DR. AYESHA ANKLE PPT.pptxankale ankle ankle

Posterior Cruciate injury and recon - Adam Watson Orthopaedic ...A Posterior Cruciate Ligament (PCL) injury is a sprain or tear of the ligament at the back of the knee, often caused by a forceful impact to the bent knee, such as during a car accident or a dashboard injury. Symptoms include pain and swelling behind the knee, instability, and difficulty walking. Treatment depends on the severity, ranging from home care for mild sprains to physical therapy or surgery for severe tears.

1. THE ANKLE JOINT BY DR.AYESHA PARVEEN-PG 1 ST YEAR DR.MEGHANA – Pg 2 nd year Department of orthopaedics

2. Moderators 1.DR.S.LAXMINARAYANA SIR (PROFFESOR AND UNIT CHIEF) 2 .DR. KIRAN KUMAR SIR (ASSOCIATE PROFFESOR) 3.DR.RAVIKANTH(ASSISTANT PROFFESOR) 4.DR.SAI CHARAN (ASSISTANT PROFFESOR)

3. Anatomy of ankle Type This is a synovial joint of the hinge variety. Articular Surfaces The upper articular surface is formed by: 1 The lower end of the tibia including the medial malleolus (Fig. 12.17), 2 The lateral malleolus of the fibula, and 3 The inferior transverse tibiofibular ligament. These structures form a deep socket (Fig. 12.18). The inferior articular surface is formed by articular areas on the upper, medial and lateral aspects of the talus.

4. Structurally, the joint is very strong. The stability of the joint is ensured by: a. Close interlocking of the articular surfaces. b. Strong collateral ligaments on the sides. c. The tendons that cross the joint, four in front, and three on posteromedial side and two on posterolateral side

5. The depth of the superior articular socket is contributed by: a. The downward projection of medial and lateral malleoli, on the corresponding sides of talus. b. By the inferior transverse tibiofibular ligament that bridges across the gap between the tibia and the fibula behind the talus (Fig. 12.18). The socket is provided flexibility by strong tibiofibular ligaments and by slight movements of the fibula at the superior tibiofibular joint.

6. There are two factors, however, that tend to displace the tibia and fibula forwards over the talus. These factors are: a. The forward pull of tendons which pass from the leg to the foot. b. The pull of gravity when the heel is raised. Displacement is prevented by the following factors. i . The talus is wedge-shaped, being wider a nteriorly . The malleoli are oriented to fit this Wedge. ii. The posterior border of the lower end of the t ibia is prolonged downwards iii. The presence of the inferior transverse t ibiofibular ligament. iv. The tibiocalcanean , posterior tibiotalar (parts o f deltoid ligament), calcaneofibular and po sterior talofibular ligaments p ass backwards a nd resist forward movement of the tibia and fibula

7. Ligaments The joint is supported by: a. Fibrous capsule b. The deltoid or medial ligament c. A lateral ligament. Fibrous Capsule Fibrous capsule surrounds the joint but is weak anteriorly and posteriorly. It is attached all around the articular margins with two exceptions. 1 Posterosuperiorly , it is attached to the inferior transverse tibiofibular ligament. 2 Anteroinferiorly , it is attached to the dorsum of the neck of the talus at some distance from the trochlear surface.

8. Deltoid or Medial Ligament This is a very strong triangular ligament present on the medial side of the ankle. The ligament is divided i nto a superficial and a deep part. Both parts have a common attachment above to the apex and m argins of the medial malleolus. -- Superficial portion: This is composed of three ligaments that orig nate on the anterior colliculus but add little to ankle stability - Tibionavicular ligament: This suspends the spring ligament and prevents inward displacement of the talar head. - Tibiocalcaneal ligament: This prevents valgus displacement, superficial tibiotalar ligament - Talotibial ligament: most prominent of the three.

9. -- Deep portion: This intra-articular ligament (deep tibiotalar ) originates on the intercollicular groove and the posterior colliculus ot the distal tibia and inserts on the entire nonarticular medial surtace of the talus. It s fibers are transversely oriented; it is the primary medial stabilizer against lateral displacement of the talus. Fib ular collateral ligament : It i s made up of three ligaments that, together with the distal fibula, provide lateral support to the ankle. The lateral ligamentous complex is not as strong as the medial complex. -Anterior talofibular ligament: This is the weakest of the lateral lig aments; it prevents anterior subluxation of the talus primarily in plantar flexion. - Posterior talofibular ligament: This is the strongest of the lateral ligaments; it prevents posterior and rotatory subluxation of the talus.

10. - Calcaneofibular ligament: This is lax in neutral dorsiflexion o wing to relative valgus orientation of calcaneus; i t stabilizes the subtalar joint and limits inversion; rupture of this ligament will cause a pos itiv e talar tilt test.

11. Relations of the Ankle Joint Anteriorly, from medial to lateral side, there are the t ibialis anterior, th e extensor hallucis longus, theanterior tibial vessels, t he deep peroneal nerve, e xtensor digitorum longus, and the peroneus tertius . Posteromedially, from medial to lateral side, there are the tibialis posterior, the flexor digitorum longus, theposterior tibial vessels, the tibial nerve, t he flexorhallucis longus. Posterolaterally , the peroneus longus, and theperoneus brevis .

12. MOVEMENTS:- Active movements are dorsiflexion and plantar flexion 1 .In dorsiflexion , the forefoot is raised, and the anglebetween the front of the leg and the dorsum of the f oot is diminished. It is a close-pack position withmaximum congruence of the joint surfaces. Thewider anterior tr ochlear surface of the talus fits intolower end of narrow posterior part of the lower end of tibia. There are no chances of dislocation indorsiflexion 2. In plantar flexion , the forefoot is depressed, and theangle between the leg and the foot is increased. T he n arrow posterior part of trochlear surface of talusoosely fits into the wide anterior part of the lower End of tibia. High heels cause plantar flexion of anklejoint and its dislocations

13. Movements:-

14. BIOMECHANICS Biomechanics - The normal range of motion (ROM) of the ankle in dorsiflexion is 30 degrees and, in plantar flexion, it is 45 degrees; motion analysis studies reveal that a minimum of 10 degrees of dorsiflexion and 20 degrees of plantar flexion are required for normal gait. T he axis of flexion of the ankle runs between the distal aspect of the two malleoli, which is externally rotated 20 degrees compared with the knee axis. A lateral talar shift of l mm will decrease surface contact by 40%; a 3-mm shift results in >60% decrease. Disruption of the syndesmotic ligaments may result in decreased tibiofibular overlap. Syndesmotic disruption associated with fibula frac ture may be associated with a 2- to 3-mm lateral talar shift even with an intact deep deltoid ligament. Further lateral talar shift implies medial compromise.

15. Blood Supply From anterior tibial , posterior tibial , and peroneal arteries. Nerve Supply F rom deep peroneal and tibial nerves.

16. INJURIES AROUND ANKLE EPIDEMIOLOGY . T he highest incidence of ankle iractures Occurs in elderly women. although fractures of the ankle are generally not considered to be "fragility" fractures. Most ankle fractures are isolated malleolar fractures, accounting for two-thirds of fractures, with bimalleolar fractures occurring in one fourth of patients and trimalleolar fractures occurring in the remaining 5% to 10%. • Th e incidence of ankle fractures is approximately 187 fractures per 100,000 people each year. Open tractures are rare, accounting for just 2% of all ankle fractures. Increased body mass index is considered a risk factor for sustaining an ankle fracture.

17. The sprains of the ankle are almost always abductionsprains of the subtalar joints, although a few fibres of the deltoid ligament are also torn. True sprains of t he ankle joint are caused by forced plantar Flexion, which leads to tearing of the anterior fibres o l f the capsule. The joint is unstable during plantarflexion . • Dislocations of the ankle are rare because joint is very st able due to the presence of deep tibiofibular S ocket . Whenever dislocation occurs, it i s accompanied by fracture of one of the malleoli.