1
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Sun S, Chen C, Sheng Z, Wei M. The distal tibiofibular joint effusion may be a reliable index for diagnosing the distal tibiofibular syndesmosis instability in ankle. Skeletal Radiol 2024; 53:329-338. [PMID: 37466645 PMCID: PMC10730661 DOI: 10.1007/s00256-023-04395-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE To analyze the accuracy of MRI in diagnosis of distal tibiofibular syndesmosis instability (DTSI) and construct new diagnostic parameters. MATERIALS AND METHODS This retrospective study evaluated 212 patients with history of ankle sprains and 3 T MRI and received a final diagnosis of distal tibiofibular syndesmosis instability by ankle arthroscopic surgery from October 2017 and December 2021. We compared the accuracy of syndesmotic injury, qualitative index of distal tibiofibular joint effusion (DTJE), and quantitative index of distal tibiofibular joint effusion (DTJE) in diagnosing distal tibiofibular syndesmosis instability. The criteria for syndesmotic injury were consistent with previous literature, and DTJE was grouped according to the pre-experimental results. RESULTS A total of 212 patients (mean age, 35.64 ± 11.79, 74 female and 138 male) were included. Independent predictive MRI features included syndesmotic injury, qualitative index of distal tibiofibular joint effusion, and quantitative index of DTJE including the height, projected area of equal-point method, and projected area of incremental-value method. The quantitative index of DTJE showed a higher area under the receiver operating characteristic curve (0.805/0.803/0.804/0.811/0.817/0.805 > 0.8, P < 0.05; in comparison with all other method). The height measurement method was simpler and easier to operate, that could be gotten only by measuring the DTJE distance of a MRI independent layer, and the cut-off value of the effusion height was 8.00 mm and the Youden index (0.56) was the best. CONCLUSIONS Our research translated a complicated string of MRI multi-dimensional spatial measurements into a simple measuring process, and established the significance of quantifying DTJE in the diagnosis of DTSI. We found that the 8-mm height of DTJE was a more specific indicator for DTSI and could serve as a novel MRI diagnostic cutoff in clinical practice.
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Affiliation(s)
- Shouqi Sun
- Medical School of Chinese PLA, Beijing, China
- Department of Orthopedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Orthopedics/Chinese National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese PLA General Hospital, Beijing, China
| | - Chao Chen
- Medical School of Chinese PLA, Beijing, China
- Department of Rehabilitation Medicine, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | | | - Min Wei
- Medical School of Chinese PLA, Beijing, China.
- Department of Orthopedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China.
- Department of Orthopedics/Chinese National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese PLA General Hospital, Beijing, China.
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2
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Chen J, Peng X, Yang Y, Tang X, Yang S, Liu T, Shi H, Zhang L. In Different Gender Groups, What Is the Impact of the Fibular Notch on the Severity of High Ankle Sprain: A Retrospective Study of 360 Cases. Orthop Surg 2023; 15:2557-2565. [PMID: 37537373 PMCID: PMC10549795 DOI: 10.1111/os.13833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVES The role of the distal tibiofibular ligament in the occurrence of high ankle sprain (HAS) has been widely studied. But previous studies have overlooked the physiological and anatomical differences between males and females and have not further refined gender. Therefore, the impact of the anatomical morphology of fibular notch (FN) on HAS in different genders is still unclear. This study aimed to explore the impact of different types of FN on the severity of HAS and to estimate the prognosis of patients with HAS while excluding anatomical differences caused by gender. METHODS One hundred and eighty patients with HAS were included in this study as the experimental group (i.e., HAS group). They were further divided into four groups according to gender and FN depth, with deep concave FN ≥ 4 mm and shallow flat FN < 4 mm. Another 180 normal individuals were set as the control group. The FN morphological indicators, tibiofibular distance (TFD), and ankle mortise indexes were measured and compared with those in HAS group. The independent t-test was used to compare continuous variables between groups, the intraclass correlation coefficient (ICC) was used to analyze the reliability of intra-observer measurement, and the Pearson correlation coefficient was used to verify the correlation between FN and the severity of HAS. RESULTS In males with shallow flat type, the measurements of anterior tibiofibular distance (aTFD), middle tibiofibular distance (mTFD), posterior tibiofibular distance (pTFD), front ankle mortise width (fAMW), middle ankle mortise width (mAMW), posterior ankle mortise width (pAMW), and depth of ankle mortise (DOAM) in HAS group were significantly larger than those in normal group (p < 0.05). In male patients with deep concave type, the measurements of aTFD, mTFD, fAMW, mAMW, and DOAM were significantly larger than those in normal group (p < 0.05). Among female patients with shallow flat type, the measurements of aTFD, mTFD, pTFD, fAMW, mAMW, pAMW, and DOAM were found to be significantly larger than those in normal group (p < 0.05). Among female patients with deep concave type, the measurements of mTFD, pTFD, fAMW, mAMW, and DOAM were found to be significantly larger than those of the normal group (p < 0.05). The depth of FN was negatively correlated with TFD, and the AOFAS score of patients with shallow flat type was significantly lower than that of patients with deep concave type after treatment (p < 0.05). CONCLUSIONS In different gender groups, compared with the normal controls, the TFD and partial ankle mortise indices were significantly different in HAS patients. Moreover, FN depth was negatively correlated with TFD, and the AOFAS score of shallow flat patients was significantly lower than that of deep concave patients. These suggested that shallow flat FN may be associated with more severe distal tibiofibular ligament injury and ankle mortise widening, leading to poorer prognosis. This should be taken seriously in clinical practice.
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Affiliation(s)
- Junyao Chen
- School of Clinical MedicineSouthwest Medical UniversityLuzhouChina
| | - Xiaoyao Peng
- School of Clinical MedicineSouthwest Medical UniversityLuzhouChina
| | - Yuening Yang
- School of Clinical MedicineSouthwest Medical UniversityLuzhouChina
| | - Xiangyu Tang
- School of Clinical MedicineSouthwest Medical UniversityLuzhouChina
| | - Siyi Yang
- School of Integrated Traditional Chinese and Western MedicineSouthwest Medical UniversityLuzhouChina
| | - Tianyu Liu
- School of Clinical MedicineSouthwest Medical UniversityLuzhouChina
| | - Houyin Shi
- Department of OrthopedicsThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhouChina
| | - Lei Zhang
- Department of OrthopedicsThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhouChina
- Center for Orthopedic Diseases ResearchThe Affiliated Traditional Chinese Medicine Hospital of Southwest Medical UniversityLuzhouChina
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Mei N, Jiang Z, Zhong Z, Fu L, Hao J, Li Z, Wang Q, Wang Y, Zhang H, Chang F. Modified Stabilization Test to Diagnose Chronic Syndesmotic Injuries Based on Posture Control. Foot Ankle Int 2023; 44:1034-1043. [PMID: 37772832 DOI: 10.1177/10711007231189713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND To propose and validate a modified noninvasive method for the diagnosis of chronic syndesmotic injuries. METHODS This study included 16 patients with chronic ankle instability. Herein, we propose the Modified Stabilization Test, a new measurement for use in the diagnosis of chronic syndesmotic injury, as determined by wearing a 60-kPa pneumatic brace. The test combines the center of pressure and sensory organization test to measure postural control. For comparison, we also measured the tibiofibular clear space, tibiofibular overlap, and medial clear space using anteroposterior radiograph; a line marked horizontally above the tibial plaque using computed tomography (CT) to measure the syndesmotic gap and fibular rotation angle; and magnetic resonance imaging (MRI) scans to determine the presence of the λ sign. The distance of syndesmosis was confirmed in 16 individuals through arthroscopy, and the results of the examination were used to determine the diagnostic efficacy of each index. RESULTS Receiver operating characteristic curve analysis revealed that the optimal cut-off value, sensitivity, and specificity of the Modified Stabilization Test for the diagnosis of chronic syndesmotic injuries were 0.80, 100%, and 87.5%, respectively. The area under the curve (AUC) of the Modified Stabilization Test was 0.906 (95% CI 0.656, 0.993; P < .001), which was superior to imaging indices such as radiography, CT, and MRI (AUC = 0.516-0.891). CONCLUSION We developed the Modified Stabilization Test-a noninvasive diagnostic tool for the screening of chronic syndesmotic injuries. The test showed high sensitivity and specificity for the identification of chronic syndesmotic injuries and is helpful in the identification of chronic syndesmotic injuries. LEVEL OF EVIDENCE Level II, diagnostic-investigating a diagnostic test.
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Affiliation(s)
- Nan Mei
- College of Human Movement Science, Jilin Sport University, Changchun, China
| | - Zhende Jiang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Zhuan Zhong
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Lijuan Fu
- College of Human Movement Science, Jilin Sport University, Changchun, China
| | - Jianyuan Hao
- Laboratory of Athletic Training, Jilin Sport University, Changchun, China
| | - Zhaoyan Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Qingyu Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Yinan Wang
- Division of Clinical Research, First Hospital of Jilin University, Changchun, China
| | - Hanyang Zhang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Fei Chang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
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4
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Lei Q, Chen P, He X, Xu Z, He W. Preoperative CT parameters to predict tibiofibular syndesmosis injury associated with ankle fracture: a propensity score-matched analysis. Eur J Trauma Emerg Surg 2023; 49:1883-1890. [PMID: 37072565 DOI: 10.1007/s00068-023-02256-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/24/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Untreated ankle fractures with concomitant tibiofibular syndesmosis injury often lead to postoperative pain and early traumatic arthritis. CT has advantages in the preoperative diagnosis of combined ankle injuries. However, a few studies have investigated the best preoperative CT parameters to predict tibiofibular syndesmosis injuries associated with ankle fractures. This study aimed to identify and evaluate the optimal preoperative CT parameters for predicting tibiofibular syndesmosis injuries associated with ankle fractures. METHODS We retrospectively analyzed 129 patients who underwent preoperative CT of an ankle fracture treated between January 2016 and April 2022 at a tertiary A hospital. All patients underwent open reduction and internal fixation and intraoperative stability testing. Based on the Cotton test, the patients were divided into the stable group (n = 83, 64.3%) and unstable group (n = 46, 35.7%). After 1:1 propensity score matching, the general conditions, anterior tibiofibular distance (TFD), posterior TFD, maximum TFD, tibiofibular syndesmosis area, sagittal fracture angle, Angle-A, and Angle-B were compared between the stable and unstable groups. RESULTS The propensity score-matched cohort comprised 82 patients. There were no significant differences between the stable and unstable groups in sex, age, affected side, operation interval, injury mechanism, Lauge-Hansen classification, sagittal fracture angle, and Angle-A (all P > 0.05). Compared with the stable group, the unstable group had a significantly greater aTFD, pTFD, maxTFD, and area (all P < 0.05). PTFD, maxTFD, and area were positively correlated with joint instability. Angle-B was smaller in the unstable group (57.13°) than the stable group (65.56°). ROC analysis showed that Area (AUC 0.711) and maxTFD (AUC 0.707) had the highest diagnostic efficacy. CONCLUSION MaxTFD and Area were the best predictive parameters; a larger Area was associated with a higher likelihood of instability of the tibiofibular syndesmosis after ankle fracture fixation.
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Affiliation(s)
- Qinliang Lei
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Pinhua Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
- Department of Emergency Trauma Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
- Fujian Trauma Medicine Center, Fuzhou, 350001, Fujian, China
- Fujian Key Laboratory of Emergency Medicine, Fuzhou, 350001, Fujian, China
| | - Xueyi He
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
- Department of Emergency Trauma Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
- Fujian Trauma Medicine Center, Fuzhou, 350001, Fujian, China
- Fujian Key Laboratory of Emergency Medicine, Fuzhou, 350001, Fujian, China
| | - Zhixian Xu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China.
- Department of Emergency Trauma Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China.
- Fujian Trauma Medicine Center, Fuzhou, 350001, Fujian, China.
- Fujian Key Laboratory of Emergency Medicine, Fuzhou, 350001, Fujian, China.
| | - Wubing He
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China.
- Department of Emergency Trauma Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China.
- Fujian Trauma Medicine Center, Fuzhou, 350001, Fujian, China.
- Fujian Key Laboratory of Emergency Medicine, Fuzhou, 350001, Fujian, China.
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5
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Barbachan Mansur NS, Godoy-Santos AL, Schepers T. High-Ankle Sprain and Syndesmotic Instability: How Far Have We Come with Diagnosis and Treatment? Foot Ankle Clin 2023; 28:369-403. [PMID: 37137630 DOI: 10.1016/j.fcl.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Probably one of the most controversial subjects in the orthopedic field is the distal tibiofibular articulation. Even though its most primary knowledge can be a matter of enormous debate, it is in the diagnosis and treatment most of the disagreements reign. Distinguishing between injury and instability remains challenging as well as an optimal clinical decision regarding surgical intervention. The last years presented technology and that was able to bring body to an already well-developed scientifical rationale. In this review article, we aim to demonstrate the current data behind syndesmotic instability in the ligament scenario, whereas using few fracture concepts.
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Affiliation(s)
- Nacime Salomao Barbachan Mansur
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Brazil; University of Iowa, Carver College of Medicine, USA.
| | | | - Tim Schepers
- Trauma Unit, Department of Surgery, Amsterdam UMC Location J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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6
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Jungmann PM, Lange T, Wenning M, Baumann FA, Bamberg F, Jung M. Ankle Sprains in Athletes: Current Epidemiological, Clinical and Imaging Trends. Open Access J Sports Med 2023; 14:29-46. [PMID: 37252646 PMCID: PMC10216848 DOI: 10.2147/oajsm.s397634] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/06/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose Ankle injuries are frequent sports injuries. Despite optimizing treatment strategies during recent years, the percentage of chronification following an ankle sprain remains high. The purpose of this review article is, to highlight current epidemiological, clinical and novel advanced cross-sectional imaging trends that may help to evaluate ankle sprain injuries. Methods Systematic PubMed literature research. Identification and review of studies (i) analyzing and describing ankle sprain and (ii) focusing on advanced cross-sectional imaging techniques at the ankle. Results The ankle is one of the most frequently injured body parts in sports. During the COVID-19 pandemic, there was a change in sporting behavior and sports injuries. Ankle sprains account for about 16-40% of the sports-related injuries. Novel cross-sectional imaging techniques, including Compressed Sensing MRI, 3D MRI, ankle MRI with traction or plantarflexion-supination, quantitative MRI, CT-like MRI, CT arthrography, weight-bearing cone beam CT, dual-energy CT, photon-counting CT, and projection-based metal artifact reduction CT may be introduced for detection and evaluation of specific pathologies after ankle injury. While simple ankle sprains are generally treated conservatively, unstable syndesmotic injuries may undergo stabilization using suture-button-fixation. Minced cartilage implantation is a novel cartilage repair technique for osteochondral defects at the ankle. Conclusion Applications and advantages of different cross-sectional imaging techniques at the ankle are highlighted. In a personalized approach, optimal imaging techniques may be chosen that best detect and delineate structural ankle injuries in athletes.
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Affiliation(s)
- Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland
| | - Thomas Lange
- Department of Radiology, Medical Physics, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Markus Wenning
- Department of Orthopedic and Trauma Surgery, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Frédéric A Baumann
- Department of Vascular Medicine, Hospital of Schiers, Schiers, Switzerland
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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7
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Baumbach SF, Hamberger MA, Polzer H, Schepers T. Letter to the Editor: Can Weightbearing Cone-beam CT Reliably Differentiate Between Stable and Unstable Syndesmotic Ankle Injuries? A Systematic Review and Meta-analysis. Clin Orthop Relat Res 2022; 480:2465-2467. [PMID: 36190511 PMCID: PMC10538888 DOI: 10.1097/corr.0000000000002442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/12/2022] [Indexed: 11/22/2022]
Affiliation(s)
| | | | - Hans Polzer
- Department of Trauma Surgery, Ludwig Maximilian University Hospital, Munich, Germany
| | - Tim Schepers
- Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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8
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Rougereau G, Langlais T, Vigan M, Hardy A, Vialle R, Marty-Diloy T, Cambon-Binder A. Ankle syndesmosis biomechanical evaluation by shear-waves elastography in healthy young adults: Assessment of the reliability and accuracy of the measurements and definition of a corridor of normality. Foot Ankle Surg 2022; 28:1279-1285. [PMID: 35717494 DOI: 10.1016/j.fas.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/22/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Aims of this study were: 1/ to evaluate the shear wave speed (SWS) properties of the anteroinferior tibiofibular ligament (AITFL) and the distal interosseous membrane (DIOM) in neutral, dorsal flexion and plantar flexion positions in a cohort of healthy adult volunteers; 2/ to assess the reliability and reproducibility of these measurements. METHODS Both ankles were analyzed by shear wave elastography (SWE) in 20 healthy patients (10 females/10 males) standing on a hinge support with their ankles in neutral, 20° dorsal flexion and 30° plantar flexion positions. Stiffness of AITFL and DIOM was evaluated by SWS measurement. RESULTS The SWS of AITFL and DIOM were minimal in the plantar flexion position (4.28 m/s [2.65-5.11] and 3.35 m/s [1.69-4.55], respectively). It increased significantly for both ligaments in neutral position (4.69 m/s [3.53-5.71] and 3.81 m/s [1.91-4.74], respectively; p < 0.0001), and reached their maximum values in dorsal flexion (6.58 m/s [5.23-8.34] and 4.79 m/s [3.07-6.19], respectively; p < 0.0001). There was no correlation between each ligament regardless the positions. SWS of AITFL was independent of demographic characteristics analyzed. SWS of DIOM was negatively correlated with height in dorsal flexion (ρ = -0.35; p = 0.03) and in plantar flexion (ρ = -0.37; p = 0.02). Female gender was associated with increased DIOM SWS in neutral (p = 0.005), dorsal flexion (p = 0.003), and plantar flexion (p = 0.001) positions. Moreover, foot morphology (foot arch, hind foot frontal deviation) did not impact AITFL nor DIOM SWS. Inter- and intra-observer measurements were all good or excellent. CONCLUSION The AITFL and DIOM, stabilizers of the distal tibiofibular syndesmosis, increase in stiffness while dorsal flexion increases. This study describes a reliable and reproducible protocol to assess their stiffness by SWE, and defines a corridor of normality.
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Affiliation(s)
- Grégoire Rougereau
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; Sorbonne University, Department of Adult Orthopedic Surgery, Pitié-Salpêtrière Hospital, APHP, 75571 Paris, France.
| | - Tristan Langlais
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; Toulouse University, Department of Pediatric Orthopedic Surgery, Children's Hospital, Purpan, Toulouse, France
| | - Marie Vigan
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; Department of Adult Orthopedic surgery, Hospital Ambroise Paré, APHP, 92100 Boulogne-Billancourt, France
| | - Alexandre Hardy
- Clinique du sport, Department of Orthopedic Surgery, 75005 Paris, France
| | - Raphaël Vialle
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; The MAMUTH Hospital University Department for Innovative Therapies in Musculoskeletal Disease Sorbonne University, Paris, France
| | - Thibault Marty-Diloy
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France
| | - Adeline Cambon-Binder
- Sorbonne University, Department of Adult Orthopedic Surgery, Saint Antoine Hospital, APHP, 75571 Paris, France
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Spindler FT, Herterich V, Holzapfel BM, Böcker W, Polzer H, Baumbach SF. A systematic review and meta-analysis on the value of the external rotation stress test under fluoroscopy to detect syndesmotic injuries. EFORT Open Rev 2022; 7:671-679. [PMID: 36287127 PMCID: PMC9619390 DOI: 10.1530/eor-22-0037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- F T Spindler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - V Herterich
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - B M Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - W Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - H Polzer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany,Correspondence should be addressed to H Polzer;
| | - S F Baumbach
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
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10
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Takahashi K, Teramoto A, Murahashi Y, Nabeki S, Shiwaku K, Kamiya T, Watanabe K, Yamashita T. Comparison of Treatment Methods for Syndesmotic Injuries With Posterior Tibiofibular Ligament Ruptures: A Cadaveric Biomechanical Study. Orthop J Sports Med 2022; 10:23259671221122811. [PMID: 36119124 PMCID: PMC9478698 DOI: 10.1177/23259671221122811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Studies on ankle syndesmosis have focused on anterior inferior tibiofibular
ligament (AITFL) and interosseous membrane injuries; however, the
characteristics of posterior inferior tibiofibular ligament (PITFL) ruptures
remain unclear. Purpose/Hypothesis: This study evaluated the biomechanical characteristics of syndesmotic
instability caused by PITFL injury and compared various treatment methods.
We hypothesized that PITFL injury would lead to syndesmotic internal
rotational instability and that the stability would be restored with suture
tape (ST) PITFL augmentation. Study Design: Controlled laboratory study. Methods: Ten uninjured fresh-frozen cadaveric leg specimens were tested via forces
applied to the external and internal rotation of the ankle joint. The
fibular rotational angle (FRA) related to the tibia, anterior tibiofibular
diastasis (aTFD), and posterior tibiofibular diastasis (pTFD) were measured
using a magnetic tracking system. Six models were created: (1) intact, (2)
AITFL injury; (3) AITFL + PITFL injury; (4) suture button (SB) fixation; (5)
SB + anterior ST (aST) fixation; and (6) SB + aST + posterior ST fixation.
The FRA, aTFD, and pTFD were statistically compared between the intact ankle
and each injury or fixation model. Results: In the intact state, the changes in FRA and aTFD were 1.09° and 0.33 mm when
external rotation force was applied and were 0.57° and 0.41 mm when internal
rotation force was applied. In the AITFL injury model, the changes in FRA
and aTFD were 2.38° and 1.51 mm when external rotation force was applied,
which were significantly greater versus intact (P = .032
and .008, respectively). In the AITFL + PITFL injury model, the changes in
FRA and pTFD were 2.12° and 1.02 mm when internal rotation force was
applied, which were significantly greater versus intact (P
= .007 and .003, respectively). In the SB fixation model, the change in FRA
was 2.98° when external rotation force was applied, which was significantly
higher compared with intact (P < .001). There were no
significant differences between the SB + aST fixation model and the intact
state on any measurement. Conclusion: PITFL injury significantly increased syndesmotic instability when internal
rotation force was applied. SB + aST fixation was effective in restoring
syndesmotic stability. Clinical Relevance: These results suggest that SB + aST fixation is sufficient for treating
severe syndesmotic injury with PITFL rupture.
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Affiliation(s)
- Katsunori Takahashi
- Department of Orthopaedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Hokkaido, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Hokkaido, Japan
- Atsushi Teramoto, MD, PhD, Department of Orthopaedic Surgery,
Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku,
Sapporo, Hokkaido 060-8543, Japan (
)
| | - Yasutaka Murahashi
- Department of Orthopaedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Hokkaido, Japan
| | - Shogo Nabeki
- Department of Orthopaedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Hokkaido, Japan
| | - Kousuke Shiwaku
- Department of Orthopaedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Hokkaido, Japan
| | - Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Hokkaido, Japan
| | - Kota Watanabe
- Department of Physical Therapy, Sapporo Medical University School of
Health Sciences, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Hokkaido, Japan
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11
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Kang L, Helms E, Broadhead M. Bilateral ankle syndesmosis injury: a rare case report. Orthop Rev (Pavia) 2022. [DOI: 10.52965/001c.35494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This report describes a case of bilateral acute ankle syndesmosis injuries in a 15-year-old male basketball player. The patient had a background of previous inversion injuries but no symptoms of chronic pain or instability. The case report illustrates the importance of clinical suspicion when evaluating acute syndesmosis injuries in conjunction with radiographic assessments in primary care. This is the first reported case of such injury in bilateral limbs.
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12
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Shiwaku K, Teramoto A, Iba K, Otsubo H, Kamiya T, Shoji H, Watanabe K, Yamashita T. The prevalence of posterior inferior tibiofibular ligament and inferior tibiofibular transverse ligament injuries in syndesmosis-injured ankles evaluated by oblique axial magnetic resonance imaging: a retrospective study. BMC Musculoskelet Disord 2022; 23:264. [PMID: 35303842 PMCID: PMC8932331 DOI: 10.1186/s12891-022-05220-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background Transverse ligament and posterior inferior tibiofibular ligament injuries have not been investigated till date because these are difficult to evaluate using standard magnetic resonance imaging. This study aimed to investigate the prevalence of transverse ligament and posterior inferior tibiofibular ligament injuries in syndesmosis-injured ankles using oblique axial magnetic resonance imaging. Methods The patients who were diagnosed with syndesmosis injury using magnetic resonance imaging (MRI) within 7 days of the trauma were included. Patients with concomitant fractures were excluded. A total of 34 patients (1 woman and 33 men) with an average age of 22 years (range, 14–64 years) were included. The anterior inferior tibiofibular, interosseous, transverse, and posterior inferior tibiofibular ligaments were classified as intact, partial tear, or complete tear using usual axial and oblique axial MRIs. Results There were 8 (23.5%) ankles with an intact, 21 (61.8%) ankles with a partially torn, and 5 (14.7%) ankles with a complete tear of transverse ligament. There were 20 (58.8%) ankles with an intact, 12 (35.3%) ankles with a partially torn, and 2 (5.9%) ankles with a complete tear of posterior inferior tibiofibular ligament. Overall, 50% of the transverse ligament injuries occurred without posterior inferior tibiofibular ligament involvement. Conclusions The oblique axial magnetic resonance imaging scan revealed that the prevalence of transverse ligament and posterior inferior tibiofibular ligament injuries in syndesmosis-injured ankles were 76.5 and 41.2%, respectively. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05220-0.
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Affiliation(s)
- Kousuke Shiwaku
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | | | - Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroaki Shoji
- Department of Orthopaedic Surgery, Sunagawa City Medical Center, Sunagawa, Japan
| | - Kota Watanabe
- Second Division of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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13
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Baltes TPA, Al Sayrafi O, Arnáiz J, Al-Naimi MR, Geertsema C, Geertsema L, Holtzhausen L, D'Hooghe P, Kerkhoffs GMMJ, Tol JL. Acute clinical evaluation for syndesmosis injury has high diagnostic value. Knee Surg Sports Traumatol Arthrosc 2022; 30:3871-3880. [PMID: 35508553 PMCID: PMC9568458 DOI: 10.1007/s00167-022-06989-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the diagnostic value of injury history, physical examination, six syndesmosis tests and overall clinical suspicion for syndesmosis injury. METHODS All athletes (> 18 yrs) with an acute ankle injury presenting within 7 days post-injury were assessed for eligibility. Acute ankle injuries were excluded if imaging studies demonstrated a frank fracture or 3 T MRI could not be acquired within 10 days post-injury. Standardized injury history was recorded, and physical examination was performed by an Orthopaedic Surgeon or Sports Medicine Physician. Overall clinical suspicion was documented prior to MRI. Multivariate logistic regression was used to determine the association between independent predictors and syndesmosis injury. RESULTS Between September 2016 and July 2019, a total of 150 acute ankle injuries were included. The median time from injury to acute clinical evaluation was 2 days (IQR 2). Prior to clinical evaluation, the median patient reported Visual Analog Scale for pain was 8/10 (IQR 2). Syndesmosis injury was present in 26 acute ankle injuries. An eversion mechanism of injury had a positive LR 3.47 (CI 95% 1.55-7.77). The squeeze tests had a positive LR of 2.20 (CI 95% 1.29-3.77) and a negative LR of 0.68 (CI 95% 0.48-0.98). Overall clinical suspicion had a sensitivity of 73% (CI 95% 52-88) and negative predictive value of 89% (CI 95% 78-95). Multivariate regression analyses demonstrated significant association for eversion mechanism of injury (OR 4.99; CI 95% 1.56-16.01) and a positive squeeze test (OR 3.25; CI 95% 1.24-8.51). CONCLUSIONS In an acute clinical setting with patients reporting high levels of ankle pain, a negative overall clinical suspicion reduces the probability of syndesmosis injury. Eversion mechanism of injury and a positive squeeze test are associated with higher odds of syndesmosis injury. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Thomas P A Baltes
- Research Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands.
| | - Omar Al Sayrafi
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Javier Arnáiz
- Department of Radiology, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Maryam R Al-Naimi
- Department of Radiology, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Celeste Geertsema
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Liesel Geertsema
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Louis Holtzhausen
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Pieter D'Hooghe
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Johannes L Tol
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
- Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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14
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Tampere T, D'Hooghe P. The ankle syndesmosis pivot shift "Are we reviving the ACL story?". Knee Surg Sports Traumatol Arthrosc 2021; 29:3508-3511. [PMID: 32335700 DOI: 10.1007/s00167-020-06008-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/16/2020] [Indexed: 12/28/2022]
Abstract
In recent literature, there is a growing interest for the high ankle sprain with emerging evidence on biomechanical behavior, function, injury, and treatment. Interpretation of emerging publications on the distal tibiofibular syndesmosis may raise questions about striking similarities with the anterior cruciate ligament function and pivot-shift mechanism of injury in the knee. This editorial note puts to question whether identical entities, a continuum or separate injuries are faced by contemplating on the mechanism of injury, diagnostics, treatment, and outcome.
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Affiliation(s)
- Thomas Tampere
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street 1, Aspire Zone, PO Box 29222, Doha, Qatar. .,Department of Orthopaedic Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Pieter D'Hooghe
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street 1, Aspire Zone, PO Box 29222, Doha, Qatar
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15
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Bejarano-Pineda L, Guss D, Waryasz G, DiGiovanni CW, Kwon JY. The Syndesmosis, Part I: Anatomy, Injury Mechanism, Classification, and Diagnosis. Orthop Clin North Am 2021; 52:403-415. [PMID: 34538351 DOI: 10.1016/j.ocl.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ankle fractures are common injuries to the lower extremity with approximately 20% sustaining a concomitant injury to the syndesmosis. Although the deltoid ligament is not formally included in the syndesmotic complex, it plays an important role in the mortise stability. Therefore, its integrity should be always evaluated when syndesmotic injury is suspected. Given the anatomic variability of the syndesmosis between individuals, bilateral ankle imaging is recommended, especially in cases of subtle instability. Diagnostic tests that allow dynamic assessment of the distal tibiofibular joint in the 3 planes are the most reliable in determining the presence of syndesmotic injury.
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Affiliation(s)
- Lorena Bejarano-Pineda
- Foot & Ankle Research and Innovation Laboratory - Harvard Medical School, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital - Newton-Wellesley Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA; Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA
| | - Daniel Guss
- Foot & Ankle Research and Innovation Laboratory - Harvard Medical School, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital - Newton-Wellesley Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA; Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA
| | - Gregory Waryasz
- Foot & Ankle Research and Innovation Laboratory - Harvard Medical School, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital - Newton-Wellesley Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA; Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA
| | - Christopher W DiGiovanni
- Foot & Ankle Research and Innovation Laboratory - Harvard Medical School, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital - Newton-Wellesley Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA; Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA
| | - John Y Kwon
- Foot & Ankle Research and Innovation Laboratory - Harvard Medical School, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital - Newton-Wellesley Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA; Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA.
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16
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Jiao C, Gui J, Kurokawa H, Tanaka Y, Yung P, Han SH, Angthong C, Song Y, Hua Y, Li H, Shi Z, Li Q, Ling SKK. APKASS Consensus Statement on Chronic Syndesmosis Injury, Part 1: Clinical Manifestation, Radiologic Examination, Diagnosis Criteria, Classification, and Nonoperative Treatment. Orthop J Sports Med 2021; 9:23259671211021057. [PMID: 34222547 PMCID: PMC8221687 DOI: 10.1177/23259671211021057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/20/2021] [Indexed: 02/05/2023] Open
Abstract
Background Clinical manifestation, radiologic examination, diagnostic criteria, classification, and nonoperative treatment strategies regarding chronic syndesmosis injury remain unclear. Purpose An international group of experts representing the fields of sports injuries in the foot and ankle area were invited to collaboratively advance toward consensus opinions based on the best available evidence regarding chronic syndesmosis injuries. All were members of the Asia-Pacific Knee, Arthroscopy and Sports Medicine Society (APKASS). Study Design Consensus statement. Methods From November to December 2020, a total of 111 international experts on sports medicine or ankle surgery participated in a 2-stage Delphi process that included an anonymous online survey and an online meeting. A total of 13 items with 38 statements were drafted by 13 core authors. Of these, 4 items with 15 clinical questions and statements were related to the clinical manifestation, radiologic examination, diagnostic criteria, classification, and nonoperative treatment strategies for chronic syndesmosis injury and are presented here. Each statement was individually presented and discussed, followed by a general vote. The strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. Results Of the 15 questions and statements, 5 reached unanimous support and 10 achieved strong consensus. Conclusion This APKASS consensus statement, developed by international experts in the field, will assist surgeons and physical therapists with diagnosis, classification, and nonoperative treatment strategies for chronic syndesmosis injury.
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Affiliation(s)
- Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Jianchao Gui
- Department of Sports Medicine, Nanjing First Hospital, Nanjing, China
| | - Hiroaki Kurokawa
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Patrick Yung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Seung Hwan Han
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chayanin Angthong
- Division of Digital and Innovative Medicine, Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Yujie Song
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhongmin Shi
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Jiaotong University, Shanghai, China
| | - Qi Li
- Department of Orthopedic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Samuel K K Ling
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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17
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Kurokawa H, Li H, Angthong C, Tanaka Y, Song Y, Shi Z, Ling SKK, Yung P, Han SH, Hua Y, Jiao C, Gui J, Li Q. APKASS Consensus Statement on Chronic Syndesmosis Injury, Part 2: Indications for Surgical Treatment, Arthroscopic or Open Debridement, and Reconstruction Techniques of Suture Button and Screw Fixation. Orthop J Sports Med 2021; 9:23259671211021063. [PMID: 34222549 PMCID: PMC8221688 DOI: 10.1177/23259671211021063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/20/2021] [Indexed: 12/26/2022] Open
Abstract
Background: The indications for surgical treatment of chronic syndesmosis injury are challenging for many orthopaedic clinicians, as there is no international consensus on the optimal management of these injuries. Purpose: An international group of experts representing the field of sports injuries in the foot and ankle area was invited to collaboratively advance toward consensus opinions based on the best available evidence regarding chronic syndesmosis injury. All were members of the Asia-Pacific Knee, Arthroscopy and Sports Medicine Society (APKASS). Study Design: Consensus statement. Methods: From November to December 2020, a total of 111 international experts on sports medicine or ankle surgery participated in a 2-stage Delphi process that included an anonymous online survey and an online meeting. A total of 13 items with 38 statements were drafted by 13 core authors. Of these, 9 items with 17 clinical questions and statements were related to indications for surgical treatment, arthroscopic versus open debridement, and suture button versus screw fixation reconstruction techniques and are presented here. Each statement was individually presented and discussed, followed by a general vote. The strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; and unanimous, 100%. Results: Of the 17 questions and statements, 4 achieved unanimous support, 11 reached strong consensus, and 2 reached consensus. Conclusion: This APKASS consensus statement, developed by international experts in the field, will assist surgeons and physical therapists with surgical indications and techniques for chronic syndesmosis injury.
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Affiliation(s)
- Hiroaki Kurokawa
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Chayanin Angthong
- Division of Digital and Innovative Medicine, Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Yujie Song
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhongmin Shi
- Department of Orthopedics, Shanghai Sixth People Hospital, Jiaotong University, Shanghai, China
| | - Samuel K K Ling
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Patrick Yung
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Seung Hwan Han
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Jianchao Gui
- Department of Sports Medicine, Nanjing First Hospital, Nanjing, China
| | - Qi Li
- Department of Sports Medicine, Nanjing First Hospital, Nanjing, China
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18
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Spennacchio P, Seil R, Gathen M, Cucchi D. Diagnosing instability of ligamentous syndesmotic injuries: A biomechanical perspective. Clin Biomech (Bristol, Avon) 2021; 84:105312. [PMID: 33756400 DOI: 10.1016/j.clinbiomech.2021.105312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND High ankle sprains are insidious injuries associated with a long recovery period, functional impairment and long-term sequelae if mistreated. This systematic review investigates the biomechanical knowledge on the kinematic consequences of sequential syndesmotic ligamentous injuries, aiming to furnish an updated and objective contribution for the critical appraisal and further elaboration of current diagnostic algorithms for high ankle sprains. METHODS A systematic review was performed to identify human biomechanical studies evaluating the stabilizing role of the syndesmotic ligaments. Special attention was paid to identify the smallest lesion within the progressive simulated injuries able to provoke statistically significant changes of the syndesmotic kinematic on the specimen, the mechanical solicitation that provoked it, and the measurement methodology. FINDINGS Fourteen studies were included. In eight articles already an isolated injury to the anterior inferior tibiofibular ligament provoked significant changes of the syndesmotic kinematic, which was always depicted under an external rotation torque. In three articles an isolated deltoid ligament injury provoked significant changes of the syndesmotic kinematic. Four articles described a direct measure of the bony movements, whereas seven collected data through conventional radiography or CT-scan imaging and three via a 3D motion analysis tracking system. INTERPRETATION An isolated lesion of the anterior inferior tibiofibular ligament can provoke significant kinematic modifications in ex vivo syndesmotic models and may be responsible of subtle patterns of dynamic instability, regardless of further syndesmotic ligamentous injuries. The data observed support efforts to define reliable CT imaging parameters to improve non-invasive diagnostic of subtle forms of syndesmotic instability.
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Affiliation(s)
- Pietro Spennacchio
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg.
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg; Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg.
| | - Martin Gathen
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
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19
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Rellensmann K, Behzadi C, Usseglio J, Vosseller JT, Böcker W, Polzer H, Baumbach SF. Acute, isolated and unstable syndesmotic injuries are frequently associated with intra-articular pathologies. Knee Surg Sports Traumatol Arthrosc 2021; 29:1516-1522. [PMID: 32728787 PMCID: PMC8038950 DOI: 10.1007/s00167-020-06141-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/02/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Although simultaneous arthroscopy for the surgical treatment of acute isolated, unstable syndesmotic injuries has been recommended, little knowledge is present about the actual frequency of intra-articular pathologies for this injury. The aim of this study was to investigate the frequency and severity of intra-articular pathologies detected during arthroscopy and their subsequent treatment in acute isolated, unstable syndesmotic injuries. METHODS A retrospective chart review of patients treated by arthroscopic-assisted stabilization for acute isolated, syndesmotic instability was performed. The primary outcome parameter was the frequency of intra-articular pathologies. Secondary outcome parameters were the type of syndesmotic lesion (ligamentous/bony), severity of chondral lesions, MRI findings, treatment details, complications and the identification of factors associated with intra-articular pathologies. RESULTS Twenty-seven patients, 19% female, with a mean age of 37 ± 12 years met the inclusion criteria. 70% suffered isolated ligamentous injuries, the remaining suffered avulsion fractures of the syndesmosis. Chondral lesions occurred in 48% (ICRS grade II: 33%; ICRS grade IV 15%) and intra-articular loose bodies in 11% of patients. Overall, arthroscopy revealed intra-articular pathologies necessitating further treatment in 19% of patients. Neither the type of syndesmotic injury (bony vs. ligamentous; ns) nor the degree of ligamentous instability (West Point IIB vs. III; ns) had a significant influence on the occurrence of chondral lesions. One complication (SSI) occurred. Pre-operative MRI revealed a sensitivity/specificity of 100/79% for chondral lesions and 50/93% for loose bodies. CONCLUSION Intra-articular pathologies in acute isolated, unstable syndesmotic injuries occur in up to 50% of patients, 19% necessitated additional treatment. Simultaneous arthroscopy, independent of the pre-operative MRI findings, appears reasonable in highly active patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kathrin Rellensmann
- grid.5252.00000 0004 1936 973XDepartment of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Cyrus Behzadi
- Radiologie München, Dienerstraße 12, 80331 Munich, Germany
| | - John Usseglio
- grid.21729.3f0000000419368729Long Health Sciences Library, Columbia University Irving Medical Center, New York, USA
| | - James Turner Vosseller
- grid.239585.00000 0001 2285 2675Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY USA
| | - Wolfgang Böcker
- grid.5252.00000 0004 1936 973XDepartment of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Hans Polzer
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Nussbaumstraße 20, 80336, Munich, Germany. .,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA.
| | - Sebastian Felix Baumbach
- grid.5252.00000 0004 1936 973XDepartment of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Nussbaumstraße 20, 80336 Munich, Germany
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20
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Kent S, Yeo G, Marsland D, Randell M, Forster B, Lutz M, Okano S. Delayed stabilisation of dynamically unstable syndesmotic injuries results in worse functional outcomes. Knee Surg Sports Traumatol Arthrosc 2020; 28:3347-3353. [PMID: 32246172 DOI: 10.1007/s00167-020-05962-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/23/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Patients with primarily ligamentous injuries of the distal tibiofibular joint comprise up to 12% of all ankle sprains. Patients frequently present late after a syndesmosis injury and delayed treatment potentially leads to pain, prolonged disability and arthritis in the long term. This study aimed to assess clinical outcomes in patients who required syndesmosis fixation in the presence of arthroscopically proven instability, the hypothesis being that a delay to treatment would be associated with worse function. METHOD A retrospective cohort study was performed of patients with dynamic instability requiring fixation between the years of 2010-2016. The procedures were performed by two foot and ankle fellowship trained orthopaedic surgeons, over three hospital sites. Patients were classified into three groups based on the time since injury to surgery, acute syndesmotic injury (< 6 weeks), sub-acute (6 weeks-6 months) and chronic syndesmotic injury (> 6 months). Functional scores were retrospectively collected using the Foot and Ankle Outcome Score (FAOS). RESULTS Compared to patients with acute injuries, those with chronic injuries had significantly lower FAOS subscales (p < 0.001), with the greatest difference in quality of life (- 20.7, 95% CI - 31.6 to - 9.8, p = 0.012). There was a mean follow-up of 4.3 years. Although the average FAOS subscales in those with sub-acute injuries were lower than in those with acute injuries, the difference was not statistically significant. CONCLUSION The results of this study suggest that delayed surgical stabilisation (> 6 months) is associated with significantly worse clinical function, and thus timely identification and early referral of those patients with potentially unstable syndesmotic injuries is recommended. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Steven Kent
- Mater Hospital, Brisbane, QLD, Australia. .,Department of Orthopaedic Surgery, Mater Adults Hospital, Raymond Terrace, South Brisbane, QLD, 4101, Australia.
| | - Gerald Yeo
- Prince Charles Hospital, Brisbane, QLD, Australia
| | | | | | | | | | - Satomi Okano
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
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