Portable dynamic ultrasonography is a useful tool for the evaluation of suspected syndesmotic instability: a cadaveric study

Abstract

Purpose Portable ultrasonography (P-US) is increasingly used to diagnose syndesmotic instability. The aim of this study was to evaluate syndesmotic instability by measuring the distal tibiofibular clear space (TFCS) in a cadaveric model using P-US with progressive stages of syndesmotic ligamentous transection under external rotation stress. Methods Ten fresh lower leg cadaveric specimens amputated above the proximal tibiofibular joint were used. Using P-US, the TFCS was evaluated in the intact stage and after progressive sectioning of the (1) anterior–inferior tibiofibular ligament (AITFL), (2) interosseous ligament (IOL), and (3) posterior–inferior tibiofibular ligament (PITFL). The TFCS was measured in both the unstressed (0 Nm) state and with 4.5, 6.0, 7.5, and 9.0 Nm of external rotation stress using a bone hook placed on the first metatarsal bone at each stage of ligamentous transection stage using both P-US and fluoroscopy. Results When assessed with P-US, partial syndesmotic injury encompassing the AITFL and IOL resulted in significant TFCS widening at 4.5 Nm of external rotation torque when compared to intact state with a TFCS-opening of 2.6 ± 2 mm, p = 0.01. In contrast, no significant differences in TFCS were detected using fluoroscopy. Only a moderate correlation was found between P-US and fluoroscopy. Conclusion P-US is a useful tool in diagnosing syndesmotic instability during external rotation stress examination. TFCS-opening increased as additional ligaments of the syndesmosis were transected, and application of 4.5 Nm torque was sufficient to detect a difference of 2.6 mm after the IOL cut.

Ultrasound is more reliable than clinical tests to both confirm and rule out pathologies of the long head of the biceps: a systematic review and meta-analysis

“…The role of routine LHBT inspection during shoulder arthroscopy has been advocated to identify abnormalities that may lead to persistent pain if not addressed surgically [14]. Ultrasound is a cost‐effective method that has been validated to accurately diagnose different pathologies [22, 23], and in the present meta‐analysis has shown high sensitivity and specificity to detect most LHBT pathologies, with the exception of partial‐thickness tears. There are also several clinical tests that provide moderate to high sensitivity and specificity, such as the Bear hug test, upper cut test, and active compression test.…”

Acute clinical evaluation for the diagnosis of lateral ankle ligament injuries is useful: A comparison between the acute and delayed settings

“…As demonstrated by this study, physical examination is an accurate diagnostic method and MR imaging should therefore be reserved for selected cases, including elite athletes. When a concomitant injury is suspected (e.g., syndesmosis injury), alternative diagnostic strategies might be considered [2,3,11,18].…”

Application of External Torque Enhances the Detection of Subtle Syndesmotic Ankle Instability in a Weightbearing Ct

“…The radiation dose of this device 1.1 (0.9) − 0.9 (0.9) n.s -1.1 (0.9) − 0.9 (0.9) n.s Talar Rotation (°) 6.0 (3.0) 5.2 (3.5) n.s 6.9 (2.8) 5.2 (3.5) n.s is 0.006 mSv and corresponds approximately to six foot and ankle radiographs, which would be obtained if additional stress testing of the ankle during conventional radiography is requested. Further studies could look at the potential advent of using ultrasound, with injecting local anaesthesia at the level of the syndesmosis to reduce pain inhibition, when performing the combined weightbearing-external rotation manoeuvre to further decrease the radiation for the patient [14]. Lastly, only 13 patients had a contralateral scan which served as control.…”