For talocrural distraction, what is the loose-packed position?

• A. Neutral
• B. 30 degree PF
• C. 20 degree PF
• D. 20 degrees plantarflexion

Answer: (D)

The loose-packed position is the joint position where the capsule is most lax and the joint space is greatest, allowing maximum separation during distraction. For the talocrural joint, this state occurs in around 20 degrees of plantarflexion. In this position the talus sits more anteriorly in the mortise, reducing bony congruency and making a traction pull more effective. Full dorsiflexion or a neutral position tightens the joint surfaces, placing the ankle in a more closed-packed state and limiting distraction. So, about 20 degrees of plantarflexion is the position that best fits the loose-packed/OPEN state for talocrural distraction.