{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T20:50:42Z","timestamp":1787863842615,"version":"build-2784847793"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2016,5,18]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Distinguishing between ankle instability and subtalar joint instability is challenging because the contributions of the subtalar joint\u2019s soft-tissue constraints are poorly understood. This study quantified the effects on joint stability of systematic sectioning of these constraints followed by application of torsional and drawer loads simulating a manual clinical examination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Subtalar joint motion in response to carefully controlled inversion, eversion, internal rotation, and external rotation moments and multidirectional drawer forces was quantified in fresh-frozen cadaver limbs. Sequential measurements were obtained under axial load approximating a non-weight-bearing clinical setting with the foot in neutral, 10\u00b0 of dorsiflexion, and 10\u00b0 and 20\u00b0 of plantar flexion. The contributions of the components of the inferior extensor retinaculum were documented after incremental sectioning. The calcaneofibular, cervical, and interosseous talocalcaneal ligaments were then sectioned sequentially, in two different orders, to produce five different ligament-insufficiency scenarios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Incremental detachment of the components of the inferior extensor retinaculum had no effect on subtalar motion independent of foot position. Regardless of the subsequent ligament-sectioning order, significant motion increases relative to the intact condition occurred only after transection of the calcaneofibular ligament. Sectioning of this ligament produced increased inversion and external rotation, which was most evident with the foot dorsiflexed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Calcaneofibular ligament disruption results in increases in subtalar inversion and external rotation that might be detectable during a manual examination. Insufficiency of other subtalar joint constraints may result in motion increases that are too subtle to be perceptible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>If calcaneofibular ligament insufficiency is established, its reconstruction or repair should receive priority over that of other ankle or subtalar periarticular soft-tissue structures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.15.00948","type":"journal-article","created":{"date-parts":[[2016,5,18]],"date-time":"2016-05-18T15:04:21Z","timestamp":1463583861000},"page":"842-848","source":"Crossref","is-referenced-by-count":46,"title":["Systematic Quantification of Stabilizing Effects of Subtalar Joint Soft-Tissue Constraints in a Novel Cadaveric Model"],"prefix":"10.2106","volume":"98","author":[{"given":"Manuel J.","family":"Pellegrini","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital Clinico Universidad de Chile, Santiago, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard R.","family":"Glisson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Wurm","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul H.","family":"Ousema","sequence":"additional","affiliation":[{"name":"Department of Radiology, Deventer Ziekenhuis, Deventer, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael M.","family":"Romash","sequence":"additional","affiliation":[{"name":"Sports Medicine and Orthopaedic Surgery, Orthopedic Foot and Ankle Center of Hampton Roads, Chesapeake, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Nunley","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark E.","family":"Easley","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"10","key":"bib1-20230714","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1177\/107110070602701019","article-title":"Current concepts: lateral ankle instability","volume":"27","author":"DiGiovanni","year":"2006","journal-title":"Foot Ankle Int."},{"issue":"7","key":"bib2-20230714","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1177\/107110070002100715","article-title":"The role of the passive structures in the mobility and stability of the human ankle joint: a literature review","volume":"21","author":"Leardini","year":"2000","journal-title":"Foot Ankle Int."},{"issue":"6","key":"bib3-20230714","doi-asserted-by":"crossref","first-page":"368","DOI":"10.5435\/00124635-199811000-00005","article-title":"Surgical treatment of the unstable ankle","volume":"6","author":"Colville","year":"1998","journal-title":"J Am Acad Orthop Surg."},{"issue":"3","key":"bib4-20230714","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1177\/107110079501600308","article-title":"Stress radiography of the talocrural and subtalar joints","volume":"16","author":"Louwerens","year":"1995","journal-title":"Foot Ankle Int."},{"issue":"11","key":"bib5-20230714","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1097\/00005768-199911000-00002","article-title":"Talocrural and subtalar joint instability after lateral ankle sprain","volume":"31","author":"Hertel","year":"1999","journal-title":"Med Sci Sports Exerc."},{"key":"bib6-20230714","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/00003086-198801000-00023","article-title":"The subtalar sprain. A roentgenographic study","volume":"226","author":"Meyer","year":"1988","journal-title":"Clin Orthop Relat Res."},{"issue":"5","key":"bib7-20230714","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1177\/036354658801600514","article-title":"The stabilizing effect of the ligamentous structures in the sinus and canalis tarsi on movements in the hindfoot. An experimental study","volume":"16","author":"Kjaersgaard-Andersen","year":"1988","journal-title":"Am J Sports Med."},{"issue":"6","key":"bib8-20230714","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1177\/107110078700700612","article-title":"Lateral talocalcaneal instability following section of the calcaneofibular ligament: a kinesiologic study","volume":"7","author":"Kjaersgaard-Andersen","year":"1987","journal-title":"Foot Ankle."},{"issue":"3","key":"bib9-20230714","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/S1083-7515(02)00047-5","article-title":"Subtalar instability. Etiology, diagnosis, and management","volume":"7","author":"Keefe","year":"2002","journal-title":"Foot Ankle Clin."},{"issue":"2","key":"bib10-20230714","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3113\/FAI.2012.0151","article-title":"Subtalar instability: diagnosis and treatment","volume":"33","author":"Barg","year":"2012","journal-title":"Foot Ankle Int."},{"issue":"3","key":"bib11-20230714","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1302\/0301-620X.77B3.7744924","article-title":"The diagnosis and treatment of instability of the subtalar joint","volume":"77","author":"Kato","year":"1995","journal-title":"J Bone Joint Surg Br."},{"issue":"5","key":"bib12-20230714","doi-asserted-by":"crossref","first-page":"442","DOI":"10.3109\/17453679708996259","article-title":"Subtalar joint stability. Talocalcaneal interosseous ligament function studied in cadaver specimens","volume":"68","author":"Knudson","year":"1997","journal-title":"Acta Orthop Scand."},{"issue":"3","key":"bib13-20230714","doi-asserted-by":"crossref","first-page":"321","DOI":"10.2106\/00004623-197759030-00005","article-title":"Instability of the subtalar joint. Diagnosis by stress tomography in 3 cases","volume":"59","author":"Brantigan","year":"1977","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib14-20230714","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1177\/107110079201300304","article-title":"The stabilizing role of the lateral ligament complex around the ankle and subtalar joints","volume":"13","author":"Stephens","year":"1992","journal-title":"Foot Ankle."},{"issue":"8","key":"bib15-20230714","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1177\/107110070502600810","article-title":"Analysis of ankle-hindfoot stability in multiple planes: an in vitro study","volume":"26","author":"Fujii","year":"2005","journal-title":"Foot Ankle Int."},{"issue":"8","key":"bib16-20230714","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1177\/107110070402500813","article-title":"The role of the interosseous talocalcaneal ligament in subtalar joint stability","volume":"25","author":"Tochigi","year":"2004","journal-title":"Foot Ankle Int."},{"issue":"6","key":"bib17-20230714","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1177\/107110070002100607","article-title":"Influence of the interosseous talocalcaneal ligament injury on stability of the ankle-subtalar joint complex\u2014a cadaveric experimental study","volume":"21","author":"Tochigi","year":"2000","journal-title":"Foot Ankle Int."},{"issue":"3","key":"bib18-20230714","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s00402-008-0743-2","article-title":"Subtalar instability: a biomechanical cadaver study","volume":"130","author":"Weindel","year":"2010","journal-title":"Arch Orthop Trauma Surg."},{"issue":"5","key":"bib19-20230714","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1177\/107110070102200512","article-title":"Measurement of isolated subtalar range of motion: a cadaver study","volume":"22","author":"Taylor","year":"2001","journal-title":"Foot Ankle Int."},{"issue":"6","key":"bib20-20230714","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/S0021-9290(01)00031-8","article-title":"Mobility of the subtalar joint in the intact ankle complex","volume":"34","author":"Leardini","year":"2001","journal-title":"J Biomech."},{"issue":"3","key":"bib21-20230714","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1177\/107110078400500307","article-title":"3-dimensional kinematics of ankle instability following serial sectioning of lateral collateral ligaments","volume":"5","author":"Cass","year":"1984","journal-title":"Foot Ankle."},{"issue":"5","key":"bib22-20230714","doi-asserted-by":"crossref","first-page":"450","DOI":"10.3113\/FAI.2012.0450","article-title":"Peritalar instability","volume":"33","author":"Hintermann","year":"2012","journal-title":"Foot Ankle Int."},{"issue":"8","key":"bib23-20230714","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1177\/107110079701800805","article-title":"Stress radiography and stress examination of the talocrural and subtalar joint on helical computed tomography","volume":"18","author":"van Hellemondt","year":"1997","journal-title":"Foot Ankle Int."},{"issue":"3","key":"bib24-20230714","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1177\/107110079701800309","article-title":"Treatment algorithm of chronic ankle and subtalar instability","volume":"18","author":"Thermann","year":"1997","journal-title":"Foot Ankle Int."},{"issue":"12","key":"bib25-20230714","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1177\/1071100713502322","article-title":"All-inside arthroscopic lateral collateral ligament repair for ankle instability with a knotless suture anchor technique","volume":"34","author":"Vega","year":"2013","journal-title":"Foot Ankle Int."},{"issue":"7","key":"bib26-20230714","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1177\/1071100715576539","article-title":"Biomechanical analysis of an arthroscopic Brostr\u00f6m ankle ligament repair and a suture anchor-augmented repair","volume":"36","author":"Giza","year":"2015","journal-title":"Foot Ankle Int."},{"issue":"11","key":"bib27-20230714","doi-asserted-by":"crossref","first-page":"2381","DOI":"10.1177\/0363546511416069","article-title":"Arthroscopic-assisted Brostr\u00f6m-Gould for chronic ankle instability: a long-term follow-up","volume":"39","author":"Nery","year":"2011","journal-title":"Am J Sports Med."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201605180-00006","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:27:00Z","timestamp":1787750820000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201605180-00006"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,5,18]]},"references-count":27,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2016]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.15.00948","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,5,18]]}}}