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The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 9 | Pages 1232 - 1239
1 Sep 2011
Stufkens SA van Bergen CJ Blankevoort L van Dijk CN Hintermann B Knupp M

It has been suggested that a supramalleolar osteotomy can return the load distribution in the ankle joint to normal. However, due to the lack of biomechanical data, this supposition remains empirical. The purpose of this biomechanical study was to determine the effect of simulated supramalleolar varus and valgus alignment on the tibiotalar joint pressure, in order to investigate its relationship to the development of osteoarthritis. We also wished to establish the rationale behind corrective osteotomy of the distal tibia.

We studied 17 cadaveric lower legs and quantified the changes in pressure and force transfer across the tibiotalar joint for various degrees of varus and valgus deformity in the supramalleolar area. We assumed that a supramalleolar osteotomy which created a varus deformity of the ankle would result in medial overload of the tibiotalar joint. Similarly, we thought that creating a supramalleolar valgus deformity would cause a shift in contact towards the lateral side of the tibiotalar joint. The opposite was observed. The restricting role of the fibula was revealed by carrying out an osteotomy directly above the syndesmosis. In end-stage ankle osteoarthritis with either a valgus or varus deformity, the role of the fibula should be appreciated and its effect addressed where appropriate.


The Journal of Bone & Joint Surgery British Volume
Vol. 87-B, Issue 10 | Pages 1364 - 1368
1 Oct 2005
Brinkman J Schwering PJA Blankevoort L Koolos JG Luites J Wymenga AB

We have quantitatively documented the insertion geometry of the main stabilising structures of the posterolateral corner of the knee in 34 human cadavers. The lateral collateral ligament inserted posterior (4.6 mm, sd 2) and proximal (1.3 mm, sd 3.6) to the lateral epicondyle of the femur and posterior (8.1 mm, sd 3.2) to the anterior point of the head of the fibula. On the femur, the popliteus tendon inserted distally (11 mm, sd 0.8) and either anterior or posterior (mean 0.84 mm anterior, sd 4) to the lateral collateral ligament. The popliteofibular ligament inserted distal (1.3 mm, sd 1.2) and anterior (0.5 mm, sd 2.0) to the tip of the styloid process of the fibula.

The ligaments had a consistent pattern of insertion and, despite the variation between specimens, the standard deviations were less than the typical size of drill hole used in reconstruction of the posterolateral corner. The data provided in this study can be used in the anatomical repair and reconstruction of this region of the knee.