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Heitz PH, Miron MC, Beauséjour M, Hupin M, DiLiddo L, Jourdain N, Nault ML. Ultrasound Assessment of Ankle Syndesmotic Injuries in a Pediatric Population. Clin J Sport Med 2024; 34:83-90. [PMID: 37882722 DOI: 10.1097/jsm.0000000000001193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 09/05/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To determine sensitivity and specificity for anterior-inferior tibiofibular ligament (AiTFL) integrity and tibiofibular clear-space (TFCS) cut-off points for dynamic evaluation using ultrasound (US) in a pediatric population. DESIGN Prospective cohort study. SETTING Tertiary care university-affiliated pediatric hospital patients between the ages of 12 and 18 sustaining acute ankle trauma with syndesmotic injury. INTERVENTIONS Participants were assigned to the syndesmotic injury protocol that included a standardized MRI and US. MAIN OUTCOME MEASURES Anterior-inferior tibiofibular ligament integrity for static assessment and TFCS measurements for dynamic assessment on US. For dynamic assessment, the distance between the distal tibia and fibula was first measured in neutral position and then in external rotation for each ankle. The US results on AiTFL integrity were compared with MRI, considered as our gold standard. Optimal cut-off points of TFCS values were determined with receiver operating characteristics curve analysis. RESULTS Twenty-six participants were included. Mean age was 14.8 years (SD = 1.3 years). Sensitivity and specificity for AiTFL integrity were 79% and 100%, respectively (4 false negatives on partial tears). For dynamic assessment, the cut-off points for the differences in tibiofibular distance between the 2 ankles in 1) neutral position (TFCS N I-U ) and 2) external rotation (TFCS ER I-U ) were 0.2 mm (sensitivity = 83% and specificity = 80%) and 0.1 mm (sensitivity = 83% and specificity = 80%), respectively. CONCLUSIONS Static US could be used in a triage context as a diagnostic tool for AiTFL integrity in a pediatric population as it shows good sensitivity and excellent specificity.
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Affiliation(s)
- Pierre-Henri Heitz
- Department of Surgery, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Surgery, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
| | - Marie-Claude Miron
- Department of Radiology, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Radiology, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
| | - Marie Beauséjour
- Department of Surgery, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Surgery, Université de Sherbrooke, Université de Sherbrooke-Campus Longueuil, Longueuil, QC, Canada
| | - Mathilde Hupin
- Department of Surgery, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Surgery, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
| | - Lydia DiLiddo
- Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Pediatrics, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
| | | | - Marie-Lyne Nault
- Department of Surgery, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Surgery, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
- Department of Surgery, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
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Sugimoto K, Isomoto S, Ishida E, Miura K, Hyakuda Y, Ohta Y, Tanaka Y, Taniguchi A. Treatment of Intra-Articular Lesions After Posterior Inferior Tibiofibular Ligament Injury: A Case Series of Elite Rugby Players. Orthop J Sports Med 2023; 11:23259671231200934. [PMID: 37781642 PMCID: PMC10540585 DOI: 10.1177/23259671231200934] [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: 04/28/2023] [Accepted: 05/19/2023] [Indexed: 10/03/2023] Open
Abstract
Background Surgical intervention is not typically used to treat symptoms after mild tibiofibular ligament injuries without ankle dislocation or subluxation. Purpose To describe outcomes in patients arthroscopically treated for unique intra-articular lesions after sustaining syndesmosis injury of the ankle. Study Design Case series; Level of evidence, 4. Methods A total of 11 elite male rugby players with a mean age of 21.0 years (range, 17-28 years) were referred to our hospital for prolonged posterior ankle pain after a high ankle sprain during rugby football. The patients were examined using standing view radiography, computed tomography (CT) and magnetic resonance imaging (MRI) to determine the extent of ligament damage. Posterior ankle arthroscopy was performed to examine intra-articular lesions. The patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot rating scale and sports activity score of the Self-Administered Foot Evaluation Questionnaire (SAFE-Q). Results The average reduced tibiofibular overlap on the standing mortise view was 1.2 mm (range, 0.5-2.0 mm) compared with the opposite ankles. Mason type 1 fracture was detected on CT in 6 patients, and ossification of the interosseous membrane was detected in 2 patients. A bone bruise in the posterior malleolus was observed on MRI in all but 1 patient. Intra-articular fragments located in the posterior ankle were observed and removed arthroscopically. Symptoms improved rapidly after arthroscopic treatment in all patients. All patients returned to rugby games at a median of 11 weeks postoperatively. The median AOFAS scores improved from 77 preoperatively to 100 postoperatively (P < .01), and the median SAFE-Q sports activity subscale score improved from 49.4 to 100 (P < .01). Conclusion All unique intra-articular lesions that developed in rugby football players after syndesmosis injury were able to be treated arthroscopically. Patients returned to playing rugby football without syndesmosis reduction. Posterior ankle arthroscopy was effective in patients with residual symptoms after syndesmosis injury.
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Affiliation(s)
- Kazuya Sugimoto
- Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Shinji Isomoto
- Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Eiwa Ishida
- Department of Pathology, Nara Prefecture General Medical Center, Nara, Japan
| | - Kimio Miura
- Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Yoshinobu Hyakuda
- Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Yuichi Ohta
- Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, School of Medicine, Nara Medical University, Kashihara, Japan
| | - Akira Taniguchi
- Department of Orthopaedic Surgery, School of Medicine, Nara Medical University, Kashihara, Japan
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Kramer Z, Woo Lee Y, Sherrick R. Acute Ankle Sprains. Clin Podiatr Med Surg 2023; 40:117-138. [PMID: 36368838 DOI: 10.1016/j.cpm.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Understanding the types of ankle sprains is essential in determining the most appropriate treatment and preventing substantial missed time from sports. Commonly known and recognized is an acute lateral ankle sprain, however, a differentiation should also be made to understand high (syndesmotic) ankle sprains as the mechanism of injury and recovery periods differ between these two types.
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Affiliation(s)
- Zachary Kramer
- Scripps Memorial Hospital, 310 Santa Fe Drive #112, Encinitas, CA 92024, USA
| | - Yessika Woo Lee
- Dignity Health, St. Mary's Medical Center, 450 Stanyan Street, San Francisco, CA 94117, USA.
| | - Ryan Sherrick
- Foot & Ankle Surgery, Innovative Medical Solutions Foot & Ankle Institute, 2080 Century Park East, STE 710, Los Angeles, CA 90067, USA
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Campbell T, Mok A, Wolf MR, Tarakemeh A, Everist B, Vopat BG. Augmented stress weightbearing CT for evaluation of subtle tibiofibular syndesmotic injuries in the elite athlete. Skeletal Radiol 2022; 52:1221-1227. [PMID: 36376759 DOI: 10.1007/s00256-022-04229-9] [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] [Received: 07/25/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We aim to present a novel imaging technique utilizing weight-bearing CT with syndesmotic stress to identify subtle, unstable syndesmotic injuries. We illustrate this with a case presentation of such an injury in an elite athlete that ultimately required operative fixation. MATERIALS AND METHODS In order to perform an augmented stress weightbearing CT, the patient is in the standing position, feet facing forward, and with weight distributed equally. The patient is then coached to internally rotate the shin and knee. This places an external rotational moment on the TFS due to the planted foot and ankle. The augmented stress images undergo 3D reconstruction and post-processing to render coronal and sagittal images. These are subsequently compared to standard, conventional weightbearing CT images performed without the external rotation stress. RESULTS We illustrate this technique by presenting a case in which a 21-year-old collegiate athlete sustained a Grade II syndesmotic injury, diagnosed by MRI and clinical exam without evidence of instability by standard weightbearing CT or weightbearing radiographs. After undergoing the augmented stress weightbearing CT, the instability was noted. This prompted subsequent operative fixation and ultimately return to sport. CONCLUSION We propose this technique for diagnosing unrecognized, subtle dynamically unstable syndesmosis injuries where clinical suspicion persists despite negative imaging, particularly in the elite athlete.
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Affiliation(s)
| | - Anthony Mok
- School of Medicine, University of Kansas, Kansas City, USA
| | - Megan R Wolf
- School of Medicine, University of Kansas, Kansas City, USA
| | | | - Brian Everist
- School of Medicine, University of Kansas, Kansas City, USA
| | - Bryan G Vopat
- School of Medicine, University of Kansas, Kansas City, USA
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Emara KM, Diab RA, Amr M, Mahmoud SA, Nour M, Abdelsalam A, Elshobaky MA, Farhan M, Gemeah M, Emara AK. Virtual orthopedic assessment: Main principles and specific regions. World J Orthop 2021; 12:672-684. [PMID: 34631451 PMCID: PMC8472440 DOI: 10.5312/wjo.v12.i9.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/07/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Telemedicine was originally created as a way to treat patients who were located in remote places far away from local health facilities or in areas with shortages of medical professionals. Telemedicine is still used today to address those problems, and is increasingly becoming a tool for convenient medical care. With the emergence of pandemics, telemedicine became almost a mandatory and valuable option for continuing to provide medical care in various specialties. As the threat of pandemic progress has continued for months and may continue for years, it is essential to validate existing tools to maintain clinical assessment and patient treatment to avoid negative consequences of the lack of medical follow-up. Therefore, the establishment of a virtual assessment technique that can be conducted effectively is of outmost importance as a way of adapting to the current situation. This study evaluated the role of telemedicine in the assessment of various orthopedic pathologies by means of a systematic virtual evaluation.
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Affiliation(s)
- Khaled M Emara
- Orthopedic Surgery Department, Ain Shams University, Cairo 11566, Egypt
| | - Ramy Ahmed Diab
- Orthopedic Surgery Department, Ain Shams University, Cairo 11566, Egypt
| | - Mohamed Amr
- Orthopedic Surgery Department, Ain Shams University, Cairo 11566, Egypt
| | | | - Mohamed Nour
- Orthopedic Surgery Department, Bank Ahly Hospital, Cairo 11566, Egypt
| | - Ahmed Abdelsalam
- Orthopedic Surgery Department, Ain Shams University, Cairo 11566, Egypt
| | | | - Mona Farhan
- Orthopedic Surgery Department, Ain Shams University, Cairo 11566, Egypt
| | - Mostafa Gemeah
- Department of Health Care Innovation, Arizona State University, Arizona, AZ 85287, United States
| | - Ahmed K Emara
- Department of Orthopedic Surgery, Cleveland Clinic, Ohio, NY 44195, United States
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Zhang C, Ji X, Xue Y, Hu G. Statistical ankle-shape and pressure analysis for design of elastic tubular bandage. Proc Inst Mech Eng H 2020; 235:148-156. [PMID: 33070763 DOI: 10.1177/0954411920965286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Ankles can benefit from the elastic tube bandage (ETB) by providing the ankle joint with compression, but partial high- or low-pressure leads to body discomfort. The aim of this paper is to propose a method for analyzing the ankle shape with the fabric compression which is basis on the comfortable pressure on human body. First, a standard model of ankle is established from the scanned data of 306 samples, and the mapping of the fabric shape curves on ankle were constructed by the U-direction convex curves of the model. The positions or areas of maximum and minimum pressure are then marked by extracting the curvatures of the fabric shape curves. According to the Laplace's Law, the sizes of ETBs can be calculated given that the value of comfortable pressure on human body is the maximum one. The data of calculation is approximate to the relevant previous studies which has the same parameters of ETBs. Nine groups of the ankle shapes from the database are discussed, each group has a proportional coefficient to the standard model, and the result shows that six sizes of ETBs with comfort pressure match for the nine groups. These can be applied to the comfort design, and the method proposed can boost size customization of ETBs, as well as will inspire the research on other elastic compression garments.
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Affiliation(s)
- Chunqiang Zhang
- School of Mechanical and Precision Instrument Engineering, Xi'an University of Technology, Xi'an, China
| | - Xiaomin Ji
- School of Mechanical and Precision Instrument Engineering, Xi'an University of Technology, Xi'an, China
| | - Yanmin Xue
- School of Mechanical and Precision Instrument Engineering, Xi'an University of Technology, Xi'an, China
| | - Gang Hu
- School of Mechanical and Precision Instrument Engineering, Xi'an University of Technology, Xi'an, China
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