Influence of ankle joint plantarflexion and dorsiflexion on lateral ankle sprain: A computational study

Abstract

Understanding the mechanism of injury involved in lateral ankle sprain is essential to prevent injury, to establish surgical repair and reconstruction, and to plan reliable rehabilitation protocols. Most studies for lateral ankle sprain posit that ankle inversion, internal rotation, and plantarflexion are involved in the mechanism of injury. However, recent studies indicated that ankle dorsiflexion also plays an important role in the lateral ankle sprain mechanism. In this study, the contributions of ankle plantarflexion and dorsiflexion on the ankle joint were evaluated under complex combinations of internal and inversion moments. A multibody ankle joint model including 24 ligaments was developed and validated against two experimental cadaveric studies. The effects of ankle plantarflexion (up to 60°) and dorsiflexion (up to 30°) on the lateral ankle sprain mechanism under ankle inversion moment coupled with internal rotational moment were investigated using the validated model. Lateral ankle sprain injuries can occur during ankle dorsiflexion, in which the calcaneofibular ligament and anterior talofibular ligament tears may occur associated with excessive inversion and internal rotational moment, respectively. Various combinations of inversion and internal moment may lead to anterior talofibular ligament injuries at early ankle plantarflexion, while the inversion moment acts as a primary factor to tear the anterior talofibular ligament in early plantarflexion. It is better to consider inversion and internal rotation as primary factors of the lateral ankle sprain mechanism, while plantarflexion or dorsiflexion can be secondary factor. This information will help to clarify the lateral ankle sprain mechanism of injury.

Keywords

Joint biomechanics strain analysis/testing biomechanical testing/analysis biomedical analysis modeling/simulation

Get full access to this article

View all access options for this article.

References

Fong

Hong

Chan

et al . A systematic review on ankle injury and ankle sprain in sports. Sports Med 2007; 37: 73–94.

Fong

Chan

Mok

et al . Understanding acute ankle ligamentous sprain injury in sports. Sports Med Arthrosc Rehabil Ther Technol 2009; 1: 14.

Kobayashi

Gamada

. Lateral ankle sprain and chronic ankle instability: a critical review. Foot Ankle Spec 2014; 7: 298–326.

Woods

Hawkins

Hulse

et al . The football association medical research programme: an audit of injuries in professional football: an analysis of ankle sprains. Br J Sports Med 2003; 37: 233–238.

Kaumeyer

Malone

. Ankle injuries: anatomical and biomechanical considerations necessary for the development of an injury prevention program. J Orthop Sports Phys Ther 1980; 1: 171–177.

Wolfe

Uhl

Mattacola

et al . Management of ankle sprains. Am Fam Physician 2001; 63: 93–104.

Hollis

Blasier

Flahiff

et al . Biomechanical comparison of reconstruction techniques in simulated lateral ankle ligament injury. Am J Sports Med 1995; 23: 678–682.

Bahr

Pena

Shine

et al . Ligament force and joint motion in the intact ankle: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 1998; 6: 115–121.

Colville

Marder

Boyle

et al . Strain measurement in lateral ankle ligaments. Am J Sports Med 1990; 18: 196–200.

10.

Hollis

Blasier

Flahiff

. Simulated lateral ankle ligamentous injury. Change in ankle stability. Am J Sports Med 1995; 23: 672–677.

11.

Parenteau

Viano

Petit

. Biomechanical properties of human cadaveric ankle-subtalar joints in quasi-static loading. J Biomech Eng 1998; 120: 105–111.

12.

Rasmussen

Kromann-Andersen

. Experimental ankle injuries. Analysis of the traumatology of the ankle ligaments. Acta Orthop Scand 1983; 54: 356–362.

13.

Self

Harris

Greenwald

. Ankle biomechanics during impact landings on uneven surfaces. Foot Ankle Int 2000; 21: 138–144.

14.

Wilson

Phillips

Gilbert

. Plantar flexion injuries of the ankle. An experimental study. Clin Orthop Relat Res 1994; 306: 97–102.

15.

Fong

Mok

et al . Kinematics analysis of ankle inversion ligamentous sprain injuries in sports: five cases from televised tennis competitions. Am J Sports Med 2012; 40: 2627–2632.

16.

Mok

Fong

Krosshaug

et al . Kinematics analysis of ankle inversion ligamentous sprain injuries in sports: 2 cases during the 2008 Beijing Olympics. Am J Sports Med 2011; 39: 1548–1552.

17.

Liacouras

Wayne

. Computational modeling to predict mechanical function of joints: application to the lower leg with simulation of two cadaver studies. J Biomech Eng 2007; 129: 811–817.

18.

Shin

Untaroiu

. Biomechanical and injury response of human foot and ankle under complex loading. J Biomech Eng 2013; 135: 101008.

19.

Wei

Fong

Chan

et al . Estimation of ligament strains and joint moments in the ankle during a supination sprain injury. Comput Methods Biomech Biomed Engin 2015; 18: 243–248.

20.

Wright

Neptune

van den Bogert

et al . The influence of foot positioning on ankle sprains. J Biomech 2000; 33: 513–519.

21.

Fong

Hong

Shima

et al . Biomechanics of supination ankle sprain: a case report of an accidental injury event in the laboratory. Am J Sports Med 2009; 37: 822–827.

22.

Gehring

Wissler

Mornieux

et al . How to sprain your ankle—a biomechanical case report of an inversion trauma. J Biomech 2013; 46: 175–178.

23.

Kristianslund

Bahr

Krosshaug

. Kinematics and kinetics of an accidental lateral ankle sprain. J Biomech 2011; 44: 2576–2578.

24.

Funk

. Ankle injury mechanisms: lessons learned from cadaveric studies. Clin Anat 2011; 24: 350–361.

25.

Funk

Hall

Crandall

et al . Linear and quasi-linear viscoelastic characterization of ankle ligaments. J Biomech Eng 2000; 122: 15–22.

26.

Attarian

McCrackin

DeVito

et al . Biomechanical characteristics of human ankle ligaments. Foot Ankle 1985; 6: 54–58.

27.

Siegler

Block

Schneck

. The mechanical characteristics of the collateral ligaments of the human ankle joint. Foot Ankle 1988; 8: 234–242.

28.

Iaquinto

Wayne

. Computational model of the lower leg and foot/ankle complex: application to arch stability. J Biomech Eng 2010; 132: 021009.

29.

Pfaeffle

Tomaino

Grewal

et al . Tensile properties of the interosseous membrane of the human forearm. J Orthop Res 1996; 14: 842–845.

30.

Wei

Hunley

Powell

et al . Development and validation of a computational model to study the effect of foot constraint on ankle injury due to external rotation. Ann Biomed Eng 2011; 39: 756–765.

31.

Netter

Hansen

. Atlas of human anatomy. 3rd ed. Teterboro, NJ: ICON Learning Systems, 2003.

32.

Rohen

Yokochi

Lutjen-Drecoll

. Color atlas of anatomy: a photographic study of the human body. 7th ed. Stuttgart: Schattauer GmbH, 2011.

33.

Button

Wei

Meyer

et al . Specimen-specific computational models of ankle sprains produced in a laboratory setting. J Biomech Eng 2013; 135: 041001.

34.

Marqueen

Owen

Nicandri

et al . Comparison of the syndesmotic staple to the transsyndesmotic screw: a biomechanical study. Foot Ankle Int 2005; 26: 224–230.

35.

Siegler

Allard

et al . ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion—part I: ankle, hip, and spine. International Society of Biomechanics. J Biomech 2002; 35: 543–548.

36.

Ozeki

Yasuda

Kaneda

et al . Simultaneous strain measurement with determination of a zero strain reference for the medial and lateral ligaments of the ankle. Foot Ankle Int 2002; 23: 825–832.

37.

Renstrom

Wertz

Incavo

et al . Strain in the lateral ligaments of the ankle. Foot Ankle 1988; 9: 59–63.

38.

Rasmussen

. Stability of the ankle joint. Analysis of the function and traumatology of the ankle ligaments. Acta Orthop Scand Suppl 1985; 211: 1–75.

39.

Lauge-Hanse

. Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg 1950; 60: 957–985.

40.

Arimoto

Forrester

. Classification of ankle fractures: an algorithm. Am J Roentgenol 1980; 135: 1057–1063.

41.

Okanobo

Khurana

Sheehan

et al . Simplified diagnostic algorithm for Lauge-Hansen classification of ankle injuries. Radiographics 2012; 32: E71–E84.

42.

Warner

Garner

Hinds

et al . Correlation between the Lauge-Hansen classification and ligament injuries in ankle fractures. J Orthop Trauma 2015; 29: 574–578.