Diagnostic accuracy of clinical tests assessing ligamentous injury of the ankle syndesmosis: A systematic review with meta-analysis

Netterström-Wedin, Fredh; Bleakley, Chris

doi:10.1016/j.ptsp.2021.03.005

Cited by 14 publications

(7 citation statements)

References 63 publications

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“…This clinical problem is reflected in the present study, showing that the respondents use a variety of different tests, especially external rotation stress test, squeeze test and forced dorsiflexion test, to identify syndesmotic injuries. In accordance with the clinical usage of multiple diagnostic examinations, a recent meta-analysis proclaimed an initial clustering of test including high sensitivity tests (e.g., palpation or forced dorsiflexion), followed by clinical test with a high specificity (e.g., squeeze test) [ 25 ]. However, clinical tests alone are only of limited accuracy in the detection of isolated syndesmotic injuries and in the decision whether surgery is needed or not [ 13 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…In accordance with the clinical usage of multiple diagnostic examinations, a recent meta-analysis proclaimed an initial clustering of test including high sensitivity tests (e.g., palpation or forced dorsiflexion), followed by clinical test with a high specificity (e.g., squeeze test) [ 25 ]. However, clinical tests alone are only of limited accuracy in the detection of isolated syndesmotic injuries and in the decision whether surgery is needed or not [ 13 , 25 ]. This is in line with the results of the present study, where nearly half of the respondents indicated that clinical examination is not valid to thoroughly detect all fresh syndesmotic injuries and that MRI is frequently used in the advanced diagnostic work-up.…”

Section: Discussionmentioning

confidence: 99%

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Current status of the management of isolated syndesmotic injuries in Germany

Mutschler

Naendrup

Pfeiffer

et al. 2022

Arch Orthop Trauma Surg

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Introduction Although non-fracture-related syndesmotic injuries of the ankle are relatively rare, they may lead to poor clinical outcome if initially undiagnosed or managed improperly. Despite a variety of literature regarding possibilities for treatment of isolated syndesmotic injuries, little is known about effective applications of different therapeutic methods in day-to-day work. The aim of this study was to assess the current status of the treatment of isolated syndesmotic injuries in Germany. Materials and methods An online-questionnaire, capturing the routine diagnostic workup including clinical examination, radiologic assessment and treatment strategies, was sent to all members of the German Society of Orthopedic Surgery and Traumatology (DGOU) and Association of Arthroscopic and Joint Surgery (AGA). Statistical analysis was performed using Microsoft excel and SPSS. Results Each question of the questionnaire was on average answered by 431 ± 113 respondents. External rotation stress test (66%), squeeze test (61%) and forced dorsiflexion test (40%) were most commonly used for the clinical examination. In the diagnostic workup, most clinicians relied on MRI (83%) and conventional X-ray analysis (anterior–posterior 58%, lateral 41%, mortise view 38%). Only 15% of the respondents stated that there is a role for arthroscopic evaluation for the assessment of isolated syndesmotic injuries. Most frequently used fixation techniques included syndesmotic screw fixation (80%, 42% one syndesmotic screw, 38% two syndesmotic screws), followed by suture-button devices in 13%. Syndesmotic screw fixation was mainly performed tricortically (78%). While 50% of the respondents stated that syndesmotic screw fixation and suture-button devices are equivalent in the treatment of isolated syndesmotic injuries with respect to clinical outcome, 36% answered that syndesmotic screw fixation is superior compared to suture-button devices. Conclusions While arthroscopy and suture-button devices do not appear to be widely used, syndesmotic screw fixation after diagnostic work-up by MRI seems to be the common treatment algorithm for non-fracture-related syndesmotic injuries in Germany.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Current status of the management of isolated syndesmotic injuries in Germany

Mutschler

Naendrup

Pfeiffer

et al. 2022

Arch Orthop Trauma Surg

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“…The examining maneuver of dorsiflexion, external rotation, and compression has been reported to have high sensitivity and excellent intraobserver reliability, especially when eliciting pain throughout the AITFL course [12,13]. In a recent meta-analysis by Netterstrom-Wedin and Bleakley, the specificity and sensitivity of these clinical exams are reported at 97% and 85%, respectively, with the amount of instability correlating to the degree of the ligamentous injury [14,15].…”

Section: Discussionmentioning

confidence: 99%

Elastic Reconstruction of Chronic Instability of the Distal Tibiofibular Joint in an Obese Patient: A Case Report

Rozis¹,

Vlachos²,

Vasiliadis³

et al. 2022

Cureus

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An active, obese young patient was admitted to our clinic complaining of chronic ankle pain after fixation of his lateral malleolus fracture. His symptoms consisted of intermittent pain after prolonged walking, swelling, and feeling of instability. His clinical and radiological evaluations indicated chronic mechanical instability of his distal tibiofibular syndesmosis that remained unresponsive to conservative treatment.Considering his age and activity level, we proceeded to a global syndesmotic reconstruction of the three major syndesmotic ligaments with split-thickness peroneus longus graft. According to this technique, the graft was passed through specific tibiofibular tunnels restoring the native stability and elasticity of the region.The patient had an optimal postoperative function, with diminished symptoms and increased clinical scores. His late radiological evaluation revealed an anatomic ankle reduction with restoring his normal syndesmotic anatomy compared to his contralateral limb. Regardless of his high BMI, we noticed no further subluxation of his talus, while his general symptomatology was unremarkable at the 12-month follow-up.In conclusion, elastic reconstruction of the distal tibiofibular joint with split-thickness peroneus longus graft provides excellent results at 12 months regardless of the patient's BMI. To our knowledge, this is the only technique that restores the three main regional ligaments, simultaneously allowing for close-to-normal biomechanics and providing excellent short-term clinical outcomes.

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“…Sman et al (39) performed a multicenter diagnostic accuracy study of 87 patients and found that clinical history and examination is insufficient to rule in or out a syndesmosis injury. A more recent systematic review and meta-analysis found similar results and recommended clustering and combining syndesmotic palpation, dorsiflexion lunge, and the squeeze test, but still recommended confirmatory testing with MRI, ultrasound, or arthroscopy in case of positive findings (40). With regard to ultrasound, two studies found that ultrasound diagnosis of full and partial thickness AITFL tears have a sensitivity and specificity of 100% (38,41).…”

Section: Physical Examination Versus Ultrasound Accuracy In Ankle Spr...mentioning

confidence: 99%

The Role of Ultrasound in the Management of Ankle Sprains and a Clinically Relevant Geisinger Ankle Sprain Sports Ultrasound Protocol

Meyer,

Loncar,

Jensen

et al. 2023

Curr Sports Med Rep

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Ankle sprains are the most common lower extremity injury in physically active individuals. These injuries are classified as lateral, medial, and/or syndesmotic. Treatment may include functional rehabilitation, bracing, weight-bearing restriction, medications, injections, and surgery. While most sprains heal rapidly, permanent disability and pain may arise. Diagnostic ultrasound has been demonstrated to be accurate in diagnosing ligamentous injuries, but it is often excluded from management algorithms that rely on physical examination alone to diagnose significant injuries. This article proposes a comprehensive, evidence-based diagnostic ankle ultrasound protocol to implement in conjunction with thorough history and physical examination. We also review the current literature to describe where this protocol most improves diagnostic accuracy compared with physical examination alone.

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Diagnostic accuracy of clinical tests assessing ligamentous injury of the ankle syndesmosis: A systematic review with meta-analysis

Cited by 14 publications

References 63 publications

Current status of the management of isolated syndesmotic injuries in Germany

Current status of the management of isolated syndesmotic injuries in Germany

Elastic Reconstruction of Chronic Instability of the Distal Tibiofibular Joint in an Obese Patient: A Case Report

The Role of Ultrasound in the Management of Ankle Sprains and a Clinically Relevant Geisinger Ankle Sprain Sports Ultrasound Protocol

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