{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T23:45:01Z","timestamp":1787960701113,"version":"build-2784847793"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T00:00:00Z","timestamp":1682380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["32201067"],"award-info":[{"award-number":["32201067"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:p>Ankle sprain is a frequent type of sports injury leading to lateral ligament injury. The anterior talofibular ligament (ATFL) is a primary ligamentous stabilizer of the ankle joint and typically the most vulnerable ligament injured in a lateral ankle sprain (LAS). This study aimed to quantitively investigate the effect of the thickness and elastic modulus of ATFL on anterior ankle joint stiffness (AAJS) by developing nine subject-specific finite element (FE) models under acute injury, chronic injury, and control conditions of ATFL. A 120\u00a0N forward force was applied at the posterior calcaneus leading to an anterior translation of the calcaneus and talus to simulate the anterior drawer test (ADT). In the results, the ratio of the forward force to the talar displacement was used to assess the AAJS, which increased by 5.85% in the acute group and decreased by 19.78% in the chronic group, compared to those of the control group. An empirical equation described the relationship between AAJS, thickness, and elastic modulus (R-square 0.98). The equation proposed in this study provided an approach to quantify AAJS and revealed the effect of the thickness and the elastic modulus of ATFL on ankle stability, which may shed light on the potential diagnosis of lateral ligament injury.<\/jats:p>","DOI":"10.3389\/fbioe.2023.1175347","type":"journal-article","created":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T05:08:03Z","timestamp":1682399283000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["The effect of thickness and elastic modulus of the anterior talofibular ligament on anterior ankle joint stiffness: A subject-specific finite element study"],"prefix":"10.3389","volume":"11","author":[{"given":"Linjing","family":"Peng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingyi","family":"Jia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaokai","family":"Gan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angang","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yichen","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifei","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,4,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s13047-017-0194-5","article-title":"3-D computer modelling of malunited posterior malleolar fractures: Effect of fragment size and offset on ankle stability, contact pressure and pattern","volume":"10","author":"Alonso-Rasgado","year":"2017","journal-title":"J. Foot Ankle Res."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1016\/j.ultrasmedbio.2012.02.032","article-title":"Intra- and interoperator reproducibility of acoustic radiation force impulse (ARFI) elastography\u2013preliminary results","volume":"38","author":"Bota","year":"2012","journal-title":"Ultrasound Med. Biol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1177\/107110079101100609","article-title":"Biomechanical evaluation of the anterior drawer test: The contribution of the lateral ankle ligaments","volume":"11","author":"Bulucu","year":"1991","journal-title":"Foot ankle."},{"key":"B4","doi-asserted-by":"publisher","first-page":"8","DOI":"10.29328\/journal.jsmt.1001052","article-title":"The epidemiology, evaluation, and assessment of lateral ankle sprains in athletes","volume":"6","author":"Cavazos","year":"2021","journal-title":"J. Sports Med. Ther."},{"key":"B5","doi-asserted-by":"publisher","first-page":"4334","DOI":"10.21037\/qims-21-203","article-title":"Can virtual touch tissue imaging quantification be a reliable method to detect anterior talofibular ligament type I injury at the acute, subacute, and chronic stages?","volume":"11","author":"Chen","year":"2021","journal-title":"Quant. Imaging Med. Surg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1186\/s13018-022-03177-3","article-title":"Quantitative analysis with load\u2013displacement ratio measured via digital arthrometer in the diagnostic evaluation of chronic ankle instability: A cross-sectional study","volume":"17","author":"Chen","year":"","journal-title":"J. Orthop. Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1573","DOI":"10.1007\/s10237-022-01607-z","article-title":"Mechanical analysis of deep tissue injury during sitting in patients with spinal cord injury via parametric finite element model","volume":"21","author":"Chen","year":"","journal-title":"Biomech. Model. Mechanobiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1111\/j.1440-1673.2008.02018.x","article-title":"Evaluation of thickness and appearance of anterior talofibular and calcaneofibular ligaments in normal versus abnormal ankles with MRI","volume":"52","author":"Dimmick","year":"2008","journal-title":"J. Med. Imaging Radiat. Oncol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1016\/j.fcl.2006.07.002","article-title":"Epidemiology of sprains of the lateral ankle ligament complex","volume":"11","author":"Ferran","year":"2006","journal-title":"Foot Ankle Clin."},{"key":"B10","doi-asserted-by":"publisher","first-page":"2627","DOI":"10.1177\/0363546512458259","article-title":"Kinematics analysis of ankle inversion ligamentous sprain injuries in sports: Five cases from televised tennis competitions","volume":"40","author":"Fong","year":"2012","journal-title":"Am. J. Sports Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1115\/1.429623","article-title":"Linear and quasi-linear viscoelastic characterization of ankle ligaments","volume":"122","author":"Funk","year":"2000","journal-title":"J. Biomech. Eng."},{"key":"B12","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1115\/1.1318904","article-title":"Biomechanical analysis of the three-dimensional foot structure during gait: A basic tool for clinical applications","volume":"122","author":"Gefen","year":"2000","journal-title":"J. Biomech. Eng."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.1016\/j.joca.2014.04.029","article-title":"Functional ankle instability as a risk factor for osteoarthritis: Using T2-mapping to analyze early cartilage degeneration in the ankle joint of young athletes","volume":"22","author":"Golditz","year":"2014","journal-title":"Osteoarthr. Cartil."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1053\/j.jfas.2018.03.038","article-title":"Rotational instability after anterior talofibular and calcaneofibular ligament section: The experimental basis for the ankle pivot test","volume":"57","author":"Guerra-Pinto","year":"2018","journal-title":"J. Foot Ankle Surg."},{"key":"B15","doi-asserted-by":"publisher","first-page":"603","DOI":"10.4085\/1062-6050-447-17","article-title":"Epidemiology of ankle sprains and chronic ankle instability","volume":"54","author":"Herzog","year":"2019","journal-title":"J. Athl. Train."},{"key":"B16","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1080\/00913847.2018.1484658","article-title":"Acoustic radiation force impulse tissue characterization of the anterior talofibular ligament: A promising noninvasive approach in ankle imaging","volume":"46","author":"Hotfiel","year":"2018","journal-title":"Phys. Sportsmed."},{"key":"B17","doi-asserted-by":"publisher","first-page":"523","DOI":"10.4085\/1062-6050-43.5.523","article-title":"Ankle ligament healing after an acute ankle sprain: An evidence-based approach","volume":"43","author":"Hubbard","year":"2008","journal-title":"J. Athl. Train."},{"key":"B18","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1177\/1071100717693207","article-title":"Magnetic resonance imaging and stress radiography in chronic lateral ankle instability","volume":"38","author":"Jung","year":"2017","journal-title":"Foot Ankle Int."},{"key":"B19","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1302\/2046-3758.38.2000295","article-title":"The use of MRI in pre-operative evaluation of anterior talofibular ligament in chronic ankle instability","volume":"3","author":"Kanamoto","year":"2014","journal-title":"Bone Jt. Res."},{"key":"B20","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.foot.2015.05.004","article-title":"The anterior talofibular ligament: A detailed morphological study","volume":"25","author":"Khawaji","year":"2015","journal-title":"Foot"},{"key":"B21","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1034\/j.1600-0838.2002.00108.x","article-title":"Inversion injury biomechanics in functional ankle instability: A cadaver study of simulated gait","volume":"12","author":"Konradsen","year":"2002","journal-title":"Scand. J. Med. Sci. Sports."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.1249\/MSS.0000000000000872","article-title":"Association of injury history and incident injury in cadet basic military training","volume":"48","author":"Kucera","year":"2016","journal-title":"Med. Sci. Sports Exerc."},{"key":"B23","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1046\/j.1469-7580.2002.00050.x","article-title":"The functional anatomy of the human anterior talofibular ligament in relation to ankle sprains","volume":"200","author":"Kumai","year":"2002","journal-title":"J. Anat."},{"key":"B24","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s13047-019-0330-5","article-title":"Function of ankle ligaments for subtalar and talocrural joint stability during an inversion movement \u2013 An in vitro study","volume":"12","author":"Li","year":"2019","journal-title":"J. Foot Ankle Res."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1436","DOI":"10.1016\/j.ultrasmedbio.2011.05.022","article-title":"Preliminary results of acoustic radiation force impulse (ARFI) ultrasound imaging of breast lesions","volume":"37","author":"Meng","year":"2011","journal-title":"Ultrasound Med. Biol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/s11249-006-9069-9","article-title":"A rational human joint friction test using a human cartilage-on-cartilage arrangement","volume":"22","author":"Merkher","year":"2006","journal-title":"Tribol. Lett."},{"key":"B27","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1080\/00913847.2018.1409604","article-title":"Acute lateral ankle sprain to chronic ankle instability: A pathway of dysfunction","volume":"46","author":"Miklovic","year":"2018","journal-title":"Phys. Sportsmed."},{"key":"B28","doi-asserted-by":"publisher","first-page":"2356","DOI":"10.1007\/s10439-019-02314-0","article-title":"In vivo measurement of plantar tissue characteristics and its indication for foot modeling","volume":"47","author":"Mo","year":"2019","journal-title":"Ann. Biomed. Eng."},{"key":"B29","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1186\/s12891-023-06246-8","article-title":"High reproducibility of a novel supported anterior drawer test for diagnosing ankle instability","volume":"24","author":"Murahashi","year":"2023","journal-title":"BMC Musculoskelet. Disord."},{"key":"B30","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1016\/S0301-5629(01)00499-9","article-title":"Acoustic radiation force impulse imaging: In vivo demonstration of clinical feasibility","volume":"28","author":"Nightingale","year":"2002","journal-title":"Ultrasound Med. Biol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.jbiomech.2011.02.054","article-title":"Developing of a three-dimensional foot ankle model based on CT images and non-linear analysis of anterior drawer test by using the finite element method","volume":"44","author":"Pekedis","year":"2011","journal-title":"J. Biomech."},{"key":"B32","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1114\/1.1408926","article-title":"Nonlinear ligament viscoelasticity","volume":"29","author":"Provenzano","year":"2001","journal-title":"Ann. Biomed. Eng."},{"key":"B33","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1002\/mus.26863","article-title":"Shear wave elastography of the median nerve: A mechanical study","volume":"61","author":"Schrier","year":"2020","journal-title":"Muscle Nerve"},{"key":"B34","doi-asserted-by":"publisher","first-page":"2519","DOI":"10.1007\/s10439-012-0607-3","article-title":"A finite element model of the foot and ankle for automotive impact applications","volume":"40","author":"Shin","year":"2012","journal-title":"Ann. Biomed. Eng."},{"key":"B35","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1177\/107110078800800502","article-title":"The mechanical characteristics of the collateral ligaments of the human ankle joint","volume":"8","author":"Siegler","year":"1988","journal-title":"Foot Ankle"},{"key":"B36","doi-asserted-by":"publisher","first-page":"2473011421S0096","DOI":"10.1177\/2473011421S00961","article-title":"Epidemiology of ankle ligament injuries in US high school athletes","volume":"7","author":"Swanson","year":"2022","journal-title":"Foot Ankle Orthop."},{"key":"B37","doi-asserted-by":"publisher","first-page":"2367","DOI":"10.3390\/ijerph19042367","article-title":"Feasibility of an ultrasound-based method for measuring talar displacement during the anterior drawer stress test using a Telos device: A preliminary study","volume":"19","author":"Tsutsumi","year":"2022","journal-title":"Int. J. Environ. Res. Public. Health."},{"key":"B38","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/S1836-9553(12)70109-1","article-title":"Re-Sprains during the first 3 months after initial ankle sprain are related to incomplete recovery: An observational study","volume":"58","author":"van Middelkoop","year":"2012","journal-title":"J. Physiother."},{"key":"B39","doi-asserted-by":"publisher","first-page":"8","DOI":"10.5312\/wjo.v7.i1.8","article-title":"Football injuries of the ankle: A review of injury mechanisms, diagnosis and management","volume":"7","author":"Walls","year":"2016","journal-title":"World J. Orthop."},{"key":"B40","doi-asserted-by":"publisher","first-page":"3108","DOI":"10.1007\/s00167-016-4139-5","article-title":"Evaluating posterior cruciate ligament injury by using two-dimensional ultrasonography and sonoelastography","volume":"25","author":"Wang","year":"2017","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"B41","doi-asserted-by":"publisher","first-page":"100067","DOI":"10.1016\/j.medntd.2021.100067","article-title":"An instrument for methodological quality assessment of single-subject finite element analysis used in computational orthopaedics","volume":"11","author":"Wong","year":"2021","journal-title":"Med. Nov. Technol. Devices."},{"key":"B42","doi-asserted-by":"publisher","first-page":"2181","DOI":"10.1016\/j.ejrad.2015.07.015","article-title":"Acoustic radiation force impulse imaging (ARFI) for differentiation of benign and malignant thyroid nodules\u2014a meta-analysis","volume":"84","author":"Zhan","year":"2015","journal-title":"Eur. J. Radiol."}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2023.1175347\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T05:08:06Z","timestamp":1682399286000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2023.1175347\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,25]]},"references-count":42,"alternative-id":["10.3389\/fbioe.2023.1175347"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2023.1175347","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,25]]},"article-number":"1175347"}}