BIOMECHANICAL STUDY ON REPAIRING DISTAL TIBIOFIBULAR SYNDESMOSIS INJURIES WITH ARTIFICIAL LIGAMENTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WUZizheng ¹ , WANGBing ¹ , CAOYun ¹ , ZHAOYi ¹ , WANGYijin ²

1. Department of Orthopedics, Baoshan Branch, Shanghai No.1. People's Hospital, Shanghai Jiaotong University, Shanghai, 200940, P. R. China;
2. Biomechanical Engineering Research Institute of Shanghai University, Shanghai Jiaotong University, Shanghai, 200940, P. R. China;

Corresponding?author：

WUZizheng, Email: wuzizheng@163.com

Keywords：

Distal tibiofibular syndesmosis injury; Artificial ligament; Internal fixation; Biomechanics

DOI：

10.7507/1002-1892.20140264

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Objective To investigate the biomechanical properties of artificial ligament in the treatment of injuries to distal tibiofibular syndesmosis so as to provide a scientific basis for clinical application. Methods Sixteen fresh ankle specimens were harvested from 8 normal fresh-frozen cadavers. The initial tests were performed on 16 intact specimens (group A) and then the distal tibiofibular syndesmosis injury models were made (group B); the distal tibiofibular syndesmosis was fixed with artificial ligament in 8 specimens (group C) and with cannulated lag screw in the other 8 specimens (group D). The pros and cons of different fixation methods were analyzed by displacement, stress shielding effect, the strength and stiffness of ankle joints, the contact area of tibiotalar articular surface and the contact stress. Results Under the physiological loading or combined with external rotation moment, the displacement of group C was significantly lower than that of groups B and D (P < 0.05), but no significant difference was found between groups A and C (P > 0.05); and there were significant differences among groups A, B, and D (P < 0.05). The rates of stress shielding in the tibia and fibula of group C were significantly lower than those of group D (t=-71.288, P=0.000;t=-97.283, P=0.000). The stress strength in tibia of group C was significantly higher than that of groups A and D (P < 0.05), but no significant difference was found between groups A and D (P > 0.05). Group C had the highest stress strength in fibula, followed by group A, group D had the lowest; differences were significant among 3 groups (P < 0.05). There was no significant difference in shear strength among groups A, C, and D (P > 0.05). The axial stiffness in tibia of group D was significantly lower than that of groups A and C (P < 0.05), but no significant difference was found between groups A and C (P > 0.05). The axial stiffness in fibula of group C was significantly higher than that of groups A and D (P < 0.05), but no significant difference was found between groups A and D (P > 0.05). Group C had the highest shear stiffness in tibia and fibula, followed by group D, group A had the lowest; differences were significant among 3 groups (P < 0.05). In groups A, C, and D, the contact area of tibiotalar articular surface gradually reduced, and the contact stress gradually increased, and differences were significant among 3 groups (P < 0.05). Conclusion Fixation of distal tibiofibular syndesmosis injury with artificial ligament can better meet the physiological functions of the distal tibiofibular syndesmosis and has lower stress shielding, better stress distribution. Hopefully, it can reduce the complications of the distal tibiofibular syndesmosis injuries and become a better treatment choice.

Citation： WUZizheng, WANGBing, CAOYun, ZHAOYi, WANGYijin. BIOMECHANICAL STUDY ON REPAIRING DISTAL TIBIOFIBULAR SYNDESMOSIS INJURIES WITH ARTIFICIAL LIGAMENTS. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(10): 1217-1220. doi: 10.7507/1002-1892.20140264 Copy

1.	Egol KA, Pahk B, Walsh M, et al.Outcome after unstable ankle fracture:effect of syndesmotic stabilization.J Orthop Trauma, 2010, 24(1):7-11.
2.	Ebraheim NA, Taser F, Shafiq Q, et al.Anatomical evaluation and clinical importance of the tibiofibular syndesmosis ligaments.Surg Radiol Anat, 2006, 28(2):142-149.
3.	Beumer A, Valstar ER, Garling EH, et al.Effects of ligament sectioning on the kinematics ofthe distal tibiofibular syndesmosis:a radiostereometric study of 10 cadaveric specimens based on presumed trauma mechanisms with suggestions for treatment.Acta Orthop, 2006, 77(3):531-540.
4.	Schepers T.Acute distal tibiofibular syndesmosis injury:a systematic review of suture-button versus syndesmotic screw repair.Int Orthop, 2012, 36(6):1199-1206.
5.	Yasui Y, Takao M, Miyamoto W, et al.Anatomical reconstruction of the anterior inferior tibiofibular ligament for chronic disruption of the distal tibiofibular syndesmosis.Knee Surg Sports Traumatol Arthrosc, 2011, 19(4):691-695.
6.	Degroot H, Al-Omari AA, El Ghazaly SA.Outcomes of suture button repair of the distal tibiofibular syndesmosis.Foot Ankle Int, 2011, 32(3):250-256.
7.	Teramoto A, Suzuki D, Kamiya T, et al.Comparison of different fixation methods of the suture-button implant for tibiofibular syndesmosis injuries.Am J Sports Med, 2011, 39(10):2226-2232.
8.	Be'ery-Lipperman M, Gefen A.A method of quantification of stress shielding in the proximal femur using hierarchical computational modeling.Comput Methods Biomech Biomed Engin, 2006, 9(1):35-44.
9.	王以進, 王介麟.骨科生物力學.北京:人民軍醫出版社, 1989:185-196.
10.	王以進, 王公林.人體脛骨的力學性質——30例報告.生物力學, 1987, 2(1):49-52.
11.	Bartonícek J.Anatomy of the tibiofibular syndesmosis and its clinical relevance.Surg Radiol Anat, 2003, 25(5-6):379-386.
12.	Xenos JS, Hopkinson WJ, Mulligan ME, et al.The tibiofibular syndesmosis.Evaluation of the ligamentous structures, methods of fixation, and radiographic assessment.J Bone Joint Surg (Am), 1995, 77(6):847-856.
13.	Best R, Mauch F, Bauer G.Evidence for treatment of acute syndesmosis injuries in sports.Unfallchirurg, 2013, 116(6):504-511.
14.	Beumer A, Campo MM, Niesing R, et al.Screw fixation of the syndesmosi:a cadaver model comparing stainless steel and titanium screws and three and four cortical fixation.Injury, 2005, 36(1):60-64.
15.	Hinds RM, Lazaro LE, Burket JC, et al.Risk factors for posttraumatic synostosis and outcomes following operative treatment of ankle fractures.Foot Ankle Int, 2014, 35(2):141-147.
16.	van den Bekerom MP, Kloen P, Luitse JS, et al.Complications of distal tibiofibular syndesmotic screw stabilization:analysis of 236 patients.J Foot Ankle Surg, 2013, 52(4):456-459.
17.	Uchio Y, Ochi M, Sumen Y, et al.Mechanical properties of newly developed loop ligament for connection between the EndoButton and hamstring tendons:comparison with ethibond sutures and EndoButton tape.J Biomed Mater Res, 2002, 63(2):173-181.

1. Egol KA, Pahk B, Walsh M, et al.Outcome after unstable ankle fracture:effect of syndesmotic stabilization.J Orthop Trauma, 2010, 24(1):7-11.
2. Ebraheim NA, Taser F, Shafiq Q, et al.Anatomical evaluation and clinical importance of the tibiofibular syndesmosis ligaments.Surg Radiol Anat, 2006, 28(2):142-149.
3. Beumer A, Valstar ER, Garling EH, et al.Effects of ligament sectioning on the kinematics ofthe distal tibiofibular syndesmosis:a radiostereometric study of 10 cadaveric specimens based on presumed trauma mechanisms with suggestions for treatment.Acta Orthop, 2006, 77(3):531-540.
4. Schepers T.Acute distal tibiofibular syndesmosis injury:a systematic review of suture-button versus syndesmotic screw repair.Int Orthop, 2012, 36(6):1199-1206.
5. Yasui Y, Takao M, Miyamoto W, et al.Anatomical reconstruction of the anterior inferior tibiofibular ligament for chronic disruption of the distal tibiofibular syndesmosis.Knee Surg Sports Traumatol Arthrosc, 2011, 19(4):691-695.
6. Degroot H, Al-Omari AA, El Ghazaly SA.Outcomes of suture button repair of the distal tibiofibular syndesmosis.Foot Ankle Int, 2011, 32(3):250-256.
7. Teramoto A, Suzuki D, Kamiya T, et al.Comparison of different fixation methods of the suture-button implant for tibiofibular syndesmosis injuries.Am J Sports Med, 2011, 39(10):2226-2232.
8. Be'ery-Lipperman M, Gefen A.A method of quantification of stress shielding in the proximal femur using hierarchical computational modeling.Comput Methods Biomech Biomed Engin, 2006, 9(1):35-44.
9. 王以進, 王介麟.骨科生物力學.北京:人民軍醫出版社, 1989:185-196.
10. 王以進, 王公林.人體脛骨的力學性質——30例報告.生物力學, 1987, 2(1):49-52.
11. Bartonícek J.Anatomy of the tibiofibular syndesmosis and its clinical relevance.Surg Radiol Anat, 2003, 25(5-6):379-386.
12. Xenos JS, Hopkinson WJ, Mulligan ME, et al.The tibiofibular syndesmosis.Evaluation of the ligamentous structures, methods of fixation, and radiographic assessment.J Bone Joint Surg (Am), 1995, 77(6):847-856.
13. Best R, Mauch F, Bauer G.Evidence for treatment of acute syndesmosis injuries in sports.Unfallchirurg, 2013, 116(6):504-511.
14. Beumer A, Campo MM, Niesing R, et al.Screw fixation of the syndesmosi:a cadaver model comparing stainless steel and titanium screws and three and four cortical fixation.Injury, 2005, 36(1):60-64.
15. Hinds RM, Lazaro LE, Burket JC, et al.Risk factors for posttraumatic synostosis and outcomes following operative treatment of ankle fractures.Foot Ankle Int, 2014, 35(2):141-147.
16. van den Bekerom MP, Kloen P, Luitse JS, et al.Complications of distal tibiofibular syndesmotic screw stabilization:analysis of 236 patients.J Foot Ankle Surg, 2013, 52(4):456-459.
17. Uchio Y, Ochi M, Sumen Y, et al.Mechanical properties of newly developed loop ligament for connection between the EndoButton and hamstring tendons:comparison with ethibond sutures and EndoButton tape.J Biomed Mater Res, 2002, 63(2):173-181.

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