{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:57:24Z","timestamp":1787759844562,"version":"build-2784847793"},"reference-count":27,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,10,12]],"date-time":"2020-10-12T00:00:00Z","timestamp":1602460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,10,12]],"date-time":"2020-10-12T00:00:00Z","timestamp":1602460800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2020,10,12]],"date-time":"2020-10-12T00:00:00Z","timestamp":1602460800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>In the athletic population, the prevalence of isolated syndesmotic lesions is high. To detect potential instability of the ankle is crucial to define those lesions in need of surgical management.<\/jats:p><jats:p>The aim was to define how the extent of tibio\u2010fibular syndesmotic ligament injury influences the overall stability of the ankle joint in a cadaver model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty fresh\u2010frozen through knee cadaveric leg specimens were subjected to different simulated syndesmotic ligament lesions. In Group 1 (<jats:italic>n<\/jats:italic>\u2009=\u200910), the order of ligament sectioning was: anterior tibio\u2010fibular ligament (ATFL), superficial deltoid ligament (SDL), deep deltoid ligament (DDL), posterior tibio\u2010fibular ligament (PTFL), and progressive sectioning at 10, 50 and 100\u00a0mm of the distal interosseous membrane (IOM). In Group 2 (<jats:italic>n<\/jats:italic>\u2009=\u200910), the sequence was: ATFL, PITFL, 10 and then 50\u00a0mm of the distal IOM, SDL, DDL, and 100\u00a0mm of the distal IOM. Diastasis of 4\u00a0mm in the coronal or sagittal plane and external rotation of the ankle greater than 20\u00b0 were considered indicative of instability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Both coronal and sagittal diastasis exceeded 4\u00a0mm with injury patterns characterized by IOM lesions extending beyond 5\u00a0cm. External rotation of the ankle exceeded 20\u00b0 with injury patterns characterized by a DDL lesion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Coronal and sagittal plane diastases of the tibio\u2010fibular syndesmosis are particularly affected by sequential lesions involving the IOM, whereas increased external rotation of the ankle most depends on DDL. The identification of the specific syndesmotic and deltoid ligament injuries is crucial to understanding which lesions need operative management. The knowledge of which pattern of tibio\u2010fibular syndesmotic ligament injury influences the ankle joint stability is crucial in defining which lesions need for surgical management.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-020-06308-7","type":"journal-article","created":{"date-parts":[[2020,10,12]],"date-time":"2020-10-12T04:03:58Z","timestamp":1602475438000},"page":"1577-1583","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Deep deltoid ligament injury is related to rotational instability of the ankle joint: a biomechanical study"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4063-9821","authenticated-orcid":false,"given":"Umile Giuseppe","family":"Longo","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic and Trauma Surgery Campus Bio\u2010Medico University Via Alvaro del Portillo 200 00128 Rome Trigoria Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Loppini","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Humanitas University Via Alessandro Manzoni 113 20089 Milan Rozzano Italy"},{"name":"<!--<label>3<\/label>--> Humanitas Clinical and Research Center Via Alessandro Manzoni 56 20089 Milan Rozzano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Fumo","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic and Trauma Surgery Campus Bio\u2010Medico University Via Alvaro del Portillo 200 00128 Rome Trigoria Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Lanotte","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic and Trauma Surgery Campus Bio\u2010Medico University Via Alvaro del Portillo 200 00128 Rome Trigoria Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugo","family":"Trovato","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic and Trauma Surgery Campus Bio\u2010Medico University Via Alvaro del Portillo 200 00128 Rome Trigoria Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Risi Ambrogioni","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic and Trauma Surgery Campus Bio\u2010Medico University Via Alvaro del Portillo 200 00128 Rome Trigoria Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Candela","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic and Trauma Surgery Campus Bio\u2010Medico University Via Alvaro del Portillo 200 00128 Rome Trigoria Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Forriol","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Orthopaedic Surgery Department University Foundation San Pablo CEU Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher W.","family":"DiGiovanni","sequence":"additional","affiliation":[{"name":"<!--<label>5<\/label>--> Department of Orthopaedic Surgery Massachusetts General Hospital and Newton Wellesley Hospital Boston Massachusetts US"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Denaro","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic and Trauma Surgery Campus Bio\u2010Medico University Via Alvaro del Portillo 200 00128 Rome Trigoria Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,12]]},"reference":[{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00276\u2010003\u20100156\u20104"},{"key":"e_1_2_12_3_2","doi-asserted-by":"publisher","DOI":"10.1080\/17453670710046530"},{"key":"e_1_2_12_4_2","doi-asserted-by":"publisher","DOI":"10.1080\/17453670610012557"},{"key":"e_1_2_12_5_2","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.182.1.1820131"},{"key":"e_1_2_12_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110079101100609"},{"key":"e_1_2_12_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2003.10.013"},{"key":"e_1_2_12_8_2","first-page":"425","article-title":"Ankle lesions","volume":"46","author":"Cedell CA","year":"1975","journal-title":"Acta Orthop Scand"},{"key":"e_1_2_12_9_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623\u2010195638040\u201000005"},{"key":"e_1_2_12_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00276\u2010006\u20100077\u20100"},{"key":"e_1_2_12_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110078400400606"},{"key":"e_1_2_12_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110079801901002"},{"key":"e_1_2_12_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659502300606"},{"key":"e_1_2_12_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100715583456"},{"key":"e_1_2_12_15_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623\u2010198365010\u201000011"},{"key":"e_1_2_12_16_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623\u2010198466040\u201000002"},{"key":"e_1_2_12_17_2","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2006.2195"},{"key":"e_1_2_12_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010012\u20102205\u20101"},{"key":"e_1_2_12_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0749\u20108063(05)80014\u20103"},{"key":"e_1_2_12_20_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2008.0887"},{"key":"e_1_2_12_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354658501300502"},{"key":"e_1_2_12_22_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623\u2010200612000\u201000018"},{"key":"e_1_2_12_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2007.11.425"},{"key":"e_1_2_12_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010015\u20103942\u20108"},{"key":"e_1_2_12_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010016\u20104017\u20101"},{"key":"e_1_2_12_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2011.08.015"},{"key":"e_1_2_12_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514554911"},{"key":"e_1_2_12_28_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623\u2010199506000\u201000005"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-020-06308-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00167-020-06308-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-020-06308-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00167-020-06308-7","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T14:02:21Z","timestamp":1760882541000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1007\/s00167-020-06308-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,12]]},"references-count":27,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1007\/s00167-020-06308-7"],"URL":"https:\/\/doi.org\/10.1007\/s00167-020-06308-7","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,12]]},"assertion":[{"value":"14 March 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 September 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 October 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Not needed.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not needed.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors allow publication of this manuscript.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}