title: [Biomechanical study on repairing distal tibiofibular syndesmosis injuries with artificial ligaments].
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopedics, Shanghai No.1 People's Hospital, Shanghai Jiatong University, P.R. China.
authors.forename: Zizheng
authors.initials: Z
authors.lastname: Wu
authors.forename: Bing
authors.initials: B
authors.lastname: Wang
authors.forename: Yun
authors.initials: Y
authors.lastname: Cao
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhao
authors.forename: Yijin
authors.initials: Y
authors.lastname: Wang
mesh_terms: D016512:Ankle Injuries / Q000503:physiopathology* / Q000601:surgery; D000843:Ankle Joint; D001696:Biomechanical Phenomena; D001863:Bone Screws; D002102:Cadaver; D005260:Female; D005360:Fibula / Q000503:physiopathology*; D006801:Humans; D004204:Joint Dislocations / Q000503:physiopathology; D007593:Joint Instability / Q000503:physiopathology; D008023:Ligaments, Articular / Q000503:physiopathology*; D008297:Male; D008954:Models, Biological; D016059:Range of Motion, Articular / Q000502:physiology; D012399:Rotation; D013977:Tibia / Q000503:physiopathology*; D016474:Weight-Bearing / Q000502:physiology