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Defining the three most responsive and specific CT measurements of ankle syndesmotic malreduction

  • ANKLE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to compare the reliability and accuracy of existing computed tomography (CT) methods for measuring the distal tibiofibular syndesmosis in uninjured, paired cadaveric specimens and in simulated malreduction models. It was hypothesized that a repeatable set of measurements exists to accurately and quantitatively describe the typical forms of syndesmotic malreduction using contralateral ankle comparison.

Methods

Twelve cadaveric lower-leg specimen pairs were imaged with CT to generate models for this study. Thirty-five measurements were performed on each native model. Next, four distinct fibular malreductions were produced via digital simulation and all measurements were repeated for each state: (1) 2-mm lateral translation; (2) 2-mm posterior translation; (3) 7-degree external rotation; (4) the previous three states combined. The modified standardized response mean (mSRM) was calculated for each measurement. To assess rater reliability and side-to-side agreements of the native state measurements, intraclass correlation coefficients (ICC) and Pearson correlation coefficients (PCC) were calculated, respectively.

Results

The most responsive measurements for detecting isolated malreduction were the Leporjärvi clear space for lateral translation, the Nault anterior tibiofibular distance for posterior translation, and the Nault talar dome angle for external rotation of the fibula. These measurements demonstrated fair to excellent inter-rater ICCs (0.64–0.76) and variable side-to-side PCCs (0.14–0.47).

Conclusions

The most reliable method to assess the syndesmosis on CT was to compare side-to-side differences using three distinct measurements, one for each type of fibular malreduction, allowing assessment of the magnitude and directionality of syndesmosis malreduction. Reliable evaluation is essential for assessing subtle syndesmosis injuries, malreduction and surgical planning.

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Notes

  1. [1, 9, 10, 13, 17, 24,25,26, 28, 29, 31, 34, 36, 38, 39, 46, 49, 55].

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Funding

This study was funded internally by the Steadman Philippon Research Institute.

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Authors and Affiliations

  1. Steadman Philippon Research Institute, 181 W Meadow Drive, Suite 1000, Vail, CO, 81657, USA

    Jason M. Schon, Alex W. Brady, Joseph J. Krob, Carly A. Lockard, Daniel C. Marchetti, Grant J. Dornan & Thomas O. Clanton

  2. The Steadman Clinic, Vail, CO, USA

    Thomas O. Clanton

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  1. Jason M. Schon
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  2. Alex W. Brady
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Correspondence to Thomas O. Clanton.

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Institutional review board approval was not required because deidentified cadaveric specimens are exempt from review at our institution.

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Investigation performed at the Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado.

Appendix

Appendix

See Table 4.

Table 4 Description of methods
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Schon, J.M., Brady, A.W., Krob, J.J. et al. Defining the three most responsive and specific CT measurements of ankle syndesmotic malreduction. Knee Surg Sports Traumatol Arthrosc 27, 2863–2876 (2019). https://doi.org/10.1007/s00167-019-05457-8

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