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Subtalar instability: a biomechanical cadaver study

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Hypothesis

Subtalar instability is thought to be one of the possible causes for chronic functional instability of the foot and ankle. The purpose of this study was to determine the extent of ligament injury that is followed by subtalar instability and to depict consecutive pathologic joint motion.

Methods

Twelve fresh human cadaver lower legs were investigated with respect to pathologic motion and mobility of the subtalar joint in a modified spinal column simulator after arthrodesis of the talocrural articulation and selective sectioning of the lateral ligaments of the subtalar joint. In order to simulate several injury mechanisms, ligaments were dissected starting anteriorly in group one (n = 6) and posteriorly in group two (n = 6).

Results

Dissection of the bifurcate ligament in group one resulted in a significant increase in plantar- and dorsiflexion, dissection of the inferior extensor retinaculum resulted in a significant increase in eversion and inversion. Additional dissection of the lateral talocalcaneal ligament resulted in a significant increase in internal and external rotation. Dissection of the calcaneofibular ligament in group two was followed by significant kinematic changes regarding all degrees of motion in the subtalar joint.

Conclusions

The calcaneofibular ligament plays a key role in lateral stabilisation of the subtalar joint. Therefore, ligaments of the subtalar joint should be included in surgical repair.

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References

  1. Astion DJ, Deland JT, Otis JC, Kenneally S (1997) Motion of the hindfoot after simulated arthrodesis. J Bone Joint Surg Am 79:241–246

    CAS  PubMed  Google Scholar 

  2. Becker HP, Rosenbaum D (1999) Chronisch-rezidivierende Bandinstabilitäten am lateralen Sprunggelenk. Orthopäde 28:483–492

    CAS  PubMed  Google Scholar 

  3. Brantigan JW, Pedegana LR, Lippert FG (1977) Instability of the subtalar joint Diagnosis by stress tomography in three cases. J Bone Joint Surg Am 59:321–324

    CAS  PubMed  Google Scholar 

  4. Brunner R, Gächter A (1991) Repair of fibular ligaments: comparison of reconstructive techniques using plantaris and peroneal tendons. Foot Ankle 11:359–367

    CAS  PubMed  Google Scholar 

  5. Cahill DR (1965) The anatomy and function of the contents of the human tarsal sinus and canal. Anat Rec 153:1–17

    Article  CAS  PubMed  Google Scholar 

  6. Chrisman OD, Snook G (1969) Reconstruction of lateral ligament tears of the ankle: an experimental study and clinical evaluation of seven patients treated by a new modification of the Elmslie procedure. J Bone Joint Surg 51-A:904–912

    Google Scholar 

  7. Clanton TO (1989) Instability of the subtalar joint. Orthop Clin North Am 20:583–592

    CAS  PubMed  Google Scholar 

  8. Colville MR, Grondel RJ (1995) Anatomic reconstruction of the lateral ankle ligaments using a split peroneus brevis tendon graft. Am J Sports Med 23:210–213

    Article  CAS  PubMed  Google Scholar 

  9. Colville MR (1995) Reconstruction of the lateral ankle ligaments. Instr Course Lect 44:341–348

    CAS  PubMed  Google Scholar 

  10. Elmslie DL (1934) Recurrent subluxation of the ankle. Ann Surg 100:364–367

    Article  CAS  PubMed  Google Scholar 

  11. Fellmann J, Zollinger H (1996) Versteifungseingriffe am unteren Sprunggelenk-wechselnde Konzepte im Wandel der Zeit. Z Orthop Ihre Grenzgeb 134:341–345

    Article  CAS  PubMed  Google Scholar 

  12. Glas E, Paar O, Smasal V, Bernett P (1985) Die Periostlappenplastik (PLP) am Außenbandapparat des oberen Sprunggelenkes. Unfallchirurg 88:219–222

    CAS  PubMed  Google Scholar 

  13. Gould N, Seligson D, Gassman J (1980) Early and late repair of lateral ligament of the ankle. Foot Ankle Int 1:84–89

    CAS  Google Scholar 

  14. Harper MC (1991) The lateral ligamentous support of the subtalar joint. Foot Ankle Int 11:319–325

    Google Scholar 

  15. Heilman AE, Braly WG, Bishop JO, Noble PC, Tullos HS (1990) An anatomic study of subtalar instability. Foot Ankle 10:224–228

    CAS  PubMed  Google Scholar 

  16. Hollis JM, Blasier RD, Flahiff CM, Hofmann OE (1995) Biomechanical comparison of reconstruction techniques in simulated lateral ankle ligament injury. Am J Sports Med 23:678–682

    Article  CAS  PubMed  Google Scholar 

  17. Ishii T, Miyagawa S, Fukubayashi T, Hayashi K (1996) Subtalar stress radiography using forced dorsiflexion and supination. J Bone Joint Surg Br 78:56–60

    CAS  PubMed  Google Scholar 

  18. Jotoku T, Kinoshita M, Okuda R, Abe M (2006) Anatomy of ligamentous structures in the tarsal sinus and canal. Foot Ankle Int 27(7):533–538

    PubMed  Google Scholar 

  19. Karlsson J, Eriksson BI, Renström PA (1997) Subtalar ankle instability. A review. Sports Med 24:337–346

    Article  CAS  PubMed  Google Scholar 

  20. Karlsso J, Eriksson BI, Renström P (1998) Subtalar instability of the foot. A review and results after surgical treatment. Scand J Med Sci Sports 8:191–197

    Article  Google Scholar 

  21. Kato T (1995) The diagnosis and treatment of instability of the subtalar joint. J Bone Joint Surg Br 77:400–406

    CAS  PubMed  Google Scholar 

  22. Kjaersgaard-Andersen P, Wethelund JO, Helmig P, Soballe K (1988) The stabilizing effect of the ligamentous structures in the sinus and canalis tarsi on movements in the hindfoot An experimental study. Am J Sports Med 16:512–516

    Article  CAS  PubMed  Google Scholar 

  23. Kjaersgaard-Andersen P, Wethelund JO, Helmig P, Nielsen S (1987) Effect of the calcaneofibular ligament on hindfoot rotation in amputation specimens. Acta Orthop Scand 58:135–138

    CAS  PubMed  Google Scholar 

  24. Kjaersgaard-Andersen P, Wethelund J-O, Nielsen S (1987) Lateral talocalcaneal instability following section of the calcaneofibular ligament. Foot Ankle 7:355–361

    CAS  PubMed  Google Scholar 

  25. Klenerman L (1998) The management of sprained ankle. J Bone Joint Surg Br 80:11–12

    Article  CAS  PubMed  Google Scholar 

  26. Knudson GA, Kitaoka HB, Lu CL, Luo ZP, An KN (1997) Subtalar joint stability Talocalcaneal interosseous ligament function studied in cadaver specimens. Acta Orthop Scand 68:442–446

    CAS  PubMed  Google Scholar 

  27. Larsen E (1988) Tendon transfer for lateral ankle and subtalar joint instability. Acta Orthop Scand 59:168–172

    CAS  PubMed  Google Scholar 

  28. Laurin CA, Quellet R, St-Jacques R (1968) Talar and subtalar tilt: an experimental investigation. Can J Surg 11:270–279

    CAS  PubMed  Google Scholar 

  29. Louwerens JW, Ginai AZ, van Linge B (1995) Stress radiography of the talocrural and subtalar joints. Foot Ankle Int 16:148–155

    CAS  PubMed  Google Scholar 

  30. Mabit C, Boncoeur-Martel MP, Chaudruc JM, Valleix D, Descottes B, Caix M (1997) Anatomic and MRI study of the subtalar ligamentous support. Surg Radiol Anat 19:111–117

    Article  CAS  PubMed  Google Scholar 

  31. Pisani G (1996) Chronic laxity of the subtalar joint. Orthopedics 19:431–437

    CAS  PubMed  Google Scholar 

  32. Rosenbaum D, Engelhardt M, Becker HP, Claes L, Gerngross H (1999) Clinical and functional outcome after anatomic and nonanatomic ankle ligament reconstruction: Evans tenodesis versus periosteal flap. Foot Ankle Int 20:636–639

    CAS  PubMed  Google Scholar 

  33. Rubin G, Witten M (1962) The subtalar joint and the symptom of turning over on the ankle: a new method of evaluation utilizing tomography. Am J Orthop 16–19

  34. Sammarco GJ, Idusuyi OB (1999) Reconstruction of the lateral ankle ligaments using a split peroneus brevis tendon graft. Foot Ankle Int 20:97–103

    CAS  PubMed  Google Scholar 

  35. Sarrafian SK (1993) Biomechanics of the subtalar joint complex. Clin Orthop Relat Res 290:17–26

    PubMed  Google Scholar 

  36. Schmidt HM, Grünewald E (1981) Untersuchungen an den Bandsystemen der talocruralen und intertarsalen Gelenke des Menschen. Gegenbaurs Morphol Jahrb 127:792–831

    CAS  PubMed  Google Scholar 

  37. Schon LC, Clanton TO, Baxter DE (1991) Reconstruction for subtalar instability: a review. Foot Ankle 11:319–325

    CAS  PubMed  Google Scholar 

  38. Siegler S, Chen J, Schneck CD (1988) The three-dimensional kinematics and flexibility characteristics of the human ankle and subtalar joints—part I: kinematics. J Biomech Eng 110:364–373

    Article  CAS  PubMed  Google Scholar 

  39. Smith JW (1958) The ligamentous structures in the canalis and sinus tarsi. J Anat 92:616–620

    CAS  PubMed  Google Scholar 

  40. Smith PA, Miller SJ, Berni AJ (1995) A modified Chrisman–Snook procedure for reconstruction of the lateral ligaments of the ankle: review of 18 cases. Foot Ankle 16:259–266

    CAS  PubMed  Google Scholar 

  41. Stagni R, Leardini A, O’Connor JJ, Giannini S (2003) Role of passive structures in the mobility and stability of the human subtalar joint: a literature review. Foot Ankle Int 24(5):402–409

    PubMed  Google Scholar 

  42. Stephens MM, Sammarco GJ (1992) The stabilizing role of the lateral ligament complex around the ankle and subtalar joints. Foot Ankle 13:130–136

    CAS  PubMed  Google Scholar 

  43. Thermann H, Zwipp H, Tscherne H (1997) Treatment algorithm of chronic ankle and subtalar instability. Foot Ankle Int 18:163–169

    CAS  PubMed  Google Scholar 

  44. Tochigi Y, Amendola A, Rudert MJ, Baer TE, Brown TD, Hillis SL, Saltzman CL (2004) The role of the interosseous talocalcaneal ligament in subtalar joint stability. Foot Ankle Int 25:588–596

    PubMed  Google Scholar 

  45. Tochigi Y, Takahashi K, Yamagata M, Tamaki T (2000) Influence of the interosseous talocalcaneal ligament injury on stability of the ankle-subtalar joint complex—a cadaveric experimental study. Foot Ankle Int 21:486–491

    CAS  PubMed  Google Scholar 

  46. van Hellemondt FJ, Louwerens JW, Sijbrandij ES, van Gils AP (1997) Stress radiography and stress examination of the talocrural and subtalar joint on helical computed tomography. Foot Ankle Int 18:482–488

    PubMed  Google Scholar 

  47. Verhagen RA, de Keizer G, van Dijk CN (1995) Long-term follow-up of inversion trauma of the ankle. Arch Orthop Trauma Surg 114:92–96

    Article  CAS  PubMed  Google Scholar 

  48. Vidal J, Fassio B, Buscayret C, Escare P, Allier Y (1974) Instabilité externe de la cheville. Rev chir Ortoped 60:635–642

    CAS  Google Scholar 

  49. Wilke HJ, Claes L, Schmitt H, Wolf S (1994) A universal spine tester for in vitro experiments with muscle force simulation. Eur Spine J 3:91–97

    Article  CAS  PubMed  Google Scholar 

  50. Zwipp H, Rammelt S, Grass R (2002) Ligamentous injuries about the ankle and subtalar joints. Clin Podiatr Med Surg 19:195–229

    Article  PubMed  Google Scholar 

  51. Zwipp H, Krettek C (1986) Diagnostik und Therapie der akuten und chronischen Bandinstabilität des unteren Sprunggelenkes. Orthopäde 15:472–478

    CAS  PubMed  Google Scholar 

  52. Zwipp H, Tscherne H (1982) Die radiologische Diagnostik der Rotationsinstabilität im hinteren unteren Sprunggelenk. Unfallheilkunde 85:494–498

    CAS  PubMed  Google Scholar 

  53. Zwipp H (1994) Chirurgie des Fußes, 1 edn. Springer, Heidelberg

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Acknowledgments

The authors wish to thank Ursula Range for the statistical support as well as Thomas Albrecht for the photographical work.

Conflict of interest statement

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Authors and Affiliations

  1. Department for Hand-, Plastic and Reconstructive Surgery, Kantonsspital St Gallen, Rorschacher Str. 95, 9007, St Gallen, Switzerland

    S. Weindel & A. v. Campe

  2. Surgical Department, Military Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany

    R. Schmidt

  3. Department of Trauma and Reconstructive Surgery, University Hospital “Carl Gustav Carus”, Fetscherstr. 74, 01307, Dresden, Germany

    S. Rammelt & S. Rein

  4. Institute of Orthopedic Research and Biomechanics, University of Ulm, Helmholtzstr. 14, 89081, Ulm, Germany

    L. Claes

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  1. S. Weindel
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Correspondence to S. Weindel.

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Weindel, S., Schmidt, R., Rammelt, S. et al. Subtalar instability: a biomechanical cadaver study. Arch Orthop Trauma Surg 130, 313–319 (2010). https://doi.org/10.1007/s00402-008-0743-2

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  • DOI: https://doi.org/10.1007/s00402-008-0743-2

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