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Knee Surgery, Sports Traumatology, Arthroscopy

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Open Access 13-11-2023 | ANKLE

Reconstruction of the interosseous talocalcaneal ligament using allograft for subtalar joint stabilization is effective

Authors: Elvira Iglesias-Durán, Francisco Guerra-Pinto, Cristina Ojeda-Thies, Jesús Vilá-Rico

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2023

Abstract

Purpose

The aim of this study was to assess the biomechanical effects of subtalar ligament injury and reconstruction on stability of the subtalar joint in all three spatial planes.

Methods

Fifteen fresh frozen cadaveric legs were used, with transfixed tibiotalar joints to isolate motion to the subtalar joint. An arthrometer fixed to the lateral aspect of the calcaneus measured angular displacement in all three spatial planes on the inversion and eversion stress tests. Stress manoeuvres were tested with the intact joint, and then repeated after sequentially sectioning the inferior extensor retinaculum (IER), cervical ligament (CL), interosseous talocalcaneal ligament (ITCL), arthroscopic graft reconstruction of the ITCL, and sectioning of the calcaneo-fibular ligament (CFL).

Results

Sectioning the ITCL significantly increased angular displacement upon inversion and eversion in the coronal and sagittal planes. Reconstruction of the ITCL significantly improved angular stability against eversion in the axial and sagittal planes, and against inversion in the axial and coronal planes, at the zero time point after reconstruction. After sectioning the CFL, resistance to eversion decreased significantly in all three planes.

Conclusion

Progressive injury of ligamentous stabilisers, particularly the ITCL, led to increasing angular displacement of the subtalar joint measured with the inversion and eversion stress tests, used in clinical practice. Reconstruction of the ITCL using tendon graft significantly stabilised the subtalar joint in the axial and sagittal planes against eversion and in the axial and coronal planes against inversion, immediately after surgery.

Aynardi M, Pedowitz DI, Raikin SM (2015) Subtalar instability. Foot Ankle Clin 20(2):243–252. https://doi.org/10.1016/j.fcl.2015.02.007CrossRefPubMed

Bell KL, King BW, Sangeorzan BJ (2023) Acute and chronic subtalar joint instability: does it really exist? Foot Ankle Clin 28(2):427–444. https://doi.org/10.1016/j.fcl.2022.12.008CrossRefPubMed

Burssens A, Krähenbühl N, Lenz AL, Howell K, Zhang C, Sripanich Y, Saltzman CL, Barg A (2022) Interaction of loading and ligament injuries in subtalar joint instability quantified by 3D weightbearing computed tomography. J Orthop Res 40(4):933–944. https://doi.org/10.1002/jor.25126CrossRefPubMed

Choisne J, Ringleb SI, Samaan MA, Bawab SY, Naik D, Anderson CD (2012) Influence of kinematic analysis methods on detecting ankle and subtalar joint instability. J Biomech 45(1):46–52. https://doi.org/10.1016/j.jbiomech.2011.10.015CrossRefPubMed

D’Hooghe P, Pereira H, Kelley J, Anderson N, Fuld R, Kumparatana P, Baldini T, Hunt KJ (2020) The CFL fails before the ATFL immediately after combined ligament repair in a biomechanical cadaveric model. Knee Surg Sports Traumatol Arthrosc 28(1):253–261. https://doi.org/10.1007/s00167-019-05626-9CrossRefPubMed

Gomes TM, Oliva XM, Viridiana Sanchez E, Soares S, Diaz T (2023) Anatomy of the ankle and subtalar joint ligaments: what we do not know about it? Foot Ankle Clin 28(2):201–216. https://doi.org/10.1016/j.fcl.2022.12.003CrossRefPubMed

Guerra-Pinto F, Cunha J, Sousa L, Gomes TM, Andrade R, Oliva XM, Consciência JG, Fernandes PR (2020) Gravity stress tibiotalar laxity evaluation with a biomedical gyroscopes device - cadaver study with progressive sectioning of lateral ankle ligaments. J Exp Orthop 7(1):53. https://doi.org/10.1186/s40634-020-00269-zCrossRefPubMedPubMedCentral

Heilman AE, Braly WG, Bishop JO, Noble PC, Tullos HS (1990) An anatomic study of subtalar instability. Foot Ankle 10(4):224–228. https://doi.org/10.1177/107110079001000407CrossRefPubMed

Iglesias-Durán E, Guerra-Pinto F, García-Esteo F, Vilá-Rico J (2020) Anatomic arthroscopic graft reconstruction of the interosseous talocalcaneal ligament for subtalar instability. Arthrosc Tech 9(12):e1903–e1906. https://doi.org/10.1016/j.eats.2020.08.020CrossRefPubMedPubMedCentral

10.

Jotoku T, Kinoshita M, Okuda R, Abe M (2006) Anatomy of ligamentous structures in the tarsal sinus and canal. Foot Ankle Int 27(7):533–538. https://doi.org/10.1177/107110070602700709CrossRefPubMed

11.

Jung H-G, Kim T-H (2012) Subtalar instability reconstruction with an allograft: technical note. Foot Ankle Int 33(8):682–685. https://doi.org/10.3113/FAI.2012.0682CrossRefPubMed

12.

Kamiya T, Kura H, Suzuki D, Uchiyama E, Fujimiya M, Yamashita T (2009) Mechanical stability of the subtalar joint after lateral ligament sectioning and ankle brace application: a biomechanical experimental study. Am J Sports Med 37(12):2451–2458. https://doi.org/10.1177/0363546509339578CrossRefPubMed

13.

Karlsson J, Eriksson BI, Renström PA (1997) Subtalar ankle instability. A review. Sports Med 24(5):337–346. https://doi.org/10.2165/00007256-199724050-00005CrossRefPubMed

14.

Karlsson J, Eriksson BI, Renström P (1998) Subtalar instability of the foot. A review and results after surgical treatment. Scand J Med Sci Sports 8(4):191–197. https://doi.org/10.1111/j.1600-0838.1998.tb00191.xCrossRefPubMed

15.

Kato T (1995) The diagnosis and treatment of instability of the subtalar joint. J Bone Joint Surg Br 77(3):400–406CrossRefPubMed

16.

Keefe DT, Haddad SL (2002) Subtalar instability. Etiology, diagnosis, and management. Foot Ankle Clin 7(3):577–609. https://doi.org/10.1016/s1083-7515(02)00047-5CrossRefPubMed

17.

Kim J, Kim GL, Kim T, Cho J (2023) Evaluation of chronic ankle instability and subtalar instability using the angle between the anterior talofibular ligament and calcaneofibular ligament. Knee Surg Sports Traumatol Arthrosc 31(10):4539–4545. https://doi.org/10.1007/s00167-023-07433-9CrossRefPubMed

18.

Kjaersgaard-Andersen P, Wethelund JO, Helmig P, Søballe K (1988) The stabilizing effect of the ligamentous structures in the sinus and canalis tarsi on movements in the hindfoot. An experimental study. Am J Sports Med 16(5):512–516. https://doi.org/10.1177/036354658801600514CrossRefPubMed

19.

Knudson GA, Kitaoka HB, Lu CL, Luo ZP, An KN (1997) Subtalar joint stability. Talocalcaneal interosseous ligament function studied in cadaver specimens. Acta Orthop Scand 68(5):442–446. https://doi.org/10.3109/17453679708996259CrossRefPubMed

20.

Li S-Y, Hou Z-D, Zhang P, Li H-L, Ding Z-H, Liu Y-J (2013) Ligament structures in the tarsal sinus and canal. Foot Ankle Int 34(12):1729–1736. https://doi.org/10.1177/1071100713500653CrossRefPubMed

21.

Liu C, Jiao C, Hu Y, Guo QW, Wand C, Ao Y (2011) Interosseous talocalcaneal ligament reconstruction with hamstring autograft under subtalar arthroscopy: case report. Foot Ankle Int 32(11):1089–1094. https://doi.org/10.3113/FAI.2011.1089CrossRefPubMed

22.

Martin LP, Wayne JS, Monahan TJ, Adelaar RS (1998) Elongation behavior of calcaneofibular and cervical ligaments during inversion loads applied in an open kinetic chain. Foot Ankle Int 19(4):232–239. https://doi.org/10.1177/107110079801900409CrossRefPubMed

23.

Michels F, Pereira H, Calder J, Matricali G, Glazebrook M, Guillo S, Karlsson J, ESSKA-AFAS Ankle Instability Group, Acevedo J, Batista J, Bauer T, Calder J, Carreira D, Choi W, Corte-Real N, Glazebrook M, Ghorbani A, Giza E, Guillo S, Hunt K, Karlsson J, Kong SW, Lee JW, Michels F, Molloy A, Mangone P, Matsui K, Nery C, Ozeki S, Pearce C, Pereira H, Perera A, Pijnenburg B, Raduan F, Stone J, Takao M, Tourné Y, Vega J (2018) Searching for consensus in the approach to patients with chronic lateral ankle instability: ask the expert. Knee Surg Sports Traumatol Arthrosc 26(7):2095–2102. https://doi.org/10.1007/s00167-017-4556-0CrossRefPubMed

24.

Michels F, Clockaerts S, Van Der Bauwhede J, Stockmans F, Matricali G (2020) Does subtalar instability really exist? A systematic review. Foot Ankle Surg 26(2):119–127. https://doi.org/10.1016/j.fas.2019.02.001CrossRefPubMed

25.

Michels F, Matricali G, Vereecke E, Dewilde M, Vanrietvelde F, Stockmans F (2021) The intrinsic subtalar ligaments have a consistent presence, location and morphology. Foot Ankle Surg 27(1):101–109. https://doi.org/10.1016/j.fas.2020.03.002CrossRefPubMed

26.

Michels F, Stockmans F, Pottel H, Matricali G (2022) Reconstruction of the cervical ligament in patients with chronic subtalar instability. Foot Ankle Surg 28(8):1286–1292. https://doi.org/10.1016/j.fas.2022.06.006CrossRefPubMed

27.

Michels F, Taylan O, Stockmans F, Vereecke E, Scheys L, Matricali G (2022) The different subtalar ligaments show significant differences in their mechanical properties. Foot Ankle Surg 28(7):1014–1020. https://doi.org/10.1016/j.fas.2022.02.008CrossRefPubMed

28.

Michels F, Vereecke E, Matricali G (2023) Role of the intrinsic subtalar ligaments in subtalar instability and consequences for clinical practice. Front Bioeng Biotechnol 11:1047134. https://doi.org/10.3389/fbioe.2023.1047134CrossRefPubMedPubMedCentral

29.

Michelson J, Hamel A, Buczek F, Sharkey N (2004) The effect of ankle injury on subtalar motion. Foot Ankle Int 25(9):639–646. https://doi.org/10.1177/107110070402500908CrossRefPubMed

30.

Mittlmeier T, Rammelt S (2018) Update on Subtalar Joint Instability. Foot Ankle Clin 23(3):397–413. https://doi.org/10.1016/j.fcl.2018.04.005CrossRefPubMed

31.

Pellegrini MJ, Glisson RR, Wurm M, Ousema PH, Romash MM, Nunley JA, Easley ME (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.15.00948CrossRefPubMed

32.

Pereira BS, Andrade R, Espregueira-Mendes J, Marano RPC, Oliva XM, Karlsson J (2021) Current Concepts on Subtalar Instability. Orthop J Sports Med 9(8):23259671211021350. https://doi.org/10.1177/23259671211021352CrossRef

33.

Pisani G, Pisani PC, Parino E (2005) Sinus tarsi syndrome and subtalar joint instability. Clin Podiatr Med Surg 22(1):63–77. https://doi.org/10.1016/j.cpm.2004.08.005CrossRefPubMed

34.

Ringleb SI, Dhakal A, Anderson CD, Bawab S, Paranjape R (2011) Effects of lateral ligament sectioning on the stability of the ankle and subtalar joint. J Orthop Res 29(10):1459–1464. https://doi.org/10.1002/jor.21407CrossRefPubMed

35.

Sangeorzan A, Sangeorzan B (2018) Subtalar Joint Biomechanics: From Normal to Pathologic. Foot Ankle Clin 23(3):341–352. https://doi.org/10.1016/j.fcl.2018.04.002CrossRefPubMed

36.

Song WT, Lee J, Lee JH, Lim J-W, Im J-M, Lee D-O, Jung H-G (2021) A high rate of talocalcaneal interosseous ligament tears was found in chronic lateral ankle instability with sinus tarsi pain. Knee Surg Sports Traumatol Arthrosc 29(11):3543–3550. https://doi.org/10.1007/s00167-021-06651-3CrossRefPubMed

37.

Tan CY, Thevendran G (2023) Subtalar instability. J Orthop Surg Hong Kong 31(2):10225536231182350. https://doi.org/10.1177/10225536231182350CrossRefPubMed

38.

Thermann H, Zwipp H, Tscherne H (1997) Treatment algorithm of chronic ankle and subtalar instability. Foot Ankle Int 18(3):163–169. https://doi.org/10.1177/107110079701800309CrossRefPubMed

39.

Tochigi Y, Takahashi K, Yamagata M, Tamaki T (2000) Influence of the interosseous talocalcaneal ligament injury on stability of the ankle-subtalar joint complex–a cadaveric experimental study. Foot Ankle Int 21(6):486–491CrossRefPubMed

40.

Tochigi Y, Amendola A, Rudert MJ, Baer TE, Brown TD, Hillis SL, Saltzman CL (2004) The role of the interosseous talocalcaneal ligament in subtalar joint stability. Foot Ankle Int 25(8):588–596. https://doi.org/10.1177/107110070402500813CrossRefPubMed

41.

Weindel S, Schmidt R, Rammelt S, Claes L, von Campe A, Rein S (2010) Subtalar instability: a biomechanical cadaver study. Arch Orthop Trauma Surg 130(3):313–319. https://doi.org/10.1007/s00402-008-0743-2CrossRefPubMed

Title: Reconstruction of the interosseous talocalcaneal ligament using allograft for subtalar joint stabilization is effective
Authors: Elvira Iglesias-Durán
Francisco Guerra-Pinto
Cristina Ojeda-Thies
Jesús Vilá-Rico
Publication date: 13-11-2023
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-023-07622-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Reconstruction of the interosseous talocalcaneal ligament using allograft for subtalar joint stabilization is effective

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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