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Systematic Quantification of Stabilizing Effects of Subtalar Joint Soft-Tissue Constraints in a Novel Cadaveric Model.

Publication ,  Journal Article
Pellegrini, MJ; Glisson, RR; Wurm, M; Ousema, PH; Romash, MM; Nunley, JA; Easley, ME
Published in: J Bone Joint Surg Am
May 18, 2016

BACKGROUND: Distinguishing between ankle instability and subtalar joint instability is challenging because the contributions of the subtalar joint's soft-tissue constraints are poorly understood. This study quantified the effects on joint stability of systematic sectioning of these constraints followed by application of torsional and drawer loads simulating a manual clinical examination. METHODS: Subtalar joint motion in response to carefully controlled inversion, eversion, internal rotation, and external rotation moments and multidirectional drawer forces was quantified in fresh-frozen cadaver limbs. Sequential measurements were 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 extensor retinaculum were documented after incremental sectioning. The calcaneofibular, cervical, and interosseous talocalcaneal ligaments were then sectioned sequentially, in two different orders, to produce five different ligament-insufficiency scenarios. RESULTS: Incremental detachment of the components of the inferior extensor retinaculum had no effect on subtalar motion independent of foot position. Regardless of the subsequent ligament-sectioning order, significant motion increases relative to the intact condition occurred only after transection of the calcaneofibular ligament. Sectioning of this ligament 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 that might be detectable during a manual examination. Insufficiency of other subtalar joint constraints may result in motion increases that are too subtle to be perceptible. CLINICAL RELEVANCE: If calcaneofibular ligament insufficiency is established, its reconstruction or repair should receive priority over that of other ankle or subtalar periarticular soft-tissue structures.

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Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

May 18, 2016

Volume

98

Issue

10

Start / End Page

842 / 848

Location

United States

Related Subject Headings

  • Subtalar Joint
  • Range of Motion, Articular
  • Orthopedics
  • Models, Anatomic
  • Middle Aged
  • Ligaments, Articular
  • Lateral Ligament, Ankle
  • Joint Instability
  • Humans
  • Cadaver
 

Citation

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Pellegrini, M. J., Glisson, R. R., Wurm, M., Ousema, P. H., Romash, M. M., Nunley, J. A., & Easley, M. E. (2016). Systematic Quantification of Stabilizing Effects of Subtalar Joint Soft-Tissue Constraints in a Novel Cadaveric Model. J Bone Joint Surg Am, 98(10), 842–848. https://doi.org/10.2106/JBJS.15.00948
Pellegrini, Manuel J., Richard R. Glisson, Markus Wurm, Paul H. Ousema, Michael M. Romash, James A. Nunley, and Mark E. Easley. “Systematic Quantification of Stabilizing Effects of Subtalar Joint Soft-Tissue Constraints in a Novel Cadaveric Model.J Bone Joint Surg Am 98, no. 10 (May 18, 2016): 842–48. https://doi.org/10.2106/JBJS.15.00948.
Pellegrini MJ, Glisson RR, Wurm M, Ousema PH, Romash MM, Nunley JA, et al. Systematic Quantification of Stabilizing Effects of Subtalar Joint Soft-Tissue Constraints in a Novel Cadaveric Model. J Bone Joint Surg Am. 2016 May 18;98(10):842–8.
Pellegrini, Manuel J., et al. “Systematic Quantification of Stabilizing Effects of Subtalar Joint Soft-Tissue Constraints in a Novel Cadaveric Model.J Bone Joint Surg Am, vol. 98, no. 10, May 2016, pp. 842–48. Pubmed, doi:10.2106/JBJS.15.00948.
Pellegrini MJ, Glisson RR, Wurm M, Ousema PH, Romash MM, Nunley JA, Easley ME. Systematic Quantification of Stabilizing Effects of Subtalar Joint Soft-Tissue Constraints in a Novel Cadaveric Model. J Bone Joint Surg Am. 2016 May 18;98(10):842–848.

Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

May 18, 2016

Volume

98

Issue

10

Start / End Page

842 / 848

Location

United States

Related Subject Headings

  • Subtalar Joint
  • Range of Motion, Articular
  • Orthopedics
  • Models, Anatomic
  • Middle Aged
  • Ligaments, Articular
  • Lateral Ligament, Ankle
  • Joint Instability
  • Humans
  • Cadaver