Knee Surgery, Sports Traumatology, Arthroscopy ( IF 3.3 ) Pub Date : 2023-11-13 , DOI: 10.1007/s00167-023-07622-6
Elvira Iglesias-Durán 1, 2, 3 , Francisco Guerra-Pinto 4, 5, 6, 7 , Cristina Ojeda-Thies 8 , Jesús Vilá-Rico 3, 8, 9
Purpose
The aim of this study was to assess the biomechanical effects of subtalar ligament injury and reconstruction on stability of the subtalar joint in all three spatial planes.
Methods
Fifteen fresh frozen cadaveric legs were used, with transfixed tibiotalar joints to isolate motion to the subtalar joint. An arthrometer fixed to the lateral aspect of the calcaneus measured angular displacement in all three spatial planes on the inversion and eversion stress tests. Stress manoeuvres were tested with the intact joint, and then repeated after sequentially sectioning the inferior extensor retinaculum (IER), cervical ligament (CL), interosseous talocalcaneal ligament (ITCL), arthroscopic graft reconstruction of the ITCL, and sectioning of the calcaneo-fibular ligament (CFL).
Results
Sectioning the ITCL significantly increased angular displacement upon inversion and eversion in the coronal and sagittal planes. Reconstruction of the ITCL significantly improved angular stability against eversion in the axial and sagittal planes, and against inversion in the axial and coronal planes, at the zero time point after reconstruction. After sectioning the CFL, resistance to eversion decreased significantly in all three planes.
Conclusion
Progressive injury of ligamentous stabilisers, particularly the ITCL, led to increasing angular displacement of the subtalar joint measured with the inversion and eversion stress tests, used in clinical practice. Reconstruction of the ITCL using tendon graft significantly stabilised the subtalar joint in the axial and sagittal planes against eversion and in the axial and coronal planes against inversion, immediately after surgery.
中文翻译:
采用同种异体移植重建距跟骨间韧带稳定距下关节是有效的
目的
本研究的目的是评估距下韧带损伤和重建对距下关节在所有三个空间平面稳定性的生物力学影响。
方法
使用十五条新鲜冷冻的尸体腿,并固定胫距关节以隔离距下关节的运动。固定在跟骨侧面的关节计测量了内翻和外翻应力测试中所有三个空间平面的角位移。在完整关节上进行应力演习测试,然后依次切断下伸肌支持带(IER)、颈韧带(CL)、距跟骨间韧带(ITCL)、关节镜下移植重建ITCL和切断跟腓骨,然后重复进行应力演习韧带(CFL)。
结果
ITCL 切片显着增加了冠状面和矢状面内翻和外翻时的角位移。在重建后的零时间点,ITCL 的重建显着改善了针对轴向和矢状面的外翻以及针对轴向和冠状面的反转的角度稳定性。对 CFL 进行切片后,所有三个平面的抗外翻阻力均显着下降。
结论
韧带稳定器(尤其是 ITCL)的进行性损伤导致距下关节的角位移增加,通过临床实践中使用的内翻和外翻应力测试来测量。术后立即使用肌腱移植物重建 ITCL 显着稳定了距下关节在轴向和矢状面的稳定性,防止外翻,以及在轴向和冠状面的稳定性,防止内翻。