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. 2019 Aug 20;7(8):2325967119864018.
doi: 10.1177/2325967119864018. eCollection 2019 Aug.

Effect of a Controlled Ankle Motion Walking Boot on Syndesmotic Instability During Weightbearing: A Cadaveric Study

Stéphanie Lamer  1   2 , Jonah Hébert-Davies  3 , Vincent Dubé  1   2 , Stéphane Leduc  1   2 , Émilie Sandman  1   2 , Jérémie Ménard  1 , Marie-Lyne Nault  1   2   3
Affiliations

Effect of a Controlled Ankle Motion Walking Boot on Syndesmotic Instability During Weightbearing: A Cadaveric Study

Stéphanie Lamer et al. Orthop J Sports Med. .

Abstract

Background: Syndesmotic injuries can lead to long-term complications; hence, they require careful management. Conservative treatment is adequate when 1 syndesmotic ligament is injured, but surgery is often necessary to achieve articular congruity when 3 syndesmotic ligaments are ruptured. However, there is some controversy over the best treatment for 2-ligament injuries.

Purpose: To evaluate the effect of a controlled ankle motion (CAM) walking boot on syndesmotic instability following iatrogenic isolated anterior inferior tibiofibular ligament (AiTFL) injury and combined AiTFL/interosseous ligament (IOL) injuries in a cadaveric simulated weightbearing model.

Study design: Controlled laboratory study.

Methods: Ten cadaveric specimens were dissected to expose the tibial plateau and syndesmosis. The specimens were fitted to a custom-made device, and a reproducible axial load of 750 N was applied. Iatrogenic rupture of the syndesmotic ligaments (AiTFL + IOL) was done sequentially. Uninjured syndesmoses, isolated AiTFL rupture, and combined AiTFL/IOL rupture were compared with and without axial loading (AL) and CAM boot. The distal tibiofibular relationship was evaluated using a previously validated computed tomography scan measurement system. Wilcoxon tests for paired samples and nonparametric data were used.

Results: The only difference noted in the distal tibiofibular relationship during AL was an increase in the external rotation of the fibula when using the CAM boot. This was observed with AiTFL rupture (8.40° vs 11.17°; P = .009) and combined AiTFL/IOL rupture (8.81° vs 11.97°; P = .005).

Conclusion: AL did not cause a significant displacement between the tibia and fibula, even when 2 ligaments were ruptured. However, the CAM boot produced a significant external rotation with 1 or 2 injured ligaments.

Clinical relevance: Further studies are needed to assess the capacity of the CAM walking boot to prevent malreduction when external rotation forces are applied to the ankle. Moreover, special care should be taken during the fitting of the CAM boot to avoid overinflation of the cushions.

Keywords: CAM orthopaedic boot; high ankle sprain; syndesmotic injury; weightbearing.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This study was supported by an educational grant by the PREMIER program. J.H.-D. has received consulting fees from Globus Medical and DePuy Synthes. S.L. has received consulting fees from Stryker. É.S. has a family member who is employed by Smith & Nephew. The Hôpital du Sacré-Cœur de Montréal has received educational and research support from Arthrex, ConMed, DePuy, Linvatec, Medacta, Smith & Nephew, Stryker, Synthes, Tornier, Wright, and Zimmer Biomet. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Ankle dissection by an anterolateral approach to expose syndesmotic ligamental structures and dissect the anterior inferior tibiofibular ligament and interosseous ligament sequentially.
Figure 2.
Figure 2.
Experimental apparatus: custom-made device including a load cell applying a reproducible axial load of 750 N in the computed tomography scan.
Figure 3.
Figure 3.
Controlled ankle motion boot inside the loading device.
Figure 4.
Figure 4.
Computed tomography scan images of a specimen in the controlled ankle motion boot showing the 3 length (a, b, and c) and 2 angle (A1 and A2) measurements included in our analysis.
See this image and copyright information in PMC

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