Morphometric analysis of the incisura fibularis in patients with unstable high ankle sprains

Huysse, Wouter; Burssens, Arne; Peiffer, Matthias; Cornelis, Bert; Stufkens, Sjoerd A. S.; Kerkhoffs, Gino M. M. J.; Buedts, Kristian; Audenaert, Emmanuel

doi:10.1007/s00256-020-03649-9

Cited by 20 publications

(14 citation statements)

References 43 publications

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“…5,6 Its intrinsic stability is provided by the inherent osseous congruence between the convex distal fibula and concave incisura fibularis. 7,8 The extrinsic stability is ensured by distinct ligamentous restraints. 9 The anterior inferior tibiofibular ligament is the primary restraint to fibular external rotation, whereas the posterior inferior tibiofibular ligament restricts posterior translation.…”

Section: Introductionmentioning

confidence: 99%

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Statistical shape model‐based tibiofibular assessment of syndesmotic ankle lesions using weight‐bearing CT

Peiffer

Burssens

Mits

et al. 2022

Journal Orthopaedic Research

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Forced external rotation is hypothesized as the key mechanism of syndesmotic ankle injuries, inducing a three‐dimensional deviation from the normal distal tibiofibular joint (DTFJ) alignment. However, current diagnostic imaging modalities are impeded by a two‐dimensional assessment, without considering ligamentous stabilizers. Therefore, our aim is threefold: (1) to construct an articulated statistical shape model of the normal DTFJ with the inclusion of ligamentous morphometry, (2) to investigate the effect of weight‐bearing on the DTFJ alignment, and (3) to detect differences in predicted syndesmotic ligament length of patients with syndesmotic lesions with respect to normative data. Training data comprised non‐weight‐bearing CT scans from asymptomatic controls (N = 76), weight‐bearing CT scans from patients with syndesmotic ankle injury (N = 13), and their weight‐bearing healthy contralateral side (N = 13). Path and length of the syndesmotic ligaments were predicted using a discrete element model, wrapped around bony contours. Statistical shape model evaluation was based on accuracy, generalization, and compactness. The predicted ligament length in patients with syndesmotic lesions was compared with healthy controls. With respect to the first aim, our presented skeletal shape model described the training data with an accuracy of 0.23 ± 0.028 mm. Mean prediction accuracy of ligament insertions was 0.53 ± 0.12 mm. In accordance with the second aim, our results showed an increased tibiofibular diastasis in healthy ankles after weight‐bearing. Concerning our third aim, a statistically significant difference in anterior syndesmotic ligament length was found between ankles with syndesmotic lesions and healthy controls (p = 0.017). There was a significant correlation between the presence of syndesmotic injury and the positional alignment between the distal tibia and fibula (r = 0.873, p < 0,001). Clinical Significance: Statistical shape modeling combined with patient‐specific ligament wrapping techniques can facilitate the diagnostic workup of syndesmosic ankle lesions under weight‐bearing conditions. In doing so, an increased anterior tibiofibular distance was detected, corresponding to an “anterior open‐book injury” of the ankle syndesmosis as a result of anterior inferior tibiofibular ligament elongation/rupture.

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Section: Introductionmentioning

confidence: 99%

“…This anatomical complex is comprised of the distal tibiofibular joint (DTFJ) and the syndesmotic ligaments 5,6 . Its intrinsic stability is provided by the inherent osseous congruence between the convex distal fibula and concave incisura fibularis 7,8 …”

Section: Introductionmentioning

confidence: 99%

Statistical shape model‐based tibiofibular assessment of syndesmotic ankle lesions using weight‐bearing CT

Peiffer

Burssens

Mits

et al. 2022

Journal Orthopaedic Research

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“…For example, studies have shown that anterior displacement of the bula be with a shallow at FN and posterior displacement of bula with a deep concave FN [23]. Some studies have also included the relationship with lateral ankle sprains as well as the occurrence of HAS, but few have investigated gender as a categorical indicator, leading to the neglect of the role played by gender in the in uence of FN on the occurrence and development of HAS [18][19][20]24]. Therefore, males were rst separated from females in our study and then grouped according to FN depth to explore the association of FN morphology with HAS occurrence and severity.…”

Section: Discussionmentioning

confidence: 99%

“…The results of the study showed that participants whose FN shape resembled the number "1" had the widest range of displacement in the distal tibio bular syndesmosis on the Y axis, and had the highest risk of recurrent lateral ankle joint sprains [18]. Huysse et al converted CT images into three-dimensional models for measurement, and then found that the FN of HAS patients was shallower and shorter than that of normal people by comparing FN width, depth and other parameters, and such morphology would affect the syndesmotic stability [20].…”

Section: Introductionmentioning

confidence: 99%

In Different Gender Groups, What Is the Impact of the Fibular Notch on The Severity of High Ankle Sprain: A Retrospective Study of 240 Cases

Peng

Tang

et al. 2021

Preprint

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Background: The function of the distal tibiofibular ligament on the ankle in the occurrence of high ankle sprain (HAS) has been widely studied. Then, in different genders, the effect of the anatomical morphology of fibular notch (FN) on HAS is unclear. Therefore, on the basis of excluding the anatomical differences caused by gender, we explore the impact of different types of FN on the severity of HAS.Methods: We selected 120 patients and further classified these 120 patients into four HAS groups according to FN depth with deep concave type FN ≥ four mm and shallow flat type FN < four mm. A further 120 normal individuals were served as a control group. FN morphological indicators, tibiofibular distance (TFD), and ankle mortise indexes were measured and compared between patients and control groups.Results: In males with shallow flat type, the Anterior tibiofibular distance (aTFD), Middle tibiofibular distance (mTFD), Posterior tibiofibular distance (pTFD), Front tibial width (FTiW), Middle tibial width (MTiW), Posterior tibial width (PTiW) and Depth of ankle mortise (DOAM) of HAS group were higher than those in normal group (P < 0.05). In males with deep concave type, the aTFD, mTFD and DOAM of patients were significantly higher (P < 0.05). Among females with shallow flat type, the aTFD, mTFD, pTFD, FTiW and MTiW in HAS group were greater than those in normal group (P < 0.05). Among the females with deep concave type, the mTFD and pTFD of patients were higher (P < 0.05).Conclusions: After analyzing the morphological indicators of FN, it is found that in both males and females, HAS patients have significant differences in TFD and certain ankle mortise indexes compared with normal people. But more importantly, the above abnormalities are often more common in HAS patients with shallow flat FN, indicating that shallow flat FN may be related to more serious distal tibiofibular ligament injury and ankle mortise widening, resulting in a worse prognosis.Level of evidence: Level III, retrospective comparative study.

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“…Therefore, three-dimensional (3D) measurement methods are becoming more popular as part of the technological development 15 – 17 . Since the correct reduction of the fibula in the fibular notch of the tibia is the main factor for good functional long-term outcome and stability, accurate analysis of DTFJ is crucial 18 – 22 .…”

Section: Introductionmentioning

confidence: 99%

Effect of weightbearing and foot positioning on 3D distal tibiofibular joint parameters

Souleiman

Heilemann

Hennings

et al. 2022

Sci Rep

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The aim of this study was to investigate the effect of different loading scenarios and foot positions on the configuration of the distal tibiofibular joint (DTFJ). Fourteen paired human cadaveric lower legs were mounted in a loading frame. Computed tomography scans were obtained in unloaded state (75 N) and single-leg loaded stand (700 N) of each specimen in five foot positions: neutral, 15° external rotation, 15° internal rotation, 20° dorsiflexion, and 20° plantarflexion. An automated three-dimensional measurement protocol was used to assess clear space (diastasis), translational angle (rotation), and vertical offset (fibular shortening) in each foot position and loading condition. Foot positioning had a significant effect on DTFJ configuration. Largest effects were related to clear space increase by 0.46 mm (SD 0.21 mm) in loaded dorsal flexion and translation angle of 2.36° (SD 1.03°) in loaded external rotation, both versus loaded neutral position. Loading had no effect on clear space and vertical offset in any position. Translation angle was significantly influenced under loading by − 0.81° (SD 0.69°) in internal rotation only. Foot positioning noticeably influences the measurements when evaluating DTFJ configuration. Loading seems to have no relevant effect on native ankles in neutral position.

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Morphometric analysis of the incisura fibularis in patients with unstable high ankle sprains

Cited by 20 publications

References 43 publications

Statistical shape model‐based tibiofibular assessment of syndesmotic ankle lesions using weight‐bearing CT

Statistical shape model‐based tibiofibular assessment of syndesmotic ankle lesions using weight‐bearing CT

In Different Gender Groups, What Is the Impact of the Fibular Notch on The Severity of High Ankle Sprain: A Retrospective Study of 240 Cases

Effect of weightbearing and foot positioning on 3D distal tibiofibular joint parameters

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