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Varus talar tilt combined with an internal rotation pivot stress assesses the supination instability vector in lateral ankle ligaments' injury - cadaver study.

Abstract

BACKGROUND

The lack of consensus on the relevance of the varus talar tilt test (VTTT) might be due to the divergence between the insufficiency vector of lateral ankle instability and the direction of this clinical test. Our hypothesis is that the VTTT is more accurate to diagnose lateral ankle ligaments rupture when it's applied with a pre-positioning of the foot in internal rotation (IR).

METHODS

We compared, in 12 cadaver ankles, the varus opening during a classic VTTT with the same test starting in an IR pivot, using a new arthrometer.

RESULTS

The classic VTTT caused a 13° tilt after ATFL section and 23,8° after ATFL and CFL section. The application of a VTTT with an IR prepositioning caused a 21,2° tilt after ATFL section (p = 0,002) and 29,5° after ATFL and CFL section (p = 0,006).

CONCLUSION

The VTTT is better to identify lateral ankle ligaments' insufficiency when it's applied with a pre-positioning of the foot in internal rotation. The resulting vector is similar to the supination trauma.

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  • Authors+Show Affiliations

    ,

    Department of Orthopaedics, Hospital Dr. José de Almeida, Cascais, Portugal; NOVA Medical School, Lisbon NOVA University, Portugal; Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Spain. Electronic address: fguerrapinto@gmail.com.

    ,

    Director of the Department of Orthipaedics, Hospital Dr. José de Almeida, Cascais, Portugal.

    ,

    Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Spain.

    ,

    Associate Agreggate Professor of Orthopaedics at NOVA Medical School, Lisbon NOVA University, Portugal; CHLO, S F Xavier Central Hospital, Lisbon, Portugal.

    ,

    Professor of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.

    Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Spain; Department of Orthopaedics, Clinica del Remei, Barcelona, Spain.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    30992182

    Citation

    Guerra-Pinto, Francisco, et al. "Varus Talar Tilt Combined With an Internal Rotation Pivot Stress Assesses the Supination Instability Vector in Lateral Ankle Ligaments' Injury - Cadaver Study." Foot and Ankle Surgery : Official Journal of the European Society of Foot and Ankle Surgeons, 2019.
    Guerra-Pinto F, Côrte-Real N, Gomes TM, et al. Varus talar tilt combined with an internal rotation pivot stress assesses the supination instability vector in lateral ankle ligaments' injury - cadaver study. Foot Ankle Surg. 2019.
    Guerra-Pinto, F., Côrte-Real, N., Gomes, T. M., Consciência, J. G., Glazebrook, M., & Oliva, X. M. (2019). Varus talar tilt combined with an internal rotation pivot stress assesses the supination instability vector in lateral ankle ligaments' injury - cadaver study. Foot and Ankle Surgery : Official Journal of the European Society of Foot and Ankle Surgeons, doi:10.1016/j.fas.2019.03.007.
    Guerra-Pinto F, et al. Varus Talar Tilt Combined With an Internal Rotation Pivot Stress Assesses the Supination Instability Vector in Lateral Ankle Ligaments' Injury - Cadaver Study. Foot Ankle Surg. 2019 Mar 27; PubMed PMID: 30992182.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Varus talar tilt combined with an internal rotation pivot stress assesses the supination instability vector in lateral ankle ligaments' injury - cadaver study. AU - Guerra-Pinto,Francisco, AU - Côrte-Real,Nuno, AU - Gomes,Tiago Mota, AU - Consciência,José Guimarães, AU - Glazebrook,Mark, AU - Oliva,Xavier Martin, Y1 - 2019/03/27/ PY - 2018/11/10/received PY - 2019/02/22/revised PY - 2019/03/15/accepted PY - 2019/4/18/entrez KW - (MeSH terms) Ankle sprains KW - Ankle lateral ligament KW - Anterior talofibular ligament KW - Calcaneofibular ligament KW - Instability KW - Stress test JF - Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons JO - Foot Ankle Surg N2 - BACKGROUND: The lack of consensus on the relevance of the varus talar tilt test (VTTT) might be due to the divergence between the insufficiency vector of lateral ankle instability and the direction of this clinical test. Our hypothesis is that the VTTT is more accurate to diagnose lateral ankle ligaments rupture when it's applied with a pre-positioning of the foot in internal rotation (IR). METHODS: We compared, in 12 cadaver ankles, the varus opening during a classic VTTT with the same test starting in an IR pivot, using a new arthrometer. RESULTS: The classic VTTT caused a 13° tilt after ATFL section and 23,8° after ATFL and CFL section. The application of a VTTT with an IR prepositioning caused a 21,2° tilt after ATFL section (p = 0,002) and 29,5° after ATFL and CFL section (p = 0,006). CONCLUSION: The VTTT is better to identify lateral ankle ligaments' insufficiency when it's applied with a pre-positioning of the foot in internal rotation. The resulting vector is similar to the supination trauma. SN - 1460-9584 UR - https://www.unboundmedicine.com/medline/citation/30992182/Varus_talar_tilt_combined_with_an_internal_rotation_pivot_stress_assesses_the_supination_instability_vector_in_lateral_ankle_ligaments'_injury_-_cadaver_study L2 - https://linkinghub.elsevier.com/retrieve/pii/S1268-7731(19)30043-8 DB - PRIME DP - Unbound Medicine ER -