Targeted computerised tomography scanning of the ankle syndesmosis with low dose radiation exposure

Kotwal, Rahul; Rath, N.K.; Paringe, V.; Hemmadi, Sandeep; Thomas, Rhys; Lyons, K.

doi:10.1007/s00256-015-2267-5

Cited by 18 publications

(20 citation statements)

References 18 publications

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“…Traditionally, nonweightbearing 2D CT evaluation of the tibiofibular joint space has relied on drawing 3 lines from the anterior, middle, and posterior borders of the fibula to the incisura in the axial plane, but such approaches have demonstrated a wide range of normal values. 3,7,9,10,13,15-17 Furthermore, only one such study by Lepojärvi et al 13 explored bilateral values, finding no difference based on laterality. The alternative measurement techniques we incorporated in this study were adopted from reports that investigated syndesmosis malreduction, and were explicitly chosen because of their high interrater reliability scores.…”

Section: Discussionmentioning

confidence: 99%

Range of Normal and Abnormal Syndesmotic Measurements Using Weightbearing CT

et al. 2019

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Background: Early recognition of syndesmotic instability is critical for optimizing clinical outcome. Injuries causing a more subtle instability, however, can be difficult to diagnose. The purpose of this study was to evaluate both distal tibiofibular articulations using weightbearing computed tomography (CT) in patients with known syndesmotic instability, thereafter comparing findings between the injured and uninjured sides. We also aimed to define the range of normal measurement variation among patients without syndesmotic injury. Methods: Patients with unilateral syndesmotic instability requiring operative fixation ( n = 12) underwent preoperative bilateral ankle weightbearing CT. A separate cohort of patients without ankle injury who also underwent bilateral ankle weightbearing CT were included as comparative controls ( n = 24). For each weightbearing CT, a series of 7 axial plane tibiofibular joint measurements, including 1 angular measurement, were utilized to evaluate parameters of the syndesmotic anatomy at a level 1 cm above the tibial plafond. Values were recorded by 2 independent observers to assess for interobserver reliability. Results: Among those with unilateral syndesmotic instability, values differed between the injured and uninjured sides in 4 of the 7 measurements performed including the syndesmotic area: direct anterior, middle, and posterior differences, and sagittal translation ( P < .001, < .001, < .001, and < .001, respectively). In the control population without ankle injury, no differences were identified between any of the bilateral measurements ( P value range, .172-.961). Conclusion: This study highlights the ability of weightbearing CT to effectively differentiate syndesmotic diastasis among patients with surgically confirmed syndesmotic instability from those without syndesmotic instability. It underscores the substantial utility and importance of using the contralateral, uninjured side as a valid internal control whenever the need for confirming potential syndesmotic instability arises. Prospective studies are necessary to fully understand the accuracy of weightbearing CT in diagnosing occult syndesmotic instability among patients for whom the diagnosis remains in question. Level of Evidence: Level III, comparative diagnostic study.

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Section: Discussionmentioning

confidence: 99%

Range of Normal and Abnormal Syndesmotic Measurements Using Weightbearing CT

et al. 2019

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“…Recently, researchers found that CT scans hold the advantage over radiographs for the diagnosis of lesions in the DTS [ 13 , 19 ] (Fig. 6 ).…”

Section: Discussionmentioning

confidence: 99%

An anthropometric study of distal tibiofibular syndesmosis (DTS) in a Chinese population

Zhang

et al. 2018

J Orthop Surg Res

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BackgroundTo improve the diagnostic accuracy of distal tibiofibular syndesmoses (DTS), this study quantified the range in variations of the normal DTS in a Chinese population, based on CT scan images.MethodsThe study population comprised 92 patients with unilateral ankle injury. CT scans included the non-injured contralateral DTS. The position of the fibula relative to the fibular notch (incisure) of the tibia was quantified by inclusion or separation indices, based on whether the fibula was within or outside the fibular incisure, respectively. The patients were apportioned accordingly to either a DTS contained- or separate-type group (average ages 45 and 42.1 years, respectively; 19 men/26 women and 24 men/23 women). Further variations in the position of the fibula relative to the tibia were quantified with length, anterior, and posterior indices.ResultsThe baseline characteristics of the contained- and separate-type groups were statistically comparable. The length, anterior, extra-anterior, posterior, and extra-posterior indices were successfully calculated. The anterior index of the contained group was significantly greater than that of the separated group, while the posterior index was significantly less.ConclusionsThis study provides measurements of the normal tibiofibular syndesmosis in a Chinese population. In individuals whose fibula lay within the fibular incisure of the tibia, the fibula was likely to be more anterior than that of individuals whose fibula lay outside the incisure. Offered as a reference, these data should improve diagnosis of injury of the DTS.

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“…The TFCS was measured in the resulting axial image (Fig. 3C) using the same method that was previously reported for CT [10,14,17]. The first reference point was chosen on the lateral prominence of the anterior tibial tubercle.…”

Section: Methodsmentioning

confidence: 99%

Reliable measurements of physiologic ankle syndesmosis widening using dynamic 3D ultrasonography: a preliminary study

et al. 2019

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Purpose The purpose of this study was to present a technique for measuring physiologic distal tibiofibular syndesmosis widening using 3-dimensional ultrasonography (3D-US) with an evaluation of its reliability, and to determine whether there were differences in the measurements between different dynamic stress tests. Methods We retrospectively evaluated 3D-US of 20 subjects with normal ankle syndesmosis. 3D-US was performed in neutral (N), dorsiflexion with external rotation (DFER), and weight-bearing standing (WB) positions at the anterior inferior tibiofibular ligament level in both ankles for comparison. Using 3D-US volume data, axial images were reconstructed at the level of the lateral prominence of the anterior tibial tubercle to ensure consistent measurements of the tibiofibular clear space (TFCS) by two radiologists. Results There was a wide range of TFCS values among the subjects (N, 1.2 to 4.2 mm; DFER, 2.3 to 4.8 mm; WB, 1.7 to 4.6 mm). When both ankles of each subject were evaluated, the side-to-side differences were less than 1 mm in all positions, with high intraclass correlation coefficient (ICC) values between both ankles (ICC, 0.85 to 0.93). The inter-rater agreement for all TFCS measurements between the two radiologists was excellent (ICC, 0.81 to 0.96). In comparisons between the two dynamic stress tests, the TFCS was significantly wider in the DFER position than in the WB position (DFER vs. WB, 3.3 mm vs. 2.9 mm; P<0.001). Conclusion Using 3D-US, we were able to consistently evaluate the TFCS with good reliability. In a comparison of the two dynamic tests, there was more significant widening of the TFCS in the DFER position than in the WB position.

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Targeted computerised tomography scanning of the ankle syndesmosis with low dose radiation exposure

Cited by 18 publications

References 18 publications

Range of Normal and Abnormal Syndesmotic Measurements Using Weightbearing CT

Range of Normal and Abnormal Syndesmotic Measurements Using Weightbearing CT

An anthropometric study of distal tibiofibular syndesmosis (DTS) in a Chinese population

Reliable measurements of physiologic ankle syndesmosis widening using dynamic 3D ultrasonography: a preliminary study

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