{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:47:37Z","timestamp":1788241657087,"version":"build-2803163510"},"reference-count":36,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:00:00Z","timestamp":1755216000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100007307","name":"arthrex","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007307","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Despite studies on syndesmotic and deltoid ligament (DL) repair, the biomechanical role of (partial or full) ligament repair and bracing in unstable ankles to regain rotational stability remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To determine the ability of surgical intervention on syndesmosis and SLs with suture repair and ligament bracing to restore intact external rotation ankle stability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Controlled laboratory study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A total of 24 cadaveric lower extremities were divided into 3 equal groups with anterior inferior tibiofibular ligament internal brace (AiTFL-IB), interosseous ligament (IOL) suture button repair, and superficial DL (SDL) and deep DL (DDL) suture anchor repair or bracing (DL-IB) performed in varying orders to assess their contribution to restoring rotational ankle stability. Individual external rotation angles (\u03b1\n                      <jats:sub>2.5<\/jats:sub>\n                      to \u03b1\n                      <jats:sub>7.0<\/jats:sub>\n                      ), determined from the intact time-zero load curve at 2.5, 4.0, 5.5, and 7.0 N\u00b7m, were used for rotation-controlled cycling performed sequentially (1000 cycles in total) for each surgical condition. Peak torque and stiffness were analyzed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Either IOL or SDL+DDL repair had the largest effect on restoring rotational stability (23% to 12% across \u03b1\n                      <jats:sub>2.5<\/jats:sub>\n                      to \u03b1\n                      <jats:sub>7.0<\/jats:sub>\n                      ) but showed a completely loose state with the lowest resistance to external rotation compared with the intact state. The contribution of SDL+DDL was higher (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .009) than that of isolated SDL or DDL repair (except for SDL at \u03b1\n                      <jats:sub>7.0<\/jats:sub>\n                      ). Additional AiTFL-IB stabilized the ankle in the 7% to 13% range across all rotation angles. Ankles with full ligament repair (IOL+AiTFL-IB+SDL+DDL) approached native peak torque restoration (104% to 76% across \u03b1\n                      <jats:sub>2.5<\/jats:sub>\n                      to \u03b1\n                      <jats:sub>7.0<\/jats:sub>\n                      ) and were significantly more stable (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05) than IOL+DDL repair. IOL repair with different DL-IB configurations achieved similar levels of ankle stability and stiffness to full ligament repair. Higher construct stiffness of DL-IB and the full repair groups became similar to the intact condition with increasing rotation and approached native ankle function, except at the largest rotation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>An isolated deltoid or syndesmosis repair was unable to restore rotational ankle stability. A combined repair or a combination of repair and bracing closely restored rotational stiffness and ankle stability in case of a multiligamentous ankle injury in a cadaveric model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>Knowledge of specific syndesmotic and DL repair patterns in rotational stability is crucial for appropriate surgical intervention in treating unstable ankles.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465251361148","type":"journal-article","created":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T14:23:17Z","timestamp":1755267797000},"page":"2660-2667","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Deltoid and Syndesmotic Ligaments, Part 2. The Value of Ligament Repair and Augmentation in Restoring Biomechanical Rotational Ankle Stability"],"prefix":"10.1177","volume":"53","author":[{"given":"Samuel","family":"Bachmaier","sequence":"first","affiliation":[{"name":"Arthrex Department of Orthopedic Research, Munich, Bavaria, Germany"},{"name":"Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, (MUM), University Hospital, LMU Munich, Munich, Bavaria, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasef M.N.","family":"Abdelatif","sequence":"additional","affiliation":[{"name":"Orthopedic Foot and Ankle Department, DrNasef OrthoClinic, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Warnecke","sequence":"additional","affiliation":[{"name":"Arthrex Department of Orthopedic Research, Munich, Bavaria, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Baumbach","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, (MUM), University Hospital, LMU Munich, Munich, Bavaria, 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