title: The role of the peroneal tendons in passive stabilisation of the ankle joint: an in vitro study.
abstract: OBJECTIVE
  Peroneal tendons are known as active stabilizer in acute ankle sprain while an intact ankle mortise and intact lateral ligaments are required for passive stability of the ankle joint. The goal of this study is to determine the peroneal tendons as passive stabilizer in case of lateral ligament instability.
  
  
  METHODS
  Twelve (12) human lower leg cadaver specimens underwent a torsion simulation in the testing system, 858 Mini Bionix(®) (MTS(®) Systems Corporation, Eden Prairie, MN, USA) and a specially designed mounting platform for the specimens. The preset torsion between tibia and calcaneus was primarily set at 30° of internal rotation during plantar flexion and hindfoot inversion. The resisting torque around mechanical tibial axis was recorded which ensures stability in ankle sprain trauma. The first series of measurements were performed on healthy specimens and the following after transecting structures in following order: ATFL (anterior talofibular ligament) in combination with CFL (calcaneofibular ligament), followed by peroneus longus tendon and finally peroneus brevis tendon.
  
  
  RESULTS
  The combined lateral ATFL and CFL instability shows a decrease of the resisting torque which ensures stability in ankle sprain trauma. Only a transection of PLT with existing lateral dual-ligament instability results in a significant decrease in torque (p < 0.0001).
  
  
  CONCLUSIONS
  The PLT has a substantial effect on passive stability at a present lateral ligament lesion in ankle sprain trauma. A deficiency in viscoelastic properties of the peroneus longus tendon must be considered in diagnostic and treatment for ankle instability.
authors.affiliation: Department of Orthopaedic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. ziai@sporthomed.at
authors.forename: Pejman
authors.initials: P
authors.lastname: Ziai
authors.forename: Emir
authors.initials: E
authors.lastname: Benca
authors.forename: Gobert
authors.initials: G
authors.lastname: von Skrbensky
authors.forename: Alexandra
authors.initials: A
authors.lastname: Graf
authors.forename: Florian
authors.initials: F
authors.lastname: Wenzel
authors.forename: Erhan
authors.initials: E
authors.lastname: Basad
authors.forename: Reinhard
authors.initials: R
authors.lastname: Windhager
authors.forename: Tomas
authors.initials: T
authors.lastname: Buchhorn
mesh_terms: D016512:Ankle Injuries / Q000503:physiopathology*; D000843:Ankle Joint / Q000503:physiopathology*; D002102:Cadaver; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology*; D007866:Leg; D008023:Ligaments, Articular / Q000503:physiopathology*; D013710:Tendons / Q000503:physiopathology*; D054159:Torsion, Mechanical