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Cone-beam CT measurements of distal tibio-fibular syndesmosis in asymptomatic uninjured ankles: does weight-bearing matter?

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Abstract

Objective

To evaluate the influence of weight-bearing (WB) load in standard axial ankle syndesmotic measurements using cone beam CT (CBCT) examination of asymptomatic uninjured ankles.

Materials and methods

In this IRB approved, prospective study, patients with previous unilateral ankle fractures were recruited. We simultaneously scanned the injured ankles and asymptomatic contralateral ankles of 27 patients in both WB and NWB modes. For this study, only asymptomatic contralateral ankles with normal plain radiographs were included. Twelve standardized syndesmosis measurements at two axial planes (10 mm above the tibial plafond and 5 mm below the talar dome) were obtained by two expert readers using a custom CBCT viewer with the capability for geometric measurements between user-identified anatomical landmarks. Inter-reader reliability between two readers was obtained using the intra-class correlation coefficient (ICC). We compared the WB and NWB measurements using paired t test.

Results

Significant agreement was observed between two readers for both WB and NWB measurements (p <0.05). ICC values for WB and NWB measurements had a range of 50–95 and 31–71 respectively. Mean values of the medial clear space on WB images (1.75, 95% confidence interval [95% CI]: 1.6, 1.9) were significantly lower than on NWB images (2.05, 95% CI: 1.8, 2.2) measurements (p <0.001). There was no significant difference between the remaining WB and NWB measurements.

Conclusion

Measurements obtained from WB images are reliable. Except for the medial clear space, no significant difference in syndesmotic measurements were observed during the WB mode of CBCT acquisition, implying that the tibio-fibular relationship remains unchanged when the physiological axial weight-bearing load is applied.

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Author information

Authors and Affiliations

  1. Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, USA

    Delaram Shakoor, Gaurav K. Thawait & Shadpour Demehri

  2. Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, USA

    Greg M. Osgood & Babar Shafiq

  3. Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA

    Michael Brehler & Wojciech B. Zbijewski

  4. Department of Orthopedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA

    Cesar de Cesar Netto, Jakrapong Orapin & Lew C. Shon

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  1. Delaram Shakoor
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  2. Greg M. Osgood
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Corresponding author

Correspondence to Delaram Shakoor.

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Conflicts of interest

Delarm Shakoor, Michael Brehler, Cesar de Cesar Netto, Babar Shafiq, Jakrapong Orapin, Gauarav K Thawait declared that they have no conflicts of interest.

Greg M Osgood received research support from Carestream Health.

Wojciech B Zbijewski received a research grant from Carestream Health.

Lew C Schon received research grants from Zimmer, Wright Medical, Smith-Nephew, Spine-Smith/Celing Bioscience, Carestream Health, and received research support from Arthrex, DJO, and DARCO.

Shadpour Demehri received research support from the General Electric company and Carestream Health, and is also a consultant for Toshiba Corporation.

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Shakoor, D., Osgood, G.M., Brehler, M. et al. Cone-beam CT measurements of distal tibio-fibular syndesmosis in asymptomatic uninjured ankles: does weight-bearing matter?. Skeletal Radiol 48, 583–594 (2019). https://doi.org/10.1007/s00256-018-3074-6

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  • DOI: https://doi.org/10.1007/s00256-018-3074-6

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