Abstract
Purpose of the study: Stiffness of the ankle joint is a common complication after fracture, surgical repair, or total ankle arthroplasty. Dorsiflexion is generally the most limited movement. A few older papers have focused on this common problem in orthopaedic surgery of the ankle joint but have been controversial. The purpose of this anatomy study was to evaluate the efficacy and quantify the impact of releasing the collateral ligaments of the ankle joint on dorsiflexion stiffness.
Material and methods: The two main ankle ligaments implicated in this type of stiffness, the deep bundle of the posterior tibiotalar ligament (dPTTaL) and the posterior talofibular ligament (PTaFL), were studied. We dissected 16 talocrural joints on fresh cadavers and measured with electronic goniometry coupled with electronic dynamometry their movement in dorsiflexion after section of the dPTTaL in the first group and after section of the PTaFL in the second.
Results: The results showed a significant difference (p< 0.0003) between the two populations of ankles. Section of the dPTTaL was more effective against dorsiflexion stiffness than section of the PTaFL, even though the overall benefit in dorsiflexion was less than 10° (mean 7.45 versus 3.45). Combined section of the two ligaments did not provide a statistically significant improvement in the gain in dorsiflextion (p=0.88) compared with isolated section of the two ligaments.
Discussion: If limitation of active and passive dorsiflexion persists after classical release or lengthening of the posterior periarticular tendons of the ankle joint, or after gastrocnemius lengthening, our results show that the following surgical step could be meticulous release of the dPTTaL.
Correspondence should be addressed to Ghislaine Patte at sofcot@sofcot.fr
