Automatic 3D Volumetric Analysys of the Distal Tibiofibular Syndesmotic Incisura: A Case-Control Study of Subtle Chronic Syndesmotic Instability (original) (raw)
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Foot and Ankle Surgery, 2018
Background: To investigate the reliability and reproducibility of syndesmosis measurements on weightbearing (WB) cone-beam computed tomography (CBCT) images and compare them with measurements obtained using non-weightbearing (NWB) images. Methods: In this IRB-approved, retrospective study of 5 men and 9 women with prior ankle injuries, simultaneous WB and NWB CBCT scans were taken. A set of 21 syndesmosis measurements using WB and NWB images were performed by 3 independent observers. Pearson/Spearman correlation and intra-class correlation (ICC) were used to assess intra-and inter-observer reliability, respectively. Results: We observed substantial to perfect intra-observer reliability (ICC = 0.72-0.99) in 20 measurements. Moderate to perfect agreement (ICC = 0.45-0.97) between observers was noted in 19 measurements. Conclusion: Measurements evaluating the distance between tibia and fibula in the axial plane 10 mm above the plafond had high intra-and inter-observer reliability. Mean posterior tibio-fibular distance, diastasis, and angular measurement were significantly different between WB and NWB images.
Range of Normal and Abnormal Syndesmotic Measurements Using Weightbearing CT
Foot & Ankle International, 2019
Background: Early recognition of syndesmotic instability is critical for optimizing clinical outcome. Injuries causing a more subtle instability, however, can be difficult to diagnose. The purpose of this study was to evaluate both distal tibiofibular articulations using weightbearing computed tomography (CT) in patients with known syndesmotic instability, thereafter comparing findings between the injured and uninjured sides. We also aimed to define the range of normal measurement variation among patients without syndesmotic injury. Methods: Patients with unilateral syndesmotic instability requiring operative fixation ( n = 12) underwent preoperative bilateral ankle weightbearing CT. A separate cohort of patients without ankle injury who also underwent bilateral ankle weightbearing CT were included as comparative controls ( n = 24). For each weightbearing CT, a series of 7 axial plane tibiofibular joint measurements, including 1 angular measurement, were utilized to evaluate paramet...
Clinical Radiology, 2019
To evaluate the reliability of ankle syndesmotic measurements and their changes during active motion using four-dimensional computed tomography (4DCT) examination in asymptomatic ankles. MATERIALS AND METHODS: 4DCT was performed on both ankles of patients with signs and symptoms of unilateral ankle instability. Ankles from the asymptomatic side of 10 consecutive patients were included in this analysis. Five ankle syndesmotic measurements were adopted from the available literature and performed by two fellowship-trained foot and ankle surgeons: (1) syndesmotic anterior distance (SAD); (2) syndesmotic posterior distance (SPD); (3) syndesmotic translation (ST); (4) syndesmotic tibiofibular angle (STFA); and (5) ankle tibiofibular angle (ATFA). A Monte Carlo simulation was also performed to obtain exact p-values with 99% confidence intervals. RESULTS: Excellent interobserver reliability was observed among the two readers for four out of five measurements (intra-class correlation coefficients [ICC]: 0.767e0.995, p<0.001 e0.020). The ICC values for SAD were not statistically significant (ICC¼0.548 and 0.569 for dorsi and plantarflexion respectively, p¼0.1). Among the five measurements, only ST measurements had significant changes during active motion (median [interquartile range] for change: e0.70 mm [e1.6e0.10]; p¼0.012). Of the above measurements, only the ST measurements demonstrated a negative linear association with the tibiocalcaneal angle during active motion (beta¼e2.5, p¼0.04). CONCLUSIONS: Reliable quantitative kinematic assessment of ankle syndesmosis can be performed using 4DCT examination. Syndesmotic measurements remain unchanged during ankle motion except for the syndesmotic translation, which tends to decrease during plantar flexion.
The American Journal of Sports Medicine, 2009
Background Syndesmotic ankle injuries are not easy to recognize when an associated fracture or frank diastasis is not present. There is a need for a simple, fast, inexpensive, and easily reproducible diagnostic tool to assess the integrity of the distal tibiofibular synedesmosis. Hypothesis Dynamic ultrasound (US) examination can accurately diagnose anteroinferior tibiofibular ligament (AITFL) rupture. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods We evaluated 3 groups: 9 consecutive professional athletes with recent AITFL rupture, a control group of 18 subjects without a history of ankle injury, and 20 patients with lateral ankle sprain. The dynamic US examination was performed in neutral (N), forced internal rotation (IR), and external rotation (ER) of the foot for measuring the tibiofibular clear space on the anterior aspect of the ankle, at the level of the AITFL, 1 cm proximal to the joint line. Results The mean age of the study group was 27 years (range,...
Towards Automated Ligamentous Injury Evaluation in Syndesmotic Ankle Lesions
2021
PurposeForced external rotation is hypothesized as the key mechanism of syndesmotic ankle injuries. This complex trauma pattern ruptures the syndesmotic ligaments, inducing a three-dimensional deviation from the normal distal tibiofibular joint configuration. However, current diagnostic imaging modalities are impeded by a two-dimensionalassessment, without taking into account ligamentous stabilizers. Therefore, our aim is two-fold: (1) to construct an articulated statistical shape model of the normal ankle with inclusion of ligamentous morphometry and (2) to apply this model in the assement of a clinical cohort of paient with syndesmotic ankle injuries.Methods Three-dimensional models of the distal tibiofibular joint were analyzed in asymptomatic controls (N= 76; Mean age 63 +/- 19 years),patients with syndesmotic ankle injury (N = 13; Mean age 35 +/- 15 years), and their healthy contralateral equivalent (N = 13). Subsequently, the statiscal shape model was generated after aligning ...
Arthroscopic Quantification of Syndesmotic Instability in a Cadaveric Model
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2017
Purpose: To investigate whether arthroscopy or stress radiography can identify instability resulting from single-ligament injury of the ankle syndesmosis and to determine whether either modality is capable of differentiating between various levels of ligament injury. Methods: Syndesmotic/deltoid ligament sectioning was performed in 10 cadaver legs. Arthroscopic evaluation and fluoroscopic stress testing were completed after each sectioning. In group 1 (n ¼ 5), sectioning began with anteroinferior tibiofibular ligament (AITFL), then interosseous membrane (IOM), posteroinferior tibiofibular ligament (PITFL), and deltoid. In group 2 (n ¼ 5), this order was reversed. Measurements were made by determining the largest-sized probe that would fit in the anterior and posterior syndesmosis. Radiographic parameters included tibiofibular overlap/clear space and medial clear space. Results: No radiographic measurement proved useful in distinguishing between intact and transected AITFL. Anterior probe (AP) size reached significance when distinguishing between intact and AITFL-transected specimens (P < .0001). AP detected significant differences comparing single with 2-, 3-, and 4-ligament (AITFL, IOM, PITFL, deltoid) disruptions (P ¼ .05, <.0001, and <.0001, respectively). Significant differences were observed between 2-and 3/4-ligament (P ¼ .02) transections. Posterior probe (PP) size detected significant differences between intact and single-, double-, triple-, and complete ligament transections (P values .0006, <.0001, <.0001, <.001, respectively). PP detected significant differences between single-and double-, triple-, and complete ligament transection models (P ¼ .0075, .0010, and .0010, respectively). PP distinguished between 2-and 3/4ligament (P ¼ .03) transections. Conclusions: Stress radiography did not distinguish between intact and single-ligament disruption, and was unreliable in distinguishing between sequential transection models. Arthroscopy significantly predicted isolated disruption of the AITFL or deltoid ligaments. Also, probing was able to differentiate between most patterns of ligament injury, including sequential transections. Clinical Relevance: These data can aid surgeons during arthroscopy of the ankle when attempting to correlate intraoperative syndesmotic evaluation findings with the extent of ligament injury.
Skeletal Radiology, 2011
Objective The optimal MRI scan planes of collateral ligaments of the ankle have been described extensively, with the exception of the syndesmotic ligaments. We assessed the optimal scan plane for depicting the distal tibiofibular syndesmosis. Materials and Methods In order to determine the optimal oblique caudal-cranial and lateral-medial MRI scan plane, two fresh frozen cadaveric ankles were used. The angle of the scan plane that demonstrated the anterior and posterior distal tibiofibular ligament uninterrupted in their full length was determined. In a prospective study this oblique scan plane was then used in addition to the axial and coronal planes, for MRI scans of both ankles in 21 healthy volunteers. Two observers independently evaluated the anterior tibiofibular ligament (ATIFL) and posterior tibiofibular ligament (PTIFL) regarding the continuity of the individual fascicles, thickness and wavy contour of the ligaments in both the axial and the oblique plane. Kappa was calculated to determine the interobserver agreement.