MRI Quantification of the Impact of Ankle Position on Syndesmosis Anatomy

Nault, Marie-Lyne; Marien, Mélissa; Hébert‐Davies, Jonah; Laflamme, G. Yves; Pelsser, Vincent; Rouleau, Dominique M.; Gosselin-Papadopoulos, Nayla; Leduc, Sylvain

doi:10.1177/1071100716674309

Cited by 21 publications

(6 citation statements)

References 5 publications

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“…These findings are in contrast to the results of Nault et al in an MRI-study of intact non-weight bearing ankle joints [27]. The published results show significant differences of tibiofibular distances and fibula rotation depending on dorsi- and plantarflexion.…”

Section: Discussioncontrasting

confidence: 90%

Influence of ankle joint position on angles and distances of the ankle mortise using intraoperative cone beam CT: A cadaveric study

et al. 2019

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Background The precise anatomical reduction of the ankle mortise is crucial for the clinical outcome in unstable syndesmotic injuries. Intraoperative cone beam computed tomography (CT), in addition to two-dimensional fluoroscopy, provides detailed information about the reduction and implant placement. The aim of this study was to analyze the influence of the joint position on the fibula position in the incisural notch and to determine the inter- and intraindividual anatomical differences in the intact ankle joints. Methods A total of 20 fresh-frozen lower legs disarticulated in the knee joint of 10 individuals were included. The measurements were performed using a cone beam CT. The distances and angles were measured in the standard imaging planes. The mean values of distances and angles were compared during the different joint positions: 10° dorsiflexion, 0° neutral position and 20° plantar flexion. Results The influence of the joint position was on average as follows: The anterior tibiofibular distance was 3.68 mm in 10° dorsiflexion, 3.66 mm (0° neutral position) and 3.59 mm (20° plantar flexion). The posterior tibiofibular distance measured 7.82mm, 7.76mm and 7.82mm. The rotation of the fibula measured ten millimeters proximal the joint line was 1.2°, 1.3° and 1.05°. The fibular rotation determined 4mm was 9.3°, 9.4° and 9.4°. On average, the following intraindividual variations were observed: superior tibiotalar clear space of 0.27mm and 0.15mm medial; and anterior tibiofibular distance of 0.42mm, 0.38mm posterior and 0.24mm in the incisural notch. The proximal angle of the fibular rotation was 0.2° and distal 0.4°. The interindividual variations of the angles and distances exceeded the intraindividual values partly by 3 to 4 fold. Conclusions Within the scope of this study neither the tibiofibular distance, nor the tibiofibular angle changed significantly through the different joint positions. The intraindividual differences were little while the interindividual variations of the parameters were distinctive.

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Section: Discussioncontrasting

confidence: 90%

Influence of ankle joint position on angles and distances of the ankle mortise using intraoperative cone beam CT: A cadaveric study

et al. 2019

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“… 38 However, these conclusions were based off the restoration of ankle ROM, and not syndesmotic reduction. In addition to this study, Nault et al 29 demonstrated increases in syndesmotic width with ankle plantarflexion, as did Kortekangas et al, 18 who performed intraoperative CT scans and detected 7 malreductions out of 21 cases after flexible fixation. In these cases, open exploration was performed intending to revise the reduction, but each ankle was found to be well reduced under direct inspection and on subsequent CT scans at 0 degrees dorsiflexion.…”

Section: Discussionsupporting

confidence: 63%

Four-Dimensional CT Analysis of Normal Syndesmotic Motion

et al. 2021

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Background: The syndesmosis ligament complex stabilizes the distal tibiofibular joint while allowing for small amounts of physiologic motion. When injured, malreduction of the syndesmosis is the most important factor that contributes to inferior functional outcomes. Syndesmotic reduction is a dynamic measure, which is not adequately captured by conventional computed tomography (CT). Four-dimensional CT (4DCT) can image joints as they move through range of motion (ROM). The aim of this study was to employ 4DCT to determine in vivo syndesmotic motion with ankle ROM in uninjured ankles. Methods: Uninjured ankles were analyzed in patients who had contralateral syndesmotic injuries, as well as a cohort of healthy volunteers with bilateral uninjured ankles. Bilateral ankle 4DCT scans were performed as participants moved their ankles between maximal dorsiflexion and plantarflexion. Multiple measures of syndesmotic width, as well as sagittal translation and fibular rotation, were automatically extracted from 4DCT using a custom program to determine the change in syndesmotic position with ankle ROM. Results: Fifty-eight ankles were analyzed. Measures of syndesmotic width decreased by 0.7 to 1.1 mm as the ankle moved from dorsiflexion to plantarflexion ( P < .001 for each measure). The fibula externally rotated by 1.2 degrees with ankle ROM ( P < .001), but there was no significant motion in the sagittal plane ( P = .43). No participants with bilateral uninjured ankles had a side-to-side difference in syndesmotic width of 2 mm or greater. Conclusion: 4DCT allows accurate, in vivo syndesmotic measurements, which change with ankle ROM, confirming prior work that was limited to biomechanical studies. Side-to-side syndesmotic measurements are consistent within subjects, validating the method of templating syndesmotic reduction off the contralateral ankle, in a consistent ankle position, to achieve anatomic reduction of syndesmotic injury. Level of Evidence: Level II.

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“…Prior literature suggested that over-compression is not possible in the setting of a reduced fibula and dorsiflexed ankle; this has likely perpetuated the false notion of safety when forcefully clamping across the syndesmotic axis. 42 Due to the dynamic movement of the distal tibiofibular articulation with ankle range of motion, 43 overcompression may carry significant clinical implications. In our study, manual digital pressure was sufficient to provide the appropriate amount of force to overcome syndesmotic instability without demonstrating any degree of overcompression.…”

Section: Discussionmentioning

confidence: 99%