In vivo cartilage contact strains in patients with lateral ankle instability.

Damage to the anterior talofibular ligament (ATFL) and cacaneofibular ligament (CFL) during an ankle sprain may be linked to the development of osteoarthritis. Although altered tibiotalar kinematics have been demonstrated, the effects of lateral ankle instability (LAI) on in vivo cartilage strains have not been described. We hypothesized that peak cartilage strains increase, and the location is shifted in patients with ATFL injuries. We used 3-D MRI models and biplanar fluoroscopy to evaluate in vivo cartilage contact strains in seven patients with unilateral LAI. Subjects had chronic unilateral ATFL injury or combined ATFL and CFL injury, and were evaluated with increasing load while stepping onto a force plate. Peak cartilage strain and the location of the peak strain were measured using the contralateral normal ankle as a control. Ankles with LAI demonstrated significantly increased peak strain when compared with ATFL-intact controls. For example, at 100% body weight, peak strain was 29+/-8% on the injured side compared to 21+/-5% on the intact side. The position of peak strain on the injured ankle also showed significant anterior translation and medial translation. At 100% body weight, the location of peak strain in the injured ankle translated anteriorly by 15.5+/-7.1mm and medially by 12.9+/-4.3mm relative to the intact ankle. These changes correspond to the region of clinically observed osteoarthritis. Chronic LAI, therefore, may contribute to the development of tibiotalar cartilage degeneration due to altered cartilage strains.

[1]  Harry E Rubash,et al.  In vivo cartilage contact deformation of human ankle joints under full body weight , 2008, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[2]  S. Erickson,et al.  MRI of Injury to the Lateral Collateral Ligamentous Complex of the Ankle , 1993, Journal of computer assisted tomography.

[3]  Farshid Guilak,et al.  Zonal changes in the three-dimensional morphology of the chondron under compression: the relationship among cellular, pericellular, and extracellular deformation in articular cartilage. , 2007, Journal of biomechanics.

[4]  R. Marti,et al.  Medial ankle pain after lateral ligament rupture. , 1996, The Journal of bone and joint surgery. British volume.

[5]  J. Karlsson,et al.  Anatomical reconstruction and Evans tenodesis of the lateral ligaments of the ankle. Clinical and radiological findings after follow-up for 15 to 30 years. , 2002, The Journal of bone and joint surgery. British volume.

[6]  W. Hennrikus,et al.  Outcomes of the Chrisman-Snook and Modified-Broström Procedures for Chronic Lateral Ankle Instability , 1996, The American journal of sports medicine.

[7]  C. Flahiff,et al.  Biomechanical Comparison of Reconstruction Techniques in Simulated Lateral Ankle Ligament Injury , 1995, The American journal of sports medicine.

[8]  Mitsuo Ochi,et al.  Arthroscopic Assessment for Intra-articular Disorders in Residual Ankle Disability after Sprain , 2005, The American journal of sports medicine.

[9]  T. Gill,et al.  In Vivo Function of the Posterior Cruciate Ligament during Weightbearing Knee Flexion , 2004, The American journal of sports medicine.

[10]  Lu Wan,et al.  Determination of real-time in-vivo cartilage contact deformation in the ankle joint. , 2008, Journal of biomechanics.

[11]  T. Brown,et al.  Patient‐specific finite element analysis of chronic contact stress exposure after intraarticular fracture of the tibial plafond , 2008, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[12]  D. Evans.  Recurrent Instability of the Ankle—a Method of Surgical Treatment , 1953, Proceedings of the Royal Society of Medicine.

[13]  Louis E DeFrate,et al.  In Vivo Kinematics of the Tibiotalar Joint After Lateral Ankle Instability , 2009, The American journal of sports medicine.

[14]  C. DiGiovanni,et al.  Current Concepts: Lateral Ankle Instability , 2006, Foot & ankle international.

[15]  K. An,et al.  Stability of the loaded ankle , 1985, The American journal of sports medicine.

[16]  Thomas P Andriacchi,et al.  Rotational Changes at the Knee after ACL Injury Cause Cartilage Thinning , 2006, Clinical orthopaedics and related research.

[17]  T. Yasuda,et al.  Arthroscopic Findings in Chronic Lateral Ankle Instability , 2005, The American journal of sports medicine.

[18]  F. Guilak,et al.  Tensile properties of articular cartilage are altered by meniscectomy in a canine model of osteoarthritis , 1999, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[19]  D. Rosenbaum,et al.  Reconstruction of the Lateral Ligaments: Do the Anatomical Procedures Restore Physiologic Ankle Kinematics? , 2004, Foot & ankle international.

[20]  J. Karlsson,et al.  Long-Term Outcome of Anatomical Reconstruction Versus Tenodesis for the Treatment of Chronic Anterolateral Instability of the Ankle Joint: A Multicenter Study , 2001, Foot & ankle international.

[21]  T. Yamashita,et al.  Lateral ligament injury of the ankle and associated articular cartilage degeneration in the talocrural joint: anatomic study using elderly cadavers , 2004, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[22]  C. Flahiff,et al.  Simulated Lateral Ankle Ligamentous Injury , 1995, The American journal of sports medicine.

[23]  K. Shino,et al.  Articular cartilage lesions in ankles with lateral ligament injury , 1993, The American journal of sports medicine.

[24]  S Siegler,et al.  The effect of ankle ligament damage and surgical reconstructions on the mechanics of the ankle and subtalar joints revealed by three‐dimensional stress MRI , 2005, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[25]  D. Seligson,et al.  Early and Late Repair of Lateral Ligament of the Ankle , 1980, Foot & ankle.

[26]  O D Chrisman,et al.  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. , 1969, The Journal of bone and joint surgery. American volume.

[27]  J. Kärrholm,et al.  The Outcome of Nonoperated Patients with Chronic Lateral Instability of the Ankle: A 20-Year Follow-up Study , 1994, Foot & ankle international.

[28]  H. Resch,et al.  A Randomized, Prospective Study of Operative and Non-Operative Treatment of Injuries of the Fibular Collateral Ligaments of the Ankle* , 1998, The Journal of bone and joint surgery. American volume.

[29]  R. Ferkel,et al.  Arthroscopic Findings Associated with the Unstable Ankle , 1999, Foot & ankle international.

[30]  E. Eyring,et al.  A surgical approach to the problem of severe lateral instability at the ankle. , 1986, Clinical orthopaedics and related research.

[31]  Y. Koga,et al.  The effect of an ankle brace on the 3-dimensional kinematics and tibio-talar contact condition for lateral ankle sprains , 2004, Knee Surgery, Sports Traumatology, Arthroscopy.

[32]  Ramprasad Papannagari,et al.  The 6 Degrees of Freedom Kinematics of the Knee after Anterior Cruciate Ligament Deficiency , 2006, The American journal of sports medicine.

[33]  B. Digiovanni,et al.  Associated Injuries Found in Chronic Lateral Ankle Instability , 2000, Foot & ankle international.

[34]  Gerard A. Ateshian,et al.  Patellofemoral Stresses during Open and Closed Kinetic Chain Exercises , 2001, The American journal of sports medicine.

[35]  G. Ateshian,et al.  Two-dimensional strain fields on the cross-section of the human patellofemoral joint under physiological loading. , 2009, Journal of biomechanics.

[36]  R. Ferkel,et al.  Chronic Lateral Instability: Arthroscopic Findings and Long-Term Results , 2007, Foot & ankle international.

[37]  Beat Hintermann,et al.  Ligamentous Posttraumatic Ankle Osteoarthritis , 2006, The American journal of sports medicine.

[38]  Gerard A. Ateshian,et al.  Computer Simulations of Patellofemoral Joint Surgery , 2003, The American journal of sports medicine.

[39]  L. Teresi,et al.  A Comparison of MRI and Clinical Examination of Acute Lateral Ankle Sprains , 1996, Foot & ankle international.

[40]  P. Sundelin,et al.  Sprained ankles. IV. Histologic changes in recent and "chronic" ligament ruptures. , 1966, Acta chirurgica Scandinavica.

[41]  K. Harrington.  Degenerative arthritis of the ankle secondary to long-standing lateral ligament instability. , 1979, The Journal of bone and joint surgery. American volume.

[42]  M. Colville,et al.  Anatomic Reconstruction of the Lateral Ankle Ligaments Using a Split Peroneus Brevis Tendon Graft , 1995, The American journal of sports medicine.

[43]  B. Hintermann,et al.  Arthroscopic Findings in Patients with Chronic Ankle Instability , 2002, The American journal of sports medicine.

[44]  J. Cox,et al.  Twenty-six-Year Results after Broström Procedure for Chronic Lateral Ankle Instability , 2006, The American journal of sports medicine.

[45]  D. Rosenbaum,et al.  NOVEL Award 1996: 2nd prize Tenodeses do not fully restore ankle joint loading characteristics: a biomechanical in vitro investigation in the hind foot. , 1997, Clinical biomechanics.

[46]  R. P. Mack.  Ankle injuries in athletics. , 1982, Clinics in sports medicine.

[47]  W. Hamilton,et al.  The Modified Brostrom Procedure for Lateral Ankle Instability , 1993, Foot & ankle.

[48]  Y. Takakura,et al.  Chondral injuries of the ankle with recurrent lateral instability: an arthroscopic study. , 2009, The Journal of bone and joint surgery. American volume.