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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2019

01-09-2019 | Computed Tomography | ANKLE

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

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

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2019

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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.
Appendix
Available only for authorised users
Footnotes
1
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Metadata
Title
Defining the three most responsive and specific CT measurements of ankle syndesmotic malreduction
Authors
Jason M. Schon
Alex W. Brady
Joseph J. Krob
Carly A. Lockard
Daniel C. Marchetti
Grant J. Dornan
Thomas O. Clanton
Publication date
01-09-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05457-8

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