Talonavicular ligament: prevalence of injury in ankle sprains, histological analysis and hypothesis of its biomechanical function

Male National Basketball Association G-League and Collegiate Basketball Athletes Have a High Prevalence of Radiographic Ankle Abnormalities

Purpose

To characterize radiographic foot/ankle bony abnormalities in elite-level, asymptomatic male basketball athletes and to investigate the association between anthropometric (age, height, weight) or sport-specific characteristics (total exposures, player position, pregame ankle taping) and the prevalence of abnormal radiographic findings in asymptomatic basketball athletes.

Methods

Elite-level basketball players who underwent routine, preseason static radiographic imaging, including anteroposterior, lateral, and mortise views of the ankle were included. Radiographs were collected from asymptomatic athletes participating in preseason history and physical with negative anterior drawer/talar tilt test. Radiographs were evaluated by a musculoskeletal radiologist and board-certified orthopaedic surgeon; kappa statistics were used to evaluate agreement.

Results

Fifty-four basketball players (34 collegiate, 20 professional; mean age 21.5 years) were included, totaling 5,148 player exposures from 2017 to 2019. In total, 106 ankles presented with radiographic findings (98.15%). The most prevalent radiographic finding was pes planus (47.22%), followed by degenerative joint disease (DJD; 33.33%), talonavicular sclerosis (28.70%), prominent stieda process (25.93%), os trigonum (20.93%), os subfibulare (11.11%), pes cavus (5.56%), subtalar coalition (2.78%), and cavovarus (0.93%). Height ≥80 inches was significantly associated with talonavicular sclerosis and Kellgren-Lawrence 1 changes.

Conclusions

This study showed a strong association between height and talonavicular sclerosis and DJD, as well as a relatively high prevalence of pes planus and DJD in asymptomatic collegiate and professional basketball players.

Level of Evidence

Level II; Cross-sectional study.

Bone marrow edema of the medioplantar talar head is associated with severe ligamentous injury in ankle sprain

PURPOSE

To investigate the predictive value of talar head edema (THE) in acute ankle sprain for the presence of concomitant ligament injuries.

METHODS

This retrospective study was approved by the ethics committee and informed consent was obtained. One hundred patients (mean age: 37 years ± 14 [standard deviation], range 13-77 years) with MRI of the ankle after acute trauma were included. The cohort in this matched-pair study consisted of 50 patients with THE (group 1) and 50 patients without THE (group 2). Two readers independently evaluated presence and size of bone marrow edema of the talus head and injuries of the lateral, medial, talonavicular, and spring ligament complex. Statistics included intraclass correlation coefficient (ICC) and Kappa statistics as well as parametric and non-parametric tests.

RESULTS

On average, patients with THE demonstrated significantly more ligament injuries in comparison to patients without THE (3.7 vs. 1.3, p ≤ 0.01). Also, in patients with THE, the number of injured ligaments was significantly higher at the lateral (p = 0.03), medial (p ≤ 0.01), and talonavicular (p ≤ 0.01) compartment in comparison to patients without THE. The most frequently injured ligaments in patients with THE were the anterior talofibular ligament (60%) and the anterior tibiotalar ligament (42%). There was no significant correlation between edema size and the number of injured ligaments or compartments (p = 0.5).

CONCLUSION

THE is associated with more extensive ligamentous ankle injury, in particular to the medial and lateral collateral ligament complex, and therefore indicative of severe ankle trauma.

Osteoarthritis, Osteophytes, and Enthesophytes Affect Biomechanical Function in Adults With X-linked Hypophosphatemia

CONTEXT

X-Linked hypophosphatemia (XLH) is a lifelong metabolic disease with musculoskeletal comorbidities that dominate the adult clinical presentation.

OBJECTIVE

The adult XLH disorder has yet to be quantified on the basis of the physical and functional limitations that can affect activities of daily living. Our goal was to report the impact of the musculoskeletal manifestations on physical function.

DESIGN AND SETTING

Musculoskeletal function was evaluated by validated questionnaires and in an interdisciplinary clinical space where participants underwent full-body radiologic imaging, goniometric range of motion (ROM) measurements, general performance tests, and kinematic gait analysis.

PATIENTS

Nine adults younger than 60 years with a diagnosis of XLH and self-reported musculoskeletal disability, but able to independently ambulate, were selected to participate. Passive ROM and gait analysis were also performed on age-approximated controls to account for differences between individual laboratory instrumentation.

RESULTS

Enthesophytes, degenerative arthritis, and osteophytes were found to be consistently bilateral and diffusely present at the spine and synovial joints across participants, with predominance at weight-bearing joints. Passive ROM in adults with XLH was decreased at the cervical spine, hip, knee, and ankle compared to controls. Gait analysis relative to controls revealed increased step width, markedly increased lateral trunk sway, and physical restriction at the hip, knees, and ankle joints that translated into limitations through the gait cycle.

CONCLUSIONS

The functional impact of XLH musculoskeletal comorbidities supports the necessity for creating an interprofessional health-care team with the goal of establishing a longitudinal plan of care that considers the manifestations of XLH across the lifespan.

Extremity CT and ultrasound in the assessment of ankle injuries: occult fractures and ligament injuries

OBJECTIVE

To assess the rates of fractures and ligament injuries in patients with an acute ankle injury and a normal radiographic examination, and to consider the most appropriate examination protocol.

METHODS

Patients with an acute ankle injury who presented to the John Radcliffe Hospital Emergency Department with a normal radiographic examination were eligible for the study. They were invited to receive a cone beam CT and ultrasound examination at a local radiology department within 5 days of their ankle injury.

RESULTS

Of the 100 patients recruited to the study, 19 patients were found to have major fractures and 42 patients had small avulsion fractures. Additionally, 42 patients had ankle effusions and there were a large number of soft tissue injuries. There were 83 acute injuries of the anterior talofibular ligament, 19 of the anterior tibiofibular ligaments, 26 of the calcaneofibular ligament, 39 of the deltoid ligament complex, 21 of the talonavicular ligament, 14 of the spring ligament and 3 of the calcaneocuboid ligament.

CONCLUSION

Conventional radiographic examination misses significant fractures of the foot and ankle and the presence of an ankle effusion does not relate to the severity of injury. Ultrasound is a useful imaging technique that can supplement clinical practice, but it is unlikely to replace current protocols alone. Cone beam CT is an appropriate alternative to plain radiography, being more sensitive in detecting fractures and delivering a similar dose of radiation. However, neither CT or ultrasound examination can detect all avulsion fractures. Simple anterior process fractures of the calcaneus are associated with talonavicular ligament injuries and the medial ligaments are injured in almost 50% of cases when there is a lateral ligament injury.

ADVANCES IN KNOWLEDGE

Fractures in the foot and ankle are detected more precisely with cone beam CT compared to radiographs. Cone beam CT delivers similar doses of to conventional radiographs which is around 10% of that resulting from conventional CT. Ultrasound examination is an effective assessment tool to detect ligamentous injuries. The absence of an ankle effusion does not exclude a major fracture.

Ankle and midfoot ligaments: Ultrasound with anatomical correlation: A review

We present a detailed overview of anatomical and US features of ankle and midfoot ligaments based on our own dissections and cadaver studies as well as US imaging in cadavers and volunteers. The ligament anatomy about the ankle and midfoot is complex. Most ligaments are superficial and hence very well accessible for US. US technique to obtain optimal visualization however is difficult and requires a learning curve. We discuss US technique in detail for each individual ligament. We divided the ligaments in different groups: tibiofibular ligaments, Bassett's ligament, lateral collateral ligament complex (anterior talofibular ligament, calcaneofibular ligament, lateral talocalcaneal ligament, posterior talofibular ligament), medial collateral ligament complex, spring ligament, Chopart joint ligaments (bifurcate ligament, dorsal talonavicular ligament, lateral calcaneocuboid ligament, long and short plantar ligaments), Lisfranc ligaments, sinus tarsi ligaments.

Predicting poor outcome from simple ankle injuries: a prospective cohort study

BACKGROUND

Sprained ankles are common and when there are no signs or evidence of a fracture, conventional management is conservative. At present, there are no clinical markers to identify those that may develop persisting instability and disability that would require rehabilitation or surgery.

OBJECTIVES

To investigate the nature and extent of soft tissue ankle injuries, and to consider whether the anatomical severity of injury can predict functional outcome.

METHODS

Patients attending a local Accident and Emergency Department in Oxford with an acute ankle injury with no clinical requirement for radiographs, or where radiographs were normal, were invited into the study. Within 5 days, patients underwent a diagnostic ultrasound examination, a cone beam CT study and a disability assessment. Ultrasound and physiotherapy assessments were repeated at 3 and 6 months.

RESULTS

100 patients were recruited and grouped based upon injuries. 58 had simple ankle injuries, 21 complex, 19 had significant fractures and 2 were excluded from further follow up analysis. There were no clinically significant differences in pain, disability or functional outcomes between the groups at all points of the study.

CONCLUSION

Medium to long term clinical outcomes were not solely determined by the severity of injury. Some patients with simple injuries were seen to have ongoing problems, whereas some with complex injuries recovered completely in a shorter period. Advances in knowledge: The severity of an ankle injury determined by radiological imaging does not necessarily dictate the severity of a patient's symptoms and the trajectory of their recovery.