N C Hagemeijer1, J Saengsin2, S H Chang3, G R Waryasz4, G M M J Kerkhoffs5, D Guss6, C W DiGiovanni6. 1. Foot & Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School, USA; Department of Orthopaedic Surgery Amsterdam Movement Sciences Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. Electronic address: n.c.hagemeijer@amsterdamumc.nl. 2. Foot & Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School, USA; Department of Orthopaedic Surgery Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Sri Phum subdistrict Mueang Chiang Mai District, Chiang Mai, 50200, Thailand. 3. Foot & Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School, USA; Department of Orthopaedic Surgery Faculty of Medicine, The University of Tokyo, 7 Chome-3-1 Hongo Bunkyo City, Tokyo, 113-8654, Japan. 4. Foot & Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School, USA; Foot & Ankle Service Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Building 55 Fruit St, Boston, MA, 02114, USA. 5. Department of Orthopaedic Surgery Amsterdam Movement Sciences Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), Academic Medical Centre, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands. 6. Foot & Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School, USA; Foot & Ankle Service Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Building 55 Fruit St, Boston, MA, 02114, USA; Newton-Wellesley Hospital Harvard Medical School, Massachusetts General Hospital, Yawkey Building 55 Fruit St, Boston, MA, 02114, USA.
Abstract
BACKGROUND: Syndesmotic instability, when subtle, is challenging to diagnose and often requires visualization of the syndesmosis during applied stress. The primary aim was to assess normal distal tibiofibular motion in the sagittal plane using dynamic ultrasound under stress conditions. The secondary aim was to evaluate the reliability of dynamic stress ultrasonography. METHODS: Twenty-eight participants without history of ankle injury were included. Sagittal fibular translation was generated by applying a manual force to the fibula from anterior to posterior and from posterior to anterior. Distance between the ultrasound probe and the fibula was taken at two predefined points: 1) no force applied and, 2) during maximum force application. Each participant was scanned twice by two independent examiners, and each scan was analysed by two independent examiners. Three participants were scanned a second time by the same examiner who analysed these films twice to assess for intraobserver agreement. Means of exam 1 versus exam 2 were compared using a mixed linear model. Agreement among observers was calculated using intraclass correlation coefficients (ICC) interpreted as 0.4, poor; 0.4 〈 ICC < 0.59, acceptable; 0.6 < ICC < 0.74, good; ICC 〉 0.74, excellent. RESULTS: Fifty-six ankles were included in the study, including 16 (57%) males and 12 (42%) females. Average anterior to posterior fibular sagittal translation was 0.89 ± 0.6 mm and posterior to anterior fibular sagittal translation was 0.49 ± 1.1 mm. Anterior to posterior translation means of exam 1 versus exam 2 showed no significant differences, means of 0.81 mm [0.7-0.9] versus 0.77 mm [0.7-1.0], and posterior to anterior means [95% CI] of 0.42 mm [0.3-0.5] versus 0.44 mm [0.2-0.6] (p-values 0.416 and 0.758, respectively). Excellent Inter- and intraobserver agreement was found for all measurements taken. CONCLUSION: Dynamic ultrasound allows one to effectively and readily evaluate sagittal translation of the distal tibiofibular joint. It is able to afford bilateral comparisons, which becomes critical as the amount of syndesmotic instability approaches greater degrees of subtlety.
BACKGROUND: Syndesmotic instability, when subtle, is challenging to diagnose and often requires visualization of the syndesmosis during applied stress. The primary aim was to assess normal distal tibiofibular motion in the sagittal plane using dynamic ultrasound under stress conditions. The secondary aim was to evaluate the reliability of dynamic stress ultrasonography. METHODS: Twenty-eight participants without history of ankle injury were included. Sagittal fibular translation was generated by applying a manual force to the fibula from anterior to posterior and from posterior to anterior. Distance between the ultrasound probe and the fibula was taken at two predefined points: 1) no force applied and, 2) during maximum force application. Each participant was scanned twice by two independent examiners, and each scan was analysed by two independent examiners. Three participants were scanned a second time by the same examiner who analysed these films twice to assess for intraobserver agreement. Means of exam 1 versus exam 2 were compared using a mixed linear model. Agreement among observers was calculated using intraclass correlation coefficients (ICC) interpreted as 0.4, poor; 0.4 〈 ICC < 0.59, acceptable; 0.6 < ICC < 0.74, good; ICC 〉 0.74, excellent. RESULTS: Fifty-six ankles were included in the study, including 16 (57%) males and 12 (42%) females. Average anterior to posterior fibular sagittal translation was 0.89 ± 0.6 mm and posterior to anterior fibular sagittal translation was 0.49 ± 1.1 mm. Anterior to posterior translation means of exam 1 versus exam 2 showed no significant differences, means of 0.81 mm [0.7-0.9] versus 0.77 mm [0.7-1.0], and posterior to anterior means [95% CI] of 0.42 mm [0.3-0.5] versus 0.44 mm [0.2-0.6] (p-values 0.416 and 0.758, respectively). Excellent Inter- and intraobserver agreement was found for all measurements taken. CONCLUSION: Dynamic ultrasound allows one to effectively and readily evaluate sagittal translation of the distal tibiofibular joint. It is able to afford bilateral comparisons, which becomes critical as the amount of syndesmotic instability approaches greater degrees of subtlety.
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