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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Megan R. Wolf
Arthrex: Direct payment for travel and/or courses
Stryker: Direct payment for travel and/or courses
Zimmer Biomet: Direct payment for travel and/or courses
Paragon28: Direct payment for travel and/or courses
Artelon: Direct payment for travel and/or courses
Bryan G. Vopat MD
Altior: Stock or stock Options
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Artelon: Paid consultant
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Campbell, T., Mok, A., Wolf, M.R. et al. Augmented stress weightbearing CT for evaluation of subtle tibiofibular syndesmotic injuries in the elite athlete. Skeletal Radiol 52, 1221–1227 (2023). https://doi.org/10.1007/s00256-022-04229-9
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DOI: https://doi.org/10.1007/s00256-022-04229-9