Joint Motions of the Lower Limb during Ergometer Cycling

The purpose of the study was to study the utilization of range of motion at the hip, knee, and ankle joints during exercise on a bicycle ergometer. Six healthy subjects biked at different workloads, pedaling rates, saddle heights, and pedal foot positions. The subjects were filmed in the sagittal plane with a cine-film camera at 60 frames/sec. The mean hip range of motion (ROM) during normal cycling was 38 degrees ranging from 32-70 degrees hip flexion. The mean knee ROM was 66 degrees ranging from 46-112 degrees knee flexion, and the ankle ROM was 24 degrees ranging from 2 degrees plantarflexion to 22 degrees dorsiflexion. The hip, knee, and ankle joint motions were influenced by changes of the saddle height or pedal foot position. Different workloads had a small but statistically significant influence on the joint motions while different pedaling rates did not significantly change the lower limb joint motions. The range of motion utilized during cycling is approximately equal to, but more flexed compared to level walking and stair walking. The most effective way of increasing the ROM and obtaining more extension of the lower limb joints is to change the saddle height.J Orthop Sports Phys Ther 1988;9(8):273-278.     

Technique for in vivo measurement of the three-dimensional kinematics and laxity characteristics of the ankle joint complex

We introduce here a technique to measure the three-dimensional kinematics and laxity characteristics of the ankle joint complex in vivo. The system consists of an optoelectric, kinematic data acquisition system that is used to measure the motion of the ankle joint complex in response to controlled moments applied through a system of pneumatic actuators. As a first step toward development of the method into a quantitative diagnostic tool for injuries of ankle ligaments, we addressed the following questions: (a) What is the reliability for measurement of range of motion and laxity of the ankle joint complex? (b) Are there significant differences in laxity between the left and right joints of a healthy individual? and (c) Are there significant differences in laxity of the ankle joint complex between men and women? To answer these questions, we performed repeated measures of range of motion and laxity of paired ankles in a population of 18 healthy young individuals. The high intraclass correlation coefficients obtained from the statistical analysis indicate that the new experimental system is highly reliable in measurement of total range of motion and total laxity of the ankle joint complex. We further concluded that, within the statistical power available in our experimental design, there are no significant differences in either range of motion or laxity between left and right ankles of healthy individuals or between men and women.     

The range of joint motions of the extremities in healthy Japanese people--the difference according to the age (author's transl)]

The passive range of motion was measured in the shoulder, elbow, forearm, wrist, hip, knee and ankle joints in 624 healthy Japanese persons ranging from the neonatal to 80 years of age, by the method formally decided by the Japanese Orthopaedic Association and the Japanese Association of Rehabilitation Medicine in 1974, followed by a statistical analysis. 1. The joint motions, the range of motion value of which being remarkably different by age, were found among the movements in external rotation and horizontal abduction of the shoulder, extension, abduction, adduction, external rotation, internal rotation of the hip and dorsiflexion of the ankle. 2. Elbow flexion, forearm pronation and supination, wrist dorsiflexion and knee flexion showed little change by age. 3. Extension, external rotation and horizontal abduction of the shoulder, dorsiflexion of the wrist, flexion of the hip, flexion of the knee and dorsiflexion and plantar flexion of the ankle gave values exceeding the normal range indicated by the associations. 4. The fluctuation in the range of joint motion was especially wide in the infant and the aged person.     

Patterns of compensation of functional deficits of the knee joint in patients with juvenile idiopathic arthritis

Objectives

Juvenile idiopathic arthritis (JIA) is a group of pathological syndromes of unknown aetiology, observed at the developmental age. Their common feature is sustained chronic arthritis with flares and remissions. Clinical signs and symptoms include joint pain, periarticular tissue oedema or articular exudate, frequently associated with hypertrophy of the synovial membrane. The intra- and extra-articular structural damage impairs the motion range and smoothness. The disease process may involve any joint. The knee joint is the most frequently affected in oligo- and polyarthritis. The aim of the study was to determine a direct correlation between disorders of knee joint function and the change in the range of motion of the ankle and hip joints of both lower extremities, and the so-called indirect impact of these changes on patients’ posture.

Material and methods

The study included 36 JIA patients and 56 healthy controls aged 8–16 years. The evaluation was based on physical examination.

Results

The results showed differences in the values of quality and range of motion between patients and controls. In the patient group pes planovalgus was more frequently associated with knee joint dysfunction along with the inherent restriction of dorsal flexion of the foot. Shortening of the iliotibial band, increased outward rotation of the right lower extremity with enlarged joint contour and augmented inward rotation of the contralateral healthy extremity all proved significant. Changes in motion range in the joints below and over the knee were associated with alterations of antero-posterior spine curvatures and vertebral rotation along the long spinal axis. Based on the results, the mechanism of the compensation is outlined.

Conclusions

The observed differences in the range and quality of motion in the ankle, hip and spinal joints between patients and healthy children provide evidence that dysfunction of the knee joint affects the function of the other above-mentioned levels of the motor system.     

距下关节融合对中后足周围关节活动度影响的生物力学实验研究

目的分析研究正常新鲜足标本在正常情况下进行距下关节融合后对跟骰、距舟关节和踝关节的三维运动度的影响程度。方法采用新鲜足标本12例，将距下关节融合后，通过加载使足产生某种形式的运动，用三维数字化坐标仪测量跟骰、距舟关节和踩关节各关节组成骨在某种运动状态下的相对三维坐标位移，通过矩阵转换和求解非线性函数方程计算其三维旋转角度，了解跟骰、距舟关节和踝关节在距下关节融合前后2种状态下的相对运动范围，确定距下关节融合后对于周围足踝关节运动的影响程度。结果距下关节融合前后跟骰、距舟关节和踝关节在背屈一跖屈、内翻一外翻、内收一外展轴的三维运动范围之间的统计学分析显示存在显著性差异（P＜0．01），各关节平均三维运动范围受限程度分别为36．14％、38．36％、21．84％。结论距下关节融合后对跟骰、距舟关节和踝关节的活动度存在一定的限制作用，降低了前足与后足的协同性，可能增加足跗关节间退行性关节炎发生，但保留了距舟、跟骰关节的大部分活动。     

腓骨移植与儿童踝关节生长紊乱

为探讨儿童腓骨移植后对供区踝关节发育有无影响。对４例吻合血管的腓骨移植儿童进行了临床及Ｘ线片随访观察，随访时间９～１２年，平均１０年。结果，自述供侧肢体无不适，整体生长情况正常，步态正常。Ｘ线片示：胫骨远端骨骺呈内高外低的“楔样变”，骨骺线与胫骨纵轴线角度正常，胫距关节间隙向外倾斜，关节间隙正常。距骨呈外高内低改变，均有踝穴外翻。内外踝发育较小，胫骨外侧骨皮质较内侧皮质厚。其中１例骨骺外侧半出现坏死改变，踝穴外翻、变浅。认为，破坏儿童腓骨的结构完整性——无论切取多长腓骨，必然引起踝关节生长紊乱。强调临床上应严格掌握儿童腓骨移植的适应证。     

Ankle Deformity Secondary to Acquired Fibular Segmental Defect in Children

Background

The authors report the long-term effect of acquired pseudoarthrosis of the fibula on ankle development in children during skeletal growth, and the results of a long-term follow-up of Langenskiold''s supramalleolar synostosis to correct an ankle deformity induced by an acquired fibular segmental defect in children.

Methods

Since 1980, 19 children with acquired pseudoarthrosis of the fibula were treated and followed up for an average of 11 years. Pseudoarthrosis was the result of a fibulectomy for tumor surgery, osteomyelitis of the fibula and traumatic segmental loss of the fibula in 10, 6, and 3 cases, respectively. Initially, a Langenskiold''s operation (in 4 cases) and fusion of the lateral malleolus to the distal tibial epiphysis (in 1 case) were performed, whereas only skeletal growth was monitored in the other 14 cases. After a mean follow-up of 11 years, the valgus deformity and external tibial torsion of the ankle joint associated with proximal migration of the lateral malleolus needed to be treated with a supramallolar osteotomy in 12 cases (63%). These ankle deformities were evaluated using the serial radiographs and limb length scintigraphs.

Results

In all cases, early closure of the lateral part of the distal tibial physis, upward migration of the lateral malleolus, unstable valgus deformity and external tibial torsion of the ankle joint developed during a mean follow-up of 11 years (range, 5 to 21 years). The mean valgus deformity and external tibial torsion of the ankle at the final follow-up were 15.2° (range, 5° to 35°) and 10° (range, 5° to 12°), respectively. In 12 cases (12/19, 63%), a supramalleolar corrective osteotomy was performed but three children had a recurrence requiring an additional supramalleolar corrective osteotomy 2-4 times.

Conclusions

A valgus deformity and external tibial torsion are inevitable after acquired pseudoarthrosis of the fibula in children. Both Langenskiöld supramalleolar synostosis to prevent these ankle deformities and supramalleolar corrective osteotomy to correct them in children are effective initially. However, both procedures cannot maintain the permanent ankle stability during skeletal maturity. Therefore any type of prophylactic surgery should be carried out before epiphyseal closure of the distal tibia occurs, but the possibility of a recurrence of the ankle deformities and the need for final corrective surgery after skeletal maturity should be considered.     

Motion measured from forefoot and hindfoot landmarks during passive ankle dorsiflexion range of motion

This project was funded, in part, by the Research Foundation, University of Connecticut, Storrs, CT 06269-2101. The purpose of this study was to document and compare, using surface landmarks, the magnitude of forefoot and hindfoot motion accompanying passive ankle dorsiflexion range of motion (ADROM). Twenty-two healthy subjects had their right ankle passively dorsiflexed two times from a resting position to a maximum dorsiflexion while they were supine and their subtalar joints were positioned in neutral. Initial resting position and maximum ADROM were measured from surface markings over the fibula, fifth metatarsal, and heel in pictures taken with a 35 mm camera. The difference between the maximum ADROM and the initial measurements obtained from the markings over the fifth metatarsal and heel were used to represent motion of the forefoot and hindfoot, respectively. The grand mean forefoot motion (39.8 degrees ) and hindfoot motion (37.1 degrees ) were significantly different (F = 13.62, p 相似文献   

The Effects of Kinesio? Taping on Proprioception at the Ankle

An experiment was designed to determine if Kinesio™ taping the anterior and lateral portion of the ankle would enhance ankle proprioception compared to the untaped ankle. 30 subjects, 15 men, 15 women, ages 18-30 participated in this study. Exclusion criteria: Ankle injury < 6 months prior to testing, significant ligament laxity as determined through clinical evaluation by an ATC, or any severe foot abnormality. Experiment utilized a single group, pretest and posttest. Plantar flexion and inversion with 20° of plantar flexion reproduction of joint position sense (RJPS) was determined using an ankle RJPS apparatus. Subjects were barefooted, blindfolded, and equipped with headphones playing white noise to eliminate auditory cues. Subjects had five trials in both plantar flexion and inversion with 20° plantar flexion before and after application of the Kinesio™ tape to the anterior/lateral portion of the ankle. Constant error and absolute error were determined from the difference between the target angle and the trial angle produced by the subject. The treatment group (Kinesio™ taped subjects) showed no change in constant and absolute error for ankle RJPS in plantar flexion and 20° of plantar flexion with inversion when compared to the untaped results using the same motions. The application of Kinesio™ tape does not appear to enhance proprioception (in terms of RJPS) in healthy individuals as determined by our measures of RJPS at the ankle in the motions of plantar flexion and 20° of plantar flexion with inversion.

Key Points

• Proprioception research
• Evaluation of a new taping method
• Augmentation of sensory feedback
• Rehabilitation technique

Key words: Reproduction of joint position sense, Kinesio™ Tape, target angle     

3D strength surfaces for ankle plantar- and dorsi-flexion in healthy adults: an isometric and isokinetic dynamometry study

Background

The ankle is an important component of the human kinetic chain, and deficits in ankle strength can negatively impact functional tasks such as balance and gait. While peak torque is influenced by joint angle and movement velocity, ankle strength is typically reported for a single angle or movement speed. To better identify deficits and track recovery of ankle strength after injury or surgical intervention, ankle strength across a range of movement velocities and joint angles in healthy adults is needed. Thus, the primary goals of this study were to generate a database of strength values and 3-dimensional strength surface models for plantarflexion (PF) and dorsiflexion (DF) ankle strength in healthy men and women. Secondary goals were to develop a means to estimate ankle strength percentiles as well as examine predictors of maximal ankle strength in healthy adults.

Methods

Using an isokinetic dynamometer, we tested PF and DF peak torques at five joint angles (?10° [DF], 0° [neutral], 10° [PF], 20° [PF] and 30° [PF]) and six velocities (0°/s, 30°/s, 60°/s, 90°/s, 120°/s and 180°/s) in 53 healthy adults. These data were used to generate 3D plots, or “strength surfaces”, for males and females for each direction; surfaces were fit using a logistic equation. We also tested predictors of ankle strength, including height, weight, sex, and self-reported physical activity levels.

Results

Torque-velocity and torque-angle relationships at the ankle interact, indicating that these relationships are interdependent and best modeled using 3D surfaces. Sex was the strongest predictor of ankle strength over height, weight, and self-reported physical activity levels. 79 to 97 % of the variance in mean peak torque was explained by joint angle and movement velocity using logistic equations, for men and women and PF and DF directions separately.

Conclusions

The 3D strength data and surface models provide a more comprehensive dataset of ankle strength in healthy adults than previously reported. These models may allow researchers and clinicians to quantify ankle strength deficits and track recovery in patient populations, using angle- and velocity-specific ankle strength values and/or strength percentiles from healthy adults.

     

Joint laxity in children

Joint laxity was measured clinically in 2,360 normal Chinese children aged 3-13 years with equal sex distribution using the Carter Wilkinson five tests and scoring system. Results showed minimal differences due to gender. The degree of joint laxity diminished with age. The knee extension and ankle extension tests were more sensitive than other tests. Chinese children were far more lax throughout the age range, with 100% "laxity" at age 3, 67% laxity at age 6, and 28% laxity at age 12, in contrast to 50, 5, and 1% laxity in the same age group respectively, in large series of Caucasian children.     

Idiopathic clubfoot: ten year follow-up after a soft tissue release procedure

Purpose

Our objective is to report longitudinal outcomes of selective surgical soft tissue release for idiopathic clubfoot (ICF).

Methods

Thirty-six ICF patients who had surgery at the average age of 11 (range nine to 17) months and 12 age-matched normal feet were evaluated yearly until subjects had the average age of 11 (range seven to 19) years using eight radiographic parameters. The Ponseti and Dimeglio scores were rated. Serial ankle and subtalar motions and talocalcaneal (TC) index changes over time were analyzed using mixed effects random-intercept longitudinal models.

Results

At the last follow-up, ankle and subtalar motions were more restricted in the ICF but no significant changes in motion were observed over follow-up, except for small but significant decreases in the TC index in both ICF and control feet. The average measurement in ICF group versus control revealed significantly lower angles in the five assessed parameters. The mean Ponseti score was 88 (range 40–97) and ICF showed an improvement of the Dimeglio score. A positive correlation between the Ponseti score and the subtalar motion was noted, whereas talar flattening had a negative influence on the ankle motion.

Conclusions

Soft tissue release surgery limited to only pathologies encountered during the procedure maintains motions of ankle and subtalar joints in ICF.

     

An objective sign of the presence of a dislocation of the peroneal tendon?

If being necessary to diagnose a rupture of the external ligaments of the ankle joint one must produce special "forced" X-rays of both ankle joints in the ap-direction in the apperature of "Scheuba". In these X-rays we found a sign , typical for the luxation of the peronaeus tendons: The rims of the ankle joint are not dislarged in the external areas but they show a significant dislargement of the distance between the malleolus externus and the processus subfibularis tali on the hurt side - the range is always more than 10 mm and in significant difference to the sane side, were we found this difference never more than 10 mm. The new objektive significant sign for the luxation of the peronaeus tendons is described and a comparison to X-rays of some persons is demonstrated.     

股前外侧肌皮瓣修复足踝侧方组织缺损

目的 探讨总结应用股前外侧肌皮瓣修复足踝侧方软组织合并内、外踝组织缺损中重建踝关节稳定性的疗效与作用.方法 对13例因足踝侧方软组织合并内、外踝组织缺损伤病例应用股前外侧肌皮瓣修复,将组织瓣中的阔筋膜两侧部分折叠与受区相邻软组织间断缝合固定,旋股外侧血管降支与受区血管吻合,移植股前外侧肌皮瓣面积最大为20 cm×12 cm,术后3个月石膏继续固定维持踝关节于功能位.随访时间1.5至20年.从患者主观感受、临床症状与体征和影像学检查评估踝关节稳定情况.结果 术后早期3个月内踝关节稳定性仍需外固定维持扶助,半年后即可稳定.13例中获得5年以上随访10例、10年以上6例、15年以上3例(分别为15年、18年、20年).5年后均有影像学踝关节创伤性改变,但临床症状与之不完全呈现相关性,13例中目前尚无1例因功能受限需行关节融合术.结论 股前外侧肌皮瓣是修复足踝侧方软组织合并内、外踝组织缺损重建并维持踝骨关节稳定、避免早期关节融合,特别对青少年伤者是一种良好选择.

Abstract：

Objective To explore the long-time clinical results and effection of free anterolateral thigh musculocutaneous flap for repairing the complex defects involving lateral or medial malleolar of the ankle and heel,especially for reconstructing stability of the ankle joints. Methods Thirteen patients with complex tissue defects,involving lateral or medial malleolar of the ankle and heel,were treated by free anterolateral thigh fasciomusculocutaneous flap.The fascia lata which was involved in the flap was fixed with the adjacent tissue of the recipient area.The descending branches of the lateral circumflex femoral vessels were anastomosed with the vessels in the recipient area.The largest area of the flap was 20 cm × 12 cm.The ankle joint was fixed in functional position with plaster in the early 3 months post-operatively.The following time ranged from 1.5 years to 20 years.The stability of the ankle joint were evatuated with the patients' objective feeling and clinical symptoms and imaging study.Results The stability of the ankle should be protected by external fixation in the early 3 months postoperatively,and was restored at 6 months usually.In all cases,ten cases were followed over 10 years,six cases were followed over 6 years,three cases were followed over 15 years.Though radiological discovering suggesting traumatic esteoarthritis exited in 3 cases with a follow-up more than 5 years,the clinical manifestations were fair and no one need undergo arthredesis. Conclusion Using ant erolateral thigh musculocutaneous flap for reconstructing the complex defects involving lateral or medial malleolar of the ankle and heel repairing stability of the joint and ovoiding off early arthrodosis of the joint is one of the favorable choice,especially for the teen-agers.     

Experimental Comparison of the Clinical Measurement of Ankle Joint Dorsiflexion and Radiographic Tibiotalar Position

Clinical measurement of ankle dorsiflexion is typically used to diagnose limited ankle range of motion. Controversy and a lack of clarity continue regarding the most accurate clinical method of measuring ankle joint dorsiflexion and the effect that the foot position (supinated, neutral, pronated) has on the true tibiotalar position. We investigated the effects of supinated, neutral and pronated foot positions on the clinical dorsiflexion measurements in 50 healthy subjects and compared these results to the radiographic measurement of tibiotalar joint position with the ankle maximally dorsiflexed in each of the 3 foot positions. Interrater reliability was confirmed to be adequate among the 3 clinicians of varied skill levels. Radiographic measurements of the tibiotalar position showed very little change in each of the 3 foot positions, with a total difference of 0.35° between supination and pronation. However, we found a mean difference of 14° of dorsiflexion in the clinical measurements between the pronated and supinated foot position, with a 9.08° difference between the neutral and supinated positions. Motion of the foot between the neutral and supinated positions introduced an additional source of potential error from the measurement technique when using the neutral position as the standard, which has been recommended in the past. We recommend a supinated foot position as a more reliable foot position for measuring the clinical ankle joint range of motion and propose it as a potential standard.     

The effect of axial load on the in vivo anterior drawer test of the ankle joint complex

The anterior drawer test is commonly used in the diagnosis of ankle joint mechanical instability. However, the effect of axial load on the anterior drawer test has not been examined in vivo. The purpose of the study was to assess the effect of axial load on passive anterior instability, and on the diagnostic measurement of the anterior drawer instability of the ankle joint complex. A total of 21 subjects with various degrees of ankle sprains were tested on a device that could continuously record applied anterior force and the resultant displacement of the rear-foot. Anterior drawer flexibility of the ankle joint complex in a neutral dorsi/plantar flexion position was quantified on both feet for all subjects without and with an axial load (385 N). Flexibility of the ankle joint complex in anterior drawer was defined as the slope of a linear load-displacement curve (which fitted test data with high correlation coefficients (r>0.991)). With axial load, anterior drawer flexibility was significantly reduced by 28.8% compared to that without axial load. The difference in anterior drawer flexibility between injured and intact ankles significantly decreased with axial load. An axial load increased the stability of ankle joint complex. However, axial load reduced the sensitivity of anterior drawer test to mechanical instability of the ankle joint complex.     

关节镜下治疗踝关节骨折脱位术后踝关节撞击综合征

目的探讨关节镜下治疗踝关节骨折脱位术后踝关节撞击综合征的方法及疗效。方法 2008年3月-2010年4月,收治38例踝关节骨折脱位术后发生踝关节撞击综合征的患者。男28例,女10例;年龄18～42岁,平均28岁。患者内固定术后至该次入院时间为12～16个月,平均13.8个月。踝关节前外侧和前侧有局限性压痛;关节背伸—20～—5°,平均—10.6°;跖屈30～40°,平均35.5°。根据美国矫形足踝协会(AOFAS)踝与后足评分标准,总分为(48.32±9.24)分,疼痛评分为(7.26±1.22)分。X线片检查示胫骨前缘和距骨均有骨赘增生,MRI显示22例有胫、距关节软骨面损伤。关节镜下行胫骨前缘或距骨骨赘磨削,刨削清理前外踝的瘢痕和增生滑膜组织,清除剥脱软骨;其中22例胫、距关节软骨面损伤者行微骨折术治疗。结果术后患者切口均Ⅰ期愈合。38例均获随访,随访时间10～26个月,平均16个月。末次随访时,26例踝关节活动基本恢复正常,背伸达15～25°,平均19.6°;跖屈35～45°,平均40.7°。8例轻度受限,背伸5～15°,平均7.2°;跖屈35～45°,平均39.5°。4例持续行走3～4 h后踝关节出现疼痛,关节活动轻度受限,背伸0～5°,平均2.6°;跖屈35～40°,平均37.5°。AOFAS踝与后足评分总分为(89.45±9.55)分,与术前比较差异有统计学意义(t=21.962,P=0.000);疼痛评分为(1.42±1.26)分,与术前比较差异有统计学意义(t=16.762,P=0.000)。结论关节镜下治疗踝关节骨折脱位术后踝关节撞击综合征手术操作简便,可获得较好疗效。     

单隧道悬吊固定解剖重建外侧韧带复合体治疗慢性踝关节外侧不稳

目的:探讨单隧道悬吊固定解剖重建外侧韧带复合体术治疗慢性踝关节外侧不稳的临床疗效.方法:回顾性分析2016 年 1 月至2018 年12 月行单隧道悬吊固定踝外侧韧带复合体解剖重建的23 例慢性踝关节外侧不稳患者的临床资料,其中男7 例,女16 例;年龄17～33(26.0±4.3)岁;Kellgren-Lawrenc...     

手法复位空心螺钉固定治疗儿童胫骨远端三平面骨折

目的 评估采用手法复位、经皮空心螺钉固定方法治疗儿童胫骨远端三平面骨折的疗效.方法 2004年9月至2009年3月,采用手法复位、空心螺钉固定方法治疗胫骨远端三平面骨折15例.男9例,女6例.术前经X线片或CT检查确诊.全部病例均为闭合性骨折,经手法复位治疗失败(X线片上骺板及关节面骨折间隙＞2mm)后行手术治疗.手术在"C"型臂X线机监视下进行,行踝关节轴向牵引,根据骨折类型内旋或外旋足,达到解剖复位后行经皮空心螺钉固定.术后行CT检查,确定骨折解剖复位,骺板及关节面骨折间隙＜2mm.术后石膏托固定8周.以改良Weber评估标准评价踝关节功能及愈合情况.结果 全部病例随访15-68个月,平均26个月.末次随访时按改良Weber评分,优13例,良2例.X线片检查所有病例均骨性愈合,未发现骨桥形成及关节面不平整现象,无肢体旋转和短缩畸形.所有患儿均能参加正常的体育活动.2例结果为良的患儿均与负重过早有关,主要表现为充分用力时患侧踝关节有轻度疼痛感.结论 对于闭合性胫骨远端三平面骨折手法复位失败者,采用手法复位、经皮空心螺钉固定方法手术操作简单,疗效满意.     

Diagnosis and therapy of fibular ligament injuries in the ankle joint in children

Turn fibular ligaments of the ankle go often undetected when not accompanied by osseous lesions. The significance of injuries to the major supporting ligaments of the ankle is underestimated in children. Next to the clinical findings stress radiographs of the ankle joint in two projections are mandatory. Measurements of anterior and lateral displacement under stress and displacement index need to be compared with the healthy ankle. Diagnosis of a fibular ligament rupture is based on clinical findings and on differences between the measurement results (injured compared to healthy) by way of three different techniques. Rupture of a fibular ligament is an absolute indication for surgery--even in children.