title: Analysis of ankle-hindfoot stability in multiple planes: an in vitro study.
abstract: BACKGROUND
  It is necessary to have an understanding of ankle and hindfoot motion and stability to accurately diagnosis and treat ankle-hindfoot disorders.
  
  
  METHODS
  We devised an ankle ligament testing apparatus to more critically determine ankle stability in all planes with a constant rotational force applied (inversion, eversion, internal rotation, external rotation) throughout the range of sagittal plane motion in 13 cadaver specimens. Three-dimensional kinematics were determined with a magnetic tracking device.
  
  
  RESULTS
  With inversion force applied, calcaneal-tibial inversion was greatest in maximal plantarflexion (mean 22.1 +/- 6.0 degrees) and gradually decreased with dorsiflexion, which indicated that the ankle had the most inversion instability in plantarflexion. With eversion force applied, calcaneal-tibial eversion gradually increased with increasing dorsiflexion to 12.7 +/- 7.4 degrees indicating that the most eversion instability was in dorsiflexion. With internal rotation force applied, calcaneal-tibial internal rotation from plantarflexion to neutral ankle position increased. With external rotation force application, external rotation from neutral to maximal dorsiflexion increased.
  
  
  CONCLUSIONS
  Ankle laxity was not constant but varied depending on the plantarflexion-dorsiflexion position and the direction of the applied force. The degree of ankle laxity was greater with inversion and internal rotation torque. Variation in laxity between specimens was observed, consistent with previous reports. These data indicate that the ankle is less stable in plantarflexion when inversion and internal rotation forces are applied. This may explain why the lateral ankle ligaments are most prone to injury in this position. The ankle was less stable in dorsiflexion when eversion and external rotation forces were applied. This is consistent with the observation that deltoid ligament injuries occur in the neutral to dorsiflexion position. The study demonstrates the importance of examining patients with suspected ankle ligament injuries in several ankle positions. The ankle testing device has potential application for in vivo testing of patients with suspected ankle ligament instability.
authors.affiliation: Orthopaedic Surgery, Takai Hospital, Tenri, Nara, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Fujii
authors.forename: Harold B
authors.initials: HB
authors.lastname: Kitaoka
authors.forename: Zong-Ping
authors.initials: ZP
authors.lastname: Luo
authors.forename: Hideji
authors.initials: H
authors.lastname: Kura
authors.forename: Kai-Nan
authors.initials: KN
authors.lastname: An
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000502:physiology*; D000843:Ankle Joint / Q000503:physiopathology; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D006365:Heel / Q000502:physiology*; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012399:Rotation