Cargando…

Role of the intrinsic subtalar ligaments in subtalar instability and consequences for clinical practice

Subtalar instability (STI) is a disabling complication after an acute lateral ankle sprain and remains a challenging problem. The pathophysiology is difficult to understand. Especially the relative contribution of the intrinsic subtalar ligaments in the stability of the subtalar joint is still contr...

Descripción completa

Detalles Bibliográficos
Autores principales: Michels, Frederick, Vereecke, Evie, Matricali, Giovanni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10036586/
https://www.ncbi.nlm.nih.gov/pubmed/36970618
http://dx.doi.org/10.3389/fbioe.2023.1047134
_version_ 1784911689837182976
author Michels, Frederick
Vereecke, Evie
Matricali, Giovanni
author_facet Michels, Frederick
Vereecke, Evie
Matricali, Giovanni
author_sort Michels, Frederick
collection PubMed
description Subtalar instability (STI) is a disabling complication after an acute lateral ankle sprain and remains a challenging problem. The pathophysiology is difficult to understand. Especially the relative contribution of the intrinsic subtalar ligaments in the stability of the subtalar joint is still controversial. Diagnosis is difficult because of the overlapping clinical signs with talocrural instability and the absence of a reliable diagnostic reference test. This often results in misdiagnosis and inappropriate treatment. Recent research offers new insights in the pathophysiology of subtalar instability and the importance of the intrinsic subtalar ligaments. Recent publications clarify the local anatomical and biomechanical characteristics of the subtalar ligaments. The cervical ligament and interosseous talocalcaneal ligament seem to play an important function in the normal kinematics and stability of the subtalar joint. In addition to the calcaneofibular ligament (CFL), these ligaments seem to have an important role in the pathomechanics of subtalar instability (STI). These new insights have an impact on the approach to STI in clinical practice. Diagnosis of STI can be performed be performed by a step-by-step approach to raise the suspicion to STI. This approach consists of clinical signs, abnormalities of the subtalar ligaments on MRI and intraoperative evaluation. Surgical treatment should address all the aspects of the instability and focus on a restoration of the normal anatomical and biomechanical properties. Besides a low threshold to reconstruct the CFL, a reconstruction of the subtalar ligaments should be considered in complex cases of instability. The purpose of this review is to provide a comprehensive update of the current literature focused on the contribution of the different ligaments in the stability of the subtalar joint. This review aims to introduce the more recent findings in the earlier hypotheses on normal kinesiology, pathophysiology and relation with talocrural instability. The consequences of this improved understanding of pathophysiology on patient identification, treatment and future research are described.
format Online
Article
Text
id pubmed-10036586
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-100365862023-03-25 Role of the intrinsic subtalar ligaments in subtalar instability and consequences for clinical practice Michels, Frederick Vereecke, Evie Matricali, Giovanni Front Bioeng Biotechnol Bioengineering and Biotechnology Subtalar instability (STI) is a disabling complication after an acute lateral ankle sprain and remains a challenging problem. The pathophysiology is difficult to understand. Especially the relative contribution of the intrinsic subtalar ligaments in the stability of the subtalar joint is still controversial. Diagnosis is difficult because of the overlapping clinical signs with talocrural instability and the absence of a reliable diagnostic reference test. This often results in misdiagnosis and inappropriate treatment. Recent research offers new insights in the pathophysiology of subtalar instability and the importance of the intrinsic subtalar ligaments. Recent publications clarify the local anatomical and biomechanical characteristics of the subtalar ligaments. The cervical ligament and interosseous talocalcaneal ligament seem to play an important function in the normal kinematics and stability of the subtalar joint. In addition to the calcaneofibular ligament (CFL), these ligaments seem to have an important role in the pathomechanics of subtalar instability (STI). These new insights have an impact on the approach to STI in clinical practice. Diagnosis of STI can be performed be performed by a step-by-step approach to raise the suspicion to STI. This approach consists of clinical signs, abnormalities of the subtalar ligaments on MRI and intraoperative evaluation. Surgical treatment should address all the aspects of the instability and focus on a restoration of the normal anatomical and biomechanical properties. Besides a low threshold to reconstruct the CFL, a reconstruction of the subtalar ligaments should be considered in complex cases of instability. The purpose of this review is to provide a comprehensive update of the current literature focused on the contribution of the different ligaments in the stability of the subtalar joint. This review aims to introduce the more recent findings in the earlier hypotheses on normal kinesiology, pathophysiology and relation with talocrural instability. The consequences of this improved understanding of pathophysiology on patient identification, treatment and future research are described. Frontiers Media S.A. 2023-03-10 /pmc/articles/PMC10036586/ /pubmed/36970618 http://dx.doi.org/10.3389/fbioe.2023.1047134 Text en Copyright © 2023 Michels, Vereecke and Matricali. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Bioengineering and Biotechnology
Michels, Frederick
Vereecke, Evie
Matricali, Giovanni
Role of the intrinsic subtalar ligaments in subtalar instability and consequences for clinical practice
title Role of the intrinsic subtalar ligaments in subtalar instability and consequences for clinical practice
title_full Role of the intrinsic subtalar ligaments in subtalar instability and consequences for clinical practice
title_fullStr Role of the intrinsic subtalar ligaments in subtalar instability and consequences for clinical practice
title_full_unstemmed Role of the intrinsic subtalar ligaments in subtalar instability and consequences for clinical practice
title_short Role of the intrinsic subtalar ligaments in subtalar instability and consequences for clinical practice
title_sort role of the intrinsic subtalar ligaments in subtalar instability and consequences for clinical practice
topic Bioengineering and Biotechnology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10036586/
https://www.ncbi.nlm.nih.gov/pubmed/36970618
http://dx.doi.org/10.3389/fbioe.2023.1047134
work_keys_str_mv AT michelsfrederick roleoftheintrinsicsubtalarligamentsinsubtalarinstabilityandconsequencesforclinicalpractice
AT vereeckeevie roleoftheintrinsicsubtalarligamentsinsubtalarinstabilityandconsequencesforclinicalpractice
AT matricaligiovanni roleoftheintrinsicsubtalarligamentsinsubtalarinstabilityandconsequencesforclinicalpractice