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Research Papers

Comparative Evaluation Between Anatomic and Nonanatomic Lateral Ligament Reconstruction Techniques in the Ankle Joint: A Computational Study

[+] Author and Article Information
Tserenchimed Purevsuren

Department of Mechanical Engineering,
Kyung Hee University,
Yongin 17104, South Korea
e-mail: Tserenchimed.p@gmail.com

Myagmarbayar Batbaatar

Department of Mechanical Engineering,
Kyung Hee University,
Yongin 17104, South Korea
e-mail: Miigaa1992@gmail.com

Batbayar Khuyagbaatar

Department of Mechanical Engineering,
Kyung Hee University,
Yongin 17104, South Korea
e-mail: kh.batbayar@gmail.com

Kyungsoo Kim

Department of Applied Mathematics,
Kyung Hee University,
Yongin 17104, South Korea
e-mail: kyungsoo@khu.ac.kr

Yoon Hyuk Kim

Department of Mechanical Engineering,
Kyung Hee University,
Yongin 17104, South Korea
e-mail: yoonhkim@khu.ac.kr

1Corresponding author.

Manuscript received September 30, 2017; final manuscript received February 12, 2018; published online April 4, 2018. Assoc. Editor: Tammy L. Haut Donahue.

J Biomech Eng 140(6), 061009 (Apr 04, 2018) (8 pages) Paper No: BIO-17-1441; doi: 10.1115/1.4039576 History: Received September 30, 2017; Revised February 12, 2018

Biomechanical studies have indicated that the conventional nonanatomic reconstruction techniques for lateral ankle sprain (LAS) tend to restrict subtalar joint motion compared to intact ankle joints. Excessive restriction in subtalar motion may lead to chronic pain, functional difficulties, and development of osteoarthritis (OA). Therefore, various anatomic surgical techniques to reconstruct both the anterior talofibular and calcaneofibular ligaments (CaFL) have been introduced. In this study, ankle joint stability was evaluated using multibody computational ankle joint model to assess two new anatomic reconstruction and three popular nonanatomic reconstruction techniques. An LAS injury, three popular nonanatomic reconstruction models (Watson-Jones, Evans, and Chrisman–Snook) and two common types of anatomic reconstruction models were developed based on the intact ankle model. The stability of ankle in both talocrural and subtalar joint were evaluated under anterior drawer test (150 N anterior force), inversion test (3 N·m inversion moment), internal rotational test (3 N·m internal rotation moment), and the combined loading test (9 N·m inversion and internal moment as well as 1800 N compressive force). Our overall results show that the two anatomic reconstruction techniques were superior to the nonanatomic reconstruction techniques in stabilizing both talocrural and subtalar joints. Restricted subtalar joint motion, which is mainly observed in Watson-Jones and Chrisman–Snook techniques, was not shown in the anatomical reconstructions. Evans technique was beneficial for subtalar joint as it does not restrict subtalar motion, though Evans technique was insufficient for restoring talocrural joint inversion. The anatomical reconstruction techniques best recovered ankle stability.

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Figures

Grahic Jump Location
Fig. 6

Complex high loading test under a 9 N·m inversion moment, a 9 N·m internal rotation moment, and a 1800 N ground reaction force: (a) talus inversion angle relative to the tibia on the inversion axis, (b) talus internal rotation angle relative to the tibia on the internal rotation axis, and (c) subtalar rotation angle as measured by calcaneus inversion relative to the talus. The result of the LAS injury model (ATaFL and CaFL cut) was not considered because the injury model could not resist high loading under complex loading test.

Grahic Jump Location
Fig. 5

Internal rotation test under a 3 N·m internal rotation moment. Talus internal rotation angle relative to the tibia on the internal rotation axis. The error bars indicate the range of values obtained from the previous experimental study [10].

Grahic Jump Location
Fig. 4

Inversion test under a 3 N·m inversion moment: (a) talus inversion angle relative to the tibia on the inversion axis and (b) subtalar rotation angle quantified by subtracting talus inversion relative to the tibia from total calcaneus inversion relative to the tibia. The error bars indicate the range of values obtained from the previous experimental studies [10,17,19,48].

Grahic Jump Location
Fig. 3

Anterior drawer test under a 150 N anterior force: (a) talus translation relative to the tibia along the inversion axis and (b) subtalar translation as quantified by subtracting talus anterior translation relative to the tibia from total calcaneus translation relative to the tibia. The error bars indicate the range of values obtained from the previous experimental studies [10,17,19,48].

Grahic Jump Location
Fig. 2

Directions of loading and axes of rotation. An anterior force in the anterior drawer test and a compressive force in the complex loading test were applied as concentrated force to thecalcaneus along respective axes. The tibia was fixed on the ground and the other bones were free to move except for prescribed foot flexion.

Grahic Jump Location
Fig. 1

A three-dimensional multibody dynamic model of the human ankle joint and models with commonly used surgical techniques: A—intact ankle model, B—ATaFL and CaFL cut model, C—model with Watson-Jones reconstruction technique, D—model with Evans reconstruction technique, E—model with Chrisman–Snook reconstruction technique, F—model with anatomic-1 reconstruction technique, G—model with anatomic-2 reconstruction technique, H—modeling of the curved path to mimic graft motion within the tunnel by using a system consisted of massless spheres and stiff springs. The gray and black lines in the reconstruction models indicated the reconstruction grafts inside and outside of the fibular tunnel, respectively.

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