Computed tomography with stress maneuvers for diagnosing syndesmotic instability

Abstract

Syndesmotic instability is a fundamental question that guides treatment; despite the currently available diagnostic imaging tests, its determination is still challenging. Knowledge of the instability degree assists the physician in the decision-making process regarding surgical or nonsurgical treatments. The authors are currently conducting a prospective diagnostic accuracy study by consecutively selecting individuals aged 18 years and older with an orthopaedic clinical examination indicating suspected acute syndesmotic injury. Magnetic resonance imaging is the reference standard used for evaluating the diagnostic accuracy of 3 computed tomography index tests. These tests include the neutral position and 2 ankle stress maneuvers: external rotation and dorsiflexion. Comparative measurements between the injured syndesmosis and the uninjured contralateral side of the same individual evaluate the tibiofibular relationship and investigate syndesmotic instability. This study aims to describe a summarized research protocol for a new technique using computed tomography with stress maneuvers and to show a didactic example of syndesmotic instability diagnosis. Level of Evidence V; Diagnostic Studies; Expert Opinion.

Diagnostic Accuracy of Conventional Ankle CT Scan With External Rotation and Dorsiflexion in Patients With Acute Isolated Syndesmotic Instability

“…Chans-Veres et al 9 evaluated uninjured syndesmosis. Rodrigues et al 38,39 are conducting an ongoing protocol assessing syndesmotic instability, but results have not been published to date. Therefore, a comparison to our results is not feasible.…”

Diagnostic Accuracy of Conventional Ankle CT Scan With External Rotation and Dorsiflexion: Response

“…Besides, the transparency of our work followed good clinical research practices; the research protocol was registered in advance at ClinicalTrials.gov (NCT04095598; pre-results), and the complete and abridged protocol versions were published in 2 medical journals. 9,10 In the complete protocol version, readers can observe our secondary objective, still in progress, of measuring disability outcomes with the Foot and Ankle Ability Measurement scale. 10 Many covariates are being collected to adjust for confounders, including surgical treatment.…”

Tomografia computadorizada comparativa com manobras de estresse para avaliação de instabilidade da sindesmose tibiofibular distal na fase aguda pós-entorse do tornozelo: um estudo de acurácia diagnóstica

“…Este estudo seguiu as diretrizes e normas para relato de estudos de acurácia diagnóstica (STARD) 86 . Registramos o protocolo de pesquisa no ClinicalTrials.gov (NCT04095598; pré-resultados) e também publicamos o protocolo sem resultados em duas revistas médicas 87,88 com o intuito de aumentar a transparência e a validade interna do estudo.…”