Syndesmotic ankle sprains, along with lateral ankle sprains, account for about 85–90% of foot and ankle injuries. The mechanism of syndesmotic ankle sprains is not well understood because knowledge of the relationship between gross rotations of the foot and in situ ligament mechanics is limited.
The objective of this thesis was to develop a human ankle finite element model to gain insight into the relationship between gross ankle mechanics and in situ ligament mechanics. The specific goals were to improve the representation of articular cartilage and ligaments in an existing finite element model and to evaluate the bone kinematic and gross moment responses of the model against data from cadaver ankle experiments.
The model was refined and optimized to meet the stated goals. This refinement included a representation of articular cartilage with reduced gaps and of ligaments as distributions of fiber bundles. Each fiber bundle was represented by a bilinear stiffness curve with physically interpretable parameters. One of the parameters was a zero force toe region. The fiber bundle toe regions were optimized to minimize the differences between the responses of the model and those measured from cadaver ankle experiments. Evaluation of the optimized model showed that the bone orientation, bone position and gross moment responses of the model were within 2°, 2 mm and 5 Nm of the experimental data. The optimized model also provided in situ ligament stiffness curves that can be used to describe in situ ligament behavior, which is difficult to measure experimentally.
The optimized model was used to describe the effect of calcaneus dorsiflexion, eversion and external rotation on the in situ force responses of the anterior tibio-fibular ligament. The optimized model predicted that calcaneus dorsiflexion may predispose the anterior tibio-fibular ligament to injury for an external rotation input to the calcaneus. This provided insight into the relationship between gross ankle kinematics and in situ ligament mechanics.
The optimized model can be extended to include failure criteria for the fiber bundles. This can facilitate the study of the injury mechanism of syndesmotic ankle sprains, as well as injury prevention strategies.
|2004||Verhagen E, van der Beek A, Twisk J, Bouter L, Bahr R, van Mechelen W. The effect of a proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial. Am J Sports Med. September 2004;32(6):1385-1393.|
|2010||Anderson RB, Hunt KJ, McCormick JJ. Management of common sports-related injuries about the foot and ankle. J Am Acad Orthop Surg. September 2010;18(9):546-556.|
|1980||Kastelic J, Palley I, Baer E. A structural mechanical model for tendon crimping. J Biomech. 1980;13(10):887-893.|
|1990||Ekstrand J, Tropp H. The incidence of ankle sprains in soccer. Foot Ankle Int. August 1990;11(1):41-44.|
|2000||Funk JR, Hall GW, Crandall JR, Pilkey WD. Linear and quasi-linear viscoelastic characterization of ankle ligaments. J Biomech Eng. February 2000;122(1):15-22.|
|1993||Barrett JR, Tanji JL, Drake C, Fuller D, Kawasaki RI, Fenton RM. High- versus low-top shoes for the prevention of ankle sprains in basketball players: a prospective randomized study. Am J Sports Med. July–August 1993;21(4):582-585.|
|2014||Gabler LF, Panzer MB, Salzar RS. High‐rate mechanical properties of human heel pad for simulation of a blast loading condition. In: Proceedings of the 2014 International IRCOBI Conference on the Biomechanics of Injury. September 10-12, 2014; Berlin, Germany.796-808.|
|1999||Li G, Gil J, Kanamori A, Woo SL-Y. A validated three-dimensional computational model of a human knee joint. J Biomech Eng. December 1999;121(6):657-662.|
|2011||Wei F, Hunley SC, Powell JW, Haut RC. Development and validation of a computational model to study the effect of foot constraint on ankle injury due to external rotation. Ann Biomed Eng. February 2011;39(2):756-765.|
|2010||Wei F, Villwock MR, Meyer EG, Powell JW, Haut RC. A biomechanical investigation of ankle injury under excessive external foot rotation in the human cadaver. J Biomech Eng. September 2010;132(9):091001.|
|1988||Chen J, Siegler S, Schneck CD. The three-dimensional kinematics and flexibility characteristics of the human ankle and subtalar joint, II: flexibility characteristics. J Biomech Eng. November 1988;110(4):374-385.|
|2001||Carson MC, Harrington ME, Thompson N, O’Connor JJ, Theologis TN. Kinematic analysis of a multi-segment foot model for research and clinical applications: a repeatability analysis. J Biomech. October 2001;34(10):1299-1307.|
|2012||Shin J, Yue N, Untaroiu CD. A finite element model of the foot and ankle for automotive impact applications. Ann Biomed Eng. December 2012;40(12):2519-2531.|
|1997||Reinschmidt C, van den Bogert AJ, Lundberg A, Nigg BM, Murphy N, Stacoff A, Stano A. Tibiofemoral and tibiocalcaneal motion during walking: external vs. skeletal markers. Gait Post. October 1997;6(2):98-109.|
|1990||Colville MR, Marder RA, Boyle JJ, Zarins B. Strain measurement in lateral ankle ligaments. Am J Sports Med. March 1990;18(2):196-200.|
|1983||Johnson EE, Markolf KL. The contribution of the anterior talofibular ligament to ankle laxity. J Bone Joint Surg. January 1983;65A(1):81-88.|
|2012||Wei F, Post JM, Braman JE, Meyer EG, Powell JW, Haut RC. Eversion during external rotation of the human cadaver foot produces high ankle sprains. J Orthop Res. September 2012;30(9):1423-1429.|
|2014||Forestiero A, Carniel EL, Natali AN. Biomechanical behaviour of ankle ligaments: constitutive formulation and numerical modelling. Comput Methods Biomech Biomed Eng. March 12, 2014;17(4):395-404.|
|1984||Mow VC, Holmes MH, Lai WM. Fluid transport and mechanical properties of articular cartilage: a review. J Biomech. 1984;17(5):377-394.|
|1988||Siegler S, Chen J, Schneck CD. The three-dimensional kinematics and flexibility characteristics of the human ankle and subtalar joints, I: kinematics. J Biomech Eng. November 1988;110(4):364-373.|
|2007||Liacouras PC, Wayne JS. Computational modeling to predict mechanical function of joints: application to the lower leg with simulation of two cadaver studies. J Biomech Eng. 2007;129(6):811-817.|
|2009||Lucas SR, Bass CR, Crandall JR, Kent RW, Shen FH, Salzar RS. Viscoelastic and failure properties of spine ligament collagen fascicles. Biomech Model Mechanobiol. December 2009;8(6):487-498.|
|1977||Garrick JG. The frequency of injury, mechanism of injury, and epidemiology of ankle sprains. Am J Sports Med. December 1977;5(6):241-242.|
|2007||Williams GN, Jones MH, Amendola A. Syndesmotic ankle sprains in athletes. Am J Sports Med. July 2007;35(7):1197-1207.|
|1991||Boytim MJ, Fischer DA, Neumann L. Syndesmotic ankle sprains. Am J Sports Med. 1991;19(3):294-298.|
|2001||Nussbaum ED, Hosea TM, Sieler SD, Incremona BR, Kessler DE. Prospective evaluation of syndesmotic ankle sprains without diastasis. Am J Sports Med. January 2001;29(1):31-35.|
|1990||Nigg BM, Skarvan G, Frank CB, Yeadon MR. Elongation and forces of ankle ligaments in a physiological range of motion. Foot Ankle. August 1990;11(1):30-40.|
|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.|
|1995||Xenos JS, Hopkinson WJ, Mulligan ME, Olson EJ, Popovic NA. The tibiofibular syndesmosis: evaluation of the ligamentous structures, methods of fixation, and radiographic assessment. J Bone Joint Surg. June 1995;77A(6):847-856.|
|1992||Stiehl JB, Skrade DA, Johnson RP. Experimentally produced ankle fractures in autopsy specimens. Clin Orthop Relat Res. December 1992;285:244-249.|
|2003||Beumer A, Valstar E, Garling E, Niesing R, Ranstam J, Löfvenberg R, Swierstra B. Kinematics of the distal tibiofibular syndesmosis: radiostereometry in 11 normal ankles. Acta Orthop Scand. June 2003;74(3):337-343.|
|2007||Jenkyn TR, Nicol AC. A multi-segment kinematic model of the foot with a novel definition of forefoot motion for use in clinical gait analysis during walking. J Biomech. 2007;40(14):3271-3278.|
|1976||Noyes FR, Grood ES. The strength of the anterior cruciate ligament in humans and Rhesus monkeys. J Bone Joint Surg. 1976;58A(8):1074-1082.|
|2007||Hoefnagels EM, Waites MD, Wing ID, Belkoff SM, Swierstra BA. Biomechanical comparison of the interosseous tibiofibular ligament and the anterior tibiofibular ligament. Foot Ankle Int. May 2007;28(5):602-604.|