Ankle Ligaments

Becker HP, Rosenbanm D, Zeithammel G, Gnann R, Bauer G, Gemgross H, Claes L, Tenodesis versus carbon fiber repair of ankle ligaments, a clinical comparison. Clinical Orthopaedics and Related Research, 325, 194—202, 1996. 

Campbell DG, Menz A, Isaacs J (1994) Dynamic ankle ultrasonography. A new imaging technique for acute ankle ligament injuries. Am J Sports Med 22 855-858 Campeau NG, Lewis BD (1998) Ultrasound appearance of synovial osteochondromatosis of the shoulder. Mayo Clin Proc 73 1079-1081... 

Peetrons P, Creteur V, Bacq C (2004) Sonography of ankle ligaments.) Clin Ultrasound 32 491-499 Popert J (1985) Rice bodies, synovial debris, and joint lavage. Br J Rheumatol 24 1-2... 

At US examination, ankle ligaments with partial tears may appear swollen with focal or diffuse internal hypoechoic areas (Figs. 16.39,16.40) (Krappel et al. 1997 Peetrons et al. 2004). In complete ruptures. 

Soft Tissue Injuries. Some of the more common soft tissue injuries are sprains, strains, contusions, tendonitis, bursitis, and stress injuries, caused by damaged tendons, muscles, and ligaments. A sprain is a soft tissue injury to the ligaments. Certain sprains are often associated with small fractures. This type of injury is normally associated with a localized trauma event. The severity of the sprain depends on how much of the ligament is torn and to what extent the ligament is detached from the bone. The areas of the human body that are most vulnerable to sprains are ankles, knees, and wrists. 

A sprained ankle is the most frequent injury. The recommended treatment for a simple sprain is usually rest, ice, compression, and elevation (RICE). If a ligament is tom, however, surgery may be required to repair the injury. 

A bursa, a sac filled with fluid located around a principal joint, is lined with a synovial membrane and contains synovial fluid. This fluid minimizes friction between the tendon and the bone, or between tendon and ligament. Repeated small stresses and ovemse can cause the bursa in the shoulder, hip, knee, or ankle to swell. This swelling and irritation is referred to as bursitis. Some patients experience bursitis in association with tendonitis. Bursitis can usually be reheved by rest and in some cases by using antiinflammatory medications. Some orthopedic surgeons also inject the bursa with additional medication to reduce the inflammation. 

Rheumatoid arthritis is an autoimmune disease of the synovial lining of joints. Typically, the joints affected are those in the extremities fingers, wrists, toes, and ankles. It is a debilitating disease in which ligaments may be damaged and joints deformed. 

Parlasca R., Shoji H., and D Ambrosia R.D. 1979. Effects of ligamentous injury on ankle and subtalar joints. A kinematic study. Clin. Orthop. 140 266. 

Joints such as the ankle and wrist consist of many small bones, and their surfaces must be determined accurately. This may be done via cadaveric examination or noninvasive means. The cadaveric system generally consists of the following (or a modification) The ligaments and tendons are stained to display the attachments (insertions) into the bones the construct is then embedded in Plexiglas, and sequential pictures or scans are taken as the construct is either sliced or milled. Slices on the order of a fraction of a millimeter are needed to fully describe the surfaces of wrist carpal bones. Noninvasive measures, such as modem high-sensitivity computed tomographic (CT) scans, may also be able to record geometries at the required level of detail. 

Siegler, S., Block, J. and Schneck, C.D. (1988) The mechanical characteristics of the collateral ligaments of the human ankle joint. Foot Ankle, 8(5), 234-42. 

Kumai T, Takakura Y, Rufai A et al (2002) The functional anatomy of the human anterior talofibular ligament in relation to ankle sprains. J Anat 200 457-465... 

Boden BP, Torg IS, Knowles SB, Hewett TE (2009) Video analysis of anterior cmciate ligament injury almormalities in hip and ankle kinematics. Am J Sports Med 37(2) 252-259... 

Recently, three-dimensional computed tomography (3DCT) with volume rendering has been used for diagnosing several soft tissues, such as the muscles, hand, and wrist tendons, or anterior talofibular ligament (ATFL) of the ankle [1-3]. 

Plewes DB (1994) The AAPM/RSNA physics tutorial for residents. Contrast mechanisms in spin-echo MR imaging. Radiographics 14 1389-1404 quiz 1405-1406 Pudas T, Hurme T et al. (2005) Magnetic resonance imaging in pediatric elbow fractures. Acta Radiol 46 636-644 Rand T, Ahn JM et al. (1999) Ligaments and tendons of the ankle. Evaluation with low-field (0.2 T) MR imaging. Acta Radiol 40 303-308... 

Fractures of the head and neck of the fibula occur rarely in isolation and are more commonly associated with proximal tibial fractures, especially compression, bicondylar and subcondylar fractures. A spiral fracture of the proximal fibula is often associated with an ankle fracture, resulting from an external rotation force. These fractures are known as Maisonneuve fractures. Fibula head fractures can occur from direct impact, valgus stress (associated with a tibial condylar fracture), and varus injuries. Varus stresses can cause avulsion of the fibular styloid at the site of the biceps tendon and fibular (lateral) collateral ligament. Peroneal nerve injury is not uncommon with these injuries. Dislocation of the proximal fibula is often missed on the initial radiograph. 

For paediatric ankle injuries with normal radiographs, high resolution ultrasound has been shown to be useful in diagnosing occult fractures (SiMANOVSKY et al. 2005) and ligamentous injuries (Farley et al. 2001). The majority of these occult fractures are Salter-Harris I or II fractures of the distal fibular physis. If left undiagnosed and untreated the majority of such injuries would have a satisfactory outcome. 

Arthroscopy. Orthopedic surgeons use the ar-throscope to view the interior of joints. As with other endoscopic procedures, abnormalities can be visualized and sometimes repaired. For example, a torn ligament can be rejoined using arthroscopy. Almost everyjoint in the human body can be examined with the arthroscope. The most common joints visualized are the knee, hip, ankle, foot, and shoulder. 

The human skeleton consists of both fused and individual bones supported and supplemented by ligaments, tendons, and skeletal muscles. The articular ligaments and tendons are the main parts holding together the joint(s). hr respect to the movement, there are freely moveable, partially moveable, and immovable joints. Synovial joints, the freely moveable ones, allow for a large range of motion and encompass wrists, knees, ankles, shoulders, and hips. 

This test evaluates the medial and lateral collateral structures. With the patient supine, the ankle joint is held between the examiner s side and arm, thus freeing both hands. The knee is tested in full extension by applying a valgus and then a varus force to the proximal tibia (abduction-adduction motion of leg) (Fig. 94-1). The examiner notes any instability or increased motion on application of force in either direction. Then the test is repeated with the knee slightly flexed. If the cruciate ligaments are intact, motion can be stable with the knee in full extension, even with collateral ligament rupture. 

The ankle articulation consists of the distal end of the tibia and the medial and lateral malleoli, which together form a concave surface, the crural arch, into which is fitted the body of the talus. These bones are connected by the joint capsule and by the deltoid, anterior and posterior talofibular, and calcaneofibular ligaments. The tibial malleolus extends approximately one-third of the way down the medial surface of the talus and is anterior to the lateral malleolus. The fibular malleolus extends down the entire lateral aspect of the talus. When viewed from above, the entire articulation is laterally angled, thus creating a toeing-out of 15 degrees (Fig. 95-1). 

This technique is a combination of myofascial ligamentous release and articulation of both the knee and ankle joints. It is especially useful when both the knee and ankle joints of the same leg are involved. It is designed to improve motion without a thrust. 

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