Alterations in tibiotalar joint reaction force following syndesmotic injury are restored with static syndesmotic fixation. (October 2019)

• Record Type: Journal Article
• Authors: Kelly, Meghan; Vasconcellos, Daniel; Osman, Walid S.; Masqoodi, Noorullah; Fowler, Xavier; Elfar, John C.; Olles, Mark W.; Flemister, Adolph S.; Ketz, John P.; Oh, Irvin
• Is Part Of: Clinical biomechanics. Volume 69(2019)
• Page Start: 156
• Page End: 163
• Publication Date: 2019-10
• Subjects: Syndesmosis injury -- Ankle fixation -- Malreduction -- Syndesmotic screw; Biomechanics -- Periodicals; Osteopathic medicine -- Periodicals; Biomechanics -- Periodicals; Osteopathic Medicine -- Periodicals; 612.76
• DOI: 10.1016/j.clinbiomech.2019.07.013
• Languages: English
• ISSNs: 0268-0033

Abstract

Abstract: Introduction: Syndesmotic injury alters joint mechanics, which may fail to be restored unless an anatomic reduction is obtained. Methods: A minimally invasive method of measuring joint forces was utilized that does not require significant dissection or intraarticular placement of sensory instruments. Steinmann pins were placed in the tibia and talus of eight fresh-frozen human cadaveric lower extremities and a baseline joint reaction force was determined. A syndesmotic injury was created and reduction (anatomic and anterior malreduction) performed with one or two quadricortical screws and joint reaction forces were measured after the injury and subsequent repairs. Findings: Baseline mean tibiotalar joint reaction force was 31.4 (SD 7.3 N) and syndesmotic injury resulted in a 35% decrease (mean 20.3, SD 8.4 N, p < 0.01). Fixation of the injury using one or two syndesmotic screws resulted in significant increase compared to the injury state (mean 28.7, SD3.9 N, and mean 28.3, SD 6.4 N, p < 0.05), however there was no significant difference between the two methods of fixation. Malreduction of the fibula also increased joint reaction force compared to the injury state (mean 31.5, SD 5.2 N, p < 0.01), however a significant difference was not detected between malreduction and anatomic reduction. Interpretation: The present study demonstrates that syndesmotic injury decreases joint reaction force within the tibiotalar joint, suggesting ankle joint instability. Tibiotalar force was restored with anatomic reduction with either a 1 or 2 quadricortical syndesmotic screws. Furthermore, anterior malreduction restored joint reaction force to levels similar to those observed at baseline and with anatomic reduction. Level of Evidence: Level V: biomechanical/cadaver study. Highlights: Novel minimally invasive method of joint reaction force measurements in the tibiotalar joint. Syndesmotic injury decreases tibiotalar joint reaction force, suggesting ankle instability. Malreduction and anatomic reduction restore tibiotalar joint reaction force.