.; - E



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