Tae-Keun Ahn1, Seung-Myung Choi2, Jae-Young Kim3, Woo-Chun Lee4. 1. Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Bundang-gu, Seongnam, Republic of Korea. 2. Department of Orthopaedic Surgery, Chungbuk National University Hospital, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, Republic of Korea. 3. Seoul Foot and Ankle Center, Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University, Jeo-dong, Jung-gu, Seoul, Republic of Korea. 4. Seoul Foot and Ankle Center, Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University, Jeo-dong, Jung-gu, Seoul, Republic of Korea. Electronic address: leewoochun@gmail.com.
Abstract
PURPOSE: To investigate which method can predict tibiofibular diastasis more accurately among the tibiofibular interval at the ankle joint level or previous parameters taken 1 cm above the joint line. METHODS: An arthroscopic examination was performed in 78 consecutive patients with anterolateral ankle pain. Four different methods were performed to take measurements of the tibiofibular interval using an axial computed tomography (CT) scan under existing arthroscopic diagnosis. Three previously reported parameters were assessed at 1 cm above the joint level. In the first method, 2 measurements were obtained. The anterior measurement was the closest distance between the anterior border of the fibula and anterior tibial tubercle. The posterior measurement was the closest distance between the medial border of the fibula and posterior tibial tubercle. In the second method, an angle between the fibular axis and the line connecting the anterior and posterior tibial tubercle was measured. In the third method, the nearest distance between the line perpendicular to the line connecting the tubercles at the anterior tubercle of the distal tibia and the anterior-most margin of the fibula was measured. The fourth method, which was developed in this study, measured the narrowest tibiofibular distance at the joint level. Data were analyzed using Student's t-test and the receiver operating characteristic curve to make comparisons among 4 CT-based parameters. RESULTS: In the comparison between the patients with arthroscopic diastasis and without diastasis, the posterior parameter in the first method and the narrowest tibiofibular distance at the joint level in the fourth method showed a significant difference (P < .05) The areas under the receiver operating characteristic curve (AUCs) of the anterior and posterior parameter of the first method were 0.58 (95% confidence interval [CI], 0.43-0.73; P = .167) of anterior measurement and 0.6 (95% CI, 0.45-0.75; P = .029) of posterior measurement, respectively. The second and third methods presented AUCs of 0.59 (95% CI, 0.44-0.74; P = .458) and 0.48 (95% CI, 0.33-0.64; P = .987), respectively. The fourth method presented an AUC of 0.86 (95% CI, 0.75-0.94; P = .000). When the syndesmosis was measured at the joint level, 2 mm of syndesmosis interval as a cutoff value showed 76% of sensitivity and 81% of specificity. CONCLUSIONS: Syndesmosis assessment using an axial CT scan at the joint level best correlated with the arthroscopic examination. When there is more than 2 mm of widening in syndesmosis on the axial CT scan at the joint level, there is a high likelihood of diastasis of the distal tibiofibular syndesmosis in patients who are suspicious clinically to have acute or chronic syndesmosis lesion. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
PURPOSE: To investigate which method can predict tibiofibular diastasis more accurately among the tibiofibular interval at the ankle joint level or previous parameters taken 1 cm above the joint line. METHODS: An arthroscopic examination was performed in 78 consecutive patients with anterolateral ankle pain. Four different methods were performed to take measurements of the tibiofibular interval using an axial computed tomography (CT) scan under existing arthroscopic diagnosis. Three previously reported parameters were assessed at 1 cm above the joint level. In the first method, 2 measurements were obtained. The anterior measurement was the closest distance between the anterior border of the fibula and anterior tibial tubercle. The posterior measurement was the closest distance between the medial border of the fibula and posterior tibial tubercle. In the second method, an angle between the fibular axis and the line connecting the anterior and posterior tibial tubercle was measured. In the third method, the nearest distance between the line perpendicular to the line connecting the tubercles at the anterior tubercle of the distal tibia and the anterior-most margin of the fibula was measured. The fourth method, which was developed in this study, measured the narrowest tibiofibular distance at the joint level. Data were analyzed using Student's t-test and the receiver operating characteristic curve to make comparisons among 4 CT-based parameters. RESULTS: In the comparison between the patients with arthroscopic diastasis and without diastasis, the posterior parameter in the first method and the narrowest tibiofibular distance at the joint level in the fourth method showed a significant difference (P < .05) The areas under the receiver operating characteristic curve (AUCs) of the anterior and posterior parameter of the first method were 0.58 (95% confidence interval [CI], 0.43-0.73; P = .167) of anterior measurement and 0.6 (95% CI, 0.45-0.75; P = .029) of posterior measurement, respectively. The second and third methods presented AUCs of 0.59 (95% CI, 0.44-0.74; P = .458) and 0.48 (95% CI, 0.33-0.64; P = .987), respectively. The fourth method presented an AUC of 0.86 (95% CI, 0.75-0.94; P = .000). When the syndesmosis was measured at the joint level, 2 mm of syndesmosis interval as a cutoff value showed 76% of sensitivity and 81% of specificity. CONCLUSIONS: Syndesmosis assessment using an axial CT scan at the joint level best correlated with the arthroscopic examination. When there is more than 2 mm of widening in syndesmosis on the axial CT scan at the joint level, there is a high likelihood of diastasis of the distal tibiofibular syndesmosis in patients who are suspicious clinically to have acute or chronic syndesmosis lesion. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
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