Noortje Catharina Hagemeijer1,2, Song Ho Chang1,3, Mohamed Elghazy Abdelaziz4, Jack Christopher Casey1,5, Gregory Richard Waryasz1,6,7, Daniel Guss1,6,7, Christopher William DiGiovanni1,6,7. 1. Foot and Ankle Research and Innovation Lab, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA. 2. Department of Orthopaedic Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands. 3. Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan. 4. Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt. 5. Davidson College, Davidson, NC, USA. 6. Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA. 7. Newton-Wellesley Hospital, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Abstract
BACKGROUND: Early recognition of syndesmotic instability is critical for optimizing clinical outcome. Injuries causing a more subtle instability, however, can be difficult to diagnose. The purpose of this study was to evaluate both distal tibiofibular articulations using weightbearing computed tomography (CT) in patients with known syndesmotic instability, thereafter comparing findings between the injured and uninjured sides. We also aimed to define the range of normal measurement variation among patients without syndesmotic injury. METHODS: Patients with unilateral syndesmotic instability requiring operative fixation (n = 12) underwent preoperative bilateral ankle weightbearing CT. A separate cohort of patients without ankle injury who also underwent bilateral ankle weightbearing CT were included as comparative controls (n = 24). For each weightbearing CT, a series of 7 axial plane tibiofibular joint measurements, including 1 angular measurement, were utilized to evaluate parameters of the syndesmotic anatomy at a level 1 cm above the tibial plafond. Values were recorded by 2 independent observers to assess for interobserver reliability. RESULTS: Among those with unilateral syndesmotic instability, values differed between the injured and uninjured sides in 4 of the 7 measurements performed including the syndesmotic area: direct anterior, middle, and posterior differences, and sagittal translation (P < .001, < .001, < .001, and < .001, respectively). In the control population without ankle injury, no differences were identified between any of the bilateral measurements (P value range, .172-.961). CONCLUSION: This study highlights the ability of weightbearing CT to effectively differentiate syndesmotic diastasis among patients with surgically confirmed syndesmotic instability from those without syndesmotic instability. It underscores the substantial utility and importance of using the contralateral, uninjured side as a valid internal control whenever the need for confirming potential syndesmotic instability arises. Prospective studies are necessary to fully understand the accuracy of weightbearing CT in diagnosing occult syndesmotic instability among patients for whom the diagnosis remains in question. LEVEL OF EVIDENCE: Level III, comparative diagnostic study.
BACKGROUND: Early recognition of syndesmotic instability is critical for optimizing clinical outcome. Injuries causing a more subtle instability, however, can be difficult to diagnose. The purpose of this study was to evaluate both distal tibiofibular articulations using weightbearing computed tomography (CT) in patients with known syndesmotic instability, thereafter comparing findings between the injured and uninjured sides. We also aimed to define the range of normal measurement variation among patients without syndesmotic injury. METHODS: Patients with unilateral syndesmotic instability requiring operative fixation (n = 12) underwent preoperative bilateral ankle weightbearing CT. A separate cohort of patients without ankle injury who also underwent bilateral ankle weightbearing CT were included as comparative controls (n = 24). For each weightbearing CT, a series of 7 axial plane tibiofibular joint measurements, including 1 angular measurement, were utilized to evaluate parameters of the syndesmotic anatomy at a level 1 cm above the tibial plafond. Values were recorded by 2 independent observers to assess for interobserver reliability. RESULTS: Among those with unilateral syndesmotic instability, values differed between the injured and uninjured sides in 4 of the 7 measurements performed including the syndesmotic area: direct anterior, middle, and posterior differences, and sagittal translation (P < .001, < .001, < .001, and < .001, respectively). In the control population without ankle injury, no differences were identified between any of the bilateral measurements (P value range, .172-.961). CONCLUSION: This study highlights the ability of weightbearing CT to effectively differentiate syndesmotic diastasis among patients with surgically confirmed syndesmotic instability from those without syndesmotic instability. It underscores the substantial utility and importance of using the contralateral, uninjured side as a valid internal control whenever the need for confirming potential syndesmotic instability arises. Prospective studies are necessary to fully understand the accuracy of weightbearing CT in diagnosing occult syndesmotic instability among patients for whom the diagnosis remains in question. LEVEL OF EVIDENCE: Level III, comparative diagnostic study.
Authors: Edward O Rojas; Nacime Salomao Barbachan Mansur; Kevin Dibbern; Matthieu Lalevee; Elijah Auch; Eli Schmidt; Victoria Vivtcharenko; Shuyuan Li; Phinit Phisitkul; John Femino; Cesar de Cesar Netto Journal: Iowa Orthop J Date: 2021
Authors: N C Hagemeijer; B Lubberts; J Saengsin; R Bhimani; G Sato; G R Waryasz; G M M J Kerkhoffs; C W DiGiovanni; D Guss Journal: Knee Surg Sports Traumatol Arthrosc Date: 2022-07-26 Impact factor: 4.114
Authors: Murray T Wong; Charmaine Wiens; Jeremy Lamothe; W Brent Edwards; Prism S Schneider Journal: Foot Ankle Int Date: 2021-06-04 Impact factor: 2.827