title: Effect of Complete Syndesmotic Disruption and Deltoid Injuries and Different Reduction Methods on Ankle Joint Contact Mechanics.
abstract: BACKGROUND
  Syndesmotic injuries can be associated with poor patient outcomes and posttraumatic ankle arthritis, particularly in the case of malreduction. However, ankle joint contact mechanics following a syndesmotic injury and reduction remains poorly understood. The purpose of this study was to characterize the effects of a syndesmotic injury and reduction techniques on ankle joint contact mechanics in a biomechanical model.
  
  
  METHODS
  Ten cadaveric whole lower leg specimens with undisturbed proximal tibiofibular joints were prepared and tested in this study. Contact area, contact force, and peak contact pressure were measured in the ankle joint during simulated standing in the intact, injured, and 3 reduction conditions: screw fixation with a clamp, screw fixation without a clamp (thumb technique), and a suture-button construct. Differences in these ankle contact parameters were detected between conditions using repeated-measures analysis of variance.
  
  
  RESULTS
  Syndesmotic disruption decreased tibial plafond contact area and force. Syndesmotic reduction did not restore ankle loading mechanics to values measured in the intact condition. Reduction with the thumb technique was able to restore significantly more joint contact area and force than the reduction clamp or suture-button construct.
  
  
  CONCLUSIONS
  Syndesmotic disruption decreased joint contact area and force. Although the thumb technique performed significantly better than the reduction clamp and suture-button construct, syndesmotic reduction did not restore contact mechanics to intact levels.
  
  
  CONCLUSIONS
  Decreased contact area and force with disruption imply that other structures are likely receiving more loads (eg, medial and lateral gutters), which may have clinical implications such as the development of posttraumatic arthritis.
authors.affiliation: 1 Section of Orthopaedic Surgery, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada.|2 Hospital for Special Surgery, New York, New York, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: LaMothe
authors.affiliation: 2 Hospital for Special Surgery, New York, New York, USA.|3 Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Josh R
authors.initials: JR
authors.lastname: Baxter
authors.affiliation: 4 Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA.
authors.forename: Susannah
authors.initials: S
authors.lastname: Gilbert
authors.affiliation: 2 Hospital for Special Surgery, New York, New York, USA.|5 Department of Orthopedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Conor I
authors.initials: CI
authors.lastname: Murphy
authors.affiliation: 2 Hospital for Special Surgery, New York, New York, USA.
authors.forename: Sydney C
authors.initials: SC
authors.lastname: Karnovsky
authors.affiliation: 6 Foot and Ankle Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Drakos
mesh_terms: D016512:Ankle Injuries / Q000601:surgery*; D000843:Ankle Joint / Q000503:physiopathology* / Q000601:surgery*; D001863:Bone Screws / Q000592:standards*; D006801:Humans; D008023:Ligaments, Articular / Q000503:physiopathology*; D013977:Tibia / Q000503:physiopathology* / Q000601:surgery*
keywords: ankle contact stress; suture-button construct; syndesmosis; syndesmosis repair; syndesmotic injury