Isolated Syndesmosis Diastasis: Computed Tomography Scan Assessment With Arthroscopic Correlation

Ahn, Tae-Keun; Choi, Seung-Myung; Lee, Woo-Chun

doi:10.1016/j.arthro.2017.01.009

Cited by 37 publications

(46 citation statements)

References 26 publications

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“… 10 Syndesmosis assessment using an axial CT scan at the joint level best correlates with the arthroscopic examination. 16 However, latent instability of the syndesmosis cannot be detected by this static investigation. Moreover, the pattern of syndesmosis disruption as shown on preoperative CT may not be the same after reduction and fixation of the ankle fractures.…”

Section: Techniquementioning

confidence: 87%

Arthroscopically Assisted Reduction of Sagittal-Plane Disruption of Distal Tibiofibular Syndesmosis

Sin¹,

Lui²

2019

Arthroscopy Techniques

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Injuries to the distal tibiofibular syndesmosis can occur in conjunction with ankle fractures. Sagittal instability of the syndesmosis is more critical than coronal instability and must be taken into account when considering reduction and fixation of the syndesmosis. The purpose of this Technical Note is to report the technique of arthroscopically assisted reduction of sagittal-plane disruption of the distal tibiofibular syndesmosis. This ensures a comprehensive assessment of the pattern of syndesmotic disruption, which can aid anatomic reduction of the syndesmosis.

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Section: Techniquementioning

confidence: 87%

Arthroscopically Assisted Reduction of Sagittal-Plane Disruption of Distal Tibiofibular Syndesmosis

Sin¹,

Lui²

2019

Arthroscopy Techniques

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“…10 Nevertheless, the traditional measurement of the anterior tibiofibular distance, obtained using CTNP, has an unsatisfactory area under the curve (AUC) performance of 0.56 for diagnosing SI. 11 Despite the availability of these methods, SI is still challenging to diagnose correctly and syndesmotic ligament disruption and real SI should be differentiated. Comparative ankle CT with stress manoeuvres (CTSM) is an alternative approach that might improve SI diagnosis.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…A reference line 1 cm above the tibial plafond will establish the correct plane for all the measurements, except for the second angle, which will occur in the plane of the tibial plafond. Another measurement will determine the smallest distance between the fibula and the tibia in the plane of the tibial plafond, as described by Ahn et al 11 All the measurements will occur in a standardised manner in the CTNP, CTSM-EK and CTSM-FK. Differences equal to or greater than 1 mm for distances and 2 degrees for angles between the injured and uninjured ankles of the same individual will define the cutoff values for a positive test.…”

Section: Ctnp Ctsm-ek and Ctsm-fk Reading Parametersmentioning

confidence: 99%

“…A previous study reported an AUC performance of 0.56 relative to the CTNP. 11 Assuming the null hypothesis that the existing CTNP test has an AUC of 0.56, this study proposes the alternative hypothesis that a new CTSM test will display superior accuracy, which is estimated as an AUC of 0.80. The full sample size required to detect a difference between these two outcomes is estimated as 39, with a 1:2 allotment ratio between the groups (13 and 26 participants per group, respectively).…”

Section: Sample Size Calculationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparative CT with stress manoeuvres for diagnosing distal isolated tibiofibular syndesmotic injury in acute ankle sprain: a protocol for an accuracy- test prospective study

et al. 2020

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IntroductionAlthough several imaging options are available for diagnosing syndesmotic injury, a fundamental question that guides treatment remains unanswered. Syndesmotic instability is still challenging to diagnose correctly, and syndesmotic disruption and true syndesmotic instability should be differentiated. Currently, imaging tests quickly diagnose severe syndesmotic instability but have difficulty in diagnosing mild and moderate cases. This study aims to investigate which strategy among an existing CT index test and two new add-on CT index tests with stress manoeuvres more accurately diagnoses syndesmotic instability. The secondary objective is to investigate the participants’ disability outcomes by applying the Foot and Ankle Ability Measure questionnaire.Methods and analysesThis study of a diagnostic accuracy test will consecutively select individuals older than 18 years with a clinical diagnosis of a suspected acute syndesmotic injury. Three strategies of the CT index test (one in the neutral position and two with stress) will examine the accuracy using MRI as the reference standard. The external rotation and dorsiflexion of the ankle will guide the stress manoeuvres. A comparison of measurements between the injured syndesmosis and the uninjured contralateral side of the same individual will investigate the syndesmotic instability, by evaluating the rotational and translational relationships between the fibula and tibia. Sensitivity, specificity, area under the receiver operating characteristic curve and likelihood analyses will compare the diagnostic accuracies of the strategies.Ethics and disseminationThe Internal Review Board and the Einstein Ethics Committee approved this study (registered number 62100016.5.0000.0071). All participants will receive an oral description of the study’s aim, and the choice to participate will be free and voluntary. Participants will be enrolled after they sign the written informed consent form, including the terms of confidentiality. The results will be presented at national and international conferences and published in peer-reviewed journals and social media.Trial registration numberClinicalTrials.gov Registry (NCT04095598; preresults).

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The Unstable Syndesmosis

Hintermann

Ruiz

2021

Foot and Ankle Instability

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Isolated Syndesmosis Diastasis: Computed Tomography Scan Assessment With Arthroscopic Correlation

Cited by 37 publications

References 26 publications

Arthroscopically Assisted Reduction of Sagittal-Plane Disruption of Distal Tibiofibular Syndesmosis

Arthroscopically Assisted Reduction of Sagittal-Plane Disruption of Distal Tibiofibular Syndesmosis

Comparative CT with stress manoeuvres for diagnosing distal isolated tibiofibular syndesmotic injury in acute ankle sprain: a protocol for an accuracy- test prospective study

The Unstable Syndesmosis

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