Tochigi, Yuki; Rudert, M. James; Saltzman, Charles L.; Amendola, Annunziato; Brown, Thomas D.
December 2006
Journal of Bone & Joint Surgery, American Volume;Dec2006, Vol. 88-A Issue 12, p2704
Academic Journal
Background: Passive ankle stability under weight-bearing conditions has been found to depend substantially on the role of the articular surface geometry. In the present study, it was hypothesized that, in the ankle under axial loading, contact-stress changes in response to alterations of external load involve reproducible and specific patterns to main- tain ankle stability. Methods: Six cadaver ankles with the pen-ankle ligaments intact were tested. Each specimen, held at several prede- termined ankle positions under a primary one-body-weight axial force, was subjected to an additional secondary load. The secondary load-specifically, anterior/posterior shear force, inversion/eversion torque, or internal/external rota- tion torque-was applied independently, while motion associated with the two other secondary loading directions was unconstrained. Contact stress in the tibiotalar articulation was monitored by a real-time contact-stress sensor. Site- specific stress changes solely due to secondary loading at each load/position were identified by subtraction of the corresponding axial-force-only baseline distribution. The role of these stress changes in ankle stabilization was studied for each specimen by analyzing the data with a computer model of ankle geometry. Results: In the cadaver experiment, anterior and posterior shear forces caused reproducible positive changes in ar- ticular contact stresses on the anterior and posterior regions, respectively. Similar changes with version torques oc- curred on the medial and lateral regions. Positive changes with internal/external rotation torques occurred at two diagonal locations: anterolateral and posteromedial, or anteromedial and posterolateral. In the model analysis, these stress-change patterns were found to be effective in ankle stabilization, and the levels of contribution by the articular surface were calculated as accounting for approximately 70% of anterior/posterior stability, 50% of version stability, and 30% of internal/external rotation stability. Conclusions: The documented changes in contact stress illustrate the major role of articular geometry in passive an- kle stabilization. The levels of contribution by the articular surface that we calculated are consistent with those re- ported in the literature. These findings support the conceptual mechanism of ankle stabilization by redistribution of articular contact stress. Clinical Relevance: Passive ankle stability under weight-bearing conditions appears to be dictated by the integrity of articular surface geometry, implying that any abnormality of that geometry can affect joint kinematics during locomo- tive activities.


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