title: Effect of Direct Ligament Repair and Tenodesis Reconstruction on Simulated Subtalar Joint Instability.
abstract: BACKGROUND
  Subtalar instability is associated with up to 80% of patients presenting with chronic ankle instability but is often not considered in the diagnosis or treatment. Operative procedures to repair ankle instability have shown good clinical results, but the effects of these reconstruction procedures on isolated subtalar instability are not well understood. The goal of this study was to investigate the effect of the Gould modification of the Broström procedure and a new tenodesis reconstruction procedure on ankle and subtalar joint kinematics after simulating a subtalar injury.
  
  
  METHODS
  Kinematic data were collected on 7 cadaveric ankles during inversion through the range of ankle flexion and during internal rotation. Testing was performed on the intact foot; after sectioning the calcaneofibular ligament, cervical ligament, and interosseous talocalcaneal ligament; after the Gould modification of the Broström procedure was performed; and after tenodesis was performed and sutures from the Gould modification removed.
  
  
  RESULTS
  The Gould modification of the Broström procedure significantly decreased subtalar and ankle inversion motion and subtalar internal rotation compared to the unstable condition. The tenodesis method restricted internal rotation at the subtalar joint and ankle inversion compared to the intact state.
  
  
  CONCLUSIONS
  Both operative procedures improved stability of the ankle complex, but tenodesis was unable to restore subtalar inversion and restricted ankle inversion in maximum plantarflexion.
  
  
  CONCLUSIONS
  The Gould modification of Broström ligament repair may be a favorable operative procedure for the restoration of subtalar and ankle joint kinematics.
authors.affiliation: 1 Department of Mechanical and Aerospace Engineering, Old Dominion University, Norfolk, VA, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Choisne
authors.affiliation: 2 School of Physical Therapy and Athletic Training, Old Dominion University, Norfolk, VA, USA.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Hoch
authors.affiliation: 3 Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Alexander
authors.affiliation: 1 Department of Mechanical and Aerospace Engineering, Old Dominion University, Norfolk, VA, USA.
authors.forename: Stacie I
authors.initials: SI
authors.lastname: Ringleb
mesh_terms: D000842:Ankle / Q000503:physiopathology / Q000601:surgery*; D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery*; D001696:Biomechanical Phenomena / Q000502:physiology*; D005205:Fascia / Q000503:physiopathology*; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D017844:Lateral Ligament, Ankle / Q000503:physiopathology / Q000601:surgery*; D008023:Ligaments, Articular / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013380:Subtalar Joint / Q000503:physiopathology / Q000601:surgery*; D013710:Tendons / Q000503:physiopathology / Q000601:surgery*; D053656:Tenodesis
keywords: ankle joint; chronic instability; kinematics; operative reconstruction; subtalar joint