Tibiofibular syndesmosis in asymptomatic ankles: initial kinematic analysis using four-dimensional CT

Mousavian, Alireza; Shakoor, Delaram; Hafezi-Nejad, Nima; Haj‐Mirzaian, Arya; Orapin, Jakrapong; Schon, Lew C.; Demehri, Shadpour

doi:10.1016/j.crad.2019.03.015

Cited by 13 publications

(27 citation statements)

References 42 publications

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“…When investigating 10 uninjured, unilateral ankles, the only significant change was 0.7 mm of posterior translation with plantarflexion, contrary to the prior studies showing anterior translation. 28 The current 4DCT study of 58 uninjured ankles found an in vivo decrease in syndesmotic width of up to 1.1 mm and area by 26 mm 2 , consistent with existing biomechanical literature, which can be explained by the greater width of the talar dome in dorsiflexion compared with plantarflexion. No change in sagittal translation was detected in the present study, perhaps due to our imaging protocol, which was unloaded and had subjects perform a comfortable ROM.…”

Section: Discussionsupporting

confidence: 90%

“…Prior work has also demonstrated that radiographs have poor accuracy for detecting positional changes at the distal tibiofibular joint. 3 Mousavian et al’s 28 findings may also be different due to their method of measuring sagittal translation, based off a tangent line drawn from the anterolateral fibula, which would also be impacted by fibular rotation. Our automated measurement program found 1.2 degrees of fibular external rotation with ankle plantarflexion on average.…”

Section: Discussionmentioning

confidence: 97%

“…In various biomechanical studies, the fibula translates medially 0.8 to 3 mm, anteriorly 0.9 to 1.3 mm, and rotates 0.5 to 3.7 degrees internally with plantarflexion. 15 , 33 Mousavian et al 28 have also investigated the change in syndesmotic measurements through ankle ROM using 4DCT. When investigating 10 uninjured, unilateral ankles, the only significant change was 0.7 mm of posterior translation with plantarflexion, contrary to the prior studies showing anterior translation.…”

Section: Discussionmentioning

confidence: 99%

“… 15 In cadaveric and imaging studies, when the ankle moves from dorsiflexion to plantarflexion, there is up to 1.3 mm of anterior fibular translation, 3.0 mm of medial translation, and 3.7 degrees of internal rotation relative to the tibia. 15 , 28 , 33 …”

Section: Introductionmentioning

confidence: 99%

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Four-Dimensional CT Analysis of Normal Syndesmotic Motion

et al. 2021

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Background: The syndesmosis ligament complex stabilizes the distal tibiofibular joint while allowing for small amounts of physiologic motion. When injured, malreduction of the syndesmosis is the most important factor that contributes to inferior functional outcomes. Syndesmotic reduction is a dynamic measure, which is not adequately captured by conventional computed tomography (CT). Four-dimensional CT (4DCT) can image joints as they move through range of motion (ROM). The aim of this study was to employ 4DCT to determine in vivo syndesmotic motion with ankle ROM in uninjured ankles. Methods: Uninjured ankles were analyzed in patients who had contralateral syndesmotic injuries, as well as a cohort of healthy volunteers with bilateral uninjured ankles. Bilateral ankle 4DCT scans were performed as participants moved their ankles between maximal dorsiflexion and plantarflexion. Multiple measures of syndesmotic width, as well as sagittal translation and fibular rotation, were automatically extracted from 4DCT using a custom program to determine the change in syndesmotic position with ankle ROM. Results: Fifty-eight ankles were analyzed. Measures of syndesmotic width decreased by 0.7 to 1.1 mm as the ankle moved from dorsiflexion to plantarflexion ( P < .001 for each measure). The fibula externally rotated by 1.2 degrees with ankle ROM ( P < .001), but there was no significant motion in the sagittal plane ( P = .43). No participants with bilateral uninjured ankles had a side-to-side difference in syndesmotic width of 2 mm or greater. Conclusion: 4DCT allows accurate, in vivo syndesmotic measurements, which change with ankle ROM, confirming prior work that was limited to biomechanical studies. Side-to-side syndesmotic measurements are consistent within subjects, validating the method of templating syndesmotic reduction off the contralateral ankle, in a consistent ankle position, to achieve anatomic reduction of syndesmotic injury. Level of Evidence: Level II.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Four-Dimensional CT Analysis of Normal Syndesmotic Motion

et al. 2021

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“…Die dynamische Aufhängung der Fibula in der Syndesmose ist eine wesentliche Voraussetzung für eine normale Funktion des oberen Sprunggelenks. Vor allem der ventrodorsalen Translation der Fibula in der Inzisur kommt eine besondere Bedeutung zu [27]. Bei einem Außenrotationsstress des Fußes von 7,5 Nm kommt es zu einer Außenrotation der Fibula von 2-5° und einer Translation der Fibula nach dorsal zwischen 1 und 3,1 mm [1].…”

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