Abstract:The findings challenge the previously used but unsupported standard of a 2-mm diastasis of the tibiofibular articulation for diagnosis of subtle syndesmotic instability.
“…In a study of 7 cadaveric specimens, Watson et al 21 found that ankle arthroscopy allowed the detection of syndesmotic instability when the AITFL and IOL were injured, especially in the sagittal and rotational planes. Guyton et al 10 evaluated 10 cadaveric specimens and found that, under a manual external rotation stress test, it was possible to detect rotational plane syndesmotic instability when 2 syndesmotic ligaments were cut (ie, AITFL and IOL). Less clarity exists, however, regarding which kind of ligamentous ankle injuries produce instability in the coronal plane when assessed arthroscopically using a standardized 100-N lateral hook test.…”
AITFL, IOL, and PITFL need to be injured to produce coronal plane syndesmotic instability. Arthroscopic assessment of such instability should occur along the posterior margin of the incisura. When they exist, similar findings anteriorly suggest concomitant deltoid injury.
“…In a study of 7 cadaveric specimens, Watson et al 21 found that ankle arthroscopy allowed the detection of syndesmotic instability when the AITFL and IOL were injured, especially in the sagittal and rotational planes. Guyton et al 10 evaluated 10 cadaveric specimens and found that, under a manual external rotation stress test, it was possible to detect rotational plane syndesmotic instability when 2 syndesmotic ligaments were cut (ie, AITFL and IOL). Less clarity exists, however, regarding which kind of ligamentous ankle injuries produce instability in the coronal plane when assessed arthroscopically using a standardized 100-N lateral hook test.…”
AITFL, IOL, and PITFL need to be injured to produce coronal plane syndesmotic instability. Arthroscopic assessment of such instability should occur along the posterior margin of the incisura. When they exist, similar findings anteriorly suggest concomitant deltoid injury.
“…They found that after sectioning both the AITFL and IOL that a 3-mm probe could be passed into the tibiofibular space in all 10 specimens, thus indicating syndesmotic instability, and concluded that this distance was highly predictive of injury to these 2 ligaments. 20 Evaluation of the IOM diastasis in our study revealed a measurement of >3.5 mm in 58% of specimens.…”
Section: Discussionmentioning
confidence: 49%
“…Work by Guyton et al 20 attempted to quantify syndesmotic disruption arthroscopically using a standardized measurement device (an arthroscopic spherical probe) to detect syndesmotic instability. In their cadaveric study, they sequentially sectioned the component parts of the syndesmosis and performed arthroscopy with manual external rotation stress testing in intact states and after each sequential sectioning of the AITFL, IOL, PITFL, and deltoid ligaments.…”
Background. The aim of this study was to determine the accuracy of ankle arthroscopy as a means for diagnosing syndesmotic reduction or malreduction and to determine anatomical landmarks for diagnosis. Methods. Six matched-pair cadavers (n = 12) with through-knee amputations were studied. Component parts of the syndesmosis and distal 10 cm of the interosseous membrane (IOM) were sectioned in each. The 12 specimens were divided into 2 groups: 6 specimens in the in-situ group fixed with suture button technique and 6 specimens in the malreduced group rigidly held with a 3.5-mm screw. Specimens were randomized to undergo diagnostic arthroscopy by 3 fellowship-trained foot and ankle orthopaedic surgeons in a blinded fashion. Surgeons were asked to determine if the syndesmosis was reduced or malreduced and provide arthroscopic measurements of their findings. Results. Of 36 arthroscopic evaluations, 34 (94%) were correctly diagnosed. Arthroscopic measurement of 3.5 mm diastasis or greater at the anterior aspect of the distal tibiofibular syndesmosis correlated with a posteriorly malreduced fibula. Arthroscopic evaluation of the Anterior inferior tibiofibular ligament (AITFL), IOM, Posterior inferior tibiofibular ligament (PITFL), lateral fibular gutter, and the tibia/fibula relationship were found to be reliable landmarks in determining syndesmotic reduction. An intraclass correlation coefficient (ICC) for interrater reliability of 1.00 was determined for each of these landmarks between 2 surgeons (P < .001). The ICCs between 2 surgeons’ measurements and the computed tomography measurements were found to be 0.896 (P value < .001). Conclusions. Ankle arthroscopy is a reliable method to assess syndesmotic relationship when reduced in situ or posteriorly malreduced 10 mm. Levels of Evidence: Level V: Cadaveric
“…Diastasis of the syndesmosis can be shown by passage of the arthroscopic shaver through the syndesmosis. 17 Sagittal-plane instability of the syndesmosis can be shown by pushing the lateral malleolus anteriorly and posteriorly ( Fig 4 ). Fig 4 Arthroscopically assisted reduction of sagittal-plane disruption of distal tibiofibular syndesmosis of the left ankle.…”
Section: Techniquementioning
confidence: 99%
“…The interosseous ligament is a few millimeters above the ankle joint line and usually cannot be visualized by ankle arthroscopy. Diastasis of the syndesmosis can be shown by passage of the arthroscopic shaver through the syndesmosis 17 . Sagittal-plane instability of the syndesmosis can be shown by pushing the lateral malleolus anteriorly and posteriorly (Fig 4).…”
Injuries to the distal tibiofibular syndesmosis can occur in conjunction with ankle fractures. Sagittal instability of the syndesmosis is more critical than coronal instability and must be taken into account when considering reduction and fixation of the syndesmosis. The purpose of this Technical Note is to report the technique of arthroscopically assisted reduction of sagittal-plane disruption of the distal tibiofibular syndesmosis. This ensures a comprehensive assessment of the pattern of syndesmotic disruption, which can aid anatomic reduction of the syndesmosis.
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