Novel anatomical reconstruction of distal tibiofibular ligaments restores syndesmotic biomechanics

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 25; no. 6; pp. 1866 - 1872
• Main Authors: Che, Jian, Li, Chunbao, Gao, Zhipeng, Qi, Wei, Ji, Binping, Liu, Yujie, Liow, Ming Han Lincoln
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2017; Springer Nature B.V
• Subjects: Ankle; Ankle - physiopathology; Ankle - surgery; Ankle Injuries - physiopathology; Ankle Injuries - surgery; Axial stress; Biomechanical Phenomena; Biomechanics; Bone implants; Bone Screws; Cadaver; Cadavers; Displacement; Extremities; Feet; Fibula; Fibula - surgery; Fixation; Humans; Injuries; Ligaments; Ligaments, Articular - injuries; Ligaments, Articular - physiopathology; Ligaments, Articular - surgery; Mechanical properties; Medicine; Medicine & Public Health; Orthopedics; Rotation; Skin & tissue grafts; Stability; Surgery; Surgical techniques; Tibia; Tibia - surgery; Torque; Biomechanical cadaveric study; Syndesmosis; Anatomical reconstruction; Distal tibiofibular ligaments; Surgical technique
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-017-4485-y

Purpose
To date, there is a paucity of literature on syndesmotic reconstruction techniques that restore both anatomic stability and physiologic syndesmotic biomechanics. In this cadaveric study, (1) a novel syndesmotic reconstruction surgical technique using autogenous peroneus brevis tendon was described and (2) the biomechanical properties of the reconstruction was investigated.
Methods
Ten fresh-frozen lower extremities were used in this study. Reconstruction of the anterior and posterior, as well as the interosseous tibiofibular ligaments was performed with a halved peroneus brevis tendon. Biomechanics were assessed using foot external rotation torque and ankle dorsiflexion axial loading tests, which were performed in (a) intact, (b) cut, (c) anatomically reconstructed syndesmotic ligaments, and (d) 3.5 mm tricortical syndesmotic screw fixation. Medial–lateral and anterior–posterior displacements of the distal fibula were recorded during foot external rotation and fibular axial displacement was recorded during ankle axial loading.
Results
The fibula was displaced posteriorly and proximally with respect to the tibia in all specimens during external rotation and axial loading tests, respectively. Significant differences (
p
 < 0.05) were found in distal fibular displacements between anatomically reconstructed ligaments and screw fixation. Tricortical syndesmotic screw fixation resulted in 59% of posterior fibular displacement when compared to intact ligaments. No significant differences (n.s.) in distal fibular displacement were demonstrated between intact ligaments and anatomically reconstructed ligaments.
Conclusion
Anatomical reconstruction of the distal tibiofibular ligaments with the peroneus brevis tendon provides stability and recreates the biomechanical properties of an intact syndesmosis. This new surgical technique may be a viable alternative for the treatment of syndesmotic injuries.
Level of evidence
V.