Alterations in tibiotalar joint reaction force following syndesmotic injury are restored with static syndesmotic fixation

Meghan Kelly, Daniel Vasconcellos, Walid S. Osman, Noorullah Masqoodi, Xavier Fowler, John Elfar, Mark W. Olles, Adolph S. Flemister, John P. Ketz, I. Oh

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)156-163
Number of pages8
JournalClinical Biomechanics
Volume69
DOIs
StatePublished - Oct 1 2019

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Ankle Injuries
Joints
Wounds and Injuries
Joint Instability
Talus
Fibula
Ankle Joint
Mechanics
Tibia
Cadaver
Dissection
Lower Extremity

All Science Journal Classification (ASJC) codes

  • Biophysics
  • Orthopedics and Sports Medicine

Cite this

Kelly, Meghan ; Vasconcellos, Daniel ; Osman, Walid S. ; Masqoodi, Noorullah ; Fowler, Xavier ; Elfar, John ; Olles, Mark W. ; Flemister, Adolph S. ; Ketz, John P. ; Oh, I. / Alterations in tibiotalar joint reaction force following syndesmotic injury are restored with static syndesmotic fixation. In: Clinical Biomechanics. 2019 ; Vol. 69. pp. 156-163.
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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.",
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Kelly, M, Vasconcellos, D, Osman, WS, Masqoodi, N, Fowler, X, Elfar, J, Olles, MW, Flemister, AS, Ketz, JP & Oh, I 2019, 'Alterations in tibiotalar joint reaction force following syndesmotic injury are restored with static syndesmotic fixation', Clinical Biomechanics, vol. 69, pp. 156-163. https://doi.org/10.1016/j.clinbiomech.2019.07.013

Alterations in tibiotalar joint reaction force following syndesmotic injury are restored with static syndesmotic fixation. / Kelly, Meghan; Vasconcellos, Daniel; Osman, Walid S.; Masqoodi, Noorullah; Fowler, Xavier; Elfar, John; Olles, Mark W.; Flemister, Adolph S.; Ketz, John P.; Oh, I.

In: Clinical Biomechanics, Vol. 69, 01.10.2019, p. 156-163.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Alterations in tibiotalar joint reaction force following syndesmotic injury are restored with static syndesmotic fixation

AU - Kelly, Meghan

AU - Vasconcellos, Daniel

AU - Osman, Walid S.

AU - Masqoodi, Noorullah

AU - Fowler, Xavier

AU - Elfar, John

AU - Olles, Mark W.

AU - Flemister, Adolph S.

AU - Ketz, John P.

AU - Oh, I.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - 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.

AB - 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.

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