Shapes of distal tibiofibular syndesmosis are associated with risk of recurrent lateral ankle sprains

Abstract

Distal tibiofibular syndesmosis (DTS) has wide anatomic variability in depth of incisura fibularis and shape of tibial tubercles. We designed a 3-year prospective cohort study of 300 young physical training soldiers in an Army Physical Fitness School. Ankle computed tomography (CT) scans showed that 56% of the incisura fibularis were a “C” shape, 25% were a “1” shape, and 19% were a “Г” shape. Furthermore, we invited a randomly selected subcohort of 6 participants in each shape of DTS to undergo a three-dimensional (3D) laser scanning. The “1” shape group showed widest displacement range of the DTS in the y-axis, along with the range of motion (ROM) on the position more than 20° of the ankle dorsiflexion, inversion and eversion. During the 3-year study period, 23 participants experienced recurrent lateral ankle sprains. 7 cases of the incisura fibularis were “C” shape, 13 cases were “1” shape, and 3 cases were “Г” shape. The “1” shape showed highest risk among the three shapes in incident recurrent lateral ankle sprains. We propose that it is possible to classify shapes of DTS according to the shapes of incisura fibularis, and people with “1” shape may have more risk of recurrent lateral ankle sprains.

Radiologic Evaluation of the Effect of Distal Tibiofibular Joint Anatomy on Arthroscopically Proven Ankle Instability

“…The shapes of the joint were classified into 3 distinct types based on the morphology of the incisura fibularis without any measurements, and the shallow joint shape was shown to increase the risk of ankle instability. 16 The anterior tibial tubercle also played an important role in ankle injury. An anterior tibial tubercle larger than the posterior tubercle prevents the forward slipping of the distal fibula.…”

“…It has been reported that the risk of ATFL injury and recurrent lateral ankle sprain increases with a flat-shaped incisura fibularis (Figure 2). 16 The position of the distal fibula in all directions and rotation also modify the ankle mechanics and affect the risk of ankle injury. 15,18…”

Sindezmoza gležnja

“…Plitka incisura fibularis na tibiji predstavlja jedan od predisponirajućih čimbenika za recidivirajuće ozljede gležnja ili ozljede sindezmoze s frakturama 17,18 . Liu i Lin analizirali su oblik tibiofibularnog zgloba koristeći kompju-toriziranu tomografiju (CT) i zaključili da postoje 3 osnovna oblika, a to su: C-oblik (56 %), I-oblik (25 %) i L-oblik (19 %), pri čemu su dokazali da je sloboda gibanja u DTFJ najveća kod I-oblika i da su osobe s ovakvim zglobom sklonije rekurentnim ozljedama prednje sindezmoze (slika 2) 19 . U dijelu bez ligamenta nalazi se malo područje gdje su tibija i fibula u direktnom kontaktu i taj dio naziva se tibiofibularna kontaktna zona.…”

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

“…Stability of the distal tibiofibular syndesmosis relies on the ligamentous structures and the bony architecture. 1 , 2 , 3 Injuries to the syndesmosis can occur in conjunction with ankle fractures 13% to 50% of the time. 4 , 5 Some of the injuries can lead to instability of the syndesmosis, which can be either latent or frank instability.…”

“…Stability of the distal tibiofibular syndesmosis relies on the ligamentous structures and the bony architecture 1, 2, 3. Injuries to the syndesmosis can occur in conjunction with ankle fractures 13% to 50% of the time 4, 5.…”