Novel anatomical reconstruction of distal tibiofibular ligaments restores syndesmotic biomechanics.
OBJECTIVE
To date, there is a paucity of literature on syndesmotic reconstruction techniques that restore both anatomic stability and physiologic syndesmotic biomechanics. In this cadaveric study, (1) a novel syndesmotic reconstruction surgical technique using autogenous peroneus brevis tendon was described and (2) the biomechanical properties of the reconstruction was investigated.


METHODS
Ten fresh-frozen lower extremities were used in this study. Reconstruction of the anterior and posterior, as well as the interosseous tibiofibular ligaments was performed with a halved peroneus brevis tendon. Biomechanics were assessed using foot external rotation torque and ankle dorsiflexion axial loading tests, which were performed in (a) intact, (b) cut, (c) anatomically reconstructed syndesmotic ligaments, and (d) 3.5 mm tricortical syndesmotic screw fixation. Medial-lateral and anterior-posterior displacements of the distal fibula were recorded during foot external rotation and fibular axial displacement was recorded during ankle axial loading.


RESULTS
The fibula was displaced posteriorly and proximally with respect to the tibia in all specimens during external rotation and axial loading tests, respectively. Significant differences (p < 0.05) were found in distal fibular displacements between anatomically reconstructed ligaments and screw fixation. Tricortical syndesmotic screw fixation resulted in 59% of posterior fibular displacement when compared to intact ligaments. No significant differences (n.s.) in distal fibular displacement were demonstrated between intact ligaments and anatomically reconstructed ligaments.


CONCLUSIONS
Anatomical reconstruction of the distal tibiofibular ligaments with the peroneus brevis tendon provides stability and recreates the biomechanical properties of an intact syndesmosis. This new surgical technique may be a viable alternative for the treatment of syndesmotic injuries.


METHODS
V.
Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China. chejian301@163.com.|Department of Orthopedics, Shanxi Huajin Orthopedic Hospital, Taiyuan, 030024, China. chejian301@163.com.
Jian
J
Che
Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China.
Chunbao
C
Li
Institute of Applied Mechanics and Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China.
Zhipeng
Z
Gao
Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China.
Wei
W
Qi
Department of Orthopedics, Shanxi Huajin Orthopedic Hospital, Taiyuan, 030024, China.
Binping
B
Ji
Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, China. liuyujie301@163.com.
Yujie
Y
Liu
Department of Orthopedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore.
Ming Han Lincoln
MHL
Liow
D000842:Ankle / Q000503:physiopathology / Q000601:surgery; D016512:Ankle Injuries / Q000503:physiopathology* / Q000601:surgery*; D001696:Biomechanical Phenomena; D001863:Bone Screws; D002102:Cadaver; D005360:Fibula / Q000601:surgery; D006801:Humans; D008023:Ligaments, Articular / Q000293:injuries / Q000503:physiopathology* / Q000601:surgery*; D012399:Rotation; D013977:Tibia / Q000601:surgery; D019415:Torque
Anatomical reconstruction; Biomechanical cadaveric study; Distal tibiofibular ligaments; Surgical technique; Syndesmosis