Preoperative CT parameters to predict tibiofibular syndesmosis injury associated with ankle fracture: a propensity score-matched analysis

Lei, Qinliang; Chen, Pin-Hua; He, Xueyi; Xu, Zhixian; He, Wubing

doi:10.1007/s00068-023-02256-2

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…Extended author information available on the last page of the article but lacks a dynamic assessment of the joint. [3,22] The recent advent of weightbearing cone-beam CT (WBCT) overcomes these drawbacks by imaging both ankles during bipedal loading [2,7,25]. Software-based techniques, utilized to generate models of bones and calculate their axes within a three-dimensional framework, have previously demonstrated high efficacy and accuracy in assessing the spatial orientation and detecting landmarks of ankle bones [28,37].…”

Section: Introductionmentioning

confidence: 99%

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

Huyghe,

Peiffer,

Cuigniez

et al. 2024

Bone Joint J

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One-fourth of all ankle trauma involve injury to the syndesmotic ankle complex, which may lead to syndesmotic instability and/or posttraumatic ankle osteoarthritis in the long term if left untreated. The diagnosis of these injuries still poses a deceitful challenge, as MRI scans lack physiologic weightbearing and plain weightbearing radiographs are subject to beam rotation and lack 3D information. Weightbearing cone-beam CT (WBCT) overcomes these challenges by imaging both ankles during bipedal stance, but ongoingdebate remains whether these should be taken under weightbearing conditions and/or during application of external rotation stress. The aim of this study is study therefore to compare both conditions in the assessment of syndesmotic ankle injuries using WBCT imaging combined with 3D measurement techniques.In this retrospective study, 21 patients with an acute ankle injury were analyzed using a WBCT. Patients with confirmed syndesmotic ligament injury on MRI were included, while fracture associated syndesmotic injuries were excluded. WBCT imaging was performed in weightbearing and combined weightbearing-external rotation. In the latter, the patient was asked to internally rotate the shin until pain (VAS>8/10) or a maximal range of motion was encountered. 3D models were developed from the CT slices, whereafter. The following 3D measurements were calculated using a custom-made Matlab® script; Anterior tibiofibular distance (AFTD), Alpha angle, posterior Tibiofibular distance (PFTD) and Talar rotation (TR) in comparison to the contralateral non-injured ankle.The difference in neutral-stressed Alpha angle and AFTD were significant between patients with a syndesmotic ankle lesion and contralateral control (P=0.046 and P=0.039, respectively). There was no significant difference in neutral-stressed PFTD and TR angle.Combined weightbearing-external rotation during CT scanning revealed an increased AFTD in patients with syndesmotic ligament injuries. Based on this study, application of external rotation during WBCT scans could enhance the diagnostic accuracy of subtle syndesmotic instability.

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Section: Introductionmentioning

confidence: 99%

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

Huyghe,

Peiffer,

Cuigniez

et al. 2024

Bone Joint J

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“…Conventional CT allows for a three‐dimensional (3D) analysis of the bony syndesmotic articulation, but lacks a dynamic assessment of the joint. [3, 22] The recent advent of weightbearing cone‐beam CT (WBCT) overcomes these drawbacks by imaging both ankles during bipedal loading [2, 7, 25]. Software‐based techniques, utilized to generate models of bones and calculate their axes within a three‐dimensional framework, have previously demonstrated high efficacy and accuracy in assessing the spatial orientation and detecting landmarks of ankle bones [28, 37].…”

Section: Introductionmentioning

confidence: 99%

Application of external torque enhances the detection of subtle syndesmotic ankle instability in a weight‐bearing CT

Peiffer,

Dhont,

Cuigniez

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose Acute syndesmotic ankle injuries continue to impose a diagnostic dilemma and it remains unclear whether weightbearing and/or external rotation should be added during the imaging process. Therefore, the aim of this study was to assess if combined weightbearing and external rotation increases the diagnostic sensitivity of syndesmotic ankle instability using weightbearing CT (WBCT) imaging, compared to isolated weightbearing. Methods In this retrospective study, patients with an acute syndesmotic ankle injury were analysed using a WBCT (N = 21; Age = 31.6 ± 14.1 years old). Inclusion criteria were an MRI conirmed syndesmotic ligament injury imaged by a WBCT of the ankle during weightbearing and combined weightbearing-external rotation. Exclusion criteria consisted of fracture associated syndesmotic injuries. Three-dimensional (3D) models were generated from the CT slices. Tibioibular displacement and talar rotation were quantiied using automated 3D measurements (anterior tibioibular distance (ATFD), Alpha angle, posterior Tibioibular distance (PTFD) and Talar rotation (TR) angle in comparison to the contralateral non-injured ankle. ResultsThe diference in neutral-stressed Alpha angle and ATFD showed a signiicant diference between patients with a syndesmotic ankle lesion and contralateral control (P = 0.046 and P = 0.039, respectively). The diference in neutral-stressed PTFD and TR angle did not show a signiicant diference between patients with a syndesmotic ankle lesion and healthy ankles (n.s.). Conclusion Application of combined weightbearing-external rotation reveals an increased ATFD in patients with syndesmotic ligament injuries. This study provides the irst insights based on 3D measurements to support the potential relevance of applying external rotation during WBCT imaging. In clinical practice, this could enhance the current diagnostic accuracy of subtle syndesmotic instability in a non-invasive manner. However, to what extent certain displacement patterns require operative treatment strategies has yet to be determined in future studies. Level of evidence Level III.

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“…However, discordance exist in the current literature whether the configuration of the ankle syndesmosis is symmetrical 7 , 8 . Moreover, certain types of displacement such as rotation within the distal tibiofibular joint cannot be assessed on plain radiography due to superposition of the osseous structures 9 , 10 . Conventional CT imaging overcomes this shortcoming and allows different angular measurements to quantify rotation 11 .…”

Section: Introductionmentioning

confidence: 99%

Implementing automated 3D measurements to quantify reference values and side-to-side differences in the ankle syndesmosis

Peiffer,

Van Den Borre,

Segers

et al. 2023

Sci Rep

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Detection of syndesmotic ankle instability remains challenging in clinical practice due to the limitations of two-dimensional (2D) measurements. The transition to automated three-dimensional (3D) measurement techniques is on the verge of a breakthrough but normative and side-to-side comparative data are missing. Therefore, our study aim was two-fold: (1) to establish 3D anatomical reference values of the ankle syndesmosis based on automated measurements and (2) to determine to what extent the ankle syndesmosis is symmetric across all 3D measurements. Patients without syndesmotic pathology with a non-weight-bearing CT scan (NWBCT; N = 38; Age = 51.6 ± 17.43 years) and weight-bearing CT scan (WBCT; N = 43; Age = 48.9 ± 14.3 years) were retrospectively included. After training and validation of a neural network to automate the segmentation of 3D ankle models, an iterative closest point registration was performed to superimpose the left on the right ankle. Subsequently, 3D measurements were manually and automatically computed using a custom-made algorithm and side-to-side comparison of these landmarks allowed one to investigate symmetry. Intra-observer analysis showed excellent agreements for all manual measurements (ICC range 0.85–0.99) and good (i.e. < 2.7° for the angles and < 0.5 mm for the distances) accuracy was found between the automated and manual measurements. A mean Dice coefficient of 0.99 was found for the automated segmentation framework. The established mean, standard deviation and range were provided for each 3D measurement. From these data, reference values were derived to differ physiological from pathological syndesmotic alignment. Furthermore, side-to-side symmetry was revealed when comparing left to right measurements (P > 0.05). In clinical practice, our novel algorithm could surmount the current limitations of manual 2D measurements and distinguish patients with a syndesmotic ankle lesion from normal variance.

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Preoperative CT parameters to predict tibiofibular syndesmosis injury associated with ankle fracture: a propensity score-matched analysis

Cited by 6 publications

References 25 publications

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

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

Application of external torque enhances the detection of subtle syndesmotic ankle instability in a weight‐bearing CT

Implementing automated 3D measurements to quantify reference values and side-to-side differences in the ankle syndesmosis

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