Rotational Instability after Anterior Talofibular and Calcaneofibular Ligament Section: The Experimental Basis for the Ankle Pivot Test

The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons
Francisco Guerra-PintoXavier Martin Oliva

Abstract

The clinical diagnosis of the anterior talofibular ligament (ATFL) rupture is based on the findings from the medical history and the anterior drawer test, a maneuver that allegedly pushes the talus and rearfoot anteriorly, although with great variability in its sensitivity. We consider that an ATFL rupture is best evaluated by a rotational vector (i.e., a pivot test) owing to the uncompromised medial ligaments that will block any pure anterior translation of the talus underneath the tibia. We idealized a constrained ankle cadaver model that only allows talar movements in the axial plane. Our hypothesis was that progressive sectioning of the lateral ankle ligaments in this model would cause a progressive and significant angular laxity in internal rotation. Our results showed 3.67 degrees ± 1.2 degrees of talus rotational laxity in the intact ankle, 9.6 degrees ± 3.2 degrees after ATFL sectioning, and 13.43 degrees ± 3.2 degrees after ATFL and calcaneofibular ligament sectioning, indicating almost threefold increase in internal talocrural rotation after single ATFL sectioning and an almost fourfold increase after double (ATFL and calcaneofibular ligament) sectioning. We consider this evidence of rotational ankle laxity to be a ma...Continue Reading

Citations

Aug 1, 2019·The American Journal of Sports Medicine·Mark D Porter
Aug 1, 2019·The American Journal of Sports Medicine·Nicolò MartinelliAlberto Bianchi
Oct 4, 2020·Proceedings of the Institution of Mechanical Engineers. Part H, Journal of Engineering in Medicine·G MartaF Guerra-Pinto
Dec 19, 2020·Revista española de cirugía ortopédica y traumatología·María Ángela Mellado-RomeroJesús Vilá-Rico
May 18, 2020·Foot and Ankle Surgery : Official Journal of the European Society of Foot and Ankle Surgeons·Shi-Ming FengLin Hao
Jun 18, 2021·The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons·Francisco Guerra-PintoJosé Guimarães Consciência
Jul 17, 2021·EFORT Open Reviews·Nuno Corte-Real, João Caetano
Sep 10, 2020·Orthopaedics & Traumatology, Surgery & Research : OTSR·Fabrice ColinGuillaume Cordier

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