title: Biomechanical evaluation of tenodesis reconstruction in ankle with deltoid ligament deficiency: a finite element analysis.
abstract: OBJECTIVE
  Isolated deltoid ligament injuries are relatively uncommon but can be a significant source of pain and disability. Several approaches to deltoid reconstruction have been reported. However, there is no previous comparative study of Wiltberger, Deland, Kitaoka and Hintermann procedures with respect to biomechanical characteristics such as kinematics, ligaments and grafts stresses using finite element analysis. The purpose of this study was to evaluate the biomechanical results of those deltoid ligament reconstructions using finite element analysis.
  
  
  METHODS
  A three-dimensional finite element model of the ankle including six bony structures, cartilage and nine principal ligaments surrounding the ankle joint complex was developed and validated. In addition to the intact model, superficial deltoid-deficient, deltoid-deficient, Wiltberger reconstruction, Deland reconstruction, Kitaoka reconstruction and Hintermann reconstruction models were simulated. Then, the forces in the ligaments and grafts and the kinematics of talus and calcaneus were predicted for an eversional or external torque through the range of ankle flexion.
  
  
  RESULTS
  No reconstructions could completely restore the values for ankle flexibility and the stresses of the lateral ligaments to normality. The Kitaoka procedure was the most effective technique in eliminating external rotation displacement. The Deland procedure restored better the talar tilt than the other three reconstructions.
  
  
  CONCLUSIONS
  This study showed that Kitaoka and Deland procedures have advantages with regard to rotational stabilities as well as ligaments stress in comparison with other methods.
authors.affiliation: Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China.
authors.forename: Can
authors.initials: C
authors.lastname: Xu
authors.forename: Ming-Yan
authors.initials: MY
authors.lastname: Zhang
authors.forename: Guang-Hua
authors.initials: GH
authors.lastname: Lei
authors.forename: Can
authors.initials: C
authors.lastname: Zhang
authors.forename: Shu-Guang
authors.initials: SG
authors.lastname: Gao
authors.forename: Wen
authors.initials: W
authors.lastname: Ting
authors.forename: Kang-Hua
authors.initials: KH
authors.lastname: Li
mesh_terms: D016512:Ankle Injuries / Q000503:physiopathology* / Q000601:surgery*; D001696:Biomechanical Phenomena; D002111:Calcaneus / Q000503:physiopathology; D020342:Finite Element Analysis; D006801:Humans; D008023:Ligaments, Articular / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D013628:Talus / Q000503:physiopathology; D013710:Tendons / Q000503:physiopathology / Q000601:surgery*; D053656:Tenodesis
references.citation: Acta Chir Scand. 1965 Dec;130(6):560-9
references.pmid: 5865463
references.citation: Knee Surg Sports Traumatol Arthrosc. 2008 Aug;16(8):781-6
references.pmid: 18560805
references.citation: Foot Ankle Int. 2010 Sep;31(9):781-9
references.pmid: 20880481
references.citation: Arthroscopy. 2003 Dec;19(10):1091-6
references.pmid: 14673451
references.citation: Foot Ankle Int. 1995 Sep;16(9):567-71
references.pmid: 8563926
references.citation: J Bone Joint Surg Br. 1984 Nov;66(5):672-81
references.pmid: 6501359
references.citation: Foot Ankle Int. 1998 Apr;19(4):203-7
references.pmid: 9578097
references.citation: Foot Ankle Int. 2010 Jul;31(7):639-51
references.pmid: 20663434
references.citation: J Bone Joint Surg Br. 1990 Nov;72(6):1044-9
references.pmid: 2246286
references.citation: Acta Orthop Scand. 1983 Feb;54(1):36-44
references.pmid: 6829280
references.citation: Biomech Model Mechanobiol. 2006 Jun;5(2-3):82-9
references.pmid: 16520960
references.citation: J Biomech. 2008;41(6):1341-9
references.pmid: 18316088
references.citation: Med Sci Sports Exerc. 2006 Jun;38(6):1025-31
references.pmid: 16775540
references.citation: J Theor Biol. 2005 Jul 7;235(1):105-19
references.pmid: 15833317
references.citation: Clin Biomech (Bristol, Avon). 2005 May;20(4):434-42
references.pmid: 15737452
references.citation: Clin Biomech (Bristol, Avon). 2006 Jun;21(5):508-16
references.pmid: 16472892
references.citation: Clin Orthop Relat Res. 1988 Jan;(226):156-68
references.pmid: 3121227
references.citation: Foot Ankle Int. 1999 Oct;20(10):622-9
references.pmid: 10540992
references.citation: Anat Embryol (Berl). 1996 Oct;194(4):399-406
references.pmid: 8896704
references.citation: J Orthop Res. 2005 Nov;23(6):1321-8
references.pmid: 16046096
references.citation: HSS J. 2009 Feb;5(1):51-7
references.pmid: 19052716
references.citation: Radiology. 1985 Jul;156(1):21-7
references.pmid: 4001407
references.citation: Wound Repair Regen. 1996 Jan-Mar;4(1):87-92
references.pmid: 17129353
references.citation: Clin Orthop Relat Res. 2007 Mar;456:138-47
references.pmid: 17075379
references.citation: Knee Surg Sports Traumatol Arthrosc. 2010 May;18(5):557-69
references.pmid: 20309522
references.citation: Clin Biomech (Bristol, Avon). 2004 Aug;19(7):751-9
references.pmid: 15288463
references.citation: J Orthop Res. 1995 Jul;13(4):609-14
references.pmid: 7674077
references.citation: Foot Ankle Int. 2011 Jan;32(1):21-30
references.pmid: 21288431
references.citation: Foot Ankle. 1988 Apr;8(5):234-42
references.pmid: 3366428
references.citation: J Biomech. 2005 May;38(5):1045-54
references.pmid: 15797586
references.citation: Med Biol Eng. 1966 May;4(3):253-9
references.pmid: 5964549
references.citation: Acta Orthop Scand. 1997 Oct;68(5):435-41
references.pmid: 9385242
references.citation: J Biomech. 2006;39(8):1435-43
references.pmid: 15950979
references.citation: Foot Ankle Int. 2000 Jul;21(7):602-15
references.pmid: 10919630
references.citation: Int Orthop. 2009 Oct;33(5):1255-61
references.pmid: 18758777
references.citation: Acta Orthop Scand. 1980 Feb;51(1):181-92
references.pmid: 7376839
references.citation: J Biomech Eng. 1991 Feb;113(1):107-8
references.pmid: 2020169
references.citation: J Biomech. 2007;40(7):1467-76
references.pmid: 16930609
references.citation: Med Eng Phys. 2003 Jul;25(6):491-9
references.pmid: 12787987
references.citation: Med Eng Phys. 2005 Dec;27(10):810-26
references.pmid: 16287601
references.citation: J Biomech. 1997 Aug;30(8):829-35
references.pmid: 9239568
references.citation: Arch Surg. 1950 May;60(5):957-85
references.pmid: 15411319
references.citation: Foot Ankle Int. 2004 Nov;25(11):795-9
references.pmid: 15574238
references.citation: J Biomech Eng. 2000 Feb;122(1):15-22
references.pmid: 10790825
references.citation: Arthroscopy. 2002 Jan;18(1):82-90
references.pmid: 11774147