Tibiotalar contact area and pressure distribution:​ the effect of mortise widening and syndesmosis fixation

Pereira, David S.; Koval, Kenneth J.; Resnick, Ronald B.; Sheskier, Steven C.; Kummer, Frederick; Zuckerman, Joseph D.

Affiliations

¹Departments of Orthopaedics and Bioengineering, Hospital for Joint Diseases Orthopaedic Institute, 301 East 17th St., New York, New York 10003

Abstract

An unconstrained cadaver ankle model was designed to reevaluate the effect of ankle mortise widening and syndesmotic fixation on the load-bearing characteristics of the tibiotalar joint. Tibiotalar contact area, centroid shift, and mean contact pressure were quantified using a pressure-sensitive film technique. Six fresh-frozen below-knee amputation specimens were axially loaded with 500 N in three positions: neutral, 10 [degrees] of dorsiflexion, and 20 [degrees] of plantarflexion. The tibiotalar contact area and centroid position for each specimen in its intact state were first determined and then compared with values obtained after syndesmotic fixation, mortise widening of 2 and 4 mm, and deep deltoid ligament transection. Syndesmotic fixation significantly decreased joint contact area but did not consistently affect centroid position. However, unlike earlier studies, which used more constrained ankle fracture models, mortise widening with or without deltoid rupture was not found to significantly affect contact area, centroid position, or joint contact pressure. When statically loaded, the talus moved to its position of maximal congruence in the mortise, rather than displacing laterally along with the lateral malleolus.

Links

PubMed: 8734797

WoS: A1996UL23500006

Ovid: 00041550-199605000-00006

Cited Works (9)

Year	Entry
1976	Scranton PE Jr, McMaster JH, Kelly E. Dynamic fibular function: a new concept. Clin Orthop Relat Res. July–August 1976;118:76-81.
1985	Olerud C. The effect of the syndesmotic screw on the extension capacity of the ankle joint. Arch Orthop Trauma Surg. 1985;104(5):299-302.
1977	Yablon IG, Heller FG, Shouse L. The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg. March 1977;59A(2):169-173.
1983	Pettrone FA, Gail M, Pee D, Fitzpatrick T, van Herpe LB. Quantitative criteria for prediction of the results after displaced fracture of the ankle. J Bone Joint Surg. June 1983;65A(5):667-677.
1985	Phillips WA, Schwartz HS, Keller CS, Woodward HR, Rudd WS, Spiegel PG, Laros GS. A prospective, randomized study of the management of severe ankle fractures. J Bone Joint Surg. January 1985;67A(1):67-78.
1994	Peter RE, Harrington RM, Henley MB, Tencer AF. Biomechanical effects of internal fixation of the distal tibiofibular syndesmotic joint: comparison of two fixation techniques. J Orthop Trauma. June 1994;8(3):215-219.
1976	Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg. April 1976;58A(3):356-357.
1956	Close JR. Some applications of the functional anatomy of the ankle joint. J Bone Joint Surg. July 1956;38A(4):761-781.
1976	Inman VT. The Joints of the Ankle. Baltimore, MD: Williams & Wilkins; 1976.

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2009	Coetzee JC, Ebeling PB. Treatment of syndesmoses disruptions: a prospective, randomized study comparing conventional screw fixation vs tightrope® fiber wire fixation – medium term results. South Afr Orthop J. Autumn, 2009;8(1):32-37.
2007	Taylor DC, Tenuta JJ, Uhorchak JM, Arciero RA. Aggressive surgical treatment and early return to sports in athletes with grade III syndesmosis sprains. Am J Sports Med. 2007;35(11):1833-1838.
2000	Leardini A, O'Connor JJ, Catani F, Giannini S. The role of the passive structures in the mobility and stability of the human ankle joint: a literature review. Foot Ankle Int. 2000;21(7):602-615.
2000	Thompson MC, Gesink DS. Biomechanical comparison of syndesmosis fixation with 3.5- and 4.5-millimeter stainless steel screws. Foot Ankle Int. September 2000;21(9):736-741.
2003	Thornes B, Walsh A, Hislop M, Murray P, O'Brien M. Suture-endobutton fixation of ankle tibio-fibular diastasis: a cadaver study. Foot Ankle Int. February 2003;24(2):142-146.
2006	Moore JA Jr, Shank JR, Morgan SJ, Smith WR. Syndesmosis fixation: a comparison of three and four cortices of screw fixation without hardware removal. Foot Ankle Int. August 2006;27(8):567-572.
2010	Klitzman R, Zhao H, Zhang L-Q, Strohmeyer G, Vora A. Suture-button versus screw fixation of the syndesmosis: a biomechanical analysis. Foot Ankle Int. January 2010;31(1):69-75.
2006	Lin C-F, Gross MT, Weinhold P. Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. J Orthop Sports Phys Ther. June 2006;36(6):372-384.
2004	Høiness P, Strømsøe K. Tricortical versus quadricortical syndesmosis fixation in ankle fractures: a prospective, randomized study comparing two methods of syndesmosis fixation. J Orthop Trauma. July 2004;18(6):331-337.
2005	Weening B, Bhandari M. Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. J Orthop Trauma. February 2005;19(2):102-108.
2003	Sammarco VJ. Principles and techniques in rehabilitation of the athlete's foot, IV: rehabilitation of static joints. Tech Foot Ankle Surg. 2003;2(4):272-279.
2016	Bailey AM. Injury Assessment for the Human Leg Exposed to Axial Impact Loading [PhD thesis]. Charlottesville, VA: University of Virginia; September 2016.