title: Biomechanical stability of tape augmentation for anterior talofibular ligament (ATFL) repair compared to the native ATFL.
abstract: OBJECTIVE
  Current methods of anterior talofibular ligament (ATFL) reconstruction fail to restore the stability of the native ATFL. Therefore, augmented anatomic ATFL reconstruction gained popularity in patients with attenuated tissue and additional stress on the lateral ankle ligament complex. The aim of the present study was to evaluate the biomechanical stability of the InternalBrace (Arthrex Inc., Naples, FL, USA), a tape augmentation designed to augment the traditional Broström procedure.
  
  
  METHODS
  Twelve (12) fresh-frozen human anatomic lower leg specimens were randomized into two groups: a native ATFL (ATFL) and a tape augmentation group (IB). Dual-energy X-ray absorptiometry (DEXA) scans were carried out to determine bone mineral density (BMD) of the specimens. The ligaments were stressed by internally rotating the tibia against the inverted fixated hindfoot. Torque at failure (Nm) and angle at failure (°) were recorded.
  
  
  RESULTS
  The ATFL group failed at an angle of 33 ± 10°. In the IB group, construct failure occurred at an angle of 46 ± 16°. Failure torque reached 8.3 ± 4.5 Nm in the ATFL group, whereas the IB group achieved 11.2 ± 7.1 Nm. There was no correlation between angle at ATFL or IB construct failure or torque at failure, respectively, and BMD for both groups.
  
  
  CONCLUSIONS
  This study reveals that tape augmentation for ATFL reconstruction shows similar biomechanical stability compared to an intact native ATFL in terms of torque at failure and angle at failure. BMD did not influence the construct stability. Tape augmentation proved an enhanced initial stability in ATFL reconstruction which may allow for an accelerated rehabilitation process.
  
  
  METHODS
  II.
authors.affiliation: Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Willegger
authors.affiliation: Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: E
authors.initials: E
authors.lastname: Benca
authors.affiliation: Institute of Anatomy, Medical University of Vienna, Vienna, Austria.
authors.forename: L
authors.initials: L
authors.lastname: Hirtler
authors.affiliation: Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: K
authors.initials: K
authors.lastname: Hradecky
authors.affiliation: Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Holinka
authors.affiliation: Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Windhager
authors.affiliation: Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. Reinhard.schuh@meduniwien.ac.at.
authors.forename: R
authors.initials: R
authors.lastname: Schuh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery*; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D017844:Lateral Ligament, Ankle / Q000293:injuries / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation*
keywords: Anterior talofibular ligament reconstruction; Biomechanical stability; Bone mineral density; Lateral ankle instability; Tape augmentation